To amend titles XIX and XXI of the Social Security Act to permit States to cover low-income youth up to age 23 with an enhanced matching rate.

November 19, 2003

Mrs. LINCOLN (for herself and Mr. BINGAMAN) introduced the following bill; which was read twice and referred to the Committee on Finance

To amend titles XIX and XXI of the Social Security Act to permit States to cover low-income youth up to age 23 with an enhanced matching rate.

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

SECTION 1. SHORT TITLE.

This Act may be cited as `Medicaid/SCHIP Optional Coverage for Young Adults Act of 2003'.

SEC. 2. PROVIDING STATE OPTION FOR SCHIP AND MEDICAID COVERAGE OF YOUNG ADULTS UP TO AGE 23.

(a) IN GENERAL-

(1) MEDICAID- (A) Section 1902(l)(1)(D) of the Social Security Act (42 U.S.C. 1396a(l)(1)(D)) is amended by inserting `(or, at the option of the State, who have not attained 20, 21, or 22 years of age, as the State may elect)' after `have not attained 19 years of age'.

(B) Clause (i) of section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended by striking `under the age of 21, or, at the option of the State, under the age of 20, 19, or 18 as the State may choose' and inserting `under the age of 23, or, at the option of the State, under the age of 22, 21, 20, 19, or 18 as the State may elect'.

(2) SCHIP- Section 2110(c)(1) of such Act (42 U.S.C. 1397jj(c)(1)) is amended by inserting after `19 years of age' the following: `(or, at the option of the State and subject to the availability of additional allotments under section 2104(d), 20, 21, 22, or 23 years of age)'.

(b) AVAILABILITY OF ENHANCED MATCHING FUNDS-

(1) UNDER MEDICAID- Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended--

(A) in the fourth sentence of subsection (b), by striking `or subsection (u)(3)' and inserting `, (u)(3), or (u)(4)(A)'; and

(B) in subsection (u)--

(i) by adding at the end of paragraph (1) the following new subparagraph:

`(C) Only with respect to expenditures described in paragraph (4)(A), if the State is providing for benefits under its State child health plan under title XXI for children under 19 years of age exclusively through benefits under its State plan under this title, the State is also providing under such plan the benefits for individuals over 18 years of age who are eligible for such benefits only because of an election referred to in such paragraph.';

(ii) by redesignating paragraph (4) as paragraph (5); and

(iii) by inserting after paragraph (3) the following new paragraph:

`(4) For purposes of the fourth sentence of subsection (b) and section 2105(a), the expenditures described in this paragraph are expenditures for medical assistance for individuals who are over 18 (and less than 23) years of age and who are eligible for such medical assistance because of an election by the State under section 1902(l)(1)(D) or clause (i) of section 1905(a).'.

(2) ADDITIONAL ALLOTMENTS FOR PROVIDING COVERAGE OF OPTIONAL YOUNG ADULTS-

(A) IN GENERAL- Section 2104 of such Act (42 U.S.C. 1397dd) is amended by inserting after subsection (c) the following:

`(d) ADDITIONAL ALLOTMENTS FOR THE PROVISION OF COVERAGE TO OPTIONAL YOUNG ADULTS-

`(1) APPROPRIATION; TOTAL ALLOTMENT- For the purpose of providing additional allotments to States under this title, there is appropriated, out of any money in the Treasury not otherwise appropriated, for each of fiscal years 2004 through 2007, $200,000,000.

`(2) STATE AND TERRITORIAL ALLOTMENTS- In addition to the allotments provided under subsections (b) and (c), subject to paragraph (3), of the amount available for the additional allotments under paragraph (1) for a fiscal year, the Secretary shall allot to each State with a State child health plan approved under this title--

`(A) in the case of such a State other than a commonwealth or territory described in subparagraph (B), the same proportion as the proportion of the State's allotment under subsection (b) (determined without regard to subsection (f)) to the total amount of the allotments under subsection (b) for such States eligible for an allotment under this paragraph for such fiscal year; and

`(B) in the case of a commonwealth or territory described in subsection (c)(3), the same proportion as the proportion of the commonwealth's or territory's allotment under subsection (c) (determined without regard to subsection (f)) to the total amount of the allotments under subsection (c) for commonwealths and territories eligible for an allotment under this paragraph for such fiscal year.

`(3) USE OF ADDITIONAL ALLOTMENT- Additional allotments provided under this subsection are not available for amounts expended before October 1, 2003. Such amounts are available for amounts expended on or after such date only for--

`(A) expenditures described in section 1905(u)(4)(A); and

`(B) child health assistance for individuals who are targeted low-income children and over 18 years of age and who are low-income children only because of an election by the State under section 2110(c)(1).'.

(B) CONFORMING AMENDMENTS- Section 2104 of the Social Security Act (42 U.S.C. 1397dd) is amended--

(i) in subsection (a), in the matter preceding paragraph (1), by inserting `subject to subsection (d),' after `under this section,';

(ii) in subsection (b)(1), by inserting `and subsection (d)' after `Subject to paragraph (4)'; and

(iii) in subsection (c)(1), by inserting `subject to subsection (d),' after `for a fiscal year,'.

(c) EFFECTIVE DATE- The amendments made by this section apply to items and services furnished on or after October 1, 2003, without regard to whether regulations implementing such amendments have been promulgated.

SEC. 3. GRANTS TO IMPLEMENT MEDICAID AND SCHIP EXPANSIONS.

(a) IN GENERAL- The Secretary of Health and Human Services shall provide for grants to small and rural States (as defined by the Secretary) in order to enable such States to implement expansions of eligibility for children and young adults their State medicaid plans under title XIX of the Social Security Act and State child health plans under title XXI of such Act. Such grants shall be available for planning, implementation, and outreach with respect to such expanded eligibility populations.

(b) TERMS AND CONDITIONS- Grants under this section shall be made available under such terms and conditions, including the approval of a grant application, as the Secretary shall specify.

(c) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated such sums as may be necessary to provide for grants under this section.

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