42 U.S.C. § 1397ff (THE PUBLIC HEALTH AND WELFARE)
§ 1397ff. Process for submission, approval, and amendment of State child health plans
(a) Initial plan
(1) In general
As a condition of receiving payment under subsection (a) or (g) of section 1397ee of this title, a State shall submit to the Secretary a State child health plan that meets the applicable requirements of this subchapter.
(2) Approval
Except as the Secretary may provide under subsection (e), a State plan submitted under paragraph (1)—
(A) shall be approved for purposes of this subchapter, and
(B) shall be effective beginning with a calendar quarter that is specified in the plan, but in no case earlier than October 1, 1997.
(b) Plan amendments
(1) In general
A State may amend, in whole or in part, its State child health plan at any time through transmittal of a plan amendment.
(2) Approval
Except as the Secretary may provide under subsection (e), an amendment to a State plan submitted under paragraph (1)—
(A) shall be approved for purposes of this subchapter, and
(B) shall be effective as provided in paragraph (3).
(3) Effective dates for amendments
(A) In general
Subject to the succeeding provisions of this paragraph, an amendment to a State plan shall take effect on one or more effective dates specified in the amendment.
(B) Amendments relating to eligibility or benefits
(i) Notice requirement
Any plan amendment that eliminates or restricts eligibility or benefits under the plan may not take effect unless the State certifies that it has provided prior public notice of the change, in a form and manner provided under applicable State law.
(ii) Timely transmittal
Any plan amendment that eliminates or restricts eligibility or benefits under the plan shall not be effective for longer than a 60-day period unless the amendment has been transmitted to the Secretary before the end of such period.
(C) Other amendments
Any plan amendment that is not described in subparagraph (B) and that becomes effective in a State fiscal year may not remain in effect after the end of such fiscal year (or, if later, the end of the 90-day period on which it becomes effective) unless the amendment has been transmitted to the Secretary.
(c) Disapproval of plans and plan amendments
(1) Prompt review of plan submittals
The Secretary shall promptly review State plans and plan amendments submitted under this section to determine if they substantially comply with the requirements of this subchapter.
(2) 90-day approval deadlines
A State plan or plan amendment is considered approved unless the Secretary notifies the State in writing, within 90 days after receipt of the plan or amendment, that the plan or amendment is disapproved (and the reasons for disapproval) or that specified additional information is needed.
(3) Correction
In the case of a disapproval of a plan or plan amendment, the Secretary shall provide a State with a reasonable opportunity for correction before taking financial sanctions against the State on the basis of such disapproval.
(d) Program operation
(1) In general
The State shall conduct the program in accordance with the plan (and any amendments) approved under subsection (c) and with the requirements of this subchapter.
(2) Violations
The Secretary shall establish a process for enforcing requirements under this subchapter. Such process shall provide for the withholding of funds in the case of substantial noncompliance with such requirements. In the case of an enforcement action against a State under this paragraph, the Secretary shall provide a State with a reasonable opportunity for correction before taking financial sanctions against the State on the basis of such an action.
(e) Continued approval
An approved State child health plan shall continue in effect unless and until the State amends the plan under subsection (b) or the Secretary finds, under subsection (d), substantial noncompliance of the plan with the requirements of this subchapter.
(Aug. 14, 1935, ch. 531, title XXI, § 2106, as added Pub. L. 105–33, title IV, § 4901(a), Aug. 5, 1997, 111 Stat. 563; amended Pub. L. 119–21, title VII, § 71401(b)(3), July 4, 2025, 139 Stat. 332.)
heading: Editorial Notes
heading: Amendments
text: 2025—Subsec. (a)(1). Pub. L. 119–21 inserted “subsection (a) or (g) of” before “section 1397ee of this title”.