S 82 ISCommentsClose CommentsPermalink

To amend title XXI of the Social Security Act to reauthorize the State Children’s Health Insurance Program, to limit income eligibility expansions under that program until the lowest income eligible individuals are enrolled, and for other purposes.CommentsClose CommentsPermalink

January 6, 2009CommentsClose CommentsPermalink

Mr. VITTER introduced the following bill; which was read twice and referred to the Committee on FinanceCommentsClose CommentsPermalink

To amend title XXI of the Social Security Act to reauthorize the State Children’s Health Insurance Program, to limit income eligibility expansions under that program until the lowest income eligible individuals are enrolled, 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; TABLE OF CONTENTS.

(a) Short Title- This Act may be cited as the ‘Enhancing Health Care Coverage for Children Act’.CommentsClose CommentsPermalink





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





Sec. 1. Short title; table of contents.CommentsClose CommentsPermalink





Sec. 2. Reauthorization through Fiscal Year 2014.CommentsClose CommentsPermalink





Sec. 3. Requiring outreach and coverage before expansion of eligibility.CommentsClose CommentsPermalink





Sec. 4. Application of DRA Medicaid citizenship documentation requirements to SCHIP.CommentsClose CommentsPermalink





Sec. 5. Phase-out of coverage for nonpregnant adults under SCHIP.CommentsClose CommentsPermalink





Sec. 6. Requirement that individuals who are eligible for SCHIP and employer-sponsored coverage use the employer-sponsored coverage instead of SCHIP.CommentsClose CommentsPermalink

SEC. 2. REAUTHORIZATION THROUGH FISCAL YEAR 2014.

(a) In General- Section 2104 of the Social Security Act (42 U.S.C. 1397dd(a)), as amended by section 201(a)(1) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) is amended--CommentsClose CommentsPermalink





(1) in subsection (a)--CommentsClose CommentsPermalink





(A) by striking ‘and’ at the end of paragraph (10);CommentsClose CommentsPermalink





(B) in paragraph (11)--CommentsClose CommentsPermalink





(i) by striking ‘each of fiscal years 2008 and 2009’ and inserting ‘fiscal year 2008’; andCommentsClose CommentsPermalink





(ii) by striking the period at the end and inserting a semicolon; andCommentsClose CommentsPermalink





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





‘(12) for fiscal year 2009, $7,000,000,000;CommentsClose CommentsPermalink





‘(13) for fiscal year 2010, $8,000,000,000; andCommentsClose CommentsPermalink





‘(14) for each of fiscal years 2011 through 2014, $9,000,000,000.’; andCommentsClose CommentsPermalink





(2) in subsection (c)(4)(B), by striking ‘2009’ and inserting ‘2014’.CommentsClose CommentsPermalink





(b) Repeal of Limitation on Availability of Funding for Fiscal Years 2008 and 2009- Section 201 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) is amended--CommentsClose CommentsPermalink





(1) in subsection (a), by striking paragraph (2) and redesignating paragraphs (3) and (4), as paragraphs (2) and (3) respectively; andCommentsClose CommentsPermalink





(2) in subsection (b), by striking paragraph (2) and redesignating paragraph (3) as paragraph (2).CommentsClose CommentsPermalink

SEC. 3. REQUIRING OUTREACH AND COVERAGE BEFORE EXPANSION OF ELIGIBILITY.

(a) State Plan Required To Specify How It Will Achieve Coverage for 85 Percent of Targeted Low-Income Children-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 2102(a) of the Social Security Act (42 U.S.C. 1397bb(a)) is amended--CommentsClose CommentsPermalink





(A) in paragraph (6), by striking ‘and’ at the end;CommentsClose CommentsPermalink





(B) in paragraph (7), by striking the period at the end and inserting ‘; and’; andCommentsClose CommentsPermalink





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





‘(8) how the eligibility and benefits provided for under the plan for each fiscal year (beginning with fiscal year 2010) will allow for the State’s annual funding allotment to cover at least 85 percent of the eligible targeted low-income children in the State.’.CommentsClose CommentsPermalink





(2) EFFECTIVE DATE- The amendments made by paragraph (1) shall apply to State child health plans for fiscal years beginning with fiscal year 2010.CommentsClose CommentsPermalink





(b) Limitation on Program Expansions Until Lowest Income Eligible Individuals Enrolled- Section 2105(c) of such Act (42 U.S.C. 1397dd(c)) is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(8) LIMITATION ON INCREASED COVERAGE OF HIGHER INCOME CHILDREN- For child health assistance furnished in any fiscal year beginning with fiscal year 2010:CommentsClose CommentsPermalink





‘(A) NO PAYMENT FOR CHILDREN WITH FAMILY INCOME ABOVE 250 PERCENT OF POVERTY LINE- Payment shall not be made under this section for child health assistance for a targeted low-income child in a family the income of which exceeds 250 percent of the poverty line applicable to a family of the size involved.CommentsClose CommentsPermalink





‘(B) SPECIAL RULES FOR PAYMENT FOR CHILDREN WITH FAMILY INCOME ABOVE 200 PERCENT OF POVERTY LINE- In the case of child health assistance for a targeted low-income child in a family the income of which exceeds 200 percent (but does not exceed 250 percent) of the poverty line applicable to a family of the size involved no payment shall be made under this section for such assistance unless the State demonstrates to the satisfaction of the Secretary that--CommentsClose CommentsPermalink





‘(i) the State has met the 85 percent retrospective coverage test specified in subparagraph (C)(i) for the previous fiscal year; andCommentsClose CommentsPermalink





‘(ii) the State will meet the 85 percent prospective coverage test specified in subparagraph (C)(ii) for the fiscal year.CommentsClose CommentsPermalink





‘(C) 85 PERCENT COVERAGE TESTS-CommentsClose CommentsPermalink





‘(i) RETROSPECTIVE TEST- The 85 percent retrospective coverage test specified in this clause is, for a State for a fiscal year, that on average during the fiscal year, the State has enrolled under this title or title XIX at least 85 percent of the individuals residing in the State who--CommentsClose CommentsPermalink





‘(I) are children under 19 years of age (or are pregnant women) and are eligible for medical assistance under title XIX; orCommentsClose CommentsPermalink





‘(II) are targeted low-income children whose family income does not exceed 200 percent of the poverty line and who are eligible for child health assistance under this title.CommentsClose CommentsPermalink





‘(ii) PROSPECTIVE TEST- The 85 percent prospective test specified in this clause is, for a State for a fiscal year, that on average during the fiscal year, the State will enroll under this title or title XIX at least 85 percent of the individuals residing in the State who--CommentsClose CommentsPermalink





‘(I) are children under 19 years of age (or are pregnant women) and are eligible for medical assistance under title XIX; orCommentsClose CommentsPermalink





‘(II) are targeted low-income children whose family income does not exceed such percent of the poverty line (in excess of 200 percent) as the State elects consistent with this paragraph and who are eligible for child health assistance under this title.CommentsClose CommentsPermalink





‘(D) TREATMENT OF PREGNANT WOMEN- In this paragraph and sections 2102(a)(8) and 2104(a)(2), the term ‘targeted low-income child’ includes an individual under age 19, including the period from conception to birth, who is eligible for child health assistance under this title by virtue of the definition of the term ‘child’ under section 457.10 of title 42, Code of Federal Regulations.’.CommentsClose CommentsPermalink





(c) Standardization of Income Determinations-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 2110(d) of such Act (42 U.S.C. 1397jj) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(d) Standardization of Income Determinations- In determining family income under this title (including in the case of a State child health plan that provides health benefits coverage in the manner described in section 2101(a)(2)), a State shall base such determination on gross income (including amounts that would be included in gross income if they were not exempt from income taxation) and may only take into consideration such income disregards as the Secretary shall develop and specify on a uniform national basis.’.CommentsClose CommentsPermalink





(2) EFFECTIVE DATE- (A) Subject to subparagraph (B), the amendment made by paragraph (1) shall apply to determinations (and redeterminations) of income made on or after October 1, 2009.CommentsClose CommentsPermalink





(B) In the case of a State child health plan under title XXI of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendment made by paragraph (1), the State child health plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.CommentsClose CommentsPermalink

SEC. 4. APPLICATION OF DRA MEDICAID CITIZENSHIP DOCUMENTATION REQUIREMENTS TO SCHIP.

(a) In General- Section 2105(c) of the Social Security Act (42 U.S.C. 1397dd(c)), as amended by section 3(b), is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(9) APPLICATION OF CITIZENSHIP DOCUMENTATION REQUIREMENTS-CommentsClose CommentsPermalink





‘(A) IN GENERAL- Subject to subparagraph (B), no payment may be made under this section to a State with respect to amounts expended for child health assistance for an individual who declares under section 1137(d)(1)(A) to be a citizen or national of the United States for purposes of establishing eligibility for benefits under this title, unless the requirement of section 1903(x) is met.CommentsClose CommentsPermalink





‘(B) TREATMENT OF PREGNANT WOMEN- For purposes of applying subparagraph (A) in the case of a pregnant woman who qualifies for child health assistance by virtue of the application of section 457.10 of title 42, Code of Federal Regulations, the requirement of section 1903(x) shall be deemed to be satisfied by the presentation of documentation of personal identity described in section 274A(b)(1)(D) of the Immigration and Nationality Act or any other documentation of personal identity of such other type as the Secretary finds, by regulation, provides a reliable means of identification.’.CommentsClose CommentsPermalink





(b) Effective Date- The amendment made by paragraph (1) shall apply to eligibility determinations and redeterminations made after the date of enactment of this Act.CommentsClose CommentsPermalink

SEC. 5. PHASE-OUT OF COVERAGE FOR NONPREGNANT ADULTS UNDER SCHIP.

(a) In General- Title XXI of the Social Security Act (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 ADULTS.

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





‘(1) NO NEW SCHIP WAIVERS; AUTOMATIC EXTENSIONS AT STATE OPTION THROUGH DECEMBER 2009- 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 Enhancing Health Care Coverage for Children Act, 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 adult; andCommentsClose CommentsPermalink





‘(B) notwithstanding the terms and conditions of an applicable existing waiver, the provisions of paragraph (2) shall apply for purposes of any period beginning on or after January 1, 2010, 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 SCHIP COVERAGE UNDER APPLICABLE EXISTING WAIVERS AT THE END OF 2009-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 adult under an applicable existing waiver after December 31, 2009.CommentsClose CommentsPermalink





‘(B) EXTENSION UPON STATE REQUEST- If an applicable existing waiver described in subparagraph (A) would otherwise expire before January 1, 2010, and the State requests an extension of such waiver, the Secretary shall grant such an extension, but only through December 31, 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 nonpregnant childless adult during the period beginning on the date of the enactment of this subsection and ending on December 31, 2009.CommentsClose CommentsPermalink





‘(b) 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 on October 1, 2008.CommentsClose CommentsPermalink





‘(2) DEFINITIONS- The term ‘nonpregnant adult’ means any individual who is not a targeted low-income pregnant woman (as defined in section 2112(d)(2)) or a targeted low-income child.’.CommentsClose CommentsPermalink





(b) Conforming Amendments-CommentsClose CommentsPermalink





(1) Section 2107(f) of such Act (42 U.S.C. 1397gg(f)) is amended--CommentsClose CommentsPermalink





(A) by striking ‘, the Secretary’ and inserting ‘:CommentsClose CommentsPermalink





‘(1) The Secretary’;CommentsClose CommentsPermalink





(B) in the first sentence, by striking ‘childless’;CommentsClose CommentsPermalink





(C) by striking the second sentence; andCommentsClose CommentsPermalink





(D) 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 Enhancing Health Care Coverage for Children Act that would waive or modify the requirements of section 2111.’.CommentsClose CommentsPermalink





(2) 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 5 of the Enhancing Health Care Coverage for Children Act, nothing’.CommentsClose CommentsPermalink

SEC. 6. REQUIREMENT THAT INDIVIDUALS WHO ARE ELIGIBLE FOR SCHIP AND EMPLOYER-SPONSORED COVERAGE USE THE EMPLOYER-SPONSORED COVERAGE INSTEAD OF SCHIP.

(a) In General- Section 2105(c) of the Social Security Act (42 U.S.C. 1397ee(c)), as amended by sections 3(b) and 4(a), is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(10) REQUIREMENT REGARDING EMPLOYER-SPONSORED COVERAGE-CommentsClose CommentsPermalink





‘(A) IN GENERAL- Subject to subparagraph (B), no payment may be made under this title with respect to an individual who is eligible for coverage under a group health plan or health insurance coverage offered through an employer, either as an individual or as part of family coverage.CommentsClose CommentsPermalink





‘(B) STATE OPTION TO OFFER PREMIUM ASSISTANCE FOR HIGH-COST PLANS-CommentsClose CommentsPermalink





‘(i) IN GENERAL- In the case of an individual who is otherwise eligible for coverage under this title but for the application of subparagraph (A) and who is eligible for high-cost heath insurance coverage, a State may elect to offer a premium assistance subsidy for such coverage.CommentsClose CommentsPermalink





‘(ii) AMOUNT- The amount of a premium assistance subsidy under this paragraph shall be determined by the State but in no case shall exceed the lesser of--CommentsClose CommentsPermalink





‘(I) an amount equal to the value of the coverage under this title that would otherwise apply with respect to the individual but for the application of subparagraph (A); orCommentsClose CommentsPermalink





‘(II) an amount equal to the difference between--CommentsClose CommentsPermalink

‘(aa) the amount of the employee’s share of the premium costs for the high-cost health insurance coverage (for the family or the individual, as the case may be); andCommentsClose CommentsPermalink

‘(bb) an amount equal to 20 percent of the total premium costs for such coverage, including both the employer and employee share, (for the family or the individual, as the case may be).CommentsClose CommentsPermalink

‘(C) HIGH-COST HEALTH INSURANCE COVERAGE- For purposes of this paragraph, the term ‘high-cost health insurance coverage’ means a group health plan or health insurance coverage offered through an employer in which the employee is required to pay more than 20 percent of the premium costs.CommentsClose CommentsPermalink





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