S 1893 PCSCommentsClose CommentsPermalink

To amend title XXI of the Social Security Act to reauthorize the State Children's Health Insurance Program, and for other purposes.CommentsClose CommentsPermalink

July 27 (legislative day, July 26), 2007

Mr. BAUCUS, from the Committee on Finance, reported the following original bill; which was read twice and placed on the calendarCommentsClose CommentsPermalink

To amend title XXI of the Social Security Act to reauthorize the State Children's Health Insurance Program, and for other purposes.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

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

(a) Short Title- This Act may be cited as the `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 Medicaid; CHIP; 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 for this Act is as follows:CommentsClose CommentsPermalink





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

TITLE I--FINANCING OF CHIP

Sec. 101. Extension of CHIP.CommentsClose CommentsPermalink





Sec. 102. Allotments for the 50 States and the District of Columbia.CommentsClose CommentsPermalink





Sec. 103. One-time appropriation.CommentsClose CommentsPermalink





Sec. 104. Improving funding for the territories under CHIP and Medicaid.CommentsClose CommentsPermalink





Sec. 105. Incentive bonuses for States.CommentsClose CommentsPermalink





Sec. 106. Phase-out of coverage for nonpregnant childless adults under CHIP; conditions for coverage of parents.CommentsClose CommentsPermalink





Sec. 107. State option to cover low-income pregnant women under CHIP through a State plan amendment.CommentsClose CommentsPermalink





Sec. 108. CHIP Contingency fund.CommentsClose CommentsPermalink





Sec. 109. Two-year availability of allotments; expenditures counted against oldest allotments.CommentsClose CommentsPermalink





Sec. 110. 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. 111. Option for qualifying States to receive the enhanced portion of the CHIP matching rate for Medicaid coverage of certain children.CommentsClose CommentsPermalink

TITLE II--OUTREACH AND ENROLLMENT

Sec. 201. Grants for outreach and enrollment.CommentsClose CommentsPermalink





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





Sec. 203. Demonstration project to permit States to rely on findings by an Express Lane agency to determine components of a child's eligibility for Medicaid or CHIP.CommentsClose CommentsPermalink





Sec. 204. Authorization of certain information disclosures to simplify health coverage determinations.CommentsClose CommentsPermalink

TITLE III--REDUCING BARRIERS TO ENROLLMENT

Sec. 301. Verification of declaration of citizenship or nationality for purposes of eligibility for Medicaid and CHIP.CommentsClose CommentsPermalink





Sec. 302. Reducing administrative barriers to enrollment.CommentsClose CommentsPermalink

TITLE IV--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE

Subtitle A--Additional State Option for Providing Premium Assistance

Sec. 401. Additional State option for providing premium assistance.CommentsClose CommentsPermalink





Sec. 402. Outreach, education, and enrollment assistance.CommentsClose CommentsPermalink

Subtitle B--Coordinating Premium Assistance With Private Coverage

Sec. 411. 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 V--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES OF CHILDREN

Sec. 501. Child health quality improvement activities for children enrolled in Medicaid or CHIP.CommentsClose CommentsPermalink





Sec. 502. Improved information regarding access to coverage under CHIP.CommentsClose CommentsPermalink





Sec. 503. Application of certain managed care quality safeguards to CHIP.CommentsClose CommentsPermalink

TITLE VI--MISCELLANEOUS

Sec. 601. Technical correction regarding current State authority under Medicaid.CommentsClose CommentsPermalink





Sec. 602. Payment error rate measurement (`PERM').CommentsClose CommentsPermalink





Sec. 603. Elimination of counting medicaid child presumptive eligibility costs against title XXI allotment.CommentsClose CommentsPermalink





Sec. 604. Improving data collection.CommentsClose CommentsPermalink





Sec. 605. Deficit Reduction Act technical corrections.CommentsClose CommentsPermalink





Sec. 606. Elimination of confusing program references.CommentsClose CommentsPermalink





Sec. 607. Mental health parity in CHIP plans.CommentsClose CommentsPermalink





Sec. 608. Dental health grants.CommentsClose CommentsPermalink





Sec. 609. Application of prospective payment system for services provided by Federally-qualified health centers and rural health clinics.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

TITLE VIII--EFFECTIVE DATE

Sec. 801. Effective date.CommentsClose CommentsPermalink

TITLE I--FINANCING OF CHIP

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 THE 50 STATES AND THE DISTRICT OF COLUMBIA.

(a) In General- Section 2104 (42 U.S.C. 1397dd) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





`(i) Determination of Allotments for the 50 States and the District of Columbia for Fiscal Years 2008 Through 2012-CommentsClose CommentsPermalink





`(1) COMPUTATION OF ALLOTMENT-CommentsClose CommentsPermalink





`(A) IN GENERAL- Subject to the succeeding paragraphs of this subsection, the Secretary shall for each of fiscal years 2008 through 2012 allot to each subsection (b) State from the available national allotment an amount equal to 110 percent of--CommentsClose CommentsPermalink





`(i) in the case of fiscal year 2008, the highest of the amounts determined under paragraph (2);CommentsClose CommentsPermalink





`(ii) in the case of each of fiscal years 2009 through 2011, the Federal share of the expenditures determined under subparagraph (B) for the fiscal year; andCommentsClose CommentsPermalink





`(iii) beginning with fiscal year 2012, subject to subparagraph (E), each semi-annual allotment determined under subparagraph (D).CommentsClose CommentsPermalink





`(B) PROJECTED STATE EXPENDITURES FOR THE FISCAL YEAR- For purposes of subparagraphs (A)(ii) and (D), the expenditures determined under this subparagraph for a fiscal year are the projected expenditures under the State child health plan 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).CommentsClose CommentsPermalink





`(C) AVAILABLE NATIONAL ALLOTMENT- For purposes of this subsection, the term `available national allotment' means, with respect to any fiscal year, the amount available for allotment under subsection (a) for the fiscal year, reduced by the amount of the allotments made for the fiscal year under subsection (c). Subject to paragraph (3)(B), the available national allotment with respect to the amount available under subsection (a)(15)(A) for fiscal year 2012 shall be increased by the amount of the appropriation for the period beginning on October 1 and ending on March 31 of such fiscal year under section 103 of the Children's Health Insurance Program Reauthorization Act of 2007.CommentsClose CommentsPermalink





`(D) SEMI-ANNUAL ALLOTMENTS- For purposes of subparagraph (A)(iii), the semi-annual allotments determined under this paragraph with respect to a fiscal year are as follows:CommentsClose CommentsPermalink





`(i) For the period beginning on October 1 and ending on March 31 of the fiscal year, the Federal share of the portion of the expenditures determined under subparagraph (B) for the fiscal year which are allocable to such period.CommentsClose CommentsPermalink





`(ii) For the period beginning on April 1 and ending on September 30 of the fiscal year, the Federal share of the portion of the expenditures determined under subparagraph (B) for the fiscal year which are allocable to such period.CommentsClose CommentsPermalink





`(E) AVAILABILITY- Each semi-annual allotment made under subparagraph (A)(iii) shall remain available for expenditure under this title for periods after the period specified in subparagraph (D) for purposes of determining the allotment in the same manner as the allotment would have been available for expenditure if made for an entire fiscal year.CommentsClose CommentsPermalink





`(2) SPECIAL RULE FOR FISCAL YEAR 2008-CommentsClose CommentsPermalink





`(A) IN GENERAL- For purposes of paragraph (1)(A)(i), the amounts determined under this paragraph for fiscal year 2008 are as follows:CommentsClose CommentsPermalink





`(i) The total Federal payments to the State under this title for fiscal year 2007, multiplied by the annual adjustment determined under subparagraph (B) 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 annual adjustment determined under subparagraph (B) 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 paragraphs (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 annual adjustment determined under subparagraph (B) 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) ANNUAL ADJUSTMENT FOR HEALTH CARE COST GROWTH AND CHILD POPULATION GROWTH- The annual adjustment determined under this subparagraph for a fiscal year with respect to a State is equal to the product of the amounts determined under clauses (i) and (ii):CommentsClose CommentsPermalink





`(i) PER CAPITA HEALTH CARE GROWTH- 1 plus 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





`(ii) CHILD POPULATION GROWTH- 1.01 plus the percentage change in the population of children under 19 years of age in the State from July 1 of the fiscal year preceding the fiscal year involved to July 1 of the fiscal year involved, as determined by the Secretary based on the most timely and accurate published estimates of the Bureau of the Census.CommentsClose CommentsPermalink





`(C) DEFINITION- For purposes of subparagraph (B), the term `fiscal year involved' means the fiscal year for which an allotment under this subsection is being determined.CommentsClose CommentsPermalink





`(D) PRORATION RULE- If, after the application of this paragraph without regard to this subparagraph, the sum of the State allotments determined under this paragraph for fiscal year 2008 exceeds the available national allotment for fiscal year 2008, the Secretary shall reduce each such allotment on a proportional basis.CommentsClose CommentsPermalink





`(3) ALTERNATIVE ALLOTMENTS FOR FISCAL YEARS 2009 THROUGH 2012-CommentsClose CommentsPermalink





`(A) IN GENERAL- If the sum of the State allotments determined under paragraph (1)(A)(ii) for any of fiscal years 2009 through 2011 exceeds the available national allotment for the fiscal year, the Secretary shall allot to each subsection (b) State from the available national allotment for the fiscal year an amount equal to the product of--CommentsClose CommentsPermalink





`(i) the available national allotment for the fiscal year; andCommentsClose CommentsPermalink





`(ii) the percentage equal to the sum of the State allotment factors for the fiscal year determined under paragraph (4) with respect to the State.CommentsClose CommentsPermalink





`(B) SPECIAL RULES BEGINNING IN FISCAL YEAR 2012- Beginning in fiscal year 2012--CommentsClose CommentsPermalink





`(i) this paragraph shall be applied separately with respect to each of the periods described in clauses (i) and (ii) of paragraph (1)(D) and the available national allotment for each such period shall be the amount appropriated for such period (rather than the amount appropriated for the entire fiscal year), reduced by the amount of the allotments made for the fiscal year under subsection (c) for each such period, andCommentsClose CommentsPermalink





`(ii) if--CommentsClose CommentsPermalink





`(I) the sum of the State allotments determined under paragraph (1)(A)(iii) for either such period exceeds the amount of such available national allotment for such period, the Secretary shall make the allotment for each State for such period in the same manner as under subparagraph (A), andCommentsClose CommentsPermalink





`(II) the amount of such available national allotment for either such period exceeds the sum of the State allotments determined under paragraph (1)(A)(iii) for such period, the Secretary shall increase the allotment for each State for such period by the amount that bears the same ratio to such excess as the State's allotment determined under paragraph (1)(A)(iii) for such period (without regard to this subparagraph) bears to the sum of such allotments for all States.CommentsClose CommentsPermalink





`(4) WEIGHTED FACTORS-CommentsClose CommentsPermalink





`(A) FACTORS DESCRIBED- For purposes of paragraph (3), the factors described in this subparagraph are the following:CommentsClose CommentsPermalink





`(i) PROJECTED STATE EXPENDITURES FOR THE FISCAL YEAR- The ratio of the projected expenditures under the State child health plan for the fiscal year (as certified by the State to the Secretary by not later than August 31 of the preceding fiscal year) to the sum of the projected expenditures under all such plans for all subsection (b) States for the fiscal year, multiplied by the applicable percentage weight assigned under subparagraph (B).CommentsClose CommentsPermalink





`(ii) NUMBER OF LOW-INCOME CHILDREN IN THE STATE- The ratio of the number of low-income children in the State, as determined on the basis of the most timely and accurate published estimates of the Bureau of the Census, to the sum of the number of low-income children so determined for all subsection (b) States for such fiscal year, multiplied by the applicable percentage weight assigned under subparagraph (B).CommentsClose CommentsPermalink





`(iii) PROJECTED STATE EXPENDITURES FOR THE PRECEDING FISCAL YEAR- The ratio of the projected expenditures under the State child health plan for the preceding fiscal year (as determined on the basis of the projections certified by the State to the Secretary for November of the fiscal year), to the sum of the projected expenditures under all such plans for all subsection (b) States for such preceding fiscal year (as so determined), multiplied by the applicable percentage weight assigned under subparagraph (B).CommentsClose CommentsPermalink





`(iv) ACTUAL STATE EXPENDITURES FOR THE SECOND PRECEDING FISCAL YEAR- The ratio of the actual expenditures under the State child health plan for the second preceding fiscal year, as determined by the Secretary on the basis of expenditure data reported by States on CMS Form 64 or CMS Form 21, to such sum of the actual expenditures under all such plans for all subsection (b) States for such second preceding fiscal year, multiplied by the applicable percentage weight assigned under subparagraph (B).CommentsClose CommentsPermalink





`(B) ASSIGNMENT OF WEIGHTS- For each of fiscal years 2009 through 2012, the applicable weights assigned under this subparagraph are the following:CommentsClose CommentsPermalink





`(i) With respect to the factor described in subparagraph (A)(i), a weight of 75 percent for each such fiscal year.CommentsClose CommentsPermalink





`(ii) With respect to the factor described in subparagraph (A)(ii), a weight of 12 1/2 percent for each such fiscal year.CommentsClose CommentsPermalink





`(iii) With respect to the factor described in subparagraph (A)(iii), a weight of 7 1/2 percent for each such fiscal year.CommentsClose CommentsPermalink





`(iv) With respect to the factor described in subparagraph (A)(iv), a weight of 5 percent for each such fiscal year.CommentsClose CommentsPermalink





`(5) DEMONSTRATION OF NEED FOR INCREASED ALLOTMENT BASED ON PROJECTED STATE EXPENDITURES EXCEEDING 10 PERCENT OF THE PRECEDING FISCAL YEAR ALLOTMENT-CommentsClose CommentsPermalink





`(A) IN GENERAL- If the projected expenditures under the State child health plan described in paragraph (1)(B) for any of fiscal years 2009 through 2012 are at least 10 percent more than the allotment determined for the State for the preceding fiscal year (determined without regard to paragraph (2)(D) or paragraph (3)), and, during the preceding fiscal year, the State did not receive approval for a State plan amendment or waiver to expand coverage under the State child health plan or did not receive a CHIP contingency fund payment under subsection (k)--CommentsClose CommentsPermalink





`(i) the State shall submit to the Secretary, by not later than August 31 of the preceding fiscal year, information relating to the factors that contributed to the need for the increase in the State's allotment for the fiscal year, as well as any other additional information that the Secretary may require for the State to demonstrate the need for the increase in the State's allotment for the fiscal year;CommentsClose CommentsPermalink





`(ii) the Secretary shall--CommentsClose CommentsPermalink





`(I) review the information submitted under clause (i);CommentsClose CommentsPermalink





`(II) notify the State in writing within 60 days after receipt of the information that--CommentsClose CommentsPermalink

`(aa) the projected expenditures under the State child health plan are approved or disapproved (and if disapproved, the reasons for disapproval); orCommentsClose CommentsPermalink

`(bb) specified additional information is needed; andCommentsClose CommentsPermalink

`(III) if the Secretary disapproved the projected expenditures or determined additional information is needed, provide the State with a reasonable opportunity to submit additional information to demonstrate the need for the increase in the State's allotment for the fiscal year.CommentsClose CommentsPermalink





`(B) PROVISIONAL AND FINAL ALLOTMENT- In the case of a State described in subparagraph (A) for which the Secretary has not determined by September 30 of a fiscal year whether the State has demonstrated the need for the increase in the State's allotment for the succeeding fiscal year, the Secretary shall provide the State with a provisional allotment for the fiscal year equal to 110 percent of the allotment determined for the State under this subsection for the preceding fiscal year (determined without regard to paragraph (2)(D) or paragraph (3)), and may, not later than November 30 of the fiscal year, adjust the State's allotment (and the allotments of other subsection (b) States), as necessary (and, if applicable, subject to paragraph (3)), on the basis of information submitted by the State in accordance with subparagraph (A).CommentsClose CommentsPermalink





`(6) SPECIAL RULES-CommentsClose CommentsPermalink





`(A) DEADLINE AND DATA FOR DETERMINING FISCAL YEAR 2008 ALLOTMENTS- In computing the amounts under paragraph (2)(A) and subsection (c)(5)(A) that determine the allotments to subsection (b) States and territories 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 paragraph (2)(A) or subsection (c)(5)(A) for fiscal year 2008 after December 31, 2007.CommentsClose CommentsPermalink





`(B) INCLUSION OF CERTAIN EXPENDITURES-CommentsClose CommentsPermalink





`(i) PROJECTED EXPENDITURES OF QUALIFYING STATES- Payments made or projected to be made to a qualifying State described in paragraph (2) of section 2105(g) for expenditures described in paragraph (1)(B)(ii) or (4)(B) of that section shall be included for purposes of determining the projected expenditures described in paragraph (1)(B) with respect to the allotments determined for each of fiscal years 2009 through 2012 and for purposes of determining the amounts described in clauses (i) and (iv) of paragraph (2)(A) with respect to the allotments determined for fiscal year 2008.CommentsClose CommentsPermalink





`(ii) PROJECTED EXPENDITURES UNDER BLOCK GRANT SET-ASIDES FOR NONPREGNANT CHILDLESS ADULTS AND PARENTS- Payments projected to be made to a State under subsection (a) or (b) of section 2111 shall be included for purposes of determining the projected expenditures described in paragraph (1)(B) with respect to the allotments determined for each of fiscal years 2009 through 2012 (to the extent such payments are permitted under such section), including for purposes of allocating such expenditures for purposes of clauses (i) and (ii) of paragraph (1)(D).CommentsClose CommentsPermalink





`(7) SUBSECTION (b) STATE- In this paragraph, the term `subsection (b) State' means 1 of the 50 States or the District of Columbia.'.CommentsClose CommentsPermalink





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





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





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





(3) in subsection (c)(1), by striking `subsection (d)' and inserting `subsections (d), (h), and (i)'.CommentsClose CommentsPermalink

SEC. 103. 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 subsections (c)(5) and (i) of section 2104 of the Social Security Act (42 U.S.C. 1397dd) 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 and subject to the same terms and conditions as apply to the allotments provided from such subsection (a)(15)(A).CommentsClose CommentsPermalink

SEC. 104. IMPROVING FUNDING FOR THE TERRITORIES UNDER CHIP AND MEDICAID.

(a) Update of CHIP Allotments- Section 2104(c) (42 U.S.C. 1397dd(c)) is amended--CommentsClose CommentsPermalink





(1) in paragraph (1), by inserting `and paragraphs (5) and (6)' after `and (i)'; andCommentsClose CommentsPermalink





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





`(5) ANNUAL ALLOTMENTS FOR TERRITORIES BEGINNING WITH FISCAL YEAR 2008- Of the total allotment amount appropriated under subsection (a) for a fiscal year beginning with fiscal year 2008, the Secretary shall allot to each of the commonwealths and territories described in paragraph (3) the following:CommentsClose CommentsPermalink





`(A) FISCAL YEAR 2008- For fiscal year 2008, 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 annual adjustment determined under subsection (i)(2)(B) for fiscal year 2008, except that clause (ii) thereof shall be applied by substituting `the United States' for `the State'.CommentsClose CommentsPermalink





`(B) FISCAL YEARS 2009 THROUGH 2012-CommentsClose CommentsPermalink





`(i) IN GENERAL- For each of fiscal years 2009 through 2012, except as provided in clause (ii), the amount determined under this paragraph for the preceding fiscal year multiplied by the annual adjustment determined under subsection (i)(2)(B) for the fiscal year, except that clause (ii) thereof shall be applied by substituting `the United States' for `the State'.CommentsClose CommentsPermalink





`(ii) SPECIAL RULE FOR FISCAL YEAR 2012- In the case of fiscal year 2012--CommentsClose CommentsPermalink





`(I) 89 percent of the amount allocated to the commonwealth or territory for such fiscal year (without regard to this subclause) shall be allocated for the period beginning on October 1, 2011, and ending on March 31, 2012, andCommentsClose CommentsPermalink





`(II) 11 percent of such amount shall be allocated for the period beginning on April 1, 2012, and ending on September 30, 2012.'.CommentsClose CommentsPermalink





(b) 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





(c) GAO Study and Report- Not later than September 30, 2009, the Comptroller General of the United States shall submit a report to the appropriate committees of Congress 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 for improving Federal funding under Medicaid and CHIP for such commonwealths and territories.CommentsClose CommentsPermalink

SEC. 105. INCENTIVE BONUSES FOR STATES.

(a) In General- 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) Incentive Bonuses-CommentsClose CommentsPermalink





`(1) ESTABLISHMENT OF INCENTIVE POOL FROM UNOBLIGATED NATIONAL ALLOTMENT AND UNEXPENDED STATE ALLOTMENTS-CommentsClose CommentsPermalink





`(A) IN GENERAL- There is hereby established in the Treasury of the United States a fund which shall be known as the `CHIP Incentive Bonuses Pool' (in this subsection referred to as the `Incentive Pool'). Amounts in the Incentive Pool are authorized to be appropriated for payments under this subsection and shall remain available until expended.CommentsClose CommentsPermalink





`(B) DEPOSITS THROUGH INITIAL APPROPRIATION AND TRANSFERS OF FUNDS-CommentsClose CommentsPermalink





`(i) INITIAL APPROPRIATION- There is appropriated to the Incentive Pool, out of any money in the Treasury not otherwise appropriated, $3,000,000,000 for fiscal year 2008.CommentsClose CommentsPermalink





`(ii) TRANSFERS- Notwithstanding any other provision of law, the following amounts are hereby appropriated or transferred to, deposited in, and made available for expenditure from the Incentive Pool on the following dates:CommentsClose CommentsPermalink





`(I) UNEXPENDED FISCAL YEAR 2006 AND 2007 ALLOTMENTS- On December 31, 2007, the sum for all States of the excess (if any) for each State of--CommentsClose CommentsPermalink

`(aa) the aggregate allotments provided for the State under subsection (b) or (c) for fiscal years 2006 and 2007 that are not expended by September 30, 2007, overCommentsClose CommentsPermalink

`(bb) an amount equal to 50 percent of the allotment provided for the State under subsection (c) or (i) for fiscal year 2008 (as determined in accordance with subsection (i)(6)).CommentsClose CommentsPermalink

`(II) UNOBLIGATED NATIONAL ALLOTMENT-CommentsClose CommentsPermalink

`(aa) FISCAL YEARS 2008 THROUGH 2011- On December 31 of fiscal year 2008, and on 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 (c) or (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- On 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 103 of the Children's Health Insurance Program 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 (c) or (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- On 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 (c) or (i) for such fiscal year or set aside under subsection (b)(2) of section 2111 for such fiscal year.CommentsClose CommentsPermalink

`(III) PERCENTAGE OF STATE ALLOTMENTS THAT ARE UNEXPENDED BY THE END OF THE FIRST YEAR OF AVAILABILITY BEGINNING WITH THE FISCAL YEAR 2009 ALLOTMENTS- On October 1 of each of fiscal years 2009 through 2012, the sum for all States for such fiscal year (the `current fiscal year') of the excess (if any) for each State of--CommentsClose CommentsPermalink

`(aa) the allotment made for the State under subsection (b), (c), or (i) for the fiscal year preceding the current fiscal year (reduced by any amounts set aside under section 2111(a)(3)) that is not expended by the end of such preceding fiscal year, overCommentsClose CommentsPermalink

`(bb) an amount equal to the applicable percentage (for the fiscal year) of the allotment made for the State under subsection (b), (c), or (i) (as so reduced) for such preceding fiscal year.CommentsClose CommentsPermalink

For purposes of item (bb), the applicable percentage is 20 percent for fiscal year 2009, and 10 percent for each of fiscal years 2010, 2011, and 2012.CommentsClose CommentsPermalink





`(IV) REMAINDER OF STATE ALLOTMENTS THAT ARE UNEXPENDED BY THE END OF THE PERIOD OF AVAILABILITY BEGINNING WITH THE FISCAL YEAR 2006 ALLOTMENTS- On October 1 of each of fiscal years 2009 through 2012, the total amount of allotments made to States under subsection (b), (c), or (i) for the second preceding fiscal year (third preceding fiscal year in the case of the fiscal year 2006 allotments) and remaining after the application of subclause (III) that are not expended by September 30 of the preceding fiscal year.CommentsClose CommentsPermalink





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





`(VI) EXCESS CHIP CONTINGENCY FUNDS-CommentsClose CommentsPermalink

`(aa) AMOUNTS IN EXCESS OF THE AGGREGATE CAP- On October 1 of each of fiscal years 2010 through 2012, any amount in excess of the aggregate cap applicable to the CHIP Contingency Fund for the fiscal year under subsection (k)(2)(B).CommentsClose CommentsPermalink

`(bb) UNEXPENDED CHIP CONTINGENCY FUND PAYMENTS- On October 1 of each of fiscal years 2010 through 2012, any portion of a CHIP Contingency Fund payment made to a State that remains unexpended at the end of the period for which the payment is available for expenditure under subsection (e)(3).CommentsClose CommentsPermalink

`(VII) EXTENSION OF AVAILABILITY FOR PORTION OF UNEXPENDED STATE ALLOTMENTS- The portion of the allotment made to a State for a fiscal year that is not transferred to the Incentive Pool under subclause (I) or (III) shall remain available for expenditure by the State only during the fiscal year in which such transfer occurs, in accordance with subclause (IV) and subsection (e)(4).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 Incentive Pool as are not immediately required for payments from the Pool. The income derived from these investments constitutes a part of the Incentive Pool.CommentsClose CommentsPermalink





`(2) PAYMENTS TO STATES INCREASING ENROLLMENT-CommentsClose CommentsPermalink





`(A) IN GENERAL- Subject to paragraph (3)(D), with respect to each of fiscal years 2009 through 2012, the Secretary shall make payments to States from the Incentive Pool determined under subparagraph (B).CommentsClose CommentsPermalink





`(B) DETERMINATION OF PAYMENTS- If, for any coverage period ending in a fiscal year ending after September 30, 2008, the average monthly enrollment of children in the State plan under title XIX exceeds the baseline monthly average for such period, the payment made for the fiscal year shall be equal to the applicable amount determined under subparagraph (C).CommentsClose CommentsPermalink





`(C) APPLICABLE AMOUNT- For purposes of subparagraph (B), the applicable amount is the product determined in accordance with the following:CommentsClose CommentsPermalink





`(i) If such excess with respect to the number of individuals who are enrolled in the State plan under title XIX does not exceed 2 percent, the product of $75 and the number of such individuals included in such excess.CommentsClose CommentsPermalink





`(ii) If such excess with respect to the number of individuals who are enrolled in the State plan under title XIX exceeds 2, but does not exceed 5 percent, the product of $300 and the number of such individuals included in such excess, less the amount of such excess calculated in clause (i).CommentsClose CommentsPermalink





`(iii) If such excess with respect to the number of individuals who are enrolled in the State plan under title XIX exceeds 5 percent, the product of $625 and the number of such individuals included in such excess, less the sum of the amount of such excess calculated in clauses (i) and (ii).CommentsClose CommentsPermalink





`(D) INDEXING OF DOLLAR AMOUNTS- For each coverage period ending in a fiscal year ending after September 30, 2009, the dollar amounts specified in subparagraph (C) shall be increased by the percentage increase (if any) in the projected nominal per capita amount of National Health Expenditures for the calendar year beginning on January 1 of the coverage period over the preceding coverage period, as most recently published by the Secretary before the beginning of the coverage period involved.CommentsClose CommentsPermalink





`(3) RULES RELATING TO ENROLLMENT INCREASES- For purposes of paragraph (2)(B)--CommentsClose CommentsPermalink





`(A) BASELINE MONTHLY AVERAGE- Except as provided in subparagraph (C), the baseline monthly average for any fiscal year for a State is equal to--CommentsClose CommentsPermalink





`(i) the baseline monthly average for the preceding fiscal year; multiplied byCommentsClose CommentsPermalink





`(ii) the sum of 1 plus the sum of--CommentsClose CommentsPermalink





`(I) 0.01; andCommentsClose CommentsPermalink





`(II) the percentage increase in the population of low-income children in the State from the preceding fiscal year to the fiscal year involved, as determined by the Secretary based on the most timely and accurate published estimates of the Bureau of the Census before the beginning of the fiscal year involved.CommentsClose CommentsPermalink





`(B) COVERAGE PERIOD- Except as provided in subparagraph (C), the coverage period for any fiscal year consists of the last 2 quarters of the preceding fiscal year and the first 2 quarters of the fiscal year.CommentsClose CommentsPermalink





`(C) SPECIAL RULES FOR FISCAL YEAR 2009- With respect to fiscal year 2009--CommentsClose CommentsPermalink





`(i) the coverage period for that fiscal year shall be based on the first 2 quarters of fiscal year 2009; andCommentsClose CommentsPermalink





`(ii) the baseline monthly average shall be--CommentsClose CommentsPermalink





`(I) the average monthly enrollment of low-income children enrolled in the State's plan under title XIX for the first 2 quarters of fiscal year 2007 (as determined over a 6-month period on the basis of the most recent information reported through the Medicaid Statistical Information System (MSIS)); multiplied byCommentsClose CommentsPermalink





`(II) the sum of 1 plus the sum of--CommentsClose CommentsPermalink

`(aa) 0.02; andCommentsClose CommentsPermalink

`(bb) the percentage increase in the population of low-income children in the State from fiscal year 2007 to fiscal year 2009, as determined by the Secretary based on the most timely and accurate published estimates of the Bureau of the Census before the beginning of the fiscal year involved.CommentsClose CommentsPermalink

`(D) ADDITIONAL REQUIREMENT FOR ELIGIBILITY FOR PAYMENT- For purposes of subparagraphs (B) and (C), the average monthly enrollment shall be determined without regard to children who do not meet the income eligibility criteria in effect on July 19, 2007, for enrollment under the State plan under title XIX or under a waiver of such plan.CommentsClose CommentsPermalink





`(4) TIME OF PAYMENT- Payments under paragraph (2) for any fiscal year shall be made during the last quarter of such year.CommentsClose CommentsPermalink





`(5) USE OF PAYMENTS- Payments made to a State from the Incentive Pool shall be used for any purpose that the State determines is likely to reduce the percentage of low-income children in the State without health insurance.CommentsClose CommentsPermalink





`(6) PRORATION RULE- If the amount available for payment from the Incentive Pool is less than the total amount of payments to be made for such fiscal year, the Secretary shall reduce the payments described in paragraph (2) on a proportional basis.CommentsClose CommentsPermalink





`(7) REFERENCES- With respect to a State plan under title XIX, any references to a child in this subsection shall include a reference to any individual provided medical assistance under the plan who has not attained age 19 (or, if a State has so elected under such State plan, age 20 or 21).'.CommentsClose CommentsPermalink





(b) Redistribution of Unexpended Fiscal Year 2005 Allotments- Notwithstanding section 2104(f) of the Social Security Act (42 U.S.C. 1397dd(f)), with respect to fiscal year 2008, the Secretary shall provide for a redistribution under such section from the allotments for fiscal year 2005 under subsection (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)(2)(A) of the Social Security Act, as added by section 102(a), 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





(c) Conforming Amendment Eliminating Rules for Redistribution of Unexpended Allotments for Fiscal Years After 2005- Effective January 1, 2008, section 2104(f) (42 U.S.C. 1397dd(f)) is amended to read as follows:CommentsClose CommentsPermalink





`(f) Unallocated Portion of National Allotment and Unused Allotments- For provisions relating to the distribution of portions of the unallocated national allotment under subsection (a) for fiscal years beginning with fiscal year 2008, and unexpended allotments for fiscal years beginning with fiscal year 2006, see subsection (j).'.CommentsClose CommentsPermalink





(d) Additional Funding for the Secretary To Improve Timeliness of Data Reporting and Analysis for Purposes of Determining Enrollment Increases Under Medicaid and CHIP-CommentsClose CommentsPermalink





(1) APPROPRIATION- There is appropriated, out of any money in the Treasury not otherwise appropriated, $5,000,000 to the Secretary for fiscal year 2008 for the purpose of improving the timeliness of the data reported and analyzed from the Medicaid Statistical Information System (MSIS) for purposes of carrying out section 2104(j)(2)(B) of the Social Security Act (as added by subsection (a)) and to provide guidance to States with respect to any new reporting requirements related to such improvements. Amounts appropriated under this paragraph shall remain available until expended.CommentsClose CommentsPermalink





(2) REQUIREMENTS- The improvements made by the Secretary under paragraph (1) shall be designed and implemented (including with respect to any necessary guidance for States) so that, beginning no later than October 1, 2008, data regarding the enrollment of low-income children (as defined in section 2110(c)(4) of the Social Security Act (42 U.S.C. 1397jj(c)(4)) of a State enrolled in the State plan under Medicaid or the State child health plan under CHIP with respect to a fiscal year shall be collected and analyzed by the Secretary within 6 months of submission.CommentsClose CommentsPermalink

SEC. 106. 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.

`(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)(2)(B)(i). 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 clauses (i) and (ii) of subsection (i))(1)(D) and any increase or reduction in the allotment for either such period under subsection (i)(3)(B)(ii) 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 subparagraphs (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 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 process measures described in section 2104(j)(3)(A)(i) 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 payment from the Incentive Fund under paragraph (2)(C) of section 2104(j) for the most recent coverage period 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 106(a)(1) 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 appropriate committees of Congress, including recommendations (if any) for changes in legislation.CommentsClose CommentsPermalink

SEC. 107. 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 106(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.

`(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) MEDICAID INCOME ELIGIBILITY LEVEL FOR PREGNANT WOMEN OF AT LEAST 185 PERCENT OF POVERTY- The State has established an income eligibility level 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 of the income official poverty line.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





`(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 pregnancy and 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 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. 108. CHIP CONTINGENCY FUND.

Section 2104 (42 U.S.C. 1397dd), as amended by section 105, is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





`(k) CHIP 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 `CHIP Contingency Fund' (in this subsection referred to as the `Fund'). Amounts in the Fund are authorized to be appropriated for payments under this subsection.CommentsClose CommentsPermalink





`(2) DEPOSITS INTO FUND-CommentsClose CommentsPermalink





`(A) INITIAL AND SUBSEQUENT APPROPRIATIONS- Subject to subparagraphs (B) and (E), 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 2009, an amount equal to 12.5 percent of the available national allotment under subsection (i)(1)(C) for the fiscal year; andCommentsClose CommentsPermalink





`(ii) for each of fiscal years 2010 through 2012, such sums as are necessary for making payments to eligible States for such fiscal year, but not in excess of the aggregate cap described in subparagraph (B).CommentsClose CommentsPermalink





`(B) AGGREGATE CAP- Subject to subparagraph (E), the total amount available for payment from the Fund for each of fiscal years 2009 through 2012 (taking into account deposits made under subparagraph (C)), shall not exceed 12.5 percent of the available national allotment under subsection (i)(1)(C) for the fiscal year.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) TRANSFER OF EXCESS FUNDS TO THE INCENTIVE FUND- The Secretary of the Treasury shall transfer to, and deposit in, the CHIP Incentive Bonuses Pool established under subsection (j) any amounts in excess of the aggregate cap described in subparagraph (B) for a fiscal year.CommentsClose CommentsPermalink





`(E) SPECIAL RULES FOR AMOUNTS SET ASIDE FOR PARENTS AND CHILDLESS ADULTS- For purposes of subparagraphs (A) and (B)--CommentsClose CommentsPermalink





`(i) the available national allotment under subsection (i)(1)(C) shall be reduced by any amount set aside under section 2111(a)(3) for block grant payments for transitional coverage for childless adults; andCommentsClose CommentsPermalink





`(ii) the Secretary shall establish a separate account in the Fund for the portion of any amount appropriated to the Fund for any fiscal year which is allocable to the portion of the available national allotment under subsection (i)(1)(C) which is set aside for the fiscal year under section 2111(b)(2)(B)(i) for coverage of parents of low-income children.CommentsClose CommentsPermalink





The Secretary shall include in the account established under clause (ii) any income derived under subparagraph (C) which is allocable to amounts in such account.CommentsClose CommentsPermalink





`(3) CHIP CONTINGENCY FUND PAYMENTS-CommentsClose CommentsPermalink





`(A) PAYMENTS-CommentsClose CommentsPermalink





`(i) IN GENERAL- Subject to clauses (ii) and (iii) and the succeeding subparagraphs of this paragraph, the Secretary shall pay from the Fund to a State that is an eligible State for a month of a fiscal year a CHIP contingency fund payment equal to the Federal share of the shortfall determined under subparagraph (D). In the case of an eligible State under subparagraph (D)(i), the Secretary shall not make the payment under this subparagraph until the State makes, and submits to the Secretary, a projection of the amount of the shortfall.CommentsClose CommentsPermalink





`(ii) SEPARATE DETERMINATIONS OF SHORTFALLS- The Secretary shall separately compute the shortfall under subparagraph (D) for expenditures for eligible individuals other than nonpregnant childless adults and parents with respect to whom amounts are set aside under section 2111, for expenditures for such childless adults, and for expenditures for such parents.CommentsClose CommentsPermalink





`(iii) PAYMENTS-CommentsClose CommentsPermalink





`(I) NONPREGNANT CHILDLESS ADULTS- No payments shall be made from the Fund for nonpregnant childless adults with respect to whom amounts are set aside under section 2111(a)(3).CommentsClose CommentsPermalink





`(II) PARENTS- Any payments with respect to any shortfall for parents who are paid from amounts set aside under section 2111(b)(2)(B)(i) shall be made only from the account established under paragraph (2)(E)(ii) and not from any other amounts in the Fund. No other payments may be made from such account.CommentsClose CommentsPermalink





`(iv) SPECIAL RULES- Subparagraphs (B) and (C) shall be applied separately with respect to shortfalls described in clause (ii).CommentsClose CommentsPermalink





`(B) USE OF FUNDS- Amounts paid to an eligible State from the Fund shall be used only to eliminate the Federal share of a shortfall in the State's allotment under subsection (i) for a fiscal year.CommentsClose CommentsPermalink





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





`(D) ELIGIBLE STATE-CommentsClose CommentsPermalink





`(i) IN GENERAL- A State is an eligible State for a month if the State is a subsection (b) State (as defined in subsection (i)(7)), the State requests access to the Fund for the month, and it is described in clause (ii) or (iii).CommentsClose CommentsPermalink





`(ii) SHORTFALL OF FEDERAL ALLOTMENT FUNDING OF NOT MORE THAN 5 PERCENT- The Secretary estimates, on the basis of the most recent data available to the Secretary or requested from the State by the Secretary, that the State's allotment for the fiscal year is at least 95 percent, but less than 100 percent, of the projected expenditures under the State child health plan for the State for the fiscal year determined under subsection (i) (without regard to incentive bonuses or payments for which the State is eligible for under subsection (j)(2) for the fiscal year).CommentsClose CommentsPermalink





`(iii) SHORTFALL OF FEDERAL ALLOTMENT FUNDING OF MORE THAN 5 PERCENT CAUSED BY SPECIFIC EVENTS- The Secretary estimates, on the basis of the most recent data available to the Secretary or requested from the State by the Secretary, that the State's allotment for the fiscal year is less than 95 percent of the projected expenditures under the State child health plan for the State for the fiscal year determined under subsection (i) (without regard to incentive bonuses or payments for which the State is eligible for under subsection (j)(2) for the fiscal year) and that such shortfall is attributable to 1 or more of the following events:CommentsClose CommentsPermalink





`(I) STAFFORD ACT OR PUBLIC HEALTH EMERGENCY- The State has--CommentsClose CommentsPermalink

`(aa) 1 or more parishes or counties for which a major disaster has been declared in accordance with section 401 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5170) and which the President has determined warrants individual and public assistance from the Federal Government under such Act; orCommentsClose CommentsPermalink

`(bb) a public health emergency declared by the Secretary under section 319 of the Public Health Service Act.CommentsClose CommentsPermalink

`(II) STATE ECONOMIC DOWNTURN- The State unemployment rate is at least 5.5 percent during any 13-consecutive week period during the fiscal year and such rate is at least 120 percent of the State unemployment rate for the same period as averaged over the last 3 fiscal years.CommentsClose CommentsPermalink





`(III) EVENT RESULTING IN RISE IN PERCENTAGE OF LOW-INCOME CHILDREN WITHOUT HEALTH INSURANCE- The State experienced a recent event that resulted in an increase in the percentage of low-income children in the State without health insurance (as determined on the basis of the most timely and accurate published estimates of the Bureau of the Census) that was outside the control of the State and warrants granting the State access to the Fund (as determined by the Secretary).CommentsClose CommentsPermalink





`(E) PAYMENTS MADE TO ALL ELIGIBLE STATES ON A MONTHLY BASIS; AUTHORITY FOR PRO RATA PAYMENTS- The Secretary shall make monthly payments from the Fund to all States that are determined to be eligible States with respect to a month. If the sum of the payments to be made from the Fund for a month exceed the amount in the Fund, the Secretary shall reduce each such payment on a proportional basis.CommentsClose CommentsPermalink





`(F) PAYMENTS LIMITED TO FISCAL YEAR OF ELIGIBILITY DETERMINATION UNLESS NEW ELIGIBILITY BASIS DETERMINED- No State shall receive a CHIP contingency fund payment under this section for a month beginning after September 30 of the fiscal year in which the State is determined to be an eligible State under this subsection, except that in the case of an event described in subclause (I) or (III) of subparagraph (D)(iii) that occurred after July 1 of the fiscal year, any such payment with respect to such event shall remain available until September 30 of the subsequent fiscal year. Nothing in the preceding sentence shall be construed as prohibiting a State from being determined to be an eligible State under this subsection for any fiscal year occurring after a fiscal year in which such a determination is made.CommentsClose CommentsPermalink





`(G) EXEMPTION FROM DETERMINATION OF PERCENTAGE OF ALLOTMENT RETAINED AFTER FIRST YEAR OF AVAILABILITY- In no event shall payments made to a State under this subsection be treated as part of the allotment determined for a State for a fiscal year under subsection (i) for purposes of subsection (j)(1)(B)(ii)(III).CommentsClose CommentsPermalink





`(H) APPLICATION OF ALLOTMENT REPORTING RULES- Rules applicable to States for purposes of receiving payments from an allotment determined under subsection (c) or (i) shall apply in the same manner to an eligible State for purposes of receiving a CHIP contingency fund payment under this subsection.CommentsClose CommentsPermalink





`(4) ANNUAL REPORTS- The Secretary shall annually report to the Congress on the amounts in the Fund, the specific events that caused States to apply for payments from the Fund, and the payments made from the Fund.'.CommentsClose CommentsPermalink

SEC. 109. TWO-YEAR AVAILABILITY OF ALLOTMENTS; EXPENDITURES COUNTED AGAINST OLDEST 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 subsection (j)(1)(B)(ii)(III), amounts allotted to a State pursuant to this section--CommentsClose CommentsPermalink





`(A) for each of fiscal years 1998 through 2006, shall remain available for expenditure by the State through the end of the second succeeding fiscal year; andCommentsClose CommentsPermalink





`(B) for each of fiscal years 2007 through 2012, shall remain available for expenditure by the State only through the end of the succeeding fiscal year for which such amounts are allotted.CommentsClose CommentsPermalink





`(2) INCENTIVE BONUSES- Incentive bonuses paid to a State under subsection (j)(2) for a fiscal year shall remain available for expenditure by the State without limitation.CommentsClose CommentsPermalink





`(3) CHIP CONTINGENCY FUND PAYMENTS- Except as provided in paragraph (3)(F) of subsection (k), CHIP Contingency Fund payments made to a State under such subsection for a month of a fiscal year shall remain available for expenditure by the State through the end of the fiscal year.CommentsClose CommentsPermalink





`(4) RULE FOR COUNTING EXPENDITURES AGAINST CHIP CONTINGENCY FUND PAYMENTS, FISCAL YEAR ALLOTMENTS, AND INCENTIVE BONUSES-CommentsClose CommentsPermalink





`(A) IN GENERAL- Expenditures under the State child health plan made on or after October 1, 2007, shall be counted against--CommentsClose CommentsPermalink





`(i) first, any CHIP Contingency Fund payment made to the State under subsection (k) for the earliest month of the earliest fiscal year for which the payment remains available for expenditure; andCommentsClose CommentsPermalink





`(ii) second, amounts allotted to the State for the earliest fiscal year for which amounts remain available for expenditure.CommentsClose CommentsPermalink





`(B) INCENTIVE BONUSES- A State may elect, but is not required, to count expenditures under the State child health plan against any incentive bonuses paid to the State under subsection (j)(2) for a fiscal year.CommentsClose CommentsPermalink





`(C) BLOCK GRANT SET-ASIDES- Expenditures for coverage of--CommentsClose CommentsPermalink





`(i) nonpregnant childless adults for fiscal year 2009 shall be counted only against the amount set aside for such coverage under section 2111(a)(3); andCommentsClose CommentsPermalink





`(ii) parents of targeted low-income children for each of fiscal years 2010 through 2012, shall be counted only against the amount set aside for such coverage under section 2111(b)(2)(B)(i).'.CommentsClose CommentsPermalink

SEC. 110. 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) Conforming Amendment- Section 2105(a)(1) ( 42 U.S.C. 1397dd(a)(1)) is amended, in the matter preceding subparagraph (A), by inserting `or subsection (c)(8)' after `subparagraph (B)'.CommentsClose CommentsPermalink

SEC. 111. 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

TITLE II--OUTREACH AND ENROLLMENT

SEC. 201. GRANTS 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.

`(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, to remain available until expended, 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- Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)), as amended by section 603, is amended--CommentsClose CommentsPermalink





(1) 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





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





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





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





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





`(iv) for translation or interpretation services in connection with the enrollment 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





(c) Nonapplication of Administrative Expenditures Cap- 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 FUNDED UNDER SECTION 2113- Expenditures for outreach and enrollment activities funded under a grant awarded to the State under section 2113.'.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.

`(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)(C) (42 U.S.C. 1397ee(c)(2)(C)), as added by section 201(c), is amended by adding at the end the following new clause:CommentsClose CommentsPermalink





`(ii) 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. DEMONSTRATION PROGRAM TO PERMIT STATES TO RELY ON FINDINGS BY AN EXPRESS LANE AGENCY TO DETERMINE COMPONENTS OF A CHILD'S ELIGIBILITY FOR MEDICAID OR CHIP.

(a) Requirement To Conduct Demonstration Program-CommentsClose CommentsPermalink





(1) IN GENERAL- The Secretary shall establish a 3-year demonstration program under which up to 10 States shall be authorized to rely on a finding made within the preceding 12 months by an Express Lane agency to determine whether a child has met 1 or more of the eligibility requirements, such as income, assets or resources, citizenship status, or other criteria, necessary to determine the child's initial eligibility, eligibility redetermination, or renewal of eligibility, for medical assistance under the State Medicaid plan or child health assistance under the State CHIP plan. A State selected to participate in the demonstration program--CommentsClose CommentsPermalink





(A) shall not be required to direct a child (or a child's family) to submit information or documentation previously submitted by the child or family to an Express Lane agency that the State relies on for its Medicaid or CHIP eligibility determination; andCommentsClose CommentsPermalink





(B) may rely on information from an Express Lane agency when evaluating a child's eligibility for medical assistance under the State Medicaid plan or child health assistance under the State CHIP plan without a separate, independent confirmation of the information at the time of enrollment, redetermination, or renewal.CommentsClose CommentsPermalink





(2) PAYMENTS TO STATES- From the amount appropriated under paragraph (1) of subsection (f), after the application of paragraph (2) of that subsection, the Secretary shall pay the States selected to participate in the demonstration program such sums as the Secretary shall determine for expenditures made by the State for systems upgrades and implementation of the demonstration program. In no event shall a payment be made to a State from the amount appropriated under subsection (f) for any expenditures incurred for providing medical assistance or child health assistance to a child enrolled in the State Medicaid plan or the State CHIP plan through reliance on a finding made by an Express Lane agency.CommentsClose CommentsPermalink





(b) Requirements; Options for Application-CommentsClose CommentsPermalink





(1) STATE REQUIREMENTS- A State selected to participate in the demonstration program established under this section may rely on a finding of an Express Lane agency only if the following conditions are met:CommentsClose CommentsPermalink





(A) REQUIREMENT TO DETERMINE ELIGIBILITY USING REGULAR PROCEDURES IF CHILD IS FIRST FOUND INELIGIBLE- If reliance on a finding from an Express Lane agency results in a child not being found eligible for the State Medicaid plan or the State CHIP plan, the State would be required to determine eligibility under such plan using its regular procedures.CommentsClose CommentsPermalink





(B) NOTICE- The State shall inform the families (especially those whose children are enrolled in the State CHIP plan) that they may qualify for lower premium payments or more comprehensive health coverage under the State Medicaid plan if the family's income were directly evaluated for an eligibility determination by the State Medicaid agency, and that, at the family's option, the family may seek an eligibility determination by the State Medicaid agency.CommentsClose CommentsPermalink





(C) COMPLIANCE WITH DEPARTMENT OF HOMELAND SECURITY PROCEDURES- The State may rely on an Express Lane agency finding that a child is a qualified alien as long as the Express Lane agency complies with guidance and regulatory procedures issued by the Secretary of Homeland Security for eligibility determinations of qualified aliens (as defined in subsections (b) and (c) of section 431 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1641)).CommentsClose CommentsPermalink





(D) VERIFICATION OF CITIZENSHIP OR NATIONALITY STATUS- The State shall satisfy the requirements of section 1902(a)(46)(B) or 2105(c)(9) of the Social Security Act, as applicable (and as added by section 301 of this Act) for verifications of citizenship or nationality status.CommentsClose CommentsPermalink





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





(i) IN GENERAL- 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 participation in the demonstration program;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 with respect to the enrollment of such children;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 participates in the demonstration program, 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 participates in the demonstration program, a reduction in the amount otherwise payable to the State under section 1903(a) of the Social Security Act (42 Secretary 1396b(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 section shall be construed as relieving a State that participates in the demonstration program established under this section from being subject to a penalty under section 1903(u) of the Social Security Act (42 U.S.C. 1396b(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





(2) STATE OPTIONS FOR APPLICATION- A State selected to participate in the demonstration program may elect to apply any of the following:CommentsClose CommentsPermalink





(A) SATISFACTION OF CHIP SCREEN AND ENROLL REQUIREMENTS- If the State relies on a finding of an Express Lane agency for purposes of determining eligibility under the State CHIP plan, the State may meet the screen and enroll requirements imposed under subparagraphs (A) and (B) of section 2102(b)(3) of the Social Security Act (42 U.S.C. 1397bb(b)(3)) by using any of the following:CommentsClose CommentsPermalink





(i) Establishing a threshold percentage of the poverty line that is 30 percentage points (or such other higher number of percentage points) as the State determines reflects the income methodologies of the program administered by the Express Lane Agency and the State Medicaid plan.CommentsClose CommentsPermalink





(ii) Providing that a child satisfies all income requirements for eligibility under the State Medicaid plan.CommentsClose CommentsPermalink





(iii) Providing that a child has a family income that exceeds the Medicaid applicable income level.CommentsClose CommentsPermalink





(B) PRESUMPTIVE ELIGIBILITY- The State may provide for presumptive eligibility under the State CHIP plan for a child who, based on an eligibility determination of an income finding from an Express Lane agency, would qualify for child health assistance under the State CHIP plan. During the period of presumptive eligibility, the State may determine the child's eligibility for child health assistance under the State CHIP plan based on telephone contact with family members, access to data available in electronic or paper format, or other means that minimize to the maximum extent feasible the burden on the family.CommentsClose CommentsPermalink





(C) 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.CommentsClose CommentsPermalink





(ii) INFORMATION REQUIREMENT- A State that elects the option under clause (i) shall have procedures in place to inform the child or the child's family of the services that will be covered under the State Medicaid plan or the State CHIP plan (as applicable), appropriate methods for using such services, premium or other cost sharing charges (if any) that apply, medical support obligations created by the enrollment (if applicable), and the actions the child or the child's family must take to maintain enrollment and renew coverage.CommentsClose CommentsPermalink





(iii) OPTION TO WAIVE SIGNATURES- The State may waive any signature requirements for enrollment for a child who consents to, or on whose behalf consent is provided for, enrollment in the State Medicaid plan or the State CHIP plan.CommentsClose CommentsPermalink





(3) SIGNATURE REQUIREMENTS- In the case of a State selected to participate in the demonstration program--CommentsClose CommentsPermalink





(A) no signature under penalty of perjury shall be required on an application form for medical assistance under the State Medicaid plan or child health assistance under the State CHIP plan to attest to any element of the application for which eligibility is based on information received from an Express Lane agency or a source other than an applicant; andCommentsClose CommentsPermalink





(B) any signature requirement for determination of an application for medical assistance under the State Medicaid plan or child health assistance under the State CHIP plan may be satisfied through an electronic signature.CommentsClose CommentsPermalink





(4) RULES OF CONSTRUCTION- Nothing in this subsection shall be construed to--CommentsClose CommentsPermalink





(A) relieve a State of the obligation under section 1902(a)(5) of the Social Security Act (42 U.S.C. 1396a(a)(5)) to determine eligibility for medical assistance under the State Medicaid plan; orCommentsClose CommentsPermalink





(B) prohibit any State options otherwise permitted under Federal law (without regard to this paragraph or the demonstration program established under this section) that are intended to increase the enrollment of eligible children for medical assistance under the State Medicaid plan or child health assistance under the State CHIP plan, including options related to outreach, enrollment, applications, or the determination or redetermination of eligibility.CommentsClose CommentsPermalink





(c) Limited Waiver of Other Applicable Requirements-CommentsClose CommentsPermalink





(1) SOCIAL SECURITY ACT- The Secretary shall waive only such requirements of the Social Security Act as the Secretary determines are necessary to carry out the demonstration program established under this section.CommentsClose CommentsPermalink





(2) AUTHORIZATION FOR PARTICIPATING STATES TO RECEIVE CERTAIN DATA DIRECTLY RELEVANT TO DETERMINING ELIGIBILITY AND CORRECT AMOUNT OF ASSISTANCE- For provisions relating to the authority of States participating in the demonstration program to receive certain data directly, see section 204(c).CommentsClose CommentsPermalink





(d) Evaluation and Report-CommentsClose CommentsPermalink





(1) EVALUATION- The Secretary shall conduct, by grant, contract, or interagency agreement, a comprehensive, independent evaluation of the demonstration program established under this section. Such evaluation shall include an analysis of the effectiveness of the program, 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, 2012, the Secretary shall submit a report to Congress on the results of the evaluation of the demonstration program established under this section.CommentsClose CommentsPermalink





(e) Definitions- In this section:CommentsClose CommentsPermalink





(1) CHILD; CHILDREN- With respect to a State selected to participate in the demonstration program established under this section, the terms `child' and `children' have the meanings given such terms for purposes of the State plans under titles XIX and XXI of the Social Security Act.CommentsClose CommentsPermalink





(2) EXPRESS LANE AGENCY-CommentsClose CommentsPermalink





(A) IN GENERAL- The term `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 1 or more eligibility requirements described in subsection (a)(1);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





(I) of the information which shall be disclosed in accordance with this section;CommentsClose CommentsPermalink





(II) 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





(III) 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





(B) 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





(I) The temporary assistance for needy families program funded under part A of title IV of the Social Security Act (42 U.S.C. 601 et seq.).CommentsClose CommentsPermalink





(II) A State program funded under part D of title IV of such Act (42 U.S.C. 651 et seq.).CommentsClose CommentsPermalink





(III) The State Medicaid plan.CommentsClose CommentsPermalink





(IV) The State CHIP plan.CommentsClose CommentsPermalink





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





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





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





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





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





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





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





(XII) 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





(C) 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 of the Social Security Act (42 U.S.C. 1397 et seq.) or a private, for-profit organization.CommentsClose CommentsPermalink





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





(i) affecting the authority of a State Medicaid agency to enter into contracts with nonprofit and for-profit agencies to administer the Medicaid application process;CommentsClose CommentsPermalink





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





(iii) authorizing a State Medicaid agency that participates in the demonstration program established under this section 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





(3) MEDICAID APPLICABLE INCOME LEVEL- With respect to a State, the term `Medicaid applicable income level' has the meaning given that term for purposes of such State under section 2110(b)(4) of the Social Security Act (42 U.S.C. 1397jj(4)).CommentsClose CommentsPermalink





(4) POVERTY LINE- The term `poverty line' has the meaning given that term in section 2110(c)(5) of the Social Security Act (42 U.S.C. 1397jj(c)(5)).CommentsClose CommentsPermalink





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





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





(7) STATE CHIP PLAN- The term `State CHIP plan' means the State child health plan established under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.), and includes any waiver of such plan.CommentsClose CommentsPermalink





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





(9) STATE MEDICAID PLAN- The term `State Medicaid plan' means the State plan established under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), and includes any waiver of such plan.CommentsClose CommentsPermalink





(f) Appropriation-CommentsClose CommentsPermalink





(1) OPERATIONAL FUNDS- Out of any funds in the Treasury not otherwise appropriated, there is appropriated to the Secretary to carry out the demonstration program established under this section, $49,000,000 for the period of fiscal years 2008 through 2012.CommentsClose CommentsPermalink





(2) EVALUATION FUNDS- $5,000,000 of the funds appropriated under paragraph (1) shall be used to conduct the evaluation required under subsection (d).CommentsClose CommentsPermalink





(3) BUDGET AUTHORITY- Paragraph (1) constitutes budget authority in advance of appropriations Act and represents the obligation of the Federal Government to provide for the payment to States selected to participate in the demonstration program established under this section of the amounts provided under such paragraph (after the application of paragraph (2)).CommentsClose CommentsPermalink

SEC. 204. AUTHORIZATION OF CERTAIN INFORMATION DISCLOSURES TO SIMPLIFY HEALTH COVERAGE DETERMINATIONS.

(a) Authorization of Information Disclosure- Title XIX (42 U.S.C. 1396 et seq.) is amended--CommentsClose CommentsPermalink





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





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

`AUTHORIZATION TO RECEIVE PERTINENT INFORMATION

`Sec. 1939. (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, 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, but only if such conveyance meets the requirements of subsection (b).CommentsClose CommentsPermalink





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





`(1) The child whose circumstances are described in the data or information (or such child'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 children who are eligible or potentially eligible for medical assistance under this title and enrolling (or attempting to enroll) such children in the State plan; andCommentsClose CommentsPermalink





`(B) verifying the eligibility of children 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 for 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 children in the plan.CommentsClose CommentsPermalink





`(c) Criminal Penalty- A person described in subsection (a) who publishes, divulges, 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 $1,000 or imprisoned not more than 1 year, or both, for each such unauthorized activity.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





(b) Conforming Amendment to Title XXI- Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is amended by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





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





(c) Authorization for States Participating in the Express Lane Demonstration Program To Receive Certain Data Directly Relevant To Determining Eligibility and Correct Amount of Assistance- Only in the case of a State selected to participate in the Express Lane demonstration program established under section 203, the Secretary shall enter into such agreements as are necessary to permit such a State to receive data directly relevant to eligibility determinations and determining the correct amount of benefits under the State CHIP plan or the State Medicaid plan (as such terms are defined in paragraphs (7) and (9) section 203(e)) 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) The National Income Data collected by the Commissioner of Social Security from information described in subparagraphs (A) and (B) of section 6103(l)(7) of the Internal Revenue Code of 1986, in accordance with the requirements of that section.CommentsClose CommentsPermalink





(3) 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

TITLE III--REDUCING BARRIERS TO ENROLLMENT

SEC. 301. 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) 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 (dd);'; andCommentsClose CommentsPermalink





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





`(dd)(1) For purposes of section 1902(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 plan 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, the State--CommentsClose CommentsPermalink





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





`(ii) provides the individual with an opportunity to cure the invalid determination with the Commissioner of Social Security, followed by a period of 90 days from the date on which the notice required under clause (i) is received by the individual to present satisfactory documentary evidence of citizenship or nationality (as defined in section 1903(x)(3)); 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.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 enrolled in the State plan under this title that month who has attained the age of 1 before the date of the enrollment.CommentsClose CommentsPermalink





`(B) In establishing the State program under this paragraph, the State may enter into an agreement with the Commissioner of Social Security to provide for the electronic submission and verification of the name and social security number of an individual before the individual is enrolled in the State plan.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.CommentsClose CommentsPermalink





`(B) If, for any fiscal year, the average monthly percentage determined under subparagraph (A) is greater than 7 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 7 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(dd) (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 section 110(a), is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





`(9) 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





`(iii) 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- The amendments made by this section shall take effect on October 1, 2008.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