Version	Word Count	Changes From Previous Version	Percent Change
Introduced in House	2,318	n/a	n/a
Reported in House	2,823	20	28%
Engrossed in House	2,476	18	20%
Placed on Calendar Senate	2,541	17	4%
Engrossed Amendment Senate	44,559	536	99%
Engrossed Amendment House	52,097	939	59%
Enrolled Bill	50,210	14 Show Changes Hide Changes	0%

Display Version Introduced in House Reported in House Engrossed in House Placed on Calendar Senate Engrossed Amendment Senate Engrossed Amendment House Enrolled Bill

HR 976 EAH

In the House of Representatives, U. S.,September 25, 2007.Resolved, That the House agree to the amendments of the Senate to the bill (H.R.976CommentsClose CommentsPermalink

) entitled `An Act to amend the Internal Revenue Code of 1986 to provide tax relief for small businesses, and for other purposes', with the followingHOUSE AMENDMENTS TO SENATE AMENDMENTS:In lieu of the matter proposed to be inserted by the Senate amendment to the text of the bill, insert the following: One Hundred Tenth Congress CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT; REFERENCES; TABLE OF CONTENTS.

(a) Short Title- This Act may be cited as `Children's Health Insurance Program Reauthorization Act of 2007'.CommentsClose CommentsPermalink





(b) Amendments to Social Security Act- Except as otherwise specifically provided, whenever in this Act an amendment is expressed in terms of an amendment to or repeal of a section or other provision, the reference shall be considered to be made to that section or other provision of the Social Security Act.CommentsClose CommentsPermalink





(c) References to CHIP; Medicaid; Secretary- In this Act:CommentsClose CommentsPermalink





(1) CHIP- The term `CHIP' means the State Children's Health Insurance Program established under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.).CommentsClose CommentsPermalink





(2) MEDICAID- The term `Medicaid' means the program for medical assistance established under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).CommentsClose CommentsPermalink





(3) SECRETARY- The term `Secretary' means the Secretary of Health and Human Services.CommentsClose CommentsPermalink





(d) Table of Contents- The table of contents of this Act is as follows:CommentsClose CommentsPermalink





Sec. 1. Short title; amendments to Social Security Act; references; table of contents.CommentsClose CommentsPermalink





Sec. 2. Purpose.CommentsClose CommentsPermalink





Sec. 3. General effective date; exception for State legislation; contingent effective date; reliance on law.CommentsClose CommentsPermalink

TITLE I--FINANCING

Subtitle A--Funding

Sec. 101. Extension of CHIP.CommentsClose CommentsPermalink





Sec. 102. Allotments for States and territories for fiscal years 2008 through 2012.CommentsClose CommentsPermalink





Sec. 103. Child Enrollment Contingency Fund.CommentsClose CommentsPermalink





Sec. 104. CHIP performance bonus payment to offset additional enrollment costs resulting from enrollment and retention efforts.CommentsClose CommentsPermalink





Sec. 105. 2-year initial availability of CHIP allotments.CommentsClose CommentsPermalink





Sec. 106. Redistribution of unused allotments to address State funding shortfalls.CommentsClose CommentsPermalink





Sec. 107. Option for qualifying States to receive the enhanced portion of the CHIP matching rate for Medicaid coverage of certain children.CommentsClose CommentsPermalink





Sec. 108. One-time appropriation.CommentsClose CommentsPermalink





Sec. 109. Improving funding for the territories under CHIP and Medicaid.CommentsClose CommentsPermalink

Subtitle B--Focus on Low-Income Children and Pregnant Women

Sec. 111. State option to cover low-income pregnant women under CHIP through a State plan amendment.CommentsClose CommentsPermalink





Sec. 112. Phase-Out of coverage for nonpregnant childless adults under CHIP; conditions for coverage of parents.CommentsClose CommentsPermalink





Sec. 113. Elimination of counting Medicaid child presumptive eligibility costs against Title XXI allotment.CommentsClose CommentsPermalink





Sec. 114. Limitation on matching rate for States that propose to cover children with effective family income that exceeds 300 percent of the poverty line.CommentsClose CommentsPermalink





Sec. 115. State authority under Medicaid.CommentsClose CommentsPermalink





Sec. 116. Preventing substitution of CHIP coverage for private coverage.CommentsClose CommentsPermalink

TITLE II--OUTREACH AND ENROLLMENT

Subtitle A--Outreach and Enrollment Activities

Sec. 201. Grants and enhanced administrative funding for outreach and enrollment.CommentsClose CommentsPermalink





Sec. 202. Increased outreach and enrollment of Indians.CommentsClose CommentsPermalink





Sec. 203. State option to rely on findings from an Express Lane agency to conduct simplified eligibility determinations.CommentsClose CommentsPermalink

Subtitle B--Reducing Barriers to Enrollment

Sec. 211. Verification of declaration of citizenship or nationality for purposes of eligibility for Medicaid and CHIP.CommentsClose CommentsPermalink





Sec. 212. Reducing administrative barriers to enrollment.CommentsClose CommentsPermalink





Sec. 213. Model of Interstate coordinated enrollment and coverage process.CommentsClose CommentsPermalink

TITLE III--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE

Subtitle A--Additional State Option for Providing Premium Assistance

Sec. 301. Additional State option for providing premium assistance.CommentsClose CommentsPermalink





Sec. 302. Outreach, education, and enrollment assistance.CommentsClose CommentsPermalink

Subtitle B--Coordinating Premium Assistance With Private Coverage

Sec. 311. Special enrollment period under group health plans in case of termination of Medicaid or CHIP coverage or eligibility for assistance in purchase of employment-based coverage; coordination of coverage.CommentsClose CommentsPermalink

TITLE IV--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES

Sec. 401. Child health quality improvement activities for children enrolled in Medicaid or CHIP.CommentsClose CommentsPermalink





Sec. 402. Improved availability of public information regarding enrollment of children in CHIP and Medicaid.CommentsClose CommentsPermalink





Sec. 403. Application of certain managed care quality safeguards to CHIP.CommentsClose CommentsPermalink

TITLE V--IMPROVING ACCESS TO BENEFITS

Sec. 501. Dental benefits.CommentsClose CommentsPermalink





Sec. 502. Mental health parity in CHIP plans.CommentsClose CommentsPermalink





Sec. 503. Application of prospective payment system for services provided by Federally-Qualified Health Centers and rural health clinics.CommentsClose CommentsPermalink





Sec. 504. Premium grace period.CommentsClose CommentsPermalink





Sec. 505. Demonstration projects relating to diabetes prevention.CommentsClose CommentsPermalink





Sec. 506. Clarification of coverage of services provided through school-based health centers.CommentsClose CommentsPermalink

TITLE VI--PROGRAM INTEGRITY AND OTHER MISCELLANEOUS PROVISIONS

Subtitle A--Program Integrity and Data Collection

Sec. 601. Payment error rate measurement (`PERM').CommentsClose CommentsPermalink





Sec. 602. Improving data collection.CommentsClose CommentsPermalink





Sec. 603. Updated Federal evaluation of CHIP.CommentsClose CommentsPermalink





Sec. 604. Access to records for IG and GAO audits and evaluations.CommentsClose CommentsPermalink





Sec. 605. No Federal funding for illegal aliens.CommentsClose CommentsPermalink

Subtitle B--Miscellaneous Health Provisions

Sec. 611. Deficit Reduction Act technical corrections.CommentsClose CommentsPermalink





Sec. 612. References to title XXI.CommentsClose CommentsPermalink





Sec. 613. Prohibiting initiation of new health opportunity account demonstration programs.CommentsClose CommentsPermalink





Sec. 614. County medicaid health insuring organizations; GAO report on Medicaid managed care payment rates.CommentsClose CommentsPermalink





Sec. 615. Adjustment in computation of Medicaid FMAP to disregard an extraordinary employer pension contribution.CommentsClose CommentsPermalink





Sec. 616. Moratorium on certain payment restrictions.CommentsClose CommentsPermalink





Sec. 617. Medicaid DSH allotments for Tennessee and Hawaii.CommentsClose CommentsPermalink





Sec. 618. Clarification treatment of regional medical center.CommentsClose CommentsPermalink





Sec. 619. Extension of SSI web-based asset demonstration project to the Medicaid program.CommentsClose CommentsPermalink

Subtitle C--Other Provisions

Sec. 621. Support for injured servicemembers.CommentsClose CommentsPermalink





Sec. 622. Military family job protection.CommentsClose CommentsPermalink





Sec. 623. Outreach regarding health insurance options available to children.CommentsClose CommentsPermalink





Sec. 624. Sense of Senate regarding access to affordable and meaningful health insurance coverage.CommentsClose CommentsPermalink

TITLE VII--REVENUE PROVISIONS

Sec. 701. Increase in excise tax rate on tobacco products.CommentsClose CommentsPermalink





Sec. 702. Administrative improvements.CommentsClose CommentsPermalink





Sec. 703. Time for payment of corporate estimated taxes.CommentsClose CommentsPermalink

SEC. 2. PURPOSE.CommentsClose CommentsPermalink

It is the purpose of this Act to provide dependable and stable funding for children's health insurance under titles XXI and XIX of the Social Security Act in order to enroll all six million uninsured children who are eligible, but not enrolled, for coverage today through such titles.CommentsClose CommentsPermalink

SEC. 3. GENERAL EFFECTIVE DATE; EXCEPTION FOR STATE LEGISLATION; CONTINGENT EFFECTIVE DATE; RELIANCE ON LAW.

(a) General Effective Date- Unless otherwise provided in this Act, subject to subsections (b) and (c), this Act (and the amendments made by this Act) shall take effect on October 1, 2007, and shall apply to child health assistance and medical assistance provided on or after that date without regard to whether or not final regulations to carry out this Act (or such amendments) have been promulgated by such date.CommentsClose CommentsPermalink





(b) Exception for State Legislation- In the case of a State plan under title XIX or State child health plan under XXI of the Social Security Act, which the Secretary of Health and Human Services determines requires State legislation in order for respective plan to meet one or more additional requirements imposed by amendments made by this Act, the respective State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature.CommentsClose CommentsPermalink





(c) Contingent Effective Date for CHIP Funding for Fiscal Year 2008- Notwithstanding any other provision of law, if funds are appropriated under any law (other than this Act) to provide allotments to States under CHIP for all (or any portion) of fiscal year 2008--CommentsClose CommentsPermalink





(1) any amounts that are so appropriated that are not so allotted and obligated before the date of the enactment of this Act are rescinded; andCommentsClose CommentsPermalink





(2) any amount provided for CHIP allotments to a State under this Act (and the amendments made by this Act) for such fiscal year shall be reduced by the amount of such appropriations so allotted and obligated before such date.CommentsClose CommentsPermalink





(d) Reliance on Law- With respect to amendments made by this Act (other than title VII) that become effective as of a date--CommentsClose CommentsPermalink





(1) such amendments are effective as of such date whether or not regulations implementing such amendments have been issued; andCommentsClose CommentsPermalink





(2) Federal financial participation for medical assistance or child health assistance furnished under title XIX or XXI, respectively, of the Social Security Act on or after such date by a State in good faith reliance on such amendments before the date of promulgation of final regulations, if any, to carry out such amendments (or before the date of guidance, if any, regarding the implementation of such amendments) shall not be denied on the basis of the State's failure to comply with such regulations or guidance.CommentsClose CommentsPermalink

TITLE I--FINANCING

Subtitle A--Funding

SEC. 101. EXTENSION OF CHIP.

Section 2104(a) (42 U.S.C. 1397dd(a)) is amended--CommentsClose CommentsPermalink





(1) in paragraph (9), by striking `and' at the end;CommentsClose CommentsPermalink





(2) in paragraph (10), by striking the period at the end and inserting a semicolon; andCommentsClose CommentsPermalink





(3) by adding at the end the following new paragraphs:CommentsClose CommentsPermalink





`(11) for fiscal year 2008, $9,125,000,000;CommentsClose CommentsPermalink





`(12) for fiscal year 2009, $10,675,000,000;CommentsClose CommentsPermalink





`(13) for fiscal year 2010, $11,850,000,000;CommentsClose CommentsPermalink





`(14) for fiscal year 2011, $13,750,000,000; andCommentsClose CommentsPermalink





`(15) for fiscal year 2012, for purposes of making 2 semi-annual allotments--CommentsClose CommentsPermalink





`(A) $1,750,000,000 for the period beginning on October 1, 2011, and ending on March 31, 2012, andCommentsClose CommentsPermalink





`(B) $1,750,000,000 for the period beginning on April 1, 2012, and ending on September 30, 2012.'.CommentsClose CommentsPermalink

SEC. 102. ALLOTMENTS FOR STATES AND TERRITORIES FOR FISCAL YEARS 2008 THROUGH 2012.

Section 2104 (42 U.S.C. 1397dd) is amended--CommentsClose CommentsPermalink





(1) in subsection (b)(1), by striking `subsection (d)' and inserting `subsections (d) and (i)';CommentsClose CommentsPermalink





(2) in subsection (c)(1), by striking `subsection (d)' and inserting `subsections (d) and (i)(4)'; andCommentsClose CommentsPermalink





(3) by adding at the end the following new subsection:CommentsClose CommentsPermalink





`(i) Allotments for Fiscal Years 2008 Through 2012-CommentsClose CommentsPermalink





`(1) FOR FISCAL YEAR 2008-CommentsClose CommentsPermalink





`(A) FOR THE 50 STATES AND THE DISTRICT OF COLUMBIA- Subject to the succeeding provisions of this paragraph and paragraph (4), the Secretary shall allot for fiscal year 2008 from the amount made available under subsection (a)(11), to each of the 50 States and the District of Columbia 110 percent of the highest of the following amounts for such State or District:CommentsClose CommentsPermalink





`(i) The total Federal payments to the State under this title for fiscal year 2007, multiplied by the allotment increase factor determined under paragraph (5) for fiscal year 2008.CommentsClose CommentsPermalink





`(ii) The Federal share of the amount allotted to the State for fiscal year 2007 under subsection (b), multiplied by the allotment increase factor determined under paragraph (5) for fiscal year 2008.CommentsClose CommentsPermalink





`(iii) Only in the case of--CommentsClose CommentsPermalink





`(I) a State that received a payment, redistribution, or allotment under any of paragraph (1), (2), or (4) of subsection (h), the amount of the projected total Federal payments to the State under this title for fiscal year 2007, as determined on the basis of the November 2006 estimates certified by the State to the Secretary;CommentsClose CommentsPermalink





`(II) a State whose projected total Federal payments to the State under this title for fiscal year 2007, as determined on the basis of the May 2006 estimates certified by the State to the Secretary, were at least $95,000,000 but not more than $96,000,000 higher than the projected total Federal payments to the State under this title for fiscal year 2007 on the basis of the November 2006 estimates, the amount of the projected total Federal payments to the State under this title for fiscal year 2007 on the basis of the May 2006 estimates; orCommentsClose CommentsPermalink





`(III) a State whose projected total Federal payments under this title for fiscal year 2007, as determined on the basis of the November 2006 estimates certified by the State to the Secretary, exceeded all amounts available to the State for expenditure for fiscal year 2007 (including any amounts paid, allotted, or redistributed to the State in prior fiscal years), the amount of the projected total Federal payments to the State under this title for fiscal year 2007, as determined on the basis of the November 2006 estimates certified by the State to the Secretary,CommentsClose CommentsPermalink





multiplied by the allotment increase factor determined under paragraph (5) for fiscal year 2008.CommentsClose CommentsPermalink





`(iv) The projected total Federal payments to the State under this title for fiscal year 2008, as determined on the basis of the August 2007 projections certified by the State to the Secretary by not later than September 30, 2007.CommentsClose CommentsPermalink





`(B) FOR THE COMMONWEALTHS AND TERRITORIES- Subject to the succeeding provisions of this paragraph and paragraph (4), the Secretary shall allot for fiscal year 2008 from the amount made available under subsection (a)(11) to each of the commonwealths and territories described in subsection (c)(3) an amount equal to the highest amount of Federal payments to the commonwealth or territory under this title for any fiscal year occurring during the period of fiscal years 1998 through 2007, multiplied by the allotment increase factor determined under paragraph (5) for fiscal year 2008, except that subparagraph (B) thereof shall be applied by substituting `the United States' for `the State'.CommentsClose CommentsPermalink





`(C) DEADLINE AND DATA FOR DETERMINING FISCAL YEAR 2008 ALLOTMENTS- In computing the amounts under subparagraphs (A) and (B) that determine the allotments to States for fiscal year 2008, the Secretary shall use the most recent data available to the Secretary before the start of that fiscal year. The Secretary may adjust such amounts and allotments, as necessary, on the basis of the expenditure data for the prior year reported by States on CMS Form 64 or CMS Form 21 not later than November 30, 2007, but in no case shall the Secretary adjust the allotments provided under subparagraph (A) or (B) for fiscal year 2008 after December 31, 2007.CommentsClose CommentsPermalink





`(D) ADJUSTMENT FOR QUALIFYING STATES- In the case of a qualifying State described in paragraph (2) of section 2105(g), the Secretary shall permit the State to submit revised projection described in subparagraph (A)(iv) in order to take into account changes in such projections attributable to the application of paragraph (4) of such section.CommentsClose CommentsPermalink





`(2) FOR FISCAL YEARS 2009 THROUGH 2011-CommentsClose CommentsPermalink





`(A) IN GENERAL- Subject to paragraphs (4) and (6), from the amount made available under paragraphs (12) through (14) of subsection (a) for each of fiscal years 2009 through 2011, respectively, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for each such fiscal year as follows:CommentsClose CommentsPermalink





`(i) GROWTH FACTOR UPDATE FOR FISCAL YEAR 2009- For fiscal year 2009, the allotment of the State is equal to the sum of--CommentsClose CommentsPermalink





`(I) the amount of the State allotment under paragraph (1) for fiscal year 2008; andCommentsClose CommentsPermalink





`(II) the amount of any payments made to the State under subsection (j) for fiscal year 2008,CommentsClose CommentsPermalink





multiplied by the allotment increase factor under paragraph (5) for fiscal year 2009.CommentsClose CommentsPermalink





`(ii) REBASING IN FISCAL YEAR 2010- For fiscal year 2010, the allotment of a State is equal to the Federal payments to the State that are attributable to (and countable towards) the total amount of allotments available under this section to the State in fiscal year 2009 (including payments made to the State under subsection (j) for fiscal year 2009 as well as amounts redistributed to the State in fiscal year 2009) multiplied by the allotment increase factor under paragraph (5) for fiscal year 2010.CommentsClose CommentsPermalink





`(iii) GROWTH FACTOR UPDATE FOR FISCAL YEAR 2011- For fiscal year 2011, the allotment of the State is equal to the sum of--CommentsClose CommentsPermalink





`(I) the amount of the State allotment under clause (ii) for fiscal year 2010; andCommentsClose CommentsPermalink





`(II) the amount of any payments made to the State under subsection (j) for fiscal year 2010,CommentsClose CommentsPermalink





multiplied by the allotment increase factor under paragraph (5) for fiscal year 2011.CommentsClose CommentsPermalink





`(3) FOR FISCAL YEAR 2012-CommentsClose CommentsPermalink





`(A) FIRST HALF- Subject to paragraphs (4) and (6), from the amount made available under subparagraph (A) of paragraph (15) of subsection (a) for the semi-annual period described in such paragraph, increased by the amount of the appropriation for such period under section 108 of the Children's Health Insurance Program Reauthorization Act of 2007, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the first half ratio (described in subparagraph (D)) of the amount described in subparagraph (C).CommentsClose CommentsPermalink





`(B) SECOND HALF- Subject to paragraphs (4) and (6), from the amount made available under subparagraph (B) of paragraph (15) of subsection (a) for the semi-annual period described in such paragraph, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the amount made available under such subparagraph multiplied by the ratio of--CommentsClose CommentsPermalink





`(i) the amount of the allotment to such State under subparagraph (A); toCommentsClose CommentsPermalink





`(ii) the total of the amount of all of the allotments made available under such subparagraph.CommentsClose CommentsPermalink





`(C) FULL YEAR AMOUNT BASED ON REBASED AMOUNT- The amount described in this subparagraph for a State is equal to the Federal payments to the State that are attributable to (and countable towards) the total amount of allotments available under this section to the State in fiscal year 2011 (including payments made to the State under subsection (j) for fiscal year 2011 as well as amounts redistributed to the State in fiscal year 2011) multiplied by the allotment increase factor under paragraph (5) for fiscal year 2012.CommentsClose CommentsPermalink





`(D) FIRST HALF RATIO- The first half ratio described in this subparagraph is the ratio of--CommentsClose CommentsPermalink





`(i) the sum of--CommentsClose CommentsPermalink





`(I) the amount made available under subsection (a)(15)(A); andCommentsClose CommentsPermalink





`(II) the amount of the appropriation for such period under section 108 of the Children's Health Insurance Program Reauthorization Act of 2007; toCommentsClose CommentsPermalink





`(ii) the sum of the--CommentsClose CommentsPermalink





`(I) amount described in clause (i); andCommentsClose CommentsPermalink





`(II) the amount made available under subsection (a)(15)(B).CommentsClose CommentsPermalink





`(4) PRORATION RULE- If, after the application of this subsection without regard to this paragraph, the sum of the allotments determined under paragraph (1), (2), or (3) for a fiscal year (or, in the case of fiscal year 2012, for a semi-annual period in such fiscal year) exceeds the amount available under subsection (a) for such fiscal year or period, the Secretary shall reduce each allotment for any State under such paragraph for such fiscal year or period on a proportional basis.CommentsClose CommentsPermalink





`(5) ALLOTMENT INCREASE FACTOR- The allotment increase factor under this paragraph for a fiscal year is equal to the product of the following:CommentsClose CommentsPermalink





`(A) PER CAPITA HEALTH CARE GROWTH FACTOR- 1 plus the percentage increase in the projected per capita amount of National Health Expenditures from the calendar year in which the previous fiscal year ends to the calendar year in which the fiscal year involved ends, as most recently published by the Secretary before the beginning of the fiscal year.CommentsClose CommentsPermalink





`(B) CHILD POPULATION GROWTH FACTOR- 1 plus the percentage increase (if any) in the population of children in the State from July 1 in the previous fiscal year to July 1 in the fiscal year involved, as determined by the Secretary based on the most recent published estimates of the Bureau of the Census before the beginning of the fiscal year involved, plus 1 percentage point.CommentsClose CommentsPermalink





`(6) INCREASE IN ALLOTMENT TO ACCOUNT FOR APPROVED PROGRAM EXPANSIONS- In the case of one of the 50 States or the District of Columbia that--CommentsClose CommentsPermalink





`(A) has submitted to the Secretary, and has approved by the Secretary, a State plan amendment or waiver request relating to an expansion of eligibility for children or benefits under this title that becomes effective for a fiscal year (beginning with fiscal year 2009 and ending with fiscal year 2012); andCommentsClose CommentsPermalink





`(B) has submitted to the Secretary, before the August 31 preceding the beginning of the fiscal year, a request for an expansion allotment adjustment under this paragraph for such fiscal year that specifies--CommentsClose CommentsPermalink





`(i) the additional expenditures that are attributable to the eligibility or benefit expansion provided under the amendment or waiver described in subparagraph (A), as certified by the State and submitted to the Secretary by not later than August 31 preceding the beginning of the fiscal year; andCommentsClose CommentsPermalink





`(ii) the extent to which such additional expenditures are projected to exceed the allotment of the State or District for the year,CommentsClose CommentsPermalink





subject to paragraph (4), the amount of the allotment of the State or District under this subsection for such fiscal year shall be increased by the excess amount described in subparagraph (B)(i). A State or District may only obtain an increase under this paragraph for an allotment for fiscal year 2009 or fiscal year 2011.CommentsClose CommentsPermalink





`(7) AVAILABILITY OF AMOUNTS FOR SEMI-ANNUAL PERIODS IN FISCAL YEAR 2012- Each semi-annual allotment made under paragraph (3) for a period in fiscal year 2012 shall remain available for expenditure under this title for periods after the end of such fiscal year in the same manner as if the allotment had been made available for the entire fiscal year.'.CommentsClose CommentsPermalink

SEC. 103. CHILD ENROLLMENT CONTINGENCY FUND.

Section 2104 (42 U.S.C. 1397dd), as amended by section 102, is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





`(j) Child Enrollment Contingency Fund-CommentsClose CommentsPermalink





`(1) ESTABLISHMENT- There is hereby established in the Treasury of the United States a fund which shall be known as the `Child Enrollment Contingency Fund' (in this subsection referred to as the `Fund'). Amounts in the Fund shall be available without further appropriations for payments under this subsection.CommentsClose CommentsPermalink





`(2) DEPOSITS INTO FUND-CommentsClose CommentsPermalink





`(A) INITIAL AND SUBSEQUENT APPROPRIATIONS- Subject to subparagraphs (B) and (D), out of any money in the Treasury of the United States not otherwise appropriated, there are appropriated to the Fund--CommentsClose CommentsPermalink





`(i) for fiscal year 2008, an amount equal to 20 percent of the amount made available under paragraph (11) of subsection (a) for the fiscal year; andCommentsClose CommentsPermalink





`(ii) for each of fiscal years 2009 through 2011 (and for each of the semi-annual allotment periods for fiscal year 2012) , such sums as are necessary for making payments to eligible States for such fiscal year or period, but not in excess of the aggregate cap described in subparagraph (B).CommentsClose CommentsPermalink





`(B) AGGREGATE CAP- The total amount available for payment from the Fund for each of fiscal years 2009 through 2011 (and for each of the semi-annual allotment periods for fiscal year 2012), taking into account deposits made under subparagraph (C), shall not exceed 20 percent of the amount made available under subsection (a) for the fiscal year or period.CommentsClose CommentsPermalink





`(C) INVESTMENT OF FUND- The Secretary of the Treasury shall invest, in interest bearing securities of the United States, such currently available portions of the Fund as are not immediately required for payments from the Fund. The income derived from these investments constitutes a part of the Fund.CommentsClose CommentsPermalink





`(D) AVAILABILITY OF EXCESS FUNDS FOR PERFORMANCE BONUSES- Any amounts in excess of the aggregate cap described in subparagraph (B) for a fiscal year or period shall be made available for purposes of carrying out section 2105(a)(3) for any succeeding fiscal year and the Secretary of the Treasury shall reduce the amount in the Fund by the amount so made available.CommentsClose CommentsPermalink





`(3) CHILD ENROLLMENT CONTINGENCY FUND PAYMENTS-CommentsClose CommentsPermalink





`(A) IN GENERAL- If a State's expenditures under this title in fiscal year 2008, fiscal year 2009, fiscal year 2010, fiscal year 2011, or a semi-annual allotment period for fiscal year 2012, exceed the total amount of allotments available under this section to the State in the fiscal year or period (determined without regard to any redistribution it receives under subsection (f) that is available for expenditure during such fiscal year or period, but including any carryover from a previous fiscal year) and if the average monthly unduplicated number of children enrolled under the State plan under this title (including children receiving health care coverage through funds under this title pursuant to a waiver under section 1115) during such fiscal year or period exceeds its target average number of such enrollees (as determined under subparagraph (B)) for that fiscal year or period, subject to subparagraph (D), the Secretary shall pay to the State from the Fund an amount equal to the product of--CommentsClose CommentsPermalink





`(i) the amount by which such average monthly caseload exceeds such target number of enrollees; andCommentsClose CommentsPermalink





`(ii) the projected per capita expenditures under the State child health plan (as determined under subparagraph (C) for the fiscal year), multiplied by the enhanced FMAP (as defined in section 2105(b)) for the State and fiscal year involved (or in which the period occurs).CommentsClose CommentsPermalink





`(B) TARGET AVERAGE NUMBER OF CHILD ENROLLEES- In this paragraph, the target average number of child enrollees for a State--CommentsClose CommentsPermalink





`(i) for fiscal year 2008 is equal to the monthly average unduplicated number of children enrolled in the State child health plan under this title (including such children receiving health care coverage through funds under this title pursuant to a waiver under section 1115) during fiscal year 2007 increased by the population growth for children in that State for the year ending on June 30, 2006 (as estimated by the Bureau of the Census) plus 1 percentage point; orCommentsClose CommentsPermalink





`(ii) for a subsequent fiscal year (or semi-annual period occurring in a fiscal year) is equal to the target average number of child enrollees for the State for the previous fiscal year increased by the child population growth factor described in subsection (i)(5)(B) for the State for the prior fiscal year.CommentsClose CommentsPermalink





`(C) PROJECTED PER CAPITA EXPENDITURES- For purposes of subparagraph (A)(ii), the projected per capita expenditures under a State child health plan--CommentsClose CommentsPermalink





`(i) for fiscal year 2008 is equal to the average per capita expenditures (including both State and Federal financial participation) under such plan for the targeted low-income children counted in the average monthly caseload for purposes of this paragraph during fiscal year 2007, increased by the annual percentage increase in the projected per capita amount of National Health Expenditures (as estimated by the Secretary) for 2008; orCommentsClose CommentsPermalink





`(ii) for a subsequent fiscal year (or semi-annual period occurring in a fiscal year) is equal to the projected per capita expenditures under such plan for the previous fiscal year (as determined under clause (i) or this clause) increased by the annual percentage increase in the projected per capita amount of National Health Expenditures (as estimated by the Secretary) for the year in which such subsequent fiscal year ends.CommentsClose CommentsPermalink





`(D) PRORATION RULE- If the amounts available for payment from the Fund for a fiscal year or period are less than the total amount of payments determined under subparagraph (A) for the fiscal year or period, the amount to be paid under such subparagraph to each eligible State shall be reduced proportionally.CommentsClose CommentsPermalink





`(E) TIMELY PAYMENT; RECONCILIATION- Payment under this paragraph for a fiscal year or period shall be made before the end of the fiscal year or period based upon the most recent data for expenditures and enrollment and the provisions of subsection (e) of section 2105 shall apply to payments under this subsection in the same manner as they apply to payments under such section.CommentsClose CommentsPermalink





`(F) CONTINUED REPORTING- For purposes of this paragraph and subsection (f), the State shall submit to the Secretary the State's projected Federal expenditures, even if the amount of such expenditures exceeds the total amount of allotments available to the State in such fiscal year or period.CommentsClose CommentsPermalink





`(G) APPLICATION TO COMMONWEALTHS AND TERRITORIES- No payment shall be made under this paragraph to a commonwealth or territory described in subsection (c)(3) until such time as the Secretary determines that there are in effect methods, satisfactory to the Secretary, for the collection and reporting of reliable data regarding the enrollment of children described in subparagraphs (A) and (B) in order to accurately determine the commonwealth's or territory's eligibility for, and amount of payment, under this paragraph.'.CommentsClose CommentsPermalink

SEC. 104. CHIP PERFORMANCE BONUS PAYMENT TO OFFSET ADDITIONAL ENROLLMENT COSTS RESULTING FROM ENROLLMENT AND RETENTION EFFORTS.

Section 2105(a) (42 U.S.C. 1397ee(a)) is amended by adding at the end the following new paragraphs:CommentsClose CommentsPermalink





`(3) PERFORMANCE BONUS PAYMENT TO OFFSET ADDITIONAL MEDICAID AND CHIP CHILD ENROLLMENT COSTS RESULTING FROM ENROLLMENT AND RETENTION EFFORTS-CommentsClose CommentsPermalink





`(A) IN GENERAL- In addition to the payments made under paragraph (1), for each fiscal year (beginning with fiscal year 2008 and ending with fiscal year 2012) the Secretary shall pay from amounts made available under subparagraph (E), to each State that meets the condition under paragraph (4) for the fiscal year, an amount equal to the amount described in subparagraph (B) for the State and fiscal year. The payment under this paragraph shall be made, to a State for a fiscal year, as a single payment not later than the last day of the first calendar quarter of the following fiscal year.CommentsClose CommentsPermalink





`(B) AMOUNT- Subject to subparagraph (E), the amount described in this subparagraph for a State for a fiscal year is equal to the sum of the following amounts:CommentsClose CommentsPermalink





`(i) FOR ABOVE BASELINE MEDICAID CHILD ENROLLMENT COSTS-CommentsClose CommentsPermalink





`(I) FIRST TIER ABOVE BASELINE MEDICAID ENROLLEES- An amount equal to the number of first tier above baseline child enrollees (as determined under subparagraph (C)(i)) under title XIX for the State and fiscal year multiplied by 15 percent of the projected per capita State Medicaid expenditures (as determined under subparagraph (D)(i)) for the State and fiscal year under title XIX.CommentsClose CommentsPermalink





`(II) SECOND TIER ABOVE BASELINE MEDICAID ENROLLEES- An amount equal to the number of second tier above baseline child enrollees (as determined under subparagraph (C)(ii)) under title XIX for the State and fiscal year multiplied by 60 percent of the projected per capita State Medicaid expenditures (as determined under subparagraph (D)(i)) for the State and fiscal year under title XIX.CommentsClose CommentsPermalink





`(ii) FOR ABOVE BASELINE CHIP ENROLLMENT COSTS-CommentsClose CommentsPermalink





`(I) FIRST TIER ABOVE BASELINE CHIP ENROLLEES- An amount equal to the number of first tier above baseline child enrollees under this title (as determined under subparagraph (C)(i)) for the State and fiscal year multiplied by 10 percent of the projected per capita State CHIP expenditures (as determined under subparagraph (D)(ii)) for the State and fiscal year under this title.CommentsClose CommentsPermalink





`(II) SECOND TIER ABOVE BASELINE CHIP ENROLLEES- An amount equal to the number of second tier above baseline child enrollees under this title (as determined under subparagraph (C)(ii)) for the State and fiscal year multiplied by 40 percent of the projected per capita State CHIP expenditures (as determined under subparagraph (D)(ii)) for the State and fiscal year under this title.CommentsClose CommentsPermalink





`(C) NUMBER OF FIRST AND SECOND TIER ABOVE BASELINE CHILD ENROLLEES; BASELINE NUMBER OF CHILD ENROLLEES- For purposes of this paragraph:CommentsClose CommentsPermalink





`(i) FIRST TIER ABOVE BASELINE CHILD ENROLLEES- The number of first tier above baseline child enrollees for a State for a fiscal year under this title or title XIX is equal to the number (if any, as determined by the Secretary) by which--CommentsClose CommentsPermalink





`(I) the monthly average unduplicated number of qualifying children (as defined in subparagraph (F)) enrolled during the fiscal year under the State child health plan under this title or under the State plan under title XIX, respectively; exceedsCommentsClose CommentsPermalink





`(II) the baseline number of enrollees described in clause (iii) for the State and fiscal year under this title or title XIX, respectively;CommentsClose CommentsPermalink





but not to exceed 3 percent (in the case of title XIX) or 7.5 percent (in the case of this title) of the baseline number of enrollees described in subclause (II).CommentsClose CommentsPermalink





`(ii) SECOND TIER ABOVE BASELINE CHILD ENROLLEES- The number of second tier above baseline child enrollees for a State for a fiscal year under this title or title XIX is equal to the number (if any, as determined by the Secretary) by which--CommentsClose CommentsPermalink





`(I) the monthly average unduplicated number of qualifying children (as defined in subparagraph (F)) enrolled during the fiscal year under this title or under title XIX, respectively, as described in clause (i)(I); exceedsCommentsClose CommentsPermalink





`(II) the sum of the baseline number of child enrollees described in clause (iii) for the State and fiscal year under this title or title XIX, respectively, as described in clause (i)(II), and the maximum number of first tier above baseline child enrollees for the State and fiscal year under this title or title XIX, respectively, as determined under clause (i).CommentsClose CommentsPermalink





`(iii) BASELINE NUMBER OF CHILD ENROLLEES- Subject to subparagraph (H), the baseline number of child enrollees for a State under this title or title XIX--CommentsClose CommentsPermalink





`(I) for fiscal year 2008 is equal to the monthly average unduplicated number of qualifying children enrolled in the State child health plan under this title or in the State plan under title XIX, respectively, during fiscal year 2007 increased by the population growth for children in that State for the year ending on June 30, 2006 (as estimated by the Bureau of the Census) plus 1 percentage point; orCommentsClose CommentsPermalink





`(II) for a subsequent fiscal year is equal to the baseline number of child enrollees for the State for the previous fiscal year under this title or title XIX, respectively, increased by the population growth for children in that State for the year ending on June 30 before the beginning of the fiscal year (as estimated by the Bureau of the Census) plus 1 percentage point.CommentsClose CommentsPermalink





`(D) PROJECTED PER CAPITA STATE EXPENDITURES- For purposes of subparagraph (B)--CommentsClose CommentsPermalink





`(i) PROJECTED PER CAPITA STATE MEDICAID EXPENDITURES- The projected per capita State Medicaid expenditures for a State and fiscal year under title XIX is equal to the average per capita expenditures (including both State and Federal financial participation) for children under the State plan under such title, including under waivers but not including such children eligible for assistance by virtue of the receipt of benefits under title XVI, for the most recent fiscal year for which actual data are available (as determined by the Secretary), increased (for each subsequent fiscal year up to and including the fiscal year involved) by the annual percentage increase in per capita amount of National Health Expenditures (as estimated by the Secretary) for the calendar year in which the respective subsequent fiscal year ends and multiplied by a State matching percentage equal to 100 percent minus the Federal medical assistance percentage (as defined in section 1905(b)) for the fiscal year involved.CommentsClose CommentsPermalink





`(ii) PROJECTED PER CAPITA STATE CHIP EXPENDITURES- The projected per capita State CHIP expenditures for a State and fiscal year under this title is equal to the average per capita expenditures (including both State and Federal financial participation) for children under the State child health plan under this title, including under waivers, for the most recent fiscal year for which actual data are available (as determined by the Secretary), increased (for each subsequent fiscal year up to and including the fiscal year involved) by the annual percentage increase in per capita amount of National Health Expenditures (as estimated by the Secretary) for the calendar year in which the respective subsequent fiscal year ends and multiplied by a State matching percentage equal to 100 percent minus the enhanced FMAP (as defined in section 2105(b)) for the fiscal year involved.CommentsClose CommentsPermalink





`(E) AMOUNTS AVAILABLE FOR PAYMENTS-CommentsClose CommentsPermalink





`(i) INITIAL APPROPRIATION- Out of any money in the Treasury not otherwise appropriated, there are appropriated $3,000,000,000 for fiscal year 2008 for making payments under this paragraph, to be available until expended.CommentsClose CommentsPermalink





`(ii) TRANSFERS- Notwithstanding any other provision of this title, the following amounts shall also be available, without fiscal year limitation, for making payments under this paragraph:CommentsClose CommentsPermalink





`(I) UNOBLIGATED NATIONAL ALLOTMENT-CommentsClose CommentsPermalink

`(aa) FISCAL YEARS 2008 THROUGH 2011- As of December 31 of fiscal year 2008, and as of December 31 of each succeeding fiscal year through fiscal year 2011, the portion, if any, of the amount appropriated under subsection (a) for such fiscal year that is unobligated for allotment to a State under subsection (i) for such fiscal year or set aside under subsection (a)(3) or (b)(2) of section 2111 for such fiscal year.CommentsClose CommentsPermalink

`(bb) FIRST HALF OF FISCAL YEAR 2012- As of December 31 of fiscal year 2012, the portion, if any, of the sum of the amounts appropriated under subsection (a)(15)(A) and under section 108 of the Children's Health Insurance Reauthorization Act of 2007 for the period beginning on October 1, 2011, and ending on March 31, 2012, that is unobligated for allotment to a State under subsection (i) for such fiscal year or set aside under subsection (b)(2) of section 2111 for such fiscal year.CommentsClose CommentsPermalink

`(cc) SECOND HALF OF FISCAL YEAR 2012- As of June 30 of fiscal year 2012, the portion, if any, of the amount appropriated under subsection (a)(15)(B) for the period beginning on April 1, 2012, and ending on September 30, 2012, that is unobligated for allotment to a State under subsection (i) for such fiscal year or set aside under subsection (b)(2) of section 2111 for such fiscal year.CommentsClose CommentsPermalink

`(II) UNEXPENDED ALLOTMENTS NOT USED FOR REDISTRIBUTION- As of November 15 of each of fiscal years 2009 through 2012, the total amount of allotments made to States under section 2104 for the second preceding fiscal year (third preceding fiscal year in the case of the fiscal year 2006 and 2007 allotments) that is not expended or redistributed under section 2104(f) during the period in which such allotments are available for obligation.CommentsClose CommentsPermalink





`(III) EXCESS CHILD ENROLLMENT CONTINGENCY FUNDS- As of October 1 of each of fiscal years 2009 through 2012, any amount in excess of the aggregate cap applicable to the Child Enrollment Contingency Fund for the fiscal year under section 2104(j).CommentsClose CommentsPermalink





`(IV) UNEXPENDED TRANSITIONAL COVERAGE BLOCK GRANT FOR NONPREGNANT CHILDLESS ADULTS- As of October 1, 2009, any amounts set aside under section 2111(a)(3) that are not expended by September 30, 2009.CommentsClose CommentsPermalink





`(iii) PROPORTIONAL REDUCTION- If the sum of the amounts otherwise payable under this paragraph for a fiscal year exceeds the amount available for the fiscal year under this subparagraph, the amount to be paid under this paragraph to each State shall be reduced proportionally.CommentsClose CommentsPermalink





`(F) QUALIFYING CHILDREN DEFINED- For purposes of this subsection, the term `qualifying children' means, with respect to this title or title XIX, children who meet the eligibility criteria (including income, categorical eligibility, age, and immigration status criteria) in effect as of July 1, 2007, for enrollment under this title or title XIX, respectively, taking into account criteria applied as of such date under this title or title XIX, respectively, pursuant to a waiver under section 1115.CommentsClose CommentsPermalink





`(G) APPLICATION TO COMMONWEALTHS AND TERRITORIES- The provisions of subparagraph (H) of section 2104(j)(3) shall apply with respect to payments under this paragraph in the same manner as such provisions apply to payment under such section.CommentsClose CommentsPermalink





`(H) APPLICATION TO STATES THAT IMPLEMENT A MEDICAID EXPANSION FOR CHILDREN AFTER FISCAL YEAR 2007- In the case of a State that provides coverage under paragraph (1) or (2) of section 115(b) of the Children's Health Insurance Program Reauthorization Act of 2007 for any fiscal year after fiscal year 2007--CommentsClose CommentsPermalink





`(i) any child enrolled in the State plan under title XIX through the application of such an election shall be disregarded from the determination for the State of the monthly average unduplicated number of qualifying children enrolled in such plan during the first 3 fiscal years in which such an election is in effect; andCommentsClose CommentsPermalink





`(ii) in determining the baseline number of child enrollees for the State for any fiscal year subsequent to such first 3 fiscal years, the baseline number of child enrollees for the State under this title or title XIX for the third of such fiscal years shall be the monthly average unduplicated number of qualifying children enrolled in the State child health plan under this title or in the State plan under title XIX, respectively, for such third fiscal year.CommentsClose CommentsPermalink





`(4) ENROLLMENT AND RETENTION PROVISIONS FOR CHILDREN- For purposes of paragraph (3)(A), a State meets the condition of this paragraph for a fiscal year if it is implementing at least 4 of the following enrollment and retention provisions (treating each subparagraph as a separate enrollment and retention provision) throughout the entire fiscal year:CommentsClose CommentsPermalink





`(A) CONTINUOUS ELIGIBILITY- The State has elected the option of continuous eligibility for a full 12 months for all children described in section 1902(e)(12) under title XIX under 19 years of age, as well as applying such policy under its State child health plan under this title.CommentsClose CommentsPermalink





`(B) LIBERALIZATION OF ASSET REQUIREMENTS- The State meets the requirement specified in either of the following clauses:CommentsClose CommentsPermalink





`(i) ELIMINATION OF ASSET TEST- The State does not apply any asset or resource test for eligibility for children under title XIX or this title.CommentsClose CommentsPermalink





`(ii) ADMINISTRATIVE VERIFICATION OF ASSETS- The State--CommentsClose CommentsPermalink





`(I) permits a parent or caretaker relative who is applying on behalf of a child for medical assistance under title XIX or child health assistance under this title to declare and certify by signature under penalty of perjury information relating to family assets for purposes of determining and redetermining financial eligibility; andCommentsClose CommentsPermalink





`(II) takes steps to verify assets through means other than by requiring documentation from parents and applicants except in individual cases of discrepancies or where otherwise justified.CommentsClose CommentsPermalink





`(C) ELIMINATION OF IN-PERSON INTERVIEW REQUIREMENT- The State does not require an application of a child for medical assistance under title XIX (or for child health assistance under this title), including an application for renewal of such assistance, to be made in person nor does the State require a face-to-face interview, unless there are discrepancies or individual circumstances justifying an in-person application or face-to-face interview.CommentsClose CommentsPermalink





`(D) USE OF JOINT APPLICATION FOR MEDICAID AND CHIP- The application form and supplemental forms (if any) and information verification process is the same for purposes of establishing and renewing eligibility for children for medical assistance under title XIX and child health assistance under this title.CommentsClose CommentsPermalink





`(E) AUTOMATIC RENEWAL (USE OF ADMINISTRATIVE RENEWAL)-CommentsClose CommentsPermalink





`(i) IN GENERAL- The State provides, in the case of renewal of a child's eligibility for medical assistance under title XIX or child health assistance under this title, a pre-printed form completed by the State based on the information available to the State and notice to the parent or caretaker relative of the child that eligibility of the child will be renewed and continued based on such information unless the State is provided other information. Nothing in this clause shall be construed as preventing a State from verifying, through electronic and other means, the information so provided.CommentsClose CommentsPermalink





`(ii) SATISFACTION THROUGH DEMONSTRATED USE OF EX PARTE PROCESS- A State shall be treated as satisfying the requirement of clause (i) if renewal of eligibility of children under title XIX or this title is determined without any requirement for an in-person interview, unless sufficient information is not in the State's possession and cannot be acquired from other sources (including other State agencies) without the participation of the applicant or the applicant's parent or caretaker relative.CommentsClose CommentsPermalink





`(F) PRESUMPTIVE ELIGIBILITY FOR CHILDREN- The State is implementing section 1920A under title XIX as well as, pursuant to section 2107(e)(1), under this title.CommentsClose CommentsPermalink





`(G) EXPRESS LANE- The State is implementing the option described in section 1902(e)(13) under title XIX as well as, pursuant to section 2107(e)(1), under this title.'.CommentsClose CommentsPermalink

SEC. 105. 2-YEAR INITIAL AVAILABILITY OF CHIP ALLOTMENTS.

Section 2104(e) (42 U.S.C. 1397dd(e)) is amended to read as follows:CommentsClose CommentsPermalink





`(e) Availability of Amounts Allotted-CommentsClose CommentsPermalink





`(1) IN GENERAL- Except as provided in paragraph (2), amounts allotted to a State pursuant to this section--CommentsClose CommentsPermalink





`(A) for each of fiscal years 1998 through 2007, shall remain available for expenditure by the State through the end of the second succeeding fiscal year; andCommentsClose CommentsPermalink





`(B) for fiscal year 2008 and each fiscal year thereafter, shall remain available for expenditure by the State through the end of the succeeding fiscal year.CommentsClose CommentsPermalink





`(2) AVAILABILITY OF AMOUNTS REDISTRIBUTED- Amounts redistributed to a State under subsection (f) shall be available for expenditure by the State through the end of the fiscal year in which they are redistributed.'.CommentsClose CommentsPermalink

SEC. 106. REDISTRIBUTION OF UNUSED ALLOTMENTS TO ADDRESS STATE FUNDING SHORTFALLS.

(a) Fiscal Year 2005 Allotments-CommentsClose CommentsPermalink





(1) IN GENERAL- Notwithstanding section 2104(f) of the Social Security Act (42 U.S.C. 1397dd(f)), subject to paragraph (2), with respect to fiscal year 2008, the Secretary shall provide for a redistribution under such section from the allotments for fiscal year 2005 under subsections (b) and (c) of such section that are not expended by the end of fiscal year 2007, to each State described in clause (iii) of section 2104(i)(1)(A) of the Social Security Act, as added by section 102, of an amount that bears the same ratio to such unexpended fiscal year 2005 allotments as the ratio of the fiscal year 2007 allotment determined for each such State under subsection (b) of section 2104 of such Act for fiscal year 2007 (without regard to any amounts paid, allotted, or redistributed to the State under section 2104 for any preceding fiscal year) bears to the total amount of the fiscal year 2007 allotments for all such States (as so determined).CommentsClose CommentsPermalink





(2) CONTINGENCY- Paragraph (1) shall not apply if the redistribution described in such paragraph has occurred as of the date of the enactment of this Act.CommentsClose CommentsPermalink





(b) Allotments for Subsequent Fiscal Years- Section 2104(f) (42 U.S.C. 1397dd(f)) is amended--CommentsClose CommentsPermalink





(1) by striking `The Secretary' and inserting the following:CommentsClose CommentsPermalink





`(1) IN GENERAL- The Secretary';CommentsClose CommentsPermalink





(2) by striking `States that have fully expended the amount of their allotments under this section.' and inserting `States that the Secretary determines with respect to the fiscal year for which unused allotments are available for redistribution under this subsection, are shortfall States described in paragraph (2) for such fiscal year, but not to exceed the amount of the shortfall described in paragraph (2)(A) for each such State (as may be adjusted under paragraph (2)(C)).'; andCommentsClose CommentsPermalink





(3) by adding at the end the following new paragraph:CommentsClose CommentsPermalink





`(2) SHORTFALL STATES DESCRIBED-CommentsClose CommentsPermalink





`(A) IN GENERAL- For purposes of paragraph (1), with respect to a fiscal year, a shortfall State described in this subparagraph is a State with a State child health plan approved under this title for which the Secretary estimates on the basis of the most recent data available to the Secretary, that the projected expenditures under such plan for the State for the fiscal year will exceed the sum of--CommentsClose CommentsPermalink





`(i) the amount of the State's allotments for any preceding fiscal years that remains available for expenditure and that will not be expended by the end of the immediately preceding fiscal year;CommentsClose CommentsPermalink





`(ii) the amount (if any) of the child enrollment contingency fund payment under subsection (j); andCommentsClose CommentsPermalink





`(iii) the amount of the State's allotment for the fiscal year.CommentsClose CommentsPermalink





`(B) PRORATION RULE- If the amounts available for redistribution under paragraph (1) for a fiscal year are less than the total amounts of the estimated shortfalls determined for the year under subparagraph (A), the amount to be redistributed under such paragraph for each shortfall State shall be reduced proportionally.CommentsClose CommentsPermalink





`(C) RETROSPECTIVE ADJUSTMENT- The Secretary may adjust the estimates and determinations made under paragraph (1) and this paragraph with respect to a fiscal year as necessary on the basis of the amounts reported by States not later than November 30 of the succeeding fiscal year, as approved by the Secretary.'.CommentsClose CommentsPermalink

SEC. 107. OPTION FOR QUALIFYING STATES TO RECEIVE THE ENHANCED PORTION OF THE CHIP MATCHING RATE FOR MEDICAID COVERAGE OF CERTAIN CHILDREN.

Section 2105(g) (42 U.S.C. 1397ee(g)) is amended--CommentsClose CommentsPermalink





(1) in paragraph (1)(A), by inserting `subject to paragraph (4),' after `Notwithstanding any other provision of law,'; andCommentsClose CommentsPermalink





(2) by adding at the end the following new paragraph:CommentsClose CommentsPermalink





`(4) OPTION FOR ALLOTMENTS FOR FISCAL YEARS 2008 THROUGH 2012-CommentsClose CommentsPermalink





`(A) PAYMENT OF ENHANCED PORTION OF MATCHING RATE FOR CERTAIN EXPENDITURES- In the case of expenditures described in subparagraph (B), a qualifying State (as defined in paragraph (2)) may elect to be paid from the State's allotment made under section 2104 for any of fiscal years 2008 through 2012 (insofar as the allotment is available to the State under subsections (e) and (i) of such section) an amount each quarter equal to the additional amount that would have been paid to the State under title XIX with respect to such expenditures if the enhanced FMAP (as determined under subsection (b)) had been substituted for the Federal medical assistance percentage (as defined in section 1905(b)).CommentsClose CommentsPermalink





`(B) EXPENDITURES DESCRIBED- For purposes of subparagraph (A), the expenditures described in this subparagraph are expenditures made after the date of the enactment of this paragraph and during the period in which funds are available to the qualifying State for use under subparagraph (A), for the provision of medical assistance to individuals residing in the State who are eligible for medical assistance under the State plan under title XIX or under a waiver of such plan and who have not attained age 19 (or, if a State has so elected under the State plan under title XIX, age 20 or 21), and whose family income equals or exceeds 133 percent of the poverty line but does not exceed the Medicaid applicable income level.'.CommentsClose CommentsPermalink

SEC. 108. ONE-TIME APPROPRIATION.

There is appropriated to the Secretary, out of any money in the Treasury not otherwise appropriated, $12,500,000,000 to accompany the allotment made for the period beginning on October 1, 2011, and ending on March 31, 2012, under section 2104(a)(15)(A) of the Social Security Act (42 U.S.C. 1397dd(a)(15)(A)) (as added by section 101), to remain available until expended. Such amount shall be used to provide allotments to States under paragraph (3) of section 2104(i) of the Social Security Act (42 U.S.C. 1397dd(i)), as added by section 102, for the first 6 months of fiscal year 2012 in the same manner as allotments are provided under subsection (a)(15)(A) of such section 2104 and subject to the same terms and conditions as apply to the allotments provided from such subsection (a)(15)(A).CommentsClose CommentsPermalink

SEC. 109. IMPROVING FUNDING FOR THE TERRITORIES UNDER CHIP AND MEDICAID.

(a) Removal of Federal Matching Payments for Data Reporting Systems From the Overall Limit on Payments to Territories Under Title XIX- Section 1108(g) (42 U.S.C. 1308(g)) is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





`(4) EXCLUSION OF CERTAIN EXPENDITURES FROM PAYMENT LIMITS- With respect to fiscal years beginning with fiscal year 2008, if Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa qualify for a payment under subparagraph (A)(i), (B), or (F) of section 1903(a)(3) for a calendar quarter of such fiscal year, the payment shall not be taken into account in applying subsection (f) (as increased in accordance with paragraphs (1), (2), and (3) of this subsection) to such commonwealth or territory for such fiscal year.'.CommentsClose CommentsPermalink





(b) GAO Study and Report- Not later than September 30, 2009, the Comptroller General of the United States shall submit a report to the Committee on Finance of the Senate and the Committee on Energy and Commerce of the House of Representatives regarding Federal funding under Medicaid and CHIP for Puerto Rico, the United States Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. The report shall include the following:CommentsClose CommentsPermalink





(1) An analysis of all relevant factors with respect to--CommentsClose CommentsPermalink





(A) eligible Medicaid and CHIP populations in such commonwealths and territories;CommentsClose CommentsPermalink





(B) historical and projected spending needs of such commonwealths and territories and the ability of capped funding streams to respond to those spending needs;CommentsClose CommentsPermalink





(C) the extent to which Federal poverty guidelines are used by such commonwealths and territories to determine Medicaid and CHIP eligibility; andCommentsClose CommentsPermalink





(D) the extent to which such commonwealths and territories participate in data collection and reporting related to Medicaid and CHIP, including an analysis of territory participation in the Current Population Survey versus the American Community Survey.CommentsClose CommentsPermalink





(2) Recommendations regarding methods for the collection and reporting of reliable data regarding the enrollment under Medicaid and CHIP of children in such commonwealths and territories.CommentsClose CommentsPermalink





(3) Recommendations for improving Federal funding under Medicaid and CHIP for such commonwealths and territories.CommentsClose CommentsPermalink

Subtitle B--Focus on Low-Income Children and Pregnant Women

SEC. 111. STATE OPTION TO COVER LOW-INCOME PREGNANT WOMEN UNDER CHIP THROUGH A STATE PLAN AMENDMENT.

(a) In General- Title XXI (42 U.S.C. 1397aa et seq.), as amended by section 112(a), is amended by adding at the end the following new section:CommentsClose CommentsPermalink

`SEC. 2112. OPTIONAL COVERAGE OF TARGETED LOW-INCOME PREGNANT WOMEN THROUGH A STATE PLAN AMENDMENT.CommentsClose CommentsPermalink

`(a) In General- Subject to the succeeding provisions of this section, a State may elect through an amendment to its State child health plan under section 2102 to provide pregnancy-related assistance under such plan for targeted low-income pregnant women.CommentsClose CommentsPermalink





`(b) Conditions- A State may only elect the option under subsection (a) if the following conditions are satisfied:CommentsClose CommentsPermalink





`(1) MINIMUM INCOME ELIGIBILITY LEVELS FOR PREGNANT WOMEN AND CHILDREN- The State has established an income eligibility level--CommentsClose CommentsPermalink





`(A) for pregnant women under subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) of section 1902 that is at least 185 percent (or such higher percent as the State has in effect with regard to pregnant women under this title) of the poverty line applicable to a family of the size involved, but in no case lower than the percent in effect under any such subsection as of July 1, 2007; andCommentsClose CommentsPermalink





`(B) for children under 19 years of age under this title (or title XIX) that is at least 200 percent of the poverty line applicable to a family of the size involved.CommentsClose CommentsPermalink





`(2) NO CHIP INCOME ELIGIBILITY LEVEL FOR PREGNANT WOMEN LOWER THAN THE STATE'S MEDICAID LEVEL- The State does not apply an effective income level for pregnant women under the State plan amendment that is lower than the effective income level (expressed as a percent of the poverty line and considering applicable income disregards) specified under subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) of section 1902, on the date of enactment of this paragraph to be eligible for medical assistance as a pregnant woman.CommentsClose CommentsPermalink





`(3) NO COVERAGE FOR HIGHER INCOME PREGNANT WOMEN WITHOUT COVERING LOWER INCOME PREGNANT WOMEN- The State does not provide coverage for pregnant women with higher family income without covering pregnant women with a lower family income.CommentsClose CommentsPermalink





`(4) APPLICATION OF REQUIREMENTS FOR COVERAGE OF TARGETED LOW-INCOME CHILDREN- The State provides pregnancy-related assistance for targeted low-income pregnant women in the same manner, and subject to the same requirements, as the State provides child health assistance for targeted low-income children under the State child health plan, and in addition to providing child health assistance for such women.CommentsClose CommentsPermalink





`(5) NO PREEXISTING CONDITION EXCLUSION OR WAITING PERIOD- The State does not apply any exclusion of benefits for pregnancy-related assistance based on any preexisting condition or any waiting period (including any waiting period imposed to carry out section 2102(b)(3)(C)) for receipt of such assistance.CommentsClose CommentsPermalink





`(6) APPLICATION OF COST-SHARING PROTECTION- The State provides pregnancy-related assistance to a targeted low-income woman consistent with the cost-sharing protections under section 2103(e) and applies the limitation on total annual aggregate cost sharing imposed under paragraph (3)(B) of such section to the family of such a woman.CommentsClose CommentsPermalink





`(7) NO WAITING LIST FOR CHILDREN- The State does not impose, with respect to the enrollment under the State child health plan of targeted low-income children during the quarter, any enrollment cap or other numerical limitation on enrollment, any waiting list, any procedures designed to delay the consideration of applications for enrollment, or similar limitation with respect to enrollment.CommentsClose CommentsPermalink





`(c) Option To Provide Presumptive Eligibility- A State that elects the option under subsection (a) and satisfies the conditions described in subsection (b) may elect to apply section 1920 (relating to presumptive eligibility for pregnant women) to the State child health plan in the same manner as such section applies to the State plan under title XIX.CommentsClose CommentsPermalink





`(d) Definitions- For purposes of this section:CommentsClose CommentsPermalink





`(1) PREGNANCY-RELATED ASSISTANCE- The term `pregnancy-related assistance' has the meaning given the term `child health assistance' in section 2110(a) and includes any medical assistance that the State would provide for a pregnant woman under the State plan under title XIX during the period described in paragraph (2)(A).CommentsClose CommentsPermalink





`(2) TARGETED LOW-INCOME PREGNANT WOMAN- The term `targeted low-income pregnant woman' means a woman--CommentsClose CommentsPermalink





`(A) during pregnancy and through the end of the month in which the 60-day period (beginning on the last day of her pregnancy) ends;CommentsClose CommentsPermalink





`(B) whose family income exceeds 185 percent (or, if higher, the percent applied under subsection (b)(1)(A)) of the poverty line applicable to a family of the size involved, but does not exceed the income eligibility level established under the State child health plan under this title for a targeted low-income child; andCommentsClose CommentsPermalink





`(C) who satisfies the requirements of paragraphs (1)(A), (1)(C), (2), and (3) of section 2110(b) in the same manner as a child applying for child health assistance would have to satisfy such requirements.CommentsClose CommentsPermalink





`(e) Automatic Enrollment for Children Born to Women Receiving Pregnancy-Related Assistance- If a child is born to a targeted low-income pregnant woman who was receiving pregnancy-related assistance under this section on the date of the child's birth, the child shall be deemed to have applied for child health assistance under the State child health plan and to have been found eligible for such assistance under such plan or to have applied for medical assistance under title XIX and to have been found eligible for such assistance under such title, as appropriate, on the date of such birth and to remain eligible for such assistance until the child attains 1 year of age. During the period in which a child is deemed under the preceding sentence to be eligible for child health or medical assistance, the child health or medical assistance eligibility identification number of the mother shall also serve as the identification number of the child, and all claims shall be submitted and paid under such number (unless the State issues a separate identification number for the child before such period expires).CommentsClose CommentsPermalink





`(f) States Providing Assistance Through Other Options-CommentsClose CommentsPermalink





`(1) CONTINUATION OF OTHER OPTIONS FOR PROVIDING ASSISTANCE- The option to provide assistance in accordance with the preceding subsections of this section shall not limit any other option for a State to provide--CommentsClose CommentsPermalink





`(A) child health assistance through the application of sections 457.10, 457.350(b)(2), 457.622(c)(5), and 457.626(a)(3) of title 42, Code of Federal Regulations (as in effect after the final rule adopted by the Secretary and set forth at 67 Fed. Reg. 61956-61974 (October 2, 2002)), orCommentsClose CommentsPermalink





`(B) pregnancy-related services through the application of any waiver authority (as in effect on June 1, 2007).CommentsClose CommentsPermalink





`(2) CLARIFICATION OF AUTHORITY TO PROVIDE POSTPARTUM SERVICES- Any State that provides child health assistance under any authority described in paragraph (1) may continue to provide such assistance, as well as postpartum services, through the end of the month in which the 60-day period (beginning on the last day of the pregnancy) ends, in the same manner as such assistance and postpartum services would be provided if provided under the State plan under title XIX, but only if the mother would otherwise satisfy the eligibility requirements that apply under the State child health plan (other than with respect to age) during such period.CommentsClose CommentsPermalink





`(3) NO INFERENCE- Nothing in this subsection shall be construed--CommentsClose CommentsPermalink





`(A) to infer congressional intent regarding the legality or illegality of the content of the sections specified in paragraph (1)(A); orCommentsClose CommentsPermalink





`(B) to modify the authority to provide pregnancy-related services under a waiver specified in paragraph (1)(B).'.CommentsClose CommentsPermalink





(b) Additional Conforming Amendments-CommentsClose CommentsPermalink





(1) NO COST SHARING FOR PREGNANCY-RELATED BENEFITS- Section 2103(e)(2) (42 U.S.C. 1397cc(e)(2)) is amended--CommentsClose CommentsPermalink





(A) in the heading, by inserting `or pregnancy-related assistance' after `preventive services'; andCommentsClose CommentsPermalink





(B) by inserting before the period at the end the following: `or for pregnancy-related assistance'.CommentsClose CommentsPermalink





(2) NO WAITING PERIOD- Section 2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)) is amended--CommentsClose CommentsPermalink





(A) in clause (i), by striking `, and' at the end and inserting a semicolon;CommentsClose CommentsPermalink





(B) in clause (ii), by striking the period at the end and inserting `; and'; andCommentsClose CommentsPermalink





(C) by adding at the end the following new clause:CommentsClose CommentsPermalink





`(iii) may not apply a waiting period (including a waiting period to carry out paragraph (3)(C)) in the case of a targeted low-income pregnant woman provided pregnancy-related assistance under section 2112.'.CommentsClose CommentsPermalink

SEC. 112. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS ADULTS UNDER CHIP; CONDITIONS FOR COVERAGE OF PARENTS.

(a) Phase-Out Rules-CommentsClose CommentsPermalink





(1) IN GENERAL- Title XXI (42 U.S.C. 1397aa et seq.) is amended by adding at the end the following new section:CommentsClose CommentsPermalink

`SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS ADULTS; CONDITIONS FOR COVERAGE OF PARENTS.CommentsClose CommentsPermalink

`(a) Termination of Coverage for Nonpregnant Childless Adults-CommentsClose CommentsPermalink





`(1) NO NEW CHIP WAIVERS; AUTOMATIC EXTENSIONS AT STATE OPTION THROUGH FISCAL YEAR 2008- Notwithstanding section 1115 or any other provision of this title, except as provided in this subsection--CommentsClose CommentsPermalink





`(A) the Secretary shall not on or after the date of the enactment of the Children's Health Insurance Program Reauthorization Act of 2007, approve or renew a waiver, experimental, pilot, or demonstration project that would allow funds made available under this title to be used to provide child health assistance or other health benefits coverage to a nonpregnant childless adult; andCommentsClose CommentsPermalink





`(B) notwithstanding the terms and conditions of an applicable existing waiver, the provisions of paragraphs (2) and (3) shall apply for purposes of any fiscal year beginning on or after October 1, 2008, in determining the period to which the waiver applies, the individuals eligible to be covered by the waiver, and the amount of the Federal payment under this title.CommentsClose CommentsPermalink





`(2) TERMINATION OF CHIP COVERAGE UNDER APPLICABLE EXISTING WAIVERS AT THE END OF FISCAL YEAR 2008-CommentsClose CommentsPermalink





`(A) IN GENERAL- No funds shall be available under this title for child health assistance or other health benefits coverage that is provided to a nonpregnant childless adult under an applicable existing waiver after September 30, 2008.CommentsClose CommentsPermalink





`(B) EXTENSION UPON STATE REQUEST- If an applicable existing waiver described in subparagraph (A) would otherwise expire before October 1, 2008, and the State requests an extension of such waiver, the Secretary shall grant such an extension, but only through September 30, 2008.CommentsClose CommentsPermalink





`(C) APPLICATION OF ENHANCED FMAP- The enhanced FMAP determined under section 2105(b) shall apply to expenditures under an applicable existing waiver for the provision of child health assistance or other health benefits coverage to a nonpregnant childless adult during fiscal year 2008.CommentsClose CommentsPermalink





`(3) OPTIONAL 1-YEAR TRANSITIONAL COVERAGE BLOCK GRANT FUNDED FROM STATE ALLOTMENT- Subject to paragraph (4)(B), each State for which coverage under an applicable existing waiver is terminated under paragraph (2)(A) may elect to provide nonpregnant childless adults who were provided child health assistance or health benefits coverage under the applicable existing waiver at any time during fiscal year 2008 with such assistance or coverage during fiscal year 2009, as if the authority to provide such assistance or coverage under an applicable existing waiver was extended through that fiscal year, but subject to the following terms and conditions:CommentsClose CommentsPermalink





`(A) BLOCK GRANT SET ASIDE FROM STATE ALLOTMENT- The Secretary shall set aside for the State an amount equal to the Federal share of the State's projected expenditures under the applicable existing waiver for providing child health assistance or health benefits coverage to all nonpregnant childless adults under such waiver for fiscal year 2008 (as certified by the State and submitted to the Secretary by not later than August 31, 2008, and without regard to whether any such individual lost coverage during fiscal year 2008 and was later provided child health assistance or other health benefits coverage under the waiver in that fiscal year), increased by the annual adjustment for fiscal year 2009 determined under section 2104(i)(5)(A). The Secretary may adjust the amount set aside under the preceding sentence, as necessary, on the basis of the expenditure data for fiscal year 2008 reported by States on CMS Form 64 or CMS Form 21 not later than November 30, 2008, but in no case shall the Secretary adjust such amount after December 31, 2008.CommentsClose CommentsPermalink





`(B) NO COVERAGE FOR NONPREGNANT CHILDLESS ADULTS WHO WERE NOT COVERED DURING FISCAL YEAR 2008-CommentsClose CommentsPermalink





`(i) FMAP APPLIED TO EXPENDITURES- The Secretary shall pay the State for each quarter of fiscal year 2009, from the amount set aside under subparagraph (A), an amount equal to the Federal medical assistance percentage (as determined under section 1905(b) without regard to clause (4) of such section) of expenditures in the quarter for providing child health assistance or other health benefits coverage to a nonpregnant childless adult but only if such adult was enrolled in the State program under this title during fiscal year 2008 (without regard to whether the individual lost coverage during fiscal year 2008 and was reenrolled in that fiscal year or in fiscal year 2009).CommentsClose CommentsPermalink





`(ii) FEDERAL PAYMENTS LIMITED TO AMOUNT OF BLOCK GRANT SET-ASIDE- No payments shall be made to a State for expenditures described in this subparagraph after the total amount set aside under subparagraph (A) for fiscal year 2009 has been paid to the State.CommentsClose CommentsPermalink





`(4) STATE OPTION TO APPLY FOR MEDICAID WAIVER TO CONTINUE COVERAGE FOR NONPREGNANT CHILDLESS ADULTS-CommentsClose CommentsPermalink





`(A) IN GENERAL- Each State for which coverage under an applicable existing waiver is terminated under paragraph (2)(A) may submit, not later than June 30, 2009, an application to the Secretary for a waiver under section 1115 of the State plan under title XIX to provide medical assistance to a nonpregnant childless adult whose coverage is so terminated (in this subsection referred to as a `Medicaid nonpregnant childless adults waiver').CommentsClose CommentsPermalink





`(B) DEADLINE FOR APPROVAL- The Secretary shall make a decision to approve or deny an application for a Medicaid nonpregnant childless adults waiver submitted under subparagraph (A) within 90 days of the date of the submission of the application. If no decision has been made by the Secretary as of September 30, 2009, on the application of a State for a Medicaid nonpregnant childless adults waiver that was submitted to the Secretary by June 30, 2009, the application shall be deemed approved.CommentsClose CommentsPermalink





`(C) STANDARD FOR BUDGET NEUTRALITY- The budget neutrality requirement applicable with respect to expenditures for medical assistance under a Medicaid nonpregnant childless adults waiver shall--CommentsClose CommentsPermalink





`(i) in the case of fiscal year 2010, allow expenditures for medical assistance under title XIX for all such adults to not exceed the total amount of payments made to the State under paragraph (3)(B) for fiscal year 2009, increased by the percentage increase (if any) in the projected nominal per capita amount of National Health Expenditures for calendar year 2010 over calendar year 2009, as most recently published by the Secretary; andCommentsClose CommentsPermalink





`(ii) in the case of any succeeding fiscal year, allow such expenditures to not exceed the amount in effect under this subparagraph for the preceding fiscal year, increased by the percentage increase (if any) in the projected nominal per capita amount of National Health Expenditures for the calendar year that begins during the fiscal year involved over the preceding calendar year, as most recently published by the Secretary.CommentsClose CommentsPermalink





`(b) Rules and Conditions for Coverage of Parents of Targeted Low-Income Children-CommentsClose CommentsPermalink





`(1) TWO-YEAR TRANSITION PERIOD; AUTOMATIC EXTENSION AT STATE OPTION THROUGH FISCAL YEAR 2009-CommentsClose CommentsPermalink





`(A) NO NEW CHIP WAIVERS- Notwithstanding section 1115 or any other provision of this title, except as provided in this subsection--CommentsClose CommentsPermalink





`(i) the Secretary shall not on or after the date of the enactment of the Children's Health Insurance Program Reauthorization Act of 2007 approve or renew a waiver, experimental, pilot, or demonstration project that would allow funds made available under this title to be used to provide child health assistance or other health benefits coverage to a parent of a targeted low-income child; andCommentsClose CommentsPermalink





`(ii) notwithstanding the terms and conditions of an applicable existing waiver, the provisions of paragraphs (2) and (3) shall apply for purposes of any fiscal year beginning on or after October 1, 2009, in determining the period to which the waiver applies, the individuals eligible to be covered by the waiver, and the amount of the Federal payment under this title.CommentsClose CommentsPermalink





`(B) EXTENSION UPON STATE REQUEST- If an applicable existing waiver described in subparagraph (A) would otherwise expire before October 1, 2009, and the State requests an extension of such waiver, the Secretary shall grant such an extension, but only, subject to paragraph (2)(A), through September 30, 2009.CommentsClose CommentsPermalink





`(C) APPLICATION OF ENHANCED FMAP- The enhanced FMAP determined under section 2105(b) shall apply to expenditures under an applicable existing waiver for the provision of child health assistance or other health benefits coverage to a parent of a targeted low-income child during fiscal years 2008 and 2009.CommentsClose CommentsPermalink





`(2) RULES FOR FISCAL YEARS 2010 THROUGH 2012-CommentsClose CommentsPermalink





`(A) PAYMENTS FOR COVERAGE LIMITED TO BLOCK GRANT FUNDED FROM STATE ALLOTMENT- Any State that provides child health assistance or health benefits coverage under an applicable existing waiver for a parent of a targeted low-income child may elect to continue to provide such assistance or coverage through fiscal year 2010, 2011, or 2012, subject to the same terms and conditions that applied under the applicable existing waiver, unless otherwise modified in subparagraph (B).CommentsClose CommentsPermalink





`(B) TERMS AND CONDITIONS-CommentsClose CommentsPermalink





`(i) BLOCK GRANT SET ASIDE FROM STATE ALLOTMENT- If the State makes an election under subparagraph (A), the Secretary shall set aside for the State for each such fiscal year an amount equal to the Federal share of 110 percent of the State's projected expenditures under the applicable existing waiver for providing child health assistance or health benefits coverage to all parents of targeted low-income children enrolled under such waiver for the fiscal year (as certified by the State and submitted to the Secretary by not later than August 31 of the preceding fiscal year). In the case of fiscal year 2012, the set aside for any State shall be computed separately for each period described in subparagraphs (A) and (B) of section 2104(a)(15) and any reduction in the allotment for either such period under section 2104(i)(4) shall be allocated on a pro rata basis to such set aside.CommentsClose CommentsPermalink





`(ii) PAYMENTS FROM BLOCK GRANT- The Secretary shall pay the State from the amount set aside under clause (i) for the fiscal year, an amount for each quarter of such fiscal year equal to the applicable percentage determined under clause (iii) or (iv) for expenditures in the quarter for providing child health assistance or other health benefits coverage to a parent of a targeted low-income child.CommentsClose CommentsPermalink





`(iii) ENHANCED FMAP ONLY IN FISCAL YEAR 2010 FOR STATES WITH SIGNIFICANT CHILD OUTREACH OR THAT ACHIEVE CHILD COVERAGE BENCHMARKS; FMAP FOR ANY OTHER STATES- For purposes of clause (ii), the applicable percentage for any quarter of fiscal year 2010 is equal to--CommentsClose CommentsPermalink





`(I) the enhanced FMAP determined under section 2105(b) in the case of a State that meets the outreach or coverage benchmarks described in any of subparagraph (A), (B), or (C) of paragraph (3) for fiscal year 2009; orCommentsClose CommentsPermalink





`(II) the Federal medical assistance percentage (as determined under section 1905(b) without regard to clause (4) of such section) in the case of any other State.CommentsClose CommentsPermalink





`(iv) AMOUNT OF FEDERAL MATCHING PAYMENT IN 2011 OR 2012- For purposes of clause (ii), the applicable percentage for any quarter of fiscal year 2011 or 2012 is equal to--CommentsClose CommentsPermalink





`(I) the REMAP percentage if--CommentsClose CommentsPermalink

`(aa) the applicable percentage for the State under clause (iii) was the enhanced FMAP for fiscal year 2009; andCommentsClose CommentsPermalink

`(bb) the State met either of the coverage benchmarks described in subparagraph (B) or (C) of paragraph (3) for the preceding fiscal year; orCommentsClose CommentsPermalink

`(II) the Federal medical assistance percentage (as so determined) in the case of any State to which subclause (I) does not apply.CommentsClose CommentsPermalink





For purposes of subclause (I), the REMAP percentage is the percentage which is the sum of such Federal medical assistance percentage and a number of percentage points equal to one-half of the difference between such Federal medical assistance percentage and such enhanced FMAP.CommentsClose CommentsPermalink





`(v) NO FEDERAL PAYMENTS OTHER THAN FROM BLOCK GRANT SET ASIDE- No payments shall be made to a State for expenditures described in clause (ii) after the total amount set aside under clause (i) for a fiscal year has been paid to the State.CommentsClose CommentsPermalink





`(vi) NO INCREASE IN INCOME ELIGIBILITY LEVEL FOR PARENTS- No payments shall be made to a State from the amount set aside under clause (i) for a fiscal year for expenditures for providing child health assistance or health benefits coverage to a parent of a targeted low-income child whose family income exceeds the income eligibility level applied under the applicable existing waiver to parents of targeted low-income children on the date of enactment of the Children's Health Insurance Program Reauthorization Act of 2007.CommentsClose CommentsPermalink





`(3) OUTREACH OR COVERAGE BENCHMARKS- For purposes of paragraph (2), the outreach or coverage benchmarks described in this paragraph are as follows:CommentsClose CommentsPermalink





`(A) SIGNIFICANT CHILD OUTREACH CAMPAIGN- The State--CommentsClose CommentsPermalink





`(i) was awarded a grant under section 2113 for fiscal year 2009;CommentsClose CommentsPermalink





`(ii) implemented 1 or more of the enrollment and retention provisions described in section 2105(a)(4) for such fiscal year; orCommentsClose CommentsPermalink





`(iii) has submitted a specific plan for outreach for such fiscal year.CommentsClose CommentsPermalink





`(B) HIGH-PERFORMING STATE- The State, on the basis of the most timely and accurate published estimates of the Bureau of the Census, ranks in the lowest 1/3 of States in terms of the State's percentage of low-income children without health insurance.CommentsClose CommentsPermalink





`(C) STATE INCREASING ENROLLMENT OF LOW-INCOME CHILDREN- The State qualified for a performance bonus payment under section 2105(a)(3)(B) for the most recent fiscal year applicable under such section.CommentsClose CommentsPermalink





`(4) RULES OF CONSTRUCTION- Nothing in this subsection shall be construed as prohibiting a State from submitting an application to the Secretary for a waiver under section 1115 of the State plan under title XIX to provide medical assistance to a parent of a targeted low-income child that was provided child health assistance or health benefits coverage under an applicable existing waiver.CommentsClose CommentsPermalink





`(c) Applicable Existing Waiver- For purposes of this section--CommentsClose CommentsPermalink





`(1) IN GENERAL- The term `applicable existing waiver' means a waiver, experimental, pilot, or demonstration project under section 1115, grandfathered under section 6102(c)(3) of the Deficit Reduction Act of 2005, or otherwise conducted under authority that--CommentsClose CommentsPermalink





`(A) would allow funds made available under this title to be used to provide child health assistance or other health benefits coverage to--CommentsClose CommentsPermalink





`(i) a parent of a targeted low-income child;CommentsClose CommentsPermalink





`(ii) a nonpregnant childless adult; orCommentsClose CommentsPermalink





`(iii) individuals described in both clauses (i) and (ii); andCommentsClose CommentsPermalink





`(B) was in effect during fiscal year 2007.CommentsClose CommentsPermalink





`(2) DEFINITIONS-CommentsClose CommentsPermalink





`(A) PARENT- The term `parent' includes a caretaker relative (as such term is used in carrying out section 1931) and a legal guardian.CommentsClose CommentsPermalink





`(B) NONPREGNANT CHILDLESS ADULT- The term `nonpregnant childless adult' has the meaning given such term by section 2107(f).'.CommentsClose CommentsPermalink





(2) CONFORMING AMENDMENTS-CommentsClose CommentsPermalink





(A) Section 2107(f) (42 U.S.C. 1397gg(f)) is amended--CommentsClose CommentsPermalink





(i) by striking `, the Secretary' and inserting `:CommentsClose CommentsPermalink





`(1) The Secretary';CommentsClose CommentsPermalink





(ii) in the first sentence, by inserting `or a parent (as defined in section 2111(c)(2)(A)), who is not pregnant, of a targeted low-income child' before the period;CommentsClose CommentsPermalink





(iii) by striking the second sentence; andCommentsClose CommentsPermalink





(iv) by adding at the end the following new paragraph:CommentsClose CommentsPermalink





`(2) The Secretary may not approve, extend, renew, or amend a waiver, experimental, pilot, or demonstration project with respect to a State after the date of enactment of the Children's Health Insurance Program Reauthorization Act of 2007 that would waive or modify the requirements of section 2111.'.CommentsClose CommentsPermalink





(B) Section 6102(c) of the Deficit Reduction Act of 2005 (Public Law 109-171; 120 Stat. 131) is amended by striking `Nothing' and inserting `Subject to section 2111 of the Social Security Act, as added by section 112 of the Children's Health Insurance Program Reauthorization Act of 2007, nothing'.CommentsClose CommentsPermalink





(b) GAO Study and Report-CommentsClose CommentsPermalink





(1) IN GENERAL- The Comptroller General of the United States shall conduct a study of whether--CommentsClose CommentsPermalink





(A) the coverage of a parent, a caretaker relative (as such term is used in carrying out section 1931), or a legal guardian of a targeted low-income child under a State health plan under title XXI of the Social Security Act increases the enrollment of, or the quality of care for, children, andCommentsClose CommentsPermalink





(B) such parents, relatives, and legal guardians who enroll in such a plan are more likely to enroll their children in such a plan or in a State plan under title XIX of such Act.CommentsClose CommentsPermalink





(2) REPORT- Not later than 2 years after the date of the enactment of this Act, the Comptroller General shall report the results of the study to the Committee on Finance of the Senate and the Committee on Energy and Commerce of the House of Representatives, including recommendations (if any) for changes in legislation.CommentsClose CommentsPermalink

SEC. 113. ELIMINATION OF COUNTING MEDICAID CHILD PRESUMPTIVE ELIGIBILITY COSTS AGAINST TITLE XXI ALLOTMENT.

(a) In General- Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)) is amended--CommentsClose CommentsPermalink





(1) in the matter preceding subparagraph (A), by striking `(or, in the case of expenditures described in subparagraph (B), the Federal medical assistance percentage (as defined in the first sentence of section 1905(b)))'; andCommentsClose CommentsPermalink





(2) by striking subparagraph (B) and inserting the following new subparagraph:CommentsClose CommentsPermalink





`(B) [reserved]'.CommentsClose CommentsPermalink





(b) Amendments to Medicaid-CommentsClose CommentsPermalink





(1) ELIGIBILITY OF A NEWBORN- Section 1902(e)(4) (42 U.S.C. 1396a(e)(4)) is amended in the first sentence by striking `so long as the child is a member of the woman's household and the woman remains (or would remain if pregnant) eligible for such assistance'.CommentsClose CommentsPermalink





(2) APPLICATION OF QUALIFIED ENTITIES TO PRESUMPTIVE ELIGIBILITY FOR PREGNANT WOMEN UNDER MEDICAID- Section 1920(b) (42 U.S.C. 1396r-1(b)) is amended by adding after paragraph (2) the following flush sentence:CommentsClose CommentsPermalink





`The term `qualified provider' also includes a qualified entity, as defined in section 1920A(b)(3).'.CommentsClose CommentsPermalink

SEC. 114. LIMITATION ON MATCHING RATE FOR STATES THAT PROPOSE TO COVER CHILDREN WITH EFFECTIVE FAMILY INCOME THAT EXCEEDS 300 PERCENT OF THE POVERTY LINE.

(a) FMAP Applied to Expenditures- Section 2105(c) (42 U.S.C. 1397ee(c)) is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





`(8) LIMITATION ON MATCHING RATE FOR EXPENDITURES FOR CHILD HEALTH ASSISTANCE PROVIDED TO CHILDREN WHOSE EFFECTIVE FAMILY INCOME EXCEEDS 300 PERCENT OF THE POVERTY LINE-CommentsClose CommentsPermalink





`(A) FMAP APPLIED TO EXPENDITURES- Except as provided in subparagraph (B), for fiscal years beginning with fiscal year 2008, the Federal medical assistance percentage (as determined under section 1905(b) without regard to clause (4) of such section) shall be substituted for the enhanced FMAP under subsection (a)(1) with respect to any expenditures for providing child health assistance or health benefits coverage for a targeted low-income child whose effective family income would exceed 300 percent of the poverty line but for the application of a general exclusion of a block of income that is not determined by type of expense or type of income.CommentsClose CommentsPermalink





`(B) EXCEPTION- Subparagraph (A) shall not apply to any State that, on the date of enactment of the Children's Health Insurance Program Reauthorization Act of 2007, has an approved State plan amendment or waiver to provide, or has enacted a State law to submit a State plan amendment to provide, expenditures described in such subparagraph under the State child health plan.'.CommentsClose CommentsPermalink





(b) Rule of Construction- Nothing in the amendments made by this section shall be construed as--CommentsClose CommentsPermalink





(1) changing any income eligibility level for children under title XXI of the Social Security Act; orCommentsClose CommentsPermalink





(2) changing the flexibility provided States under such title to establish the income eligibility level for targeted low-income children under a State child health plan and the methodologies used by the State to determine income or assets under such plan.CommentsClose CommentsPermalink

SEC. 115. STATE AUTHORITY UNDER MEDICAID.

(a) State Authority to Expand Income or Resource Eligibility Levels for Children- Nothing in this Act, the amendments made by this Act, or title XIX of the Social Security Act, including paragraph (2)(B) of section 1905(u) of such Act, shall be construed as limiting the flexibility afforded States under such title to increase the income or resource eligibility levels for children under a State plan or waiver under such title.CommentsClose CommentsPermalink





(b) State Authority to Receive Payments Under Medicaid for Providing Medical Assistance to Children Eligible as a Result of an Income or Resource Eligibility Level Expansion- A State may, notwithstanding the fourth sentence of subsection (b) of section 1905 of the Social Security Act (42 U.S.C. 1396d) or subsection (u) of such section--CommentsClose CommentsPermalink





(1) cover individuals described in section 1902(a)(10)(A)(ii)(IX) of the Social Security Act and thereby receive Federal financial participation for medical assistance for such individuals under title XIX of the Social Security Act; orCommentsClose CommentsPermalink





(2) receive Federal financial participation for expenditures for medical assistance under Medicaid for children described in paragraph (2)(B) or (3) of section 1905(u) of such Act based on the Federal medical assistance percentage, as otherwise determined based on the first and third sentences of subsection (b) of section 1905 of the Social Security Act, rather than on the basis of an enhanced FMAP (as defined in section 2105(b) of such Act).CommentsClose CommentsPermalink

SEC. 116. PREVENTING SUBSTITUTION OF CHIP COVERAGE FOR PRIVATE COVERAGE.

(a) Findings-CommentsClose CommentsPermalink





(1) Congress agrees with the President that low-income children should be the first priority of all States in providing child health assistance under CHIP.CommentsClose CommentsPermalink





(2) Congress agrees with the President and the Congressional Budget Office that the substitution of CHIP coverage for private coverage occurs more frequently for children in families at higher income levels.CommentsClose CommentsPermalink





(3) Congress agrees with the President that it is appropriate that States that expand CHIP eligibility to children at higher income levels should have achieved a high level of health benefits coverage for low-income children and should implement strategies to address such substitution.CommentsClose CommentsPermalink





(4) Congress concludes that the policies specified in this section (and the amendments made by this section) are the appropriate policies to address these issues.CommentsClose CommentsPermalink





(b) Analyses of Best Practices and Methodology in Addressing Crowd-Out-CommentsClose CommentsPermalink





(1) GAO REPORT- Not later than 18 months after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Finance of the Senate and the Committee on Energy and Commerce of the House of Representatives and the Secretary a report describing the best practices by States in addressing the issue of CHIP crowd-out. Such report shall include analyses of--CommentsClose CommentsPermalink





(A) the impact of different geographic areas, including urban and rural areas, on CHIP crowd-out;CommentsClose CommentsPermalink





(B) the impact of different State labor markets on CHIP crowd-out;CommentsClose CommentsPermalink





(C) the impact of different strategies for addressing CHIP crowd-out;CommentsClose CommentsPermalink





(D) the incidence of crowd-out for children with different levels of family income; andCommentsClose CommentsPermalink





(E) the relationship (if any) between changes in the availability and affordability of dependent coverage under employer-sponsored health insurance and CHIP crowd-out.CommentsClose CommentsPermalink





(2) IOM REPORT ON METHODOLOGY- The Secretary shall enter into an arrangement with the Institute of Medicine under which the Institute submits to the Committee on Finance of the Senate and the Committee on Energy and Commerce of the House of Representatives and the Secretary, not later than 18 months after the date of the enactment of this Act, a report on--CommentsClose CommentsPermalink





(A) the most accurate, reliable, and timely way to measure--CommentsClose CommentsPermalink





(i) on a State-by-State basis, the rate of public and private health benefits coverage among low-income children with family income that does not exceed 200 percent of the poverty line; andCommentsClose CommentsPermalink





(ii) CHIP crowd-out, including in the case of children with family income that exceeds 200 percent of the poverty line; andCommentsClose CommentsPermalink





(B) the least burdensome way to gather the necessary data to conduct the measurements described in subparagraph (A).CommentsClose CommentsPermalink





Out of any money in the Treasury not otherwise appropriated, there are hereby appropriated $2,000,000 to carry out this paragraph for the period ending September 30, 2009.CommentsClose CommentsPermalink





(3) INCORPORATION OF DEFINITIONS- In this section, the terms `CHIP crowd-out', `children', `poverty line', and `State' have the meanings given such terms for purposes of CHIP.CommentsClose CommentsPermalink





(4) DEFINITION OF CHIP CROWD-OUT- Section 2110(c) (42 U.S.C. 1397jj(c)) is amended by adding at the end the following:CommentsClose CommentsPermalink





`(9) CHIP CROWD-OUT- The term `CHIP crowd-out' means the substitution of--CommentsClose CommentsPermalink





`(A) health benefits coverage for a child under this title, forCommentsClose CommentsPermalink





`(B) health benefits coverage for the child other than under this title or title XIX.'.CommentsClose CommentsPermalink





(c) Development of Best Practice Recommendations- Section 2107 (42 U.S.C. 1397gg) is amended by adding at the end the following:CommentsClose CommentsPermalink





`(g) Development of Best Practice Recommendations- Within 6 months after the date of receipt of the reports under subsections (a) and (b) of section 116 of the Children's Health Insurance Program Reauthorization Act of 2007, the Secretary, in consultation with States, including Medicaid and CHIP directors in States, shall publish in the Federal Register, and post on the public website for the Department of Health and Human Services--CommentsClose CommentsPermalink





`(1) recommendations regarding best practices for States to use to address CHIP crowd-out; andCommentsClose CommentsPermalink





`(2) uniform standards for data collection by States to measure and report--CommentsClose CommentsPermalink





`(A) health benefits coverage for children with family income below 200 percent of the poverty line; andCommentsClose CommentsPermalink





`(B) on CHIP crowd-out, including for children with family income that exceeds 200 percent of the poverty line.CommentsClose CommentsPermalink





The Secretary, in consultation with States, including Medicaid and CHIP directors in States, may from time to time update the best practice recommendations and uniform standards set published under paragraphs (1) and (2) and shall provide for publication and posting of such updated recommendations and standards.'.CommentsClose CommentsPermalink





(d) Requirement to Address CHIP Crowd-Out; Secretarial Review- Section 2106 (42 U.S.C. 1397ff) is amended by adding at the end the following:CommentsClose CommentsPermalink





`(f) Requirement to Address CHIP Crowd-Out; Secretarial Review-CommentsClose CommentsPermalink





`(1) IN GENERAL- Each State that, on or after the best practice application date described in paragraph (3), submits a plan amendment (or waiver request) to provide for eligibility for child health assistance under the State child health plan for higher income children described in section 2105(c)(9)(D) (relating to children whose effective family income exceeds 300 percent of the poverty line) shall include with such plan amendment or request a description of how the State--CommentsClose CommentsPermalink





`(A) will address CHIP crowd-out for such children; andCommentsClose CommentsPermalink





`(B) will incorporate recommended best practices referred to in such paragraph.CommentsClose CommentsPermalink





`(2) APPLICATION TO CERTAIN STATES- Each State that, as of the best practice application date described in paragraph (3), has a State child health plan that provides (whether under the plan or through a waiver) for eligibility for child health assistance for children referred to in paragraph (1) shall submit to the Secretary, not later than 6 months after the date of such application, a State plan amendment describing how the State--CommentsClose CommentsPermalink





`(A) will address CHIP crowd-out for such children; andCommentsClose CommentsPermalink





`(B) will incorporate recommended best practices referred to in such paragraph.CommentsClose CommentsPermalink





`(3) BEST PRACTICE APPLICATION DATE- The best practice application date described in this paragraph is the date that is 6 months after the date of publication of recommendations regarding best practices under section 2107(g)(1).CommentsClose CommentsPermalink





`(4) SECRETARIAL REVIEW- The Secretary shall--CommentsClose CommentsPermalink





`(A) review each State plan amendment or waiver request submitted under paragraph (1) or (2);CommentsClose CommentsPermalink





`(B) determine whether the amendment or request incorporates recommended best practices referred to in paragraph (3);CommentsClose CommentsPermalink





`(C) determine whether the State meets the enrollment targets required under reference section 2105(c)(9)(C); andCommentsClose CommentsPermalink





`(D) notify the State of such determinations.'.CommentsClose CommentsPermalink





(e) Limitation on Payments for States Covering Higher Income Children- Section 2105(c) (42 U.S.C. 1397ee(c)), as amended by section 114(a), is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





`(9) LIMITATION ON PAYMENTS FOR STATES COVERING HIGHER INCOME CHILDREN-CommentsClose CommentsPermalink





`(A) DETERMINATIONS-CommentsClose CommentsPermalink





`(i) IN GENERAL- The Secretary shall determine, for each State that is a higher income eligibility State as of April 1 of 2010 and each subsequent year, whether the State meets the target rate of coverage of low-income children required under subparagraph (C) and shall notify the State in that month of such determination.CommentsClose CommentsPermalink





`(ii) DETERMINATION OF FAILURE- If the Secretary determines in such month that a higher income eligibility State does not meet such target rate of coverage, subject to subparagraph (E), no payment shall be made as of October 1 of such year on or after October 1, 2010, under this section for child health assistance provided for higher-income children (as defined in subparagraph (D)) under the State child health plan unless and until the State establishes it is in compliance with such requirement.CommentsClose CommentsPermalink





`(B) HIGHER INCOME ELIGIBILITY STATE- A higher income eligibility State described in this clause is a State that--CommentsClose CommentsPermalink





`(i) applies under its State child health plan an eligibility income standard for targeted low-income children that exceeds 300 percent of the poverty line; orCommentsClose CommentsPermalink





`(ii) because of the application of a general exclusion of a block of income that is not determined by type of expense or type of income, applies an effective income standard under the State child health plan for such children that exceeds 300 percent of the poverty line.CommentsClose CommentsPermalink





`(C) REQUIREMENT FOR TARGET RATE OF COVERAGE OF LOW-INCOME CHILDREN-CommentsClose CommentsPermalink





`(i) IN GENERAL- The requirement of this subparagraph for a State is that the rate of health benefits coverage (both private and public) for low-income children in the State is not statistically significantly (at a p=0.05 level) less than the target rate of coverage specified in clause (ii).CommentsClose CommentsPermalink





`(ii) TARGET RATE- The target rate of coverage specified in this clause is the average rate (determined by the Secretary) of health benefits coverage (both private and public) as of January 1, 2010, among the 10 of the 50 States and the District of Columbia with the highest percentage of health benefits coverage (both private and public) for low-income children.CommentsClose CommentsPermalink





`(iii) STANDARDS FOR DATA- In applying this subparagraph, rates of health benefits coverage for States shall be determined using the uniform standards identified by the Secretary under section 2107(g)(2).CommentsClose CommentsPermalink





`(D) HIGHER-INCOME CHILD- For purposes of this paragraph, the term `higher income child' means, with respect to a State child health plan, a targeted low-income child whose family income--CommentsClose CommentsPermalink





`(i) exceeds 300 percent of the poverty line; orCommentsClose CommentsPermalink





`(ii) would exceed 300 percent of the poverty line if there were not taken into account any general exclusion described in subparagraph (B)(ii).CommentsClose CommentsPermalink





`(E) NOTICE AND OPPORTUNITY TO COMPLY WITH TARGET RATE- If the Secretary makes a determination described in subparagraph (A)(ii) in April of a year, the Secretary--CommentsClose CommentsPermalink





`(i) shall provide the State with the opportunity to submit and implement a corrective action plan for the State to come into compliance with the requirement of subparagraph (C) before October 1 of such year;CommentsClose CommentsPermalink





`(ii) shall not effect a denial of payment under subparagraph (A) on the basis of such determination before October 1 of such year; andCommentsClose CommentsPermalink





`(iii) shall not effect such a denial if the Secretary determines that there is a reasonable likelihood that the implementation of such a correction action plan will bring the State into compliance with the requirement of subparagraph (C).'.CommentsClose CommentsPermalink





(f) Treatment of Medical Support Orders- Section 2102(b) (42 U.S.C. 1397bb(c)) is amended by adding at the end the following:CommentsClose CommentsPermalink





`(5) TREATMENT OF MEDICAL SUPPORT ORDERS-CommentsClose CommentsPermalink





`(A) IN GENERAL- Nothing in this title shall be construed to allow the Secretary to require that a State deny eligibility for child health assistance to a child who is otherwise eligible on the basis of the existence of a valid medical support order being in effect.CommentsClose CommentsPermalink





`(B) STATE ELECTION- A State may elect to limit eligibility for child health assistance to a targeted low-income child on the basis of the existence of a valid medical support order on the child's behalf, but only if the State does not deny such eligibility for a child on such basis if the child asserts that the order is not being complied with for any of the reasons described in subparagraph (C) unless the State demonstrates that none of such reasons applies in the case involved.CommentsClose CommentsPermalink





`(C) REASONS FOR NONCOMPLIANCE- The reasons described in this subparagraph for noncompliance with a medical support order with respect to a child are that the child is not being provided health benefits coverage pursuant to such order because--CommentsClose CommentsPermalink





`(i) of failure of the noncustodial parent to comply with the order;CommentsClose CommentsPermalink





`(ii) of the failure of an employer, group health plan or health insurance issuer to comply with such order; orCommentsClose CommentsPermalink





`(iii) the child resides in a geographic area in which benefits under the health benefits coverage are generally unavailable.'.CommentsClose CommentsPermalink





(g) Effective Date of Amendments; Consistency of Policies- The amendments made by this section shall take effect as if enacted on August 16, 2007. The Secretary may not impose (or continue in effect) any requirement, prevent the implementation of any provision, or condition the approval of any provision under any State child health plan, State plan amendment, or waiver request on the basis of any policy or interpretation relating to CHIP crowd-out or medical support order other than under the amendments made by this section.CommentsClose CommentsPermalink

TITLE II--OUTREACH AND ENROLLMENT

Subtitle A--Outreach and Enrollment Activities

SEC. 201. GRANTS AND ENHANCED ADMINISTRATIVE FUNDING FOR OUTREACH AND ENROLLMENT.

(a) Grants- Title XXI (42 U.S.C. 1397aa et seq.), as amended by section 107, is amended by adding at the end the following:CommentsClose CommentsPermalink

`SEC. 2113. GRANTS TO IMPROVE OUTREACH AND ENROLLMENT.CommentsClose CommentsPermalink

`(a) Outreach and Enrollment Grants; National Campaign-CommentsClose CommentsPermalink





`(1) IN GENERAL- From the amounts appropriated under subsection (g), subject to paragraph (2), the Secretary shall award grants to eligible entities during the period of fiscal years 2008 through 2012 to conduct outreach and enrollment efforts that are designed to increase the enrollment and participation of eligible children under this title and title XIX.CommentsClose CommentsPermalink





`(2) TEN PERCENT SET ASIDE FOR NATIONAL ENROLLMENT CAMPAIGN- An amount equal to 10 percent of such amounts shall be used by the Secretary for expenditures during such period to carry out a national enrollment campaign in accordance with subsection (h).CommentsClose CommentsPermalink





`(b) Priority for Award of Grants-CommentsClose CommentsPermalink





`(1) IN GENERAL- In awarding grants under subsection (a), the Secretary shall give priority to eligible entities that--CommentsClose CommentsPermalink





`(A) propose to target geographic areas with high rates of--CommentsClose CommentsPermalink





`(i) eligible but unenrolled children, including such children who reside in rural areas; orCommentsClose CommentsPermalink





`(ii) racial and ethnic minorities and health disparity populations, including those proposals that address cultural and linguistic barriers to enrollment; andCommentsClose CommentsPermalink





`(B) submit the most demonstrable evidence required under paragraphs (1) and (2) of subsection (c).CommentsClose CommentsPermalink





`(2) TEN PERCENT SET ASIDE FOR OUTREACH TO INDIAN CHILDREN- An amount equal to 10 percent of the funds appropriated under subsection (g) shall be used by the Secretary to award grants to Indian Health Service providers and urban Indian organizations receiving funds under title V of the Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.) for outreach to, and enrollment of, children who are Indians.CommentsClose CommentsPermalink





`(c) Application- An eligible entity that desires to receive a grant under subsection (a) shall submit an application to the Secretary in such form and manner, and containing such information, as the Secretary may decide. Such application shall include--CommentsClose CommentsPermalink





`(1) evidence demonstrating that the entity includes members who have access to, and credibility with, ethnic or low-income populations in the communities in which activities funded under the grant are to be conducted;CommentsClose CommentsPermalink





`(2) evidence demonstrating that the entity has the ability to address barriers to enrollment, such as lack of awareness of eligibility, stigma concerns and punitive fears associated with receipt of benefits, and other cultural barriers to applying for and receiving child health assistance or medical assistance;CommentsClose CommentsPermalink





`(3) specific quality or outcomes performance measures to evaluate the effectiveness of activities funded by a grant awarded under this section; andCommentsClose CommentsPermalink





`(4) an assurance that the eligible entity shall--CommentsClose CommentsPermalink





`(A) conduct an assessment of the effectiveness of such activities against the performance measures;CommentsClose CommentsPermalink





`(B) cooperate with the collection and reporting of enrollment data and other information in order for the Secretary to conduct such assessments; andCommentsClose CommentsPermalink





`(C) in the case of an eligible entity that is not the State, provide the State with enrollment data and other information as necessary for the State to make necessary projections of eligible children and pregnant women.CommentsClose CommentsPermalink





`(d) Dissemination of Enrollment Data and Information Determined From Effectiveness Assessments; Annual Report- The Secretary shall--CommentsClose CommentsPermalink





`(1) make publicly available the enrollment data and information collected and reported in accordance with subsection (c)(4)(B); andCommentsClose CommentsPermalink





`(2) submit an annual report to Congress on the outreach and enrollment activities conducted with funds appropriated under this section.CommentsClose CommentsPermalink





`(e) Maintenance of Effort for States Awarded Grants; No State Match Required- In the case of a State that is awarded a grant under this section--CommentsClose CommentsPermalink





`(1) the State share of funds expended for outreach and enrollment activities under the State child health plan shall not be less than the State share of such funds expended in the fiscal year preceding the first fiscal year for which the grant is awarded; andCommentsClose CommentsPermalink





`(2) no State matching funds shall be required for the State to receive a grant under this section.CommentsClose CommentsPermalink





`(f) Definitions- In this section:CommentsClose CommentsPermalink





`(1) ELIGIBLE ENTITY- The term `eligible entity' means any of the following:CommentsClose CommentsPermalink





`(A) A State with an approved child health plan under this title.CommentsClose CommentsPermalink





`(B) A local government.CommentsClose CommentsPermalink





`(C) An Indian tribe or tribal consortium, a tribal organization, an urban Indian organization receiving funds under title V of the Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.), or an Indian Health Service provider.CommentsClose CommentsPermalink





`(D) A Federal health safety net organization.CommentsClose CommentsPermalink





`(E) A national, State, local, or community-based public or nonprofit private organization, including organizations that use community health workers or community-based doula programs.CommentsClose CommentsPermalink





`(F) A faith-based organization or consortia, to the extent that a grant awarded to such an entity is consistent with the requirements of section 1955 of the Public Health Service Act (42 U.S.C. 300x-65) relating to a grant award to nongovernmental entities.CommentsClose CommentsPermalink





`(G) An elementary or secondary school.CommentsClose CommentsPermalink





`(2) FEDERAL HEALTH SAFETY NET ORGANIZATION- The term `Federal health safety net organization' means--CommentsClose CommentsPermalink





`(A) a Federally-qualified health center (as defined in section 1905(l)(2)(B));CommentsClose CommentsPermalink





`(B) a hospital defined as a disproportionate share hospital for purposes of section 1923;CommentsClose CommentsPermalink





`(C) a covered entity described in section 340B(a)(4) of the Public Health Service Act (42 U.S.C. 256b(a)(4)); andCommentsClose CommentsPermalink





`(D) any other entity or consortium that serves children under a federally funded program, including the special supplemental nutrition program for women, infants, and children (WIC) established under section 17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786), the Head Start and Early Head Start programs under the Head Start Act (42 U.S.C. 9801 et seq.), the school lunch program established under the Richard B. Russell National School Lunch Act, and an elementary or secondary school.CommentsClose CommentsPermalink





`(3) INDIANS; INDIAN TRIBE; TRIBAL ORGANIZATION; URBAN INDIAN ORGANIZATION- The terms `Indian', `Indian tribe', `tribal organization', and `urban Indian organization' have the meanings given such terms in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603).CommentsClose CommentsPermalink





`(4) COMMUNITY HEALTH WORKER- The term `community health worker' means an individual who promotes health or nutrition within the community in which the individual resides--CommentsClose CommentsPermalink





`(A) by serving as a liaison between communities and health care agencies;CommentsClose CommentsPermalink





`(B) by providing guidance and social assistance to community residents;CommentsClose CommentsPermalink





`(C) by enhancing community residents' ability to effectively communicate with health care providers;CommentsClose CommentsPermalink





`(D) by providing culturally and linguistically appropriate health or nutrition education;CommentsClose CommentsPermalink





`(E) by advocating for individual and community health or nutrition needs; andCommentsClose CommentsPermalink





`(F) by providing referral and followup services.CommentsClose CommentsPermalink





`(g) Appropriation- There is appropriated, out of any money in the Treasury not otherwise appropriated, $100,000,000 for the period of fiscal years 2008 through 2012, for the purpose of awarding grants under this section. Amounts appropriated and paid under the authority of this section shall be in addition to amounts appropriated under section 2104 and paid to States in accordance with section 2105, including with respect to expenditures for outreach activities in accordance with subsections (a)(1)(D)(iii) and (c)(2)(C) of that section.CommentsClose CommentsPermalink





`(h) National Enrollment Campaign- From the amounts made available under subsection (a)(2), the Secretary shall develop and implement a national enrollment campaign to improve the enrollment of underserved child populations in the programs established under this title and title XIX. Such campaign may include--CommentsClose CommentsPermalink





`(1) the establishment of partnerships with the Secretary of Education and the Secretary of Agriculture to develop national campaigns to link the eligibility and enrollment systems for the assistance programs each Secretary administers that often serve the same children;CommentsClose CommentsPermalink





`(2) the integration of information about the programs established under this title and title XIX in public health awareness campaigns administered by the Secretary;CommentsClose CommentsPermalink





`(3) increased financial and technical support for enrollment hotlines maintained by the Secretary to ensure that all States participate in such hotlines;CommentsClose CommentsPermalink





`(4) the establishment of joint public awareness outreach initiatives with the Secretary of Education and the Secretary of Labor regarding the importance of health insurance to building strong communities and the economy;CommentsClose CommentsPermalink





`(5) the development of special outreach materials for Native Americans or for individuals with limited English proficiency; andCommentsClose CommentsPermalink





`(6) such other outreach initiatives as the Secretary determines would increase public awareness of the programs under this title and title XIX.'.CommentsClose CommentsPermalink





(b) Enhanced Administrative Funding for Translation or Interpretation Services Under CHIP and Medicaid-CommentsClose CommentsPermalink





(1) CHIP- Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)), as amended by section 113, is amended--CommentsClose CommentsPermalink





(A) in the matter preceding subparagraph (A), by inserting `(or, in the case of expenditures described in subparagraph (D)(iv), the higher of 75 percent or the sum of the enhanced FMAP plus 5 percentage points)' after `enhanced FMAP'; andCommentsClose CommentsPermalink





(B) in subparagraph (D)--CommentsClose CommentsPermalink





(i) in clause (iii), by striking `and' at the end;CommentsClose CommentsPermalink





(ii) by redesignating clause (iv) as clause (v); andCommentsClose CommentsPermalink





(iii) by inserting after clause (iii) the following new clause:CommentsClose CommentsPermalink





`(iv) for translation or interpretation services in connection with the enrollment of, retention of, and use of services under this title by, individuals for whom English is not their primary language (as found necessary by the Secretary for the proper and efficient administration of the State plan); and'.CommentsClose CommentsPermalink





(2) MEDICAID-CommentsClose CommentsPermalink





(A) USE OF MEDICAID FUNDS- Section 1903(a)(2) (42 U.S.C. 1396b(a)(2)) is amended by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





`(E) an amount equal to 75 percent of so much of the sums expended during such quarter (as found necessary by the Secretary for the proper and efficient administration of the State plan) as are attributable to translation or interpretation services in connection with the enrollment of, retention of, and use of services under this title by, children of families for whom English is not the primary language; plus'.CommentsClose CommentsPermalink





(B) USE OF COMMUNITY HEALTH WORKERS FOR OUTREACH ACTIVITIES-CommentsClose CommentsPermalink





(i) IN GENERAL- Section 2102(c)(1) of such Act (42 U.S.C. 1397bb(c)(1)) is amended by inserting `(through community health workers and others)' after `Outreach'.CommentsClose CommentsPermalink





(ii) IN FEDERAL EVALUATION- Section 2108(c)(3)(B) of such Act (42 U.S.C. 1397hh(c)(3)(B)) is amended by inserting `(such as through community health workers and others)' after `including practices'.CommentsClose CommentsPermalink

SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF INDIANS.

(a) In General- Section 1139 (42 U.S.C. 1320b-9) is amended to read as follows:CommentsClose CommentsPermalink

`SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE FOR INDIANS UNDER TITLES XIX AND XXI.CommentsClose CommentsPermalink

`(a) Agreements With States for Medicaid and CHIP Outreach On or Near Reservations To Increase the Enrollment of Indians in Those Programs-CommentsClose CommentsPermalink





`(1) IN GENERAL- In order to improve the access of Indians residing on or near a reservation to obtain benefits under the Medicaid and State children's health insurance programs established under titles XIX and XXI, the Secretary shall encourage the State to take steps to provide for enrollment on or near the reservation. Such steps may include outreach efforts such as the outstationing of eligibility workers, entering into agreements with the Indian Health Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations to provide outreach, education regarding eligibility and benefits, enrollment, and translation services when such services are appropriate.CommentsClose CommentsPermalink





`(2) CONSTRUCTION- Nothing in paragraph (1) shall be construed as affecting arrangements entered into between States and the Indian Health Service, Indian Tribes, Tribal Organizations, or Urban Indian Organizations for such Service, Tribes, or Organizations to conduct administrative activities under such titles.CommentsClose CommentsPermalink





`(b) Requirement To Facilitate Cooperation- The Secretary, acting through the Centers for Medicare & Medicaid Services, shall take such steps as are necessary to facilitate cooperation with, and agreements between, States and the Indian Health Service, Indian Tribes, Tribal Organizations, or Urban Indian Organizations with respect to the provision of health care items and services to Indians under the programs established under title XIX or XXI.CommentsClose CommentsPermalink





`(c) Definition of Indian; Indian Tribe; Indian Health Program; Tribal Organization; Urban Indian Organization- In this section, the terms `Indian', `Indian Tribe', `Indian Health Program', `Tribal Organization', and `Urban Indian Organization' have the meanings given those terms in section 4 of the Indian Health Care Improvement Act.'.CommentsClose CommentsPermalink





(b) Nonapplication of 10 Percent Limit on Outreach and Certain Other Expenditures- Section 2105(c)(2) (42 U.S.C. 1397ee(c)(2)) is amended by adding at the end the following:CommentsClose CommentsPermalink





`(C) NONAPPLICATION TO CERTAIN EXPENDITURES- The limitation under subparagraph (A) shall not apply with respect to the following expenditures:CommentsClose CommentsPermalink





`(i) EXPENDITURES TO INCREASE OUTREACH TO, AND THE ENROLLMENT OF, INDIAN CHILDREN UNDER THIS TITLE AND TITLE xix- Expenditures for outreach activities to families of Indian children likely to be eligible for child health assistance under the plan or medical assistance under the State plan under title XIX (or under a waiver of such plan), to inform such families of the availability of, and to assist them in enrolling their children in, such plans, including such activities conducted under grants, contracts, or agreements entered into under section 1139(a).'.CommentsClose CommentsPermalink

SEC. 203. STATE OPTION TO RELY ON FINDINGS FROM AN EXPRESS LANE AGENCY TO CONDUCT SIMPLIFIED ELIGIBILITY DETERMINATIONS.

(a) Application Under Medicaid and CHIP Programs-CommentsClose CommentsPermalink





(1) MEDICAID- Section 1902(e) (42 U.S.C. 1396a(e)) is amended by adding at the end the following:CommentsClose CommentsPermalink





`(13) Express Lane Option-CommentsClose CommentsPermalink





`(A) IN GENERAL-CommentsClose CommentsPermalink





`(i) OPTION TO USE A FINDING FROM AN EXPRESS LANE AGENCY- At the option of the State, the State plan may provide that in determining eligibility under this title for a child (as defined in subparagraph (G)), the State may rely on a finding made within a reasonable period (as determined by the State) from an Express Lane agency (as defined in subparagraph (F)) when it determines whether a child satisfies one or more components of eligibility for medical assistance under this title. The State may rely on a finding from an Express Lane agency notwithstanding sections 1902(a)(46)(B) and 1137(d) and any differences in budget unit, disregard, deeming or other methodology, if the following requirements are met:CommentsClose CommentsPermalink





`(I) PROHIBITION ON DETERMINING CHILDREN INELIGIBLE FOR COVERAGE- If a finding from an Express Lane agency would result in a determination that a child does not satisfy an eligibility requirement for medical assistance under this title and for child health assistance under title XXI, the State shall determine eligibility for assistance using its regular procedures.CommentsClose CommentsPermalink





`(II) NOTICE REQUIREMENT- For any child who is found eligible for medical assistance under the State plan under this title or child health assistance under title XXI and who is subject to premiums based on an Express Lane agency's finding of such child's income level, the State shall provide notice that the child may qualify for lower premium payments if evaluated by the State using its regular policies and of the procedures for requesting such an evaluation.CommentsClose CommentsPermalink





`(III) COMPLIANCE WITH SCREEN AND ENROLL REQUIREMENT- The State shall satisfy the requirements under subparagraphs (A) and (B) of section 2102(b)(3) (relating to screen and enroll) before enrolling a child in child health assistance under title XXI. At its option, the State may fulfill such requirements in accordance with either option provided under subparagraph (C) of this paragraph.CommentsClose CommentsPermalink





`(IV) VERIFICATION OF CITIZENSHIP OR NATIONALITY STATUS- The State shall satisfy the requirements of section 1902(a)(46)(B) or 2105(c)(10), as applicable for verifications of citizenship or nationality status.CommentsClose CommentsPermalink





`(V) CODING- The State meets the requirements of subparagraph (E).CommentsClose CommentsPermalink





`(ii) OPTION TO APPLY TO RENEWALS AND REDETERMINATIONS- The State may apply the provisions of this paragraph when conducting initial determinations of eligibility, redeterminations of eligibility, or both, as described in the State plan.CommentsClose CommentsPermalink





`(B) RULES OF CONSTRUCTION- Nothing in this paragraph shall be construed--CommentsClose CommentsPermalink





`(i) to limit or prohibit a State from taking any actions otherwise permitted under this title or title XXI in determining eligibility for or enrolling children into medical assistance under this title or child health assistance under title XXI; orCommentsClose CommentsPermalink





`(ii) to modify the limitations in section 1902(a)(5) concerning the agencies that may make a determination of eligibility for medical assistance under this title.CommentsClose CommentsPermalink





`(C) OPTIONS FOR SATISFYING THE SCREEN AND ENROLL REQUIREMENT-CommentsClose CommentsPermalink





`(i) IN GENERAL- With respect to a child whose eligibility for medical assistance under this title or for child health assistance under title XXI has been evaluated by a State agency using an income finding from an Express Lane agency, a State may carry out its duties under subparagraphs (A) and (B) of section 2102(b)(3) (relating to screen and enroll) in accordance with either clause (ii) or clause (iii).CommentsClose CommentsPermalink





`(ii) ESTABLISHING A SCREENING THRESHOLD-CommentsClose CommentsPermalink





`(I) IN GENERAL- Under this clause, the State establishes a screening threshold set as a percentage of the Federal poverty level that exceeds the highest income threshold applicable under this title to the child by a minimum of 30 percentage points or, at State option, a higher number of percentage points that reflects the value (as determined by the State and described in the State plan) of any differences between income methodologies used by the program administered by the Express Lane agency and the methodologies used by the State in determining eligibility for medical assistance under this title.CommentsClose CommentsPermalink





`(II) CHILDREN WITH INCOME NOT ABOVE THRESHOLD- If the income of a child does not exceed the screening threshold, the child is deemed to satisfy the income eligibility criteria for medical assistance under this title regardless of whether such child would otherwise satisfy such criteria.CommentsClose CommentsPermalink





`(III) CHILDREN WITH INCOME ABOVE THRESHOLD- If the income of a child exceeds the screening threshold, the child shall be considered to have an income above the Medicaid applicable income level described in section 2110(b)(4) and to satisfy the requirement under section 2110(b)(1)(C) (relating to the requirement that CHIP matching funds be used only for children not eligible for Medicaid). If such a child is enrolled in child health assistance under title XXI, the State shall provide the parent, guardian, or custodial relative with the following:CommentsClose CommentsPermalink





`(aa) Notice that the child may be eligible to receive medical assistance under the State plan under this title if evaluated for such assistance under the State's regular procedures and notice of the process through which a parent, guardian, or custodial relative can request that the State evaluate the child's eligibility for medical assistance under this title using such regular procedures.CommentsClose CommentsPermalink





`(bb) A description of differences between the medical assistance provided under this title and child health assistance under title XXI, including differences in cost-sharing requirements and covered benefits.CommentsClose CommentsPermalink





`(iii) TEMPORARY ENROLLMENT IN CHIP PENDING SCREEN AND ENROLL-CommentsClose CommentsPermalink





`(I) IN GENERAL- Under this clause, a State enrolls a child in child health assistance under title XXI for a temporary period if the child appears eligible for such assistance based on an income finding by an Express Lane agency.CommentsClose CommentsPermalink





`(II) DETERMINATION OF ELIGIBILITY- During such temporary enrollment period, the State shall determine the child's eligibility for child health assistance under title XXI or for medical assistance under this title in accordance with this clause.CommentsClose CommentsPermalink





`(III) PROMPT FOLLOW UP- In making such a determination, the State shall take prompt action to determine whether the child should be enrolled in medical assistance under this title or child health assistance under title XXI pursuant to subparagraphs (A) and (B) of section 2102(b)(3) (relating to screen and enroll).CommentsClose CommentsPermalink





`(IV) REQUIREMENT FOR SIMPLIFIED DETERMINATION- In making such a determination, the State shall use procedures that, to the maximum feasible extent, reduce the burden imposed on the individual of such determination. Such procedures may not require the child's parent, guardian, or custodial relative to provide or verify information that already has been provided to the State agency by an Express Lane agency or another source of information unless the State agency has reason to believe the information is erroneous.CommentsClose CommentsPermalink





`(V) AVAILABILITY OF CHIP MATCHING FUNDS DURING TEMPORARY ENROLLMENT PERIOD- Medical assistance for items and services that are provided to a child enrolled in title XXI during a temporary enrollment period under this clause shall be treated as child health assistance under such title.CommentsClose CommentsPermalink





`(D) OPTION FOR AUTOMATIC ENROLLMENT-CommentsClose CommentsPermalink





`(i) IN GENERAL- The State may initiate and determine eligibility for medical assistance under the State Medicaid plan or for child health assistance under the State CHIP plan without a program application from, or on behalf of, the child based on data obtained from sources other than the child (or the child's family), but a child can only be automatically enrolled in the State Medicaid plan or the State CHIP plan if the child or the family affirmatively consents to being enrolled through affirmation and signature on an Express Lane agency application, if the requirement of clause (ii) is met.CommentsClose CommentsPermalink





`(ii) INFORMATION REQUIREMENT- The requirement of this clause is that the State informs the parent, guardian, or custodial relative of the child of the services that will be covered, appropriate methods for using such services, premium or other cost sharing charges (if any) that apply, medical support obligations (under section 1912(a)) created by enrollment (if applicable), and the actions the parent, guardian, or relative must take to maintain enrollment and renew coverage.CommentsClose CommentsPermalink





`(E) CODING; APPLICATION TO ENROLLMENT ERROR RATES-CommentsClose CommentsPermalink





`(i) IN GENERAL- For purposes of subparagraph (A)(iv), the requirement of this subparagraph for a State is that the State agrees to--CommentsClose CommentsPermalink





`(I) assign such codes as the Secretary shall require to the children who are enrolled in the State Medicaid plan or the State CHIP plan through reliance on a finding made by an Express Lane agency for the duration of the State's election under this paragraph;CommentsClose CommentsPermalink





`(II) annually provide the Secretary with a statistically valid sample (that is approved by Secretary) of the children enrolled in such plans through reliance on such a finding by conducting a full Medicaid eligibility review of the children identified for such sample for purposes of determining an eligibility error rate (as described in clause (iv)) with respect to the enrollment of such children (and shall not include such children in any data or samples used for purposes of complying with a Medicaid Eligibility Quality Control (MEQC) review or a payment error rate measurement (PERM) requirement);CommentsClose CommentsPermalink





`(III) submit the error rate determined under subclause (II) to the Secretary;CommentsClose CommentsPermalink





`(IV) if such error rate exceeds 3 percent for either of the first 2 fiscal years in which the State elects to apply this paragraph, demonstrate to the satisfaction of the Secretary the specific corrective actions implemented by the State to improve upon such error rate; andCommentsClose CommentsPermalink





`(V) if such error rate exceeds 3 percent for any fiscal year in which the State elects to apply this paragraph, a reduction in the amount otherwise payable to the State under section 1903(a) for quarters for that fiscal year, equal to the total amount of erroneous excess payments determined for the fiscal year only with respect to the children included in the sample for the fiscal year that are in excess of a 3 percent error rate with respect to such children.CommentsClose CommentsPermalink





`(ii) NO PUNITIVE ACTION BASED ON ERROR RATE- The Secretary shall not apply the error rate derived from the sample under clause (i) to the entire population of children enrolled in the State Medicaid plan or the State CHIP plan through reliance on a finding made by an Express Lane agency, or to the population of children enrolled in such plans on the basis of the State's regular procedures for determining eligibility, or penalize the State on the basis of such error rate in any manner other than the reduction of payments provided for under clause (i)(V).CommentsClose CommentsPermalink





`(iii) RULE OF CONSTRUCTION- Nothing in this paragraph shall be construed as relieving a State that elects to apply this paragraph from being subject to a penalty under section 1903(u), for payments made under the State Medicaid plan with respect to ineligible individuals and families that are determined to exceed the error rate permitted under that section (as determined without regard to the error rate determined under clause (i)(II)).CommentsClose CommentsPermalink





`(iv) ERROR RATE DEFINED- In this subparagraph, the term `error rate' means the rate of erroneous excess payments for medical assistance (as defined in section 1903(u)(1)(D)) for the period involved, except that such payments shall be limited to individuals for which eligibility determinations are made under this paragraph and except that in applying this paragraph under title XXI, there shall be substituted for references to provisions of this title corresponding provisions within title XXI.CommentsClose CommentsPermalink





`(F) EXPRESS LANE AGENCY-CommentsClose CommentsPermalink





`(i) IN GENERAL- In this paragraph, the termCommentsClose CommentsPermalink

131`Express Lane agency' means a public agency that--CommentsClose CommentsPermalink

`(I) is determined by the State Medicaid agency or the State CHIP agency (as applicable) to be capable of making the determinations of one or more eligibility requirements described in subparagraph (A)(i);CommentsClose CommentsPermalink





`(II) is identified in the State Medicaid plan or the State CHIP plan; andCommentsClose CommentsPermalink





`(III) notifies the child's family--CommentsClose CommentsPermalink





`(aa) of the information which shall be disclosed in accordance with this paragraph;CommentsClose CommentsPermalink





`(bb) that the information disclosed will be used solely for purposes of determining eligibility for medical assistance under the State Medicaid plan or for child health assistance under the State CHIP plan; andCommentsClose CommentsPermalink





`(cc) that the family may elect to not have the information disclosed for such purposes; andCommentsClose CommentsPermalink





`(IV) enters into, or is subject to, an interagency agreement to limit the disclosure and use of the information disclosed.CommentsClose CommentsPermalink





`(ii) INCLUSION OF SPECIFIC PUBLIC AGENCIES- Such term includes the following:CommentsClose CommentsPermalink





`(I) A public agency that determines eligibility for assistance under any of the following:CommentsClose CommentsPermalink





`(aa) The temporary assistance for needy families program funded under part A of title IV.CommentsClose CommentsPermalink





`(bb) A State program funded under part D of title IV.CommentsClose CommentsPermalink





`(cc) The State Medicaid plan.CommentsClose CommentsPermalink





`(dd) The State CHIP plan.CommentsClose CommentsPermalink





`(ee) The Food Stamp Act of 1977 (7 U.S.C. 2011 et seq.).CommentsClose CommentsPermalink





`(ff) The Head Start Act (42 U.S.C. 9801 et seq.).CommentsClose CommentsPermalink





`(gg) The Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq.).CommentsClose CommentsPermalink





`(hh) The Child Nutrition Act of 1966 (42 U.S.C. 1771 et seq.).CommentsClose CommentsPermalink





`(ii) The Child Care and Development Block Grant Act of 1990 (42 U.S.C. 9858 et seq.).CommentsClose CommentsPermalink





`(jj) The Stewart B. McKinney Homeless Assistance Act (42 U.S.C. 11301 et seq.).CommentsClose CommentsPermalink





`(kk) The United States Housing Act of 1937 (42 U.S.C. 1437 et seq.).CommentsClose CommentsPermalink





`(ll) The Native American Housing Assistance and Self-Determination Act of 1996 (25 U.S.C. 4101 et seq.).CommentsClose CommentsPermalink





`(II) A State-specified governmental agency that has fiscal liability or legal responsibility for the accuracy of the eligibility determination findings relied on by the State.CommentsClose CommentsPermalink





`(III) A public agency that is subject to an interagency agreement limiting the disclosure and use of the information disclosed for purposes of determining eligibility under the State Medicaid plan or the State CHIP plan.CommentsClose CommentsPermalink





`(iii) EXCLUSIONS- Such term does not include an agency that determines eligibility for a program established under the Social Services Block Grant established under title XX or a private, for-profit organization.CommentsClose CommentsPermalink





`(iv) RULES OF CONSTRUCTION- Nothing in this paragraph shall be construed as--CommentsClose CommentsPermalink





`(I) exempting a State Medicaid agency from complying with the requirements of section 1902(a)(4) relating to merit-based personnel standards for employees of the State Medicaid agency and safeguards against conflicts of interest); orCommentsClose CommentsPermalink





`(II) authorizing a State Medicaid agency that elects to use Express Lane agencies under this subparagraph to use the Express Lane option to avoid complying with such requirements for purposes of making eligibility determinations under the State Medicaid plan.CommentsClose CommentsPermalink





`(v) ADDITIONAL DEFINITIONS- In this paragraph:CommentsClose CommentsPermalink





`(I) STATE- The term `State' means 1 of the 50 States or the District of Columbia.CommentsClose CommentsPermalink





`(II) STATE CHIP AGENCY- The term `State CHIP agency' means the State agency responsible for administering the State CHIP plan.CommentsClose CommentsPermalink





`(III) STATE CHIP PLAN- The term `State CHIP plan' means the State child health plan established under title XXI and includes any waiver of such plan.CommentsClose CommentsPermalink





`(IV) STATE MEDICAID AGENCY- The term `State Medicaid agency' means the State agency responsible for administering the State Medicaid plan.CommentsClose CommentsPermalink





`(V) STATE MEDICAID PLAN- The term `State Medicaid plan' means the State plan established under title XIX and includes any waiver of such plan.CommentsClose CommentsPermalink





`(G) CHILD DEFINED- For purposes of this paragraph, the term `child' means an individual under 19 years of age, or, at the option of a State, such higher age, not to exceed 21 years of age, as the State may elect.CommentsClose CommentsPermalink





`(H) APPLICATION- This paragraph shall not apply to with respect to eligibility determinations made after September 30, 2012.'.CommentsClose CommentsPermalink





(2) CHIP- Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is amended by redesignating subparagraphs (B), (C), and (D) as subparagraphs (C), (D), and (E), respectively, and by inserting after subparagraph (A) the following new subparagraph:CommentsClose CommentsPermalink





`(B) Section 1902(e)(13) (relating to the State option to rely on findings from an Express Lane agency to help evaluate a child's eligibility for medical assistance).'.CommentsClose CommentsPermalink





(b) Evaluation and Report-CommentsClose CommentsPermalink





(1) EVALUATION- The Secretary shall conduct, by grant, contract, or interagency agreement, a comprehensive, independent evaluation of the option provided under the amendments made by subsection (a). Such evaluation shall include an analysis of the effectiveness of the option, and shall include--CommentsClose CommentsPermalink





(A) obtaining a statistically valid sample of the children who were enrolled in the State Medicaid plan or the State CHIP plan through reliance on a finding made by an Express Lane agency and determining the percentage of children who were erroneously enrolled in such plans;CommentsClose CommentsPermalink





(B) determining whether enrolling children in such plans through reliance on a finding made by an Express Lane agency improves the ability of a State to identify and enroll low-income, uninsured children who are eligible but not enrolled in such plans;CommentsClose CommentsPermalink





(C) evaluating the administrative costs or savings related to identifying and enrolling children in such plans through reliance on such findings, and the extent to which such costs differ from the costs that the State otherwise would have incurred to identify and enroll low-income, uninsured children who are eligible but not enrolled in such plans; andCommentsClose CommentsPermalink





(D) any recommendations for legislative or administrative changes that would improve the effectiveness of enrolling children in such plans through reliance on such findings.CommentsClose CommentsPermalink





(2) REPORT TO CONGRESS- Not later than September 30, 2011, the Secretary shall submit a report to Congress on the results of the evaluation under paragraph (1).CommentsClose CommentsPermalink





(3) FUNDING-CommentsClose CommentsPermalink





(A) IN GENERAL- Out of any funds in the Treasury not otherwise appropriated, there is appropriated to the Secretary to carry out the evaluation under this subsection $5,000,000 for the period of fiscal years 2008 through 2011.CommentsClose CommentsPermalink





(B) BUDGET AUTHORITY- Subparagraph (A) constitutes budget authority in advance of appropriations Act and represents the obligation of the Federal Government to provide for the payment of such amount to conduct the evaluation under this subsection.CommentsClose CommentsPermalink





(c) Electronic Transmission of Information- Section 1902 (42 U.S.C. 1396a) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





`(dd) Electronic Transmission of Information- If the State agency determining eligibility for medical assistance under this title or child health assistance under title XXI verifies an element of eligibility based on information from an Express Lane Agency (as defined in subsection (e)(13)(F)), or from another public agency, then the applicant's signature under penalty of perjury shall not be required as to such element. Any signature requirement for an application for medical assistance may be satisfied through an electronic signature, as defined in section 1710(1) of the Government Paperwork Elimination Act (44 U.S.C. 3504 note). The requirements of subparagraphs (A) and (B) of section 1137(d)(2) may be met through evidence in digital or electronic form.'.CommentsClose CommentsPermalink





(d) Authorization of Information Disclosure-CommentsClose CommentsPermalink





(1) IN GENERAL- Title XIX is amended--CommentsClose CommentsPermalink





(A) by redesignating section 1939 as section 1940; andCommentsClose CommentsPermalink





(B) by inserting after section 1938 the following new section:CommentsClose CommentsPermalink

`SEC. 1939. AUTHORIZATION TO RECEIVE RELEVANT INFORMATION.CommentsClose CommentsPermalink

`(a) In General- Notwithstanding any other provision of law, a Federal or State agency or private entity in possession of the sources of data directly relevant to eligibility determinations under this title (including eligibility files maintained by Express Lane agencies described in section 1902(e)(13)(F), information described in paragraph (2) or (3) of section 1137(a), vital records information about births in any State, and information described in sections 453(i) and 1902(a)(25)(I)) is authorized to convey such data or information to the State agency administering the State plan under this title, to the extent such conveyance meets the requirements of subsection (b).CommentsClose CommentsPermalink





`(b) Requirements for Conveyance- Data or information may be conveyed pursuant to subsection (a) only if the following requirements are met:CommentsClose CommentsPermalink





`(1) The individual whose circumstances are described in the data or information (or such individual's parent, guardian, caretaker relative, or authorized representative) has either provided advance consent to disclosure or has not objected to disclosure after receiving advance notice of disclosure and a reasonable opportunity to object.CommentsClose CommentsPermalink





`(2) Such data or information are used solely for the purposes of--CommentsClose CommentsPermalink





`(A) identifying individuals who are eligible or potentially eligible for medical assistance under this title and enrolling or attempting to enroll such individuals in the State plan; andCommentsClose CommentsPermalink





`(B) verifying the eligibility of individuals for medical assistance under the State plan.CommentsClose CommentsPermalink





`(3) An interagency or other agreement, consistent with standards developed by the Secretary--CommentsClose CommentsPermalink





`(A) prevents the unauthorized use, disclosure, or modification of such data and otherwise meets applicable Federal requirements safeguarding privacy and data security; andCommentsClose CommentsPermalink





`(B) requires the State agency administering the State plan to use the data and information obtained under this section to seek to enroll individuals in the plan.CommentsClose CommentsPermalink





`(c) Penalties for Improper Disclosure-CommentsClose CommentsPermalink





`(1) CIVIL MONEY PENALTY- A private entity described in the subsection (a) that publishes, discloses, or makes known in any manner, or to any extent not authorized by Federal law, any information obtained under this section is subject to a civil money penalty in an amount equal to $10,000 for each such unauthorized publication or disclosure. The provisions of section 1128A (other than subsections (a) and (b) and the second sentence of subsection (f)) shall apply to a civil money penalty under this paragraph in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).CommentsClose CommentsPermalink





`(2) CRIMINAL PENALTY- A private entity described in the subsection (a) that willfully publishes, discloses, or makes known in any manner, or to any extent not authorized by Federal law, any information obtained under this section shall be fined not more than $10,000 or imprisoned not more than 1 year, or both, for each such unauthorized publication or disclosure.CommentsClose CommentsPermalink





`(d) Rule of Construction- The limitations and requirements that apply to disclosure pursuant to this section shall not be construed to prohibit the conveyance or disclosure of data or information otherwise permitted under Federal law (without regard to this section).'.CommentsClose CommentsPermalink





(2) CONFORMING AMENDMENT TO TITLE XXI- Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)), as amended by subsection (a)(2), is amended by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





`(F) Section 1939 (relating to authorization to receive data directly relevant to eligibility determinations).'.CommentsClose CommentsPermalink





(3) CONFORMING AMENDMENT TO PROVIDE ACCESS TO DATA ABOUT ENROLLMENT IN INSURANCE FOR PURPOSES OF EVALUATING APPLICATIONS AND FOR CHIP- Section 1902(a)(25)(I)(i) (42 U.S.C. 1396a(a)(25)(I)(i)) is amended--CommentsClose CommentsPermalink





(A) by inserting `(and, at State option, individuals who apply or whose eligibility for medical assistance is being evaluated in accordance with section 1902(e)(13)(D))' after `with respect to individuals who are eligible'; andCommentsClose CommentsPermalink





(B) by inserting `under this title (and, at State option, child health assistance under title XXI)' after `the State plan'.CommentsClose CommentsPermalink





(e) Authorization for States Electing Express Lane Option To Receive Certain Data Directly Relevant To Determining Eligibility and Correct Amount of Assistance- The Secretary shall enter into such agreements as are necessary to permit a State that elects the Express Lane option under section 1902(e)(13) of the Social Security Act to receive data directly relevant to eligibility determinations and determining the correct amount of benefits under a State child health plan under CHIP or a State plan under Medicaid from the following:CommentsClose CommentsPermalink





(1) The National Directory of New Hires established under section 453(i) of the Social Security Act (42 U.S.C. 653(i)).CommentsClose CommentsPermalink





(2) Data regarding enrollment in insurance that may help to facilitate outreach and enrollment under the State Medicaid plan, the State CHIP plan, and such other programs as the Secretary may specify.CommentsClose CommentsPermalink





(f) Effective Date- The amendments made by this section are effective on January 1, 2008.CommentsClose CommentsPermalink

Subtitle B--Reducing Barriers to Enrollment

SEC. 211. VERIFICATION OF DECLARATION OF CITIZENSHIP OR NATIONALITY FOR PURPOSES OF ELIGIBILITY FOR MEDICAID AND CHIP.

(a) State Option To Verify Declaration of Citizenship or Nationality for Purposes of Eligibility for Medicaid Through Verification of Name and Social Security Number-CommentsClose CommentsPermalink





(1) ALTERNATIVE TO DOCUMENTATION REQUIREMENT-CommentsClose CommentsPermalink





(A) IN GENERAL- Section 1902 (42 U.S.C. 1396a), as amended by section 203(c), is amended--CommentsClose CommentsPermalink





(i) in subsection (a)(46)--CommentsClose CommentsPermalink





(I) by inserting `(A)' after `(46)';CommentsClose CommentsPermalink





(II) by adding `and' after the semicolon; andCommentsClose CommentsPermalink





(III) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





`(B) provide, with respect to an individual declaring to be a citizen or national of the United States for purposes of establishing eligibility under this title, that the State shall satisfy the requirements of--CommentsClose CommentsPermalink





`(i) section 1903(x); orCommentsClose CommentsPermalink





`(ii) subsection (ee);'; andCommentsClose CommentsPermalink





(ii) by adding at the end the following new subsection:CommentsClose CommentsPermalink





`(ee)(1) For purposes of subsection (a)(46)(B)(ii), the requirements of this subsection with respect to an individual declaring to be a citizen or national of the United States for purposes of establishing eligibility under this title, are, in lieu of requiring the individual to present satisfactory documentary evidence of citizenship or nationality under section 1903(x) (if the individual is not described in paragraph (2) of that section), as follows:CommentsClose CommentsPermalink





`(A) The State submits the name and social security number of the individual to the Commissioner of Social Security as part of the program established under paragraph (2).CommentsClose CommentsPermalink





`(B) If the State receives notice from the Commissioner of Social Security that the name or social security number of the individual is invalid--CommentsClose CommentsPermalink





`(i) the State makes a reasonable effort to identify and address the causes of such invalid match, including through typographical or other clerical errors, by contacting the individual to confirm the accuracy of the name or social security number, respectively, submitted, and by taking such additional actions as the Secretary, through regulation or other guidance, or the State may identify, and continues to provide the individual with medical assistance while making such effort; andCommentsClose CommentsPermalink





`(ii) in the case that the name or social security number of the individual remains invalid after such reasonable efforts, the State--CommentsClose CommentsPermalink





`(I) notifies the individual of such fact;CommentsClose CommentsPermalink





`(II) provides the individual with a period of 90 days from the date on which the notice required under subclause (I) is received by the individual to either present satisfactory documentary evidence of citizenship or nationality (as defined in section 1903(x)(3)) or cure the invalid determination with the Commissioner of Social Security (and continues to provide the individual with medical assistance during such 90-day period); andCommentsClose CommentsPermalink





`(III) disenrolls the individual from the State plan under this title within 30 days after the end of such 90-day period if no such documentary evidence is presented or if such invalid determination is not cured.CommentsClose CommentsPermalink





`(2)(A) Each State electing to satisfy the requirements of this subsection for purposes of section 1902(a)(46)(B) shall establish a program under which the State submits each month to the Commissioner of Social Security for verification the name and social security number of each individual newly enrolled in the State plan under this title that month who is not described in section 1903(x)(2).CommentsClose CommentsPermalink





`(B) In establishing the State program under this paragraph, the State may enter into an agreement with the Commissioner of Social Security--CommentsClose CommentsPermalink





`(i) to provide for the electronic submission and verification, through an on-line system or otherwise, of the name and social security number of an individual enrolled in the State plan under this title;CommentsClose CommentsPermalink





`(ii) to submit to the Commissioner the names and social security numbers of such individuals on a batch basis, provided that such batches are submitted at least on a monthly basis; orCommentsClose CommentsPermalink





`(iii) to provide for the verification of the names and social security numbers of such individuals through such other method as agreed to by the State and the Commissioner and approved by the Secretary, provided that such method is no more burdensome for individuals to comply with than any burdens that may apply under a method described in clause (i) or (ii).CommentsClose CommentsPermalink





`(C) The program established under this paragraph shall provide that, in the case of any individual who is required to submit a social security number to the State under subparagraph (A) and who is unable to provide the State with such number, shall be provided with at least the reasonable opportunity to present satisfactory documentary evidence of citizenship or nationality (as defined in section 1903(x)(3)) as is provided under clauses (i) and (ii) of section 1137(d)(4)(A) to an individual for the submittal to the State of evidence indicating a satisfactory immigration status.CommentsClose CommentsPermalink





`(3)(A) The State agency implementing the plan approved under this title shall, at such times and in such form as the Secretary may specify, provide information on the percentage each month that the invalid names and numbers submitted bears to the total submitted for verification. For purposes of the previous sentence, a name or social security number of an individual shall be treated as invalid and included in the determination of such percentage only if--CommentsClose CommentsPermalink





`(i) the name or social security number, respectively, submitted by the individual does not match Social Security Administration records;CommentsClose CommentsPermalink





`(ii) the inconsistency between the name or number, respectively, so submitted and the Social Security Administration records could not be resolved by the State;CommentsClose CommentsPermalink





`(iii) the individual was provided with a reasonable period of time to resolve the inconsistency with the Social Security Administration or provide satisfactory documentation of citizenship and did not successfully resolve such inconsistency; andCommentsClose CommentsPermalink





`(iv) payment has been made for an item or service furnished to the individual under this title.CommentsClose CommentsPermalink





`(B) If, for any fiscal year, the average monthly percentage determined under subparagraph (A) is greater than 3 percent--CommentsClose CommentsPermalink





`(i) the State shall develop and adopt a corrective plan to review its procedures for verifying the identities of individuals seeking to enroll in the State plan under this title and to identify and implement changes in such procedures to improve their accuracy; andCommentsClose CommentsPermalink





`(ii) pay to the Secretary an amount equal to the amount which bears the same ratio to the total payments under the State plan for the fiscal year for providing medical assistance to individuals who provided invalid information as the number of individuals with invalid information in excess of 3 percent of such total submitted bears to the total number of individuals with invalid information.CommentsClose CommentsPermalink





`(C) The Secretary may waive, in certain limited cases, all or part of the payment under subparagraph (B)(ii) if the State is unable to reach the allowable error rate despite a good faith effort by such State.CommentsClose CommentsPermalink





`(D) This paragraph shall not apply to a State for a fiscal year if there is an agreement described in paragraph (2)(B) in effect as of the close of the fiscal year.CommentsClose CommentsPermalink





`(4) Nothing in this subsection shall affect the rights of any individual under this title to appeal any disenrollment from a State plan.'.CommentsClose CommentsPermalink





(B) COSTS OF IMPLEMENTING AND MAINTAINING SYSTEM- Section 1903(a)(3) (42 U.S.C. 1396b(a)(3)) is amended--CommentsClose CommentsPermalink





(i) by striking `plus' at the end of subparagraph (E) and inserting `and', andCommentsClose CommentsPermalink





(ii) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





`(F)(i) 90 percent of the sums expended during the quarter as are attributable to the design, development, or installation of such mechanized verification and information retrieval systems as the Secretary determines are necessary to implement section 1902(ee) (including a system described in paragraph (2)(B) thereof), andCommentsClose CommentsPermalink





`(ii) 75 percent of the sums expended during the quarter as are attributable to the operation of systems to which clause (i) applies, plus'.CommentsClose CommentsPermalink





(2) LIMITATION ON WAIVER AUTHORITY- Notwithstanding any provision of section 1115 of the Social Security Act (42 U.S.C. 1315), or any other provision of law, the Secretary may not waive the requirements of section 1902(a)(46)(B) of such Act (42 U.S.C. 1396a(a)(46)(B)) with respect to a State.CommentsClose CommentsPermalink





(3) CONFORMING AMENDMENTS- Section 1903 (42 U.S.C. 1396b) is amended--CommentsClose CommentsPermalink





(A) in subsection (i)(22), by striking `subsection (x)' and inserting `section 1902(a)(46)(B)'; andCommentsClose CommentsPermalink





(B) in subsection (x)(1), by striking `subsection (i)(22)' and inserting `section 1902(a)(46)(B)(i)'.CommentsClose CommentsPermalink





(b) Clarification of Requirements Relating to Presentation of Satisfactory Documentary Evidence of Citizenship or Nationality-CommentsClose CommentsPermalink





(1) ACCEPTANCE OF DOCUMENTARY EVIDENCE ISSUED BY A FEDERALLY RECOGNIZED INDIAN TRIBE- Section 1903(x)(3)(B) (42 U.S.C. 1396b(x)(3)(B)) is amended--CommentsClose CommentsPermalink





(A) by redesignating clause (v) as clause (vi); andCommentsClose CommentsPermalink





(B) by inserting after clause (iv), the following new clause:CommentsClose CommentsPermalink





`(v)(I) Except as provided in subclause (II), a document issued by a federally recognized Indian tribe evidencing membership or enrollment in, or affiliation with, such tribe (such as a tribal enrollment card or certificate of degree of Indian blood).CommentsClose CommentsPermalink





`(II) With respect to those federally recognized Indian tribes located within States having an international border whose membership includes individuals who are not citizens of the United States, the Secretary shall, after consulting with such tribes, issue regulations authorizing the presentation of such other forms of documentation (including tribal documentation, if appropriate) that the Secretary determines to be satisfactory documentary evidence of citizenship or nationality for purposes of satisfying the requirement of this subsection.'.CommentsClose CommentsPermalink





(2) REQUIREMENT TO PROVIDE REASONABLE OPPORTUNITY TO PRESENT SATISFACTORY DOCUMENTARY EVIDENCE- Section 1903(x) (42 U.S.C. 1396b(x)) is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





`(4) In the case of an individual declaring to be a citizen or national of the United States with respect to whom a State requires the presentation of satisfactory documentary evidence of citizenship or nationality under section 1902(a)(46)(B)(i), the individual shall be provided at least the reasonable opportunity to present satisfactory documentary evidence of citizenship or nationality under this subsection as is provided under clauses (i) and (ii) of section 1137(d)(4)(A) to an individual for the submittal to the State of evidence indicating a satisfactory immigration status.'.CommentsClose CommentsPermalink





(3) CHILDREN BORN IN THE UNITED STATES TO MOTHERS ELIGIBLE FOR MEDICAID-CommentsClose CommentsPermalink





(A) CLARIFICATION OF RULES- Section 1903(x) (42 U.S.C. 1396b(x)), as amended by paragraph (2), is amended--CommentsClose CommentsPermalink





(i) in paragraph (2)--CommentsClose CommentsPermalink





(I) in subparagraph (C), by striking `or' at the end;CommentsClose CommentsPermalink





(II) by redesignating subparagraph (D) as subparagraph (E); andCommentsClose CommentsPermalink





(III) by inserting after subparagraph (C) the following new subparagraph:CommentsClose CommentsPermalink





`(D) pursuant to the application of section 1902(e)(4) (and, in the case of an individual who is eligible for medical assistance on such basis, the individual shall be deemed to have provided satisfactory documentary evidence of citizenship or nationality and shall not be required to provide further documentary evidence on any date that occurs during or after the period in which the individual is eligible for medical assistance on such basis); or'; andCommentsClose CommentsPermalink





(ii) by adding at the end the following new paragraph:CommentsClose CommentsPermalink





`(5) Nothing in subparagraph (A) or (B) of section 1902(a)(46), the preceding paragraphs of this subsection, or the Deficit Reduction Act of 2005, including section 6036 of such Act, shall be construed as changing the requirement of section 1902(e)(4) that a child born in the United States to an alien mother for whom medical assistance for the delivery of such child is available as treatment of an emergency medical condition pursuant to subsection (v) shall be deemed eligible for medical assistance during the first year of such child's life.'.CommentsClose CommentsPermalink





(B) STATE REQUIREMENT TO ISSUE SEPARATE IDENTIFICATION NUMBER- Section 1902(e)(4) (42 U.S.C. 1396a(e)(4)) is amended by adding at the end the following new sentence: `Notwithstanding the preceding sentence, in the case of a child who is born in the United States to an alien mother for whom medical assistance for the delivery of the child is made available pursuant to section 1903(v), the State immediately shall issue a separate identification number for the child upon notification by the facility at which such delivery occurred of the child's birth.'.CommentsClose CommentsPermalink





(4) TECHNICAL AMENDMENTS- Section 1903(x)(2) (42 U.S.C. 1396b(x)) is amended--CommentsClose CommentsPermalink





(A) in subparagraph (B)--CommentsClose CommentsPermalink





(i) by realigning the left margin of the matter preceding clause (i) 2 ems to the left; andCommentsClose CommentsPermalink





(ii) by realigning the left margins of clauses (i) and (ii), respectively, 2 ems to the left; andCommentsClose CommentsPermalink





(B) in subparagraph (C)--CommentsClose CommentsPermalink





(i) by realigning the left margin of the matter preceding clause (i) 2 ems to the left; andCommentsClose CommentsPermalink





(ii) by realigning the left margins of clauses (i) and (ii), respectively, 2 ems to the left.CommentsClose CommentsPermalink





(c) Application of Documentation System to CHIP-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 2105(c) (42 U.S.C. 1397ee(c)), as amended by sections 114(a) and 116(c), is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





`(10) CITIZENSHIP DOCUMENTATION REQUIREMENTS-CommentsClose CommentsPermalink





`(A) IN GENERAL- No payment may be made under this section with respect to an individual who has, or is, declared to be a citizen or national of the United States for purposes of establishing eligibility under this title unless the State meets the requirements of section 1902(a)(46)(B) with respect to the individual.CommentsClose CommentsPermalink





`(B) ENHANCED PAYMENTS- Notwithstanding subsection (b), the enhanced FMAP with respect to payments under subsection (a) for expenditures described in clause (i) or (ii) of section 1903(a)(3)(F) necessary to comply with subparagraph (A) shall in no event be less than 90 percent and 75 percent, respectively.'.CommentsClose CommentsPermalink





(2) NONAPPLICATION OF ADMINISTRATIVE EXPENDITURES CAP- Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as amended by section 202(b), is amended by adding at the end the following:CommentsClose CommentsPermalink





`(ii) EXPENDITURES TO COMPLY WITH CITIZENSHIP OR NATIONALITY VERIFICATION REQUIREMENTS- Expenditures necessary for the State to comply with paragraph (9)(A).'.CommentsClose CommentsPermalink





(d) Effective Date-CommentsClose CommentsPermalink





(1) IN GENERAL-CommentsClose CommentsPermalink





(A) IN GENERAL- Except as provided in subparagraph (B), the amendments made by this section shall take effect on October 1, 2008.CommentsClose CommentsPermalink





(B) TECHNICAL AMENDMENTS- The amendments made by--CommentsClose CommentsPermalink





(i) paragraphs (1), (2), and (3) of subsection (b) shall take effect as if included in the enactment of section 6036 of the Deficit Reduction Act of 2005 (Public Law 109-171; 120 Stat. 80); andCommentsClose CommentsPermalink





(ii) paragraph (4) of subsection (b) shall take effect as if included in the enactment of section 405 of division B of the Tax Relief and Health Care Act of 2006 (Public Law 109-432; 120 Stat. 2996).CommentsClose CommentsPermalink





(2) RESTORATION OF ELIGIBILITY- In the case of an individual who, during the period that began on July 1, 2006, and ends on October 1, 2008, was determined to be ineligible for medical assistance under a State Medicaid plan, including any waiver of such plan, solely as a result of the application of subsections (i)(22) and (x) of section 1903 of the Social Security Act (as in effect during such period), but who would have been determined eligible for such assistance if such subsections, as amended by subsection (b), had applied to the individual, a State may deem the individual to be eligible for such assistance as of the date that the individual was determined to be ineligible for such medical assistance on such basis.CommentsClose CommentsPermalink





(3) SPECIAL TRANSITION RULE FOR INDIANS- During the period that begins on July 1, 2006, and ends on the effective date of final regulations issued under subclause (II) of section 1903(x)(3)(B)(v) of the Social Security Act (42 U.S.C. 1396b(x)(3)(B)(v)) (as added by subsection (b)(1)(B)), an individual who is a member of a federally-recognized Indian tribe described in subclause (II) of that section who presents a document described in subclause (I) of such section that is issued by such Indian tribe, shall be deemed to have presented satisfactory evidence of citizenship or nationality for purposes of satisfying the requirement of subsection (x) of section 1903 of such Act.CommentsClose CommentsPermalink

SEC. 212. REDUCING ADMINISTRATIVE BARRIERS TO ENROLLMENT.

Section 2102(b) (42 U.S.C. 1397bb(b)) is amended--CommentsClose CommentsPermalink





(1) by redesignating paragraph (4) as paragraph (5); andCommentsClose CommentsPermalink





(2) by inserting after paragraph (3) the following new paragraph:CommentsClose CommentsPermalink





`(4) REDUCTION OF ADMINISTRATIVE BARRIERS TO ENROLLMENT-CommentsClose CommentsPermalink





`(A) IN GENERAL- Subject to subparagraph (B), the plan shall include a description of the procedures used to reduce administrative barriers to the enrollment of children and pregnant women who are eligible for medical assistance under title XIX or for child health assistance or health benefits coverage under this title. Such procedures shall be established and revised as often as the State determines appropriate to take into account the most recent information available to the State identifying such barriers.CommentsClose CommentsPermalink





`(B) DEEMED COMPLIANCE IF JOINT APPLICATION AND RENEWAL PROCESS THAT PERMITS APPLICATION OTHER THAN IN PERSON- A State shall be deemed to comply with subparagraph (A) if the State's application and renewal forms and supplemental forms (if any) and information verification process is the same for purposes of establishing and renewing eligibility for children and pregnant women for medical assistance under title XIX and child health assistance under this title, and such process does not require an application to be made in person or a face-to-face interview.'.CommentsClose CommentsPermalink

SEC. 213. MODEL OF INTERSTATE COORDINATED ENROLLMENT AND COVERAGE PROCESS.

(a) In General- In order to assure continuity of coverage of low-income children under the Medicaid program and the State Children's Health Insurance Program (CHIP), not later than 18 months after the date of the enactment of this Act, the Secretary of Health and Human Services, in consultation with State Medicaid and CHIP directors and organizations representing program beneficiaries, shall develop a model process for the coordination of the enrollment, retention, and coverage under such programs of children who, because of migration of families, emergency evacuations, natural or other disasters, public health emergencies, educational needs, or otherwise, frequently change their State of residency or otherwise are temporarily located outside of the State of their residency.CommentsClose CommentsPermalink





(b) Report to Congress- After development of such model process, the Secretary of Health and Human Services shall submit to Congress a report describing additional steps or authority needed to make further improvements to coordinate the enrollment, retention, and coverage under CHIP and Medicaid of children described in subsection (a).CommentsClose CommentsPermalink

TITLE III--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE

Subtitle A--Additional State Option for Providing Premium Assistance

SEC. 301. ADDITIONAL STATE OPTION FOR PROVIDING PREMIUM ASSISTANCE.

(a) CHIP-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 2105(c) (42 U.S.C. 1397ee(c)), as amended by sections 114(a), 116(c), and 211(c), is amended by adding at the end the following:CommentsClose CommentsPermalink





`(11) STATE OPTION TO OFFER PREMIUM ASSISTANCE-CommentsClose CommentsPermalink





`(A) IN GENERAL- A State may elect to offer a premium assistance subsidy (as defined in subparagraph (C)) for qualified employer-sponsored coverage (as defined in subparagraph (B)) to all targeted low-income children who are eligible for child health assistance under the plan and have access to such coverage in accordance with the requirements of this paragraph. No subsidy shall be provided to a targeted low-income child under this paragraph unless the child (or the child's parent) voluntarily elects to receive such a subsidy. A State may not require such an election as a condition of receipt of child health assistance.CommentsClose CommentsPermalink





`(B) QUALIFIED EMPLOYER-SPONSORED COVERAGE-CommentsClose CommentsPermalink





`(i) IN GENERAL- Subject to clause (ii), in this paragraph, the term `qualified employer-sponsored coverage' means a group health plan or health insurance coverage offered through an employer--CommentsClose CommentsPermalink





`(I) that qualifies as creditable coverage as a group health plan under section 2701(c)(1) of the Public Health Service Act;CommentsClose CommentsPermalink





`(II) for which the employer contribution toward any premium for such coverage is at least 40 percent; andCommentsClose CommentsPermalink





`(III) that is offered to all individuals in a manner that would be considered a nondiscriminatory eligibility classification for purposes of paragraph (3)(A)(ii) of section 105(h) of the Internal Revenue Code of 1986 (but determined without regard to clause (i) of subparagraph (B) of such paragraph).CommentsClose CommentsPermalink





`(ii) EXCEPTION- Such term does not include coverage consisting of--CommentsClose CommentsPermalink





`(I) benefits provided under a health flexible spending arrangement (as defined in section 106(c)(2) of the Internal Revenue Code of 1986); orCommentsClose CommentsPermalink





`(II) a high deductible health plan (as defined in section 223(c)(2) of such Code), without regard to whether the plan is purchased in conjunction with a health savings account (as defined under section 223(d) of such Code).CommentsClose CommentsPermalink





`(C) PREMIUM ASSISTANCE SUBSIDY-CommentsClose CommentsPermalink





`(i) IN GENERAL- In this paragraph, the term `premium assistance subsidy' means, with respect to a targeted low-income child, the amount equal to the difference between the employee contribution required for enrollment only of the employee under qualified employer-sponsored coverage and the employee contribution required for enrollment of the employee and the child in such coverage, less any applicable premium cost-sharing applied under the State child health plan (subject to the limitations imposed under section 2103(e), including the requirement to count the total amount of the employee contribution required for enrollment of the employee and the child in such coverage toward the annual aggregate cost-sharing limit applied under paragraph (3)(B) of such section).CommentsClose CommentsPermalink





`(ii) STATE PAYMENT OPTION- A State may provide a premium assistance subsidy either as reimbursement to an employee for out-of-pocket expenditures or, subject to clause (iii), directly to the employee's employer.CommentsClose CommentsPermalink





`(iii) EMPLOYER OPT-OUT- An employer may notify a State that it elects to opt-out of being directly paid a premium assistance subsidy on behalf of an employee. In the event of such a notification, an employer shall withhold the total amount of the employee contribution required for enrollment of the employee and the child in the qualified employer-sponsored coverage and the State shall pay the premium assistance subsidy directly to the employee.CommentsClose CommentsPermalink





`(iv) TREATMENT AS CHILD HEALTH ASSISTANCE- Expenditures for the provision of premium assistance subsidies shall be considered child health assistance described in paragraph (1)(C) of subsection (a) for purposes of making payments under that subsection.CommentsClose CommentsPermalink





`(D) APPLICATION OF SECONDARY PAYOR RULES- The State shall be a secondary payor for any items or services provided under the qualified employer-sponsored coverage for which the State provides child health assistance under the State child health plan.CommentsClose CommentsPermalink





`(E) REQUIREMENT TO PROVIDE SUPPLEMENTAL COVERAGE FOR BENEFITS AND COST-SHARING PROTECTION PROVIDED UNDER THE STATE CHILD HEALTH PLAN-CommentsClose CommentsPermalink





`(i) IN GENERAL- Notwithstanding section 2110(b)(1)(C), the State shall provide for each targeted low-income child enrolled in qualified employer-sponsored coverage, supplemental coverage consisting of--CommentsClose CommentsPermalink





`(I) items or services that are not covered, or are only partially covered, under the qualified employer-sponsored coverage; andCommentsClose CommentsPermalink





`(II) cost-sharing protection consistent with section 2103(e).CommentsClose CommentsPermalink





`(ii) RECORD KEEPING REQUIREMENTS- For purposes of carrying out clause (i), a State may elect to directly pay out-of-pocket expenditures for cost-sharing imposed under the qualified employer-sponsored coverage and collect or not collect all or any portion of such expenditures from the parent of the child.CommentsClose CommentsPermalink





`(F) APPLICATION OF WAITING PERIOD IMPOSED UNDER THE STATE- Any waiting period imposed under the State child health plan prior to the provision of child health assistance to a targeted low-income child under the State plan shall apply to the same extent to the provision of a premium assistance subsidy for the child under this paragraph.CommentsClose CommentsPermalink





`(G) OPT-OUT PERMITTED FOR ANY MONTH- A State shall establish a process for permitting the parent of a targeted low-income child receiving a premium assistance subsidy to disenroll the child from the qualified employer-sponsored coverage and enroll the child in, and receive child health assistance under, the State child health plan, effective on the first day of any month for which the child is eligible for such assistance and in a manner that ensures continuity of coverage for the child.CommentsClose CommentsPermalink





`(H) APPLICATION TO PARENTS- If a State provides child health assistance or health benefits coverage to parents of a targeted low-income child in accordance with section 2111(b), the State may elect to offer a premium assistance subsidy to a parent of a targeted low-income child who is eligible for such a subsidy under this paragraph in the same manner as the State offers such a subsidy for the enrollment of the child in qualified employer-sponsored coverage, except that--CommentsClose CommentsPermalink





`(i) the amount of the premium assistance subsidy shall be increased to take into account the cost of the enrollment of the parent in the qualified employer-sponsored coverage or, at the option of the State if the State determines it cost-effective, the cost of the enrollment of the child's family in such coverage; andCommentsClose CommentsPermalink





`(ii) any reference in this paragraph to a child is deemed to include a reference to the parent or, if applicable under clause (i), the family of the child.CommentsClose CommentsPermalink





`(I) ADDITIONAL STATE OPTION FOR PROVIDING PREMIUM ASSISTANCE-CommentsClose CommentsPermalink





`(i) IN GENERAL- A State may establish an employer-family premium assistance purchasing pool for employers with less than 250 employees who have at least 1 employee who is a pregnant woman eligible for assistance under the State child health plan (including through the application of an option described in section 2112(f)) or a member of a family with at least 1 targeted low-income child and to provide a premium assistance subsidy under this paragraph for enrollment in coverage made available through such pool.CommentsClose CommentsPermalink





`(ii) ACCESS TO CHOICE OF COVERAGE- A State that elects the option under clause (i) shall identify and offer access to not less than 2 private health plans that are health benefits coverage that is equivalent to the benefits coverage in a benchmark benefit package described in section 2103(b) or benchmark-equivalent coverage that meets the requirements of section 2103(a)(2) for employees described in clause (i).CommentsClose CommentsPermalink





`(iii) CLARIFICATION OF PAYMENT FOR ADMINISTRATIVE EXPENDITURES- Nothing in this subparagraph shall be construed as permitting payment under this section for administrative expenditures attributable to the establishment or operation of such pool, except to the extent that such payment would otherwise be permitted under this title.CommentsClose CommentsPermalink





`(J) NO EFFECT ON PREMIUM ASSISTANCE WAIVER PROGRAMS- Nothing in this paragraph shall be construed as limiting the authority of a State to offer premium assistance under section 1906 or 1906A, a waiver described in paragraph (2)(B) or (3), a waiver approved under section 1115, or other authority in effect prior to the date of enactment of the Children's Health Insurance Program Reauthorization Act of 2007.CommentsClose CommentsPermalink





`(K) NOTICE OF AVAILABILITY- If a State elects to provide premium assistance subsidies in accordance with this paragraph, the State shall--CommentsClose CommentsPermalink





`(i) include on any application or enrollment form for child health assistance a notice of the availability of premium assistance subsidies for the enrollment of targeted low-income children in qualified employer-sponsored coverage;CommentsClose CommentsPermalink





`(ii) provide, as part of the application and enrollment process under the State child health plan, information describing the availability of such subsidies and how to elect to obtain such a subsidy; andCommentsClose CommentsPermalink





`(iii) establish such other procedures as the State determines necessary to ensure that parents are fully informed of the choices for receiving child health assistance under the State child health plan or through the receipt of premium assistance subsidies.CommentsClose CommentsPermalink





`(L) APPLICATION TO QUALIFIED EMPLOYER-SPONSORED BENCHMARK COVERAGE- If a group health plan or health insurance coverage offered through an employer is certified by an actuary as health benefits coverage that is equivalent to the benefits coverage in a benchmark benefit package described in section 2103(b) or benchmark-equivalent coverage that meets the requirements of section 2103(a)(2), the State may provide premium assistance subsidies for enrollment of targeted low-income children in such group health plan or health insurance coverage in the same manner as such subsidies are provided under this paragraph for enrollment in qualified employer-sponsored coverage, but without regard to the requirement to provide supplemental coverage for benefits and cost-sharing protection provided under the State child health plan under subparagraph (E).CommentsClose CommentsPermalink





`(M) SATISFACTION OF COST-EFFECTIVENESS TEST- Premium assistance subsidies for qualified employer-sponsored coverage offered under this paragraph shall be deemed to meet the requirement of subparagraph (A) of paragraph (3).'.CommentsClose CommentsPermalink





(2) DETERMINATION OF COST-EFFECTIVENESS FOR PREMIUM ASSISTANCE OR PURCHASE OF FAMILY COVERAGE-CommentsClose CommentsPermalink





(A) IN GENERAL- Section 2105(c)(3)(A) (42 U.S.C. 1397ee(c)(3)(A)) is amended by striking `relative to' and all that follows through the comma and inserting `relative toCommentsClose CommentsPermalink





`(i) the amount of expenditures under the State child health plan, including administrative expenditures, that the State would have made to provide comparable coverage of the targeted low-income child involved or the family involved (as applicable); orCommentsClose CommentsPermalink





`(ii) the aggregate amount of expenditures that the State would have made under the State child health plan, including administrative expenditures, for providing coverage under such plan for all such children or families.'.CommentsClose CommentsPermalink





(B) NONAPPLICATION TO PREVIOUSLY APPROVED COVERAGE- The amendment made by subparagraph (A) shall not apply to coverage the purchase of which has been approved by the Secretary under section 2105(c)(3) of the Social Security Act prior to the date of enactment of this Act.CommentsClose CommentsPermalink





(b) Medicaid- Title XIX is amended by inserting after section 1906 the following new section:CommentsClose CommentsPermalink

`PREMIUM ASSISTANCE OPTION FOR CHILDREN

`Sec. 1906A. (a) In General- A State may elect to offer a premium assistance subsidy (as defined in subsection (c)) for qualified employer-sponsored coverage (as defined in subsection (b)) to all individuals under age 19 who are entitled to medical assistance under this title (and to the parent of such an individual) who have access to such coverage if the State meets the requirements of this section.CommentsClose CommentsPermalink





`(b) Qualified Employer-Sponsored Coverage-CommentsClose CommentsPermalink





`(1) IN GENERAL- Subject to paragraph (2)), in this paragraph, the term `qualified employer-sponsored coverage' means a group health plan or health insurance coverage offered through an employer--CommentsClose CommentsPermalink





`(A) that qualifies as creditable coverage as a group health plan under section 2701(c)(1) of the Public Health Service Act;CommentsClose CommentsPermalink





`(B) for which the employer contribution toward any premium for such coverage is at least 40 percent; andCommentsClose CommentsPermalink





`(C) that is offered to all individuals in a manner that would be considered a nondiscriminatory eligibility classification for purposes of paragraph (3)(A)(ii) of section 105(h) of the Internal Revenue Code of 1986 (but determined without regard to clause (i) of subparagraph (B) of such paragraph).CommentsClose CommentsPermalink





`(2) EXCEPTION- Such term does not include coverage consisting of--CommentsClose CommentsPermalink





`(A) benefits provided under a health flexible spending arrangement (as defined in section 106(c)(2) of the Internal Revenue Code of 1986); orCommentsClose CommentsPermalink





`(B) a high deductible health plan (as defined in section 223(c)(2) of such Code), without regard to whether the plan is purchased in conjunction with a health savings account (as defined under section 223(d) of such Code).CommentsClose CommentsPermalink





`(3) TREATMENT AS THIRD PARTY LIABILITY- The State shall treat the coverage provided under qualified employer-sponsored coverage as a third party liability under section 1902(a)(25).CommentsClose CommentsPermalink





`(c) Premium Assistance Subsidy- In this section, the term `premium assistance subsidy' means the amount of the employee contribution for enrollment in the qualified employer-sponsored coverage by the individual under age 19 or by the individual's family. Premium assistance subsidies under this section shall be considered, for purposes of section 1903(a), to be a payment for medical assistance.CommentsClose CommentsPermalink





`(d) Voluntary Participation-CommentsClose CommentsPermalink





`(1) EMPLOYERS- Participation by an employer in a premium assistance subsidy offered by a State under this section shall be voluntary. An employer may notify a State that it elects to opt-out of being directly paid a premium assistance subsidy on behalf of an employee.CommentsClose CommentsPermalink





`(2) BENEFICIARIES- No subsidy shall be provided to an individual under age 19 under this section unless the individual (or the individual's parent) voluntarily elects to receive such a subsidy. A State may not require such an election as a condition of receipt of medical assistance. State may not require, as a condition of an individual under age 19 (or the individual's parent) being or remaining eligible for medical assistance under this title, apply for enrollment in qualified employer-sponsored coverage under this section.CommentsClose CommentsPermalink





`(3) OPT-OUT PERMITTED FOR ANY MONTH- A State shall establish a process for permitting the parent of an individual under age 19 receiving a premium assistance subsidy to disenroll the individual from the qualified employer-sponsored coverage.CommentsClose CommentsPermalink





`(e) Requirement to Pay Premiums and Cost-Sharing and Provide Supplemental Coverage- In the case of the participation of an individual under age 19 (or the individual's parent) in a premium assistance subsidy under this section for qualified employer-sponsored coverage, the State shall provide for payment of all enrollee premiums for enrollment in such coverage and all deductibles, coinsurance, and other cost-sharing obligations for items and services otherwise covered under the State plan under this title (exceeding the amount otherwise permitted under section 1916 or, if applicable, section 1916A). The fact that an individual under age 19 (or a parent) elects to enroll in qualified employer-sponsored coverage under this section shall not change the individual's (or parent's) eligibility for medical assistance under the State plan, except insofar as section 1902(a)(25) provides that payments for such assistance shall first be made under such coverage.'.CommentsClose CommentsPermalink





(c) GAO Study and Report- Not later than January 1, 2009, the Comptroller General of the United States shall study cost and coverage issues relating to any State premium assistance programs for which Federal matching payments are made under title XIX or XXI of the Social Security Act, including under waiver authority, and shall submit a report to the Committee on Finance of the Senate and the Committee on Energy and Commerce of the House of Representatives on the results of such study.CommentsClose CommentsPermalink

SEC. 302. OUTREACH, EDUCATION, AND ENROLLMENT ASSISTANCE.

(a) Requirement To Include Description of Outreach, Education, and Enrollment Efforts Related to Premium Assistance Subsidies in State Child Health Plan- Section 2102(c) (42 U.S.C. 1397bb(c)) is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





`(3) PREMIUM ASSISTANCE SUBSIDIES- In the case of a State that provides for premium assistance subsidies under the State child health plan in accordance with paragraph (2)(B), (3), or (10) of section 2105(c), or a waiver approved under section 1115, outreach, education, and enrollment assistance for families of children likely to be eligible for such subsidies, to inform such families of the availability of, and to assist them in enrolling their children in, such subsidies, and for employers likely to provide coverage that is eligible for such subsidies, including the specific, significant resources the State intends to apply to educate employers about the availability of premium assistance subsidies under the State child health plan.'.CommentsClose CommentsPermalink





(b) Nonapplication of 10 Percent Limit on Outreach and Certain Other Expenditures- Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as amended by section 301(c)(2), is amended by adding at the end the following new clause:CommentsClose CommentsPermalink





`(iv) EXPENDITURES FOR OUTREACH TO INCREASE THE ENROLLMENT OF CHILDREN UNDER THIS TITLE AND TITLE xix THROUGH PREMIUM ASSISTANCE SUBSIDIES- Expenditures for outreach activities to families of children likely to be eligible for premium assistance subsidies in accordance with paragraph (2)(B), (3), or (10), or a waiver approved under section 1115, to inform such families of the availability of, and to assist them in enrolling their children in, such subsidies, and to employers likely to provide qualified employer-sponsored coverage (as defined in subparagraph (B) of such paragraph), but not to exceed an amount equal to 1.25 percent of the maximum amount permitted to be expended under subparagraph (A) for items described in subsection (a)(1)(D).'.CommentsClose CommentsPermalink

Subtitle B--Coordinating Premium Assistance With Private Coverage

SEC. 311. SPECIAL ENROLLMENT PERIOD UNDER GROUP HEALTH PLANS IN CASE OF TERMINATION OF MEDICAID OR CHIP COVERAGE OR ELIGIBILITY FOR ASSISTANCE IN PURCHASE OF EMPLOYMENT-BASED COVERAGE; COORDINATION OF COVERAGE.

(a) Amendments to Internal Revenue Code of 1986- Section 9801(f) of the Internal Revenue Code of 1986 (relating to special enrollment periods) is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





`(3) SPECIAL RULES RELATING TO MEDICAID AND CHIP-CommentsClose CommentsPermalink





`(A) IN GENERAL- A group health plan shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the plan (or a dependent of such an employee if the dependent is eligible, but not enrolled, for coverage under such terms) to enroll for coverage under the terms of the plan if either of the following conditions is met:CommentsClose CommentsPermalink





`(i) TERMINATION OF MEDICAID OR CHIP COVERAGE- The employee or dependent is covered under a Medicaid plan under title XIX of the Social Security Act or under a State child health plan under title XXI of such Act and coverage of the employee or dependent under such a plan is terminated as a result of loss of eligibility for such coverage and the employee requests coverage under the group health plan not later than 60 days after the date of termination of such coverage.CommentsClose CommentsPermalink





`(ii) ELIGIBILITY FOR EMPLOYMENT ASSISTANCE UNDER MEDICAID OR CHIP- The employee or dependent becomes eligible for assistance, with respect to coverage under the group health plan under such Medicaid plan or State child health plan (including under any waiver or demonstration project conducted under or in relation to such a plan), if the employee requests coverage under the group health plan not later than 60 days after the date the employee or dependent is determined to be eligible for such assistance.CommentsClose CommentsPermalink





`(B) EMPLOYEE OUTREACH AND DISCLOSURE-CommentsClose CommentsPermalink





`(i) OUTREACH TO EMPLOYEES REGARDING AVAILABILITY OF MEDICAID AND CHIP COVERAGE-CommentsClose CommentsPermalink





`(I) IN GENERAL- Each employer that maintains a group health plan in a State that provides medical assistance under a State Medicaid plan under title XIX of the Social Security Act, or child health assistance under a State child health plan under title XXI of such Act, in the form of premium assistance for the purchase of coverage under a group health plan, shall provide to each employee a written notice informing the employee of potential opportunities then currently available in the State in which the employee resides for premium assistance under such plans for health coverage of the employee or the employee's dependents. For purposes of compliance with this clause, the employer may use any State-specific model notice developed in accordance with section 701(f)(3)(B)(i)(II) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1181(f)(3)(B)(i)(II)).CommentsClose CommentsPermalink





`(II) OPTION TO PROVIDE CONCURRENT WITH PROVISION OF PLAN MATERIALS TO EMPLOYEE- An employer may provide the model notice applicable to the State in which an employee resides concurrent with the furnishing of materials notifying the employee of health plan eligibility, concurrent with materials provided to the employee in connection with an open season or election process conducted under the plan, or concurrent with the furnishing of the summary plan description as provided in section 104(b) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1024).CommentsClose CommentsPermalink





`(ii) DISCLOSURE ABOUT GROUP HEALTH PLAN BENEFITS TO STATES FOR MEDICAID AND CHIP ELIGIBLE INDIVIDUALS- In the case of a participant or beneficiary of a group health plan who is covered under a Medicaid plan of a State under title XIX of the Social Security Act or under a State child health plan under title XXI of such Act, the plan administrator of the group health plan shall disclose to the State, upon request, information about the benefits available under the group health plan in sufficient specificity, as determined under regulations of the Secretary of Health and Human Services in consultation with the Secretary that require use of the model coverage coordination disclosure form developed under section 311(b)(1)(C) of the Children's Health Insurance Program Reauthorization Act of 2007, so as to permit the State to make a determination (under paragraph (2)(B), (3), or (10) of section 2105(c) of the Social Security Act or otherwise) concerning the cost-effectiveness of the State providing medical or child health assistance through premium assistance for the purchase of coverage under such group health plan and in order for the State to provide supplemental benefits required under paragraph (10)(E) of such section or other authority.'.CommentsClose CommentsPermalink





(b) Conforming Amendments-CommentsClose CommentsPermalink





(1) AMENDMENTS TO EMPLOYEE RETIREMENT INCOME SECURITY ACT-CommentsClose CommentsPermalink





(A) IN GENERAL- Section 701(f) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1181(f)) is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





`(3) SPECIAL RULES FOR APPLICATION IN CASE OF MEDICAID AND CHIP-CommentsClose CommentsPermalink





`(A) IN GENERAL- A group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the plan (or a dependent of such an employee if the dependent is eligible, but not enrolled, for coverage under such terms) to enroll for coverage under the terms of the plan if either of the following conditions is met:Comments