H.R. 3963
10-25-07, Bill Passed House 265-142
11-01-07, Bill Passed Senate 64-30
12-12-07, Vetoed by President
Consideration of Veto Postponed by 211-180
Vote
1-23-08, House Vote Failed to Override Veto 260-152
One Hundred Tenth Congress
of the
United States of America
AT THE FIRST SESSION
Begun and held at the City of Washington on Thursday,
the fourth day of January, two thousand and seven
An Act
To amend title XXI of the Social Security Act to extend and improve
the Children's Health Insurance Program, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT; REFERENCES;
TABLE OF CONTENTS.
(a) Short Title- This Act may be cited as `Children's Health Insurance
Program Reauthorization Act of 2007'.
(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.
(c) References to CHIP; Medicaid; Secretary- In this Act:
(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.).
(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.).
(3) SECRETARY- The term `Secretary' means the Secretary of Health and
Human Services.
(d) Table of Contents- The table of contents of this Act is as follows:
Sec. 1. Short title; amendments to Social Security Act; references;
table of contents.
Sec. 3. General effective date; exception for State legislation; contingent
effective date; reliance on law.
TITLE I--FINANCING
Subtitle A--Funding
Sec. 101. Extension of CHIP.
Sec. 102. Allotments for States and territories for fiscal years 2008
through 2012.
Sec. 103. Child Enrollment Contingency Fund.
Sec. 104. CHIP performance bonus payment to offset additional enrollment
costs resulting from enrollment and retention efforts.
Sec. 105. Two-year initial availability of CHIP allotments.
Sec. 106. Making permanent redistribution of unused fiscal year 2005
allotments to address State funding shortfalls; conforming extension
of qualifying State authority; redistribution of unused allotments for
subsequent fiscal years.
Sec. 107. Option for qualifying States to receive the enhanced portion
of the CHIP matching rate for Medicaid coverage of certain children.
Sec. 108. One-time appropriation.
Sec. 109. Improving funding for the territories under CHIP and Medicaid.
Subtitle B--Focus on Low-Income Children and Pregnant Women
Sec. 111. State option to cover low-income pregnant women under CHIP
through a State plan amendment.
Sec. 112. Phase-out of coverage for nonpregnant childless adults under
CHIP; conditions for coverage of parents.
Sec. 113. Elimination of counting Medicaid child presumptive eligibility
costs against title XXI allotment.
Sec. 114. Denial of payments for coverage of children with effective
family income that exceeds 300 percent of the poverty line.
Sec. 115. State authority under Medicaid.
Sec. 116. Preventing substitution of CHIP coverage for private coverage.
TITLE II--OUTREACH AND ENROLLMENT
Subtitle A--Outreach and Enrollment Activities
Sec. 201. Grants and enhanced administrative funding for outreach and
enrollment.
Sec. 202. Increased outreach and enrollment of Indians.
Sec. 203. State option to rely on findings from an Express Lane agency
to conduct simplified eligibility determinations.
Subtitle B--Reducing Barriers to Enrollment
Sec. 211. Verification of declaration of citizenship or nationality
for purposes of eligibility for Medicaid and CHIP.
Sec. 212. Reducing administrative barriers to enrollment.
Sec. 213. Model of Interstate coordinated enrollment and coverage process.
TITLE III--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE
Subtitle A--Additional State Option for Providing Premium Assistance
Sec. 301. Additional State option for providing premium assistance.
Sec. 302. Outreach, education, and enrollment assistance.
Subtitle B--Coordinating Premium Assistance With Private Coverage
Sec. 311. Special enrollment period under group health plans in case
of termination of Medicaid or CHIP coverage or eligibility for assistance
in purchase of employment-based coverage; coordination of coverage.
TITLE IV--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES
Sec. 401. Child health quality improvement activities for children enrolled
in Medicaid or CHIP.
Sec. 402. Improved availability of public information regarding enrollment
of children in CHIP and Medicaid.
Sec. 403. Application of certain managed care quality safeguards to
CHIP.
TITLE V--IMPROVING ACCESS TO BENEFITS
Sec. 501. Dental benefits.
Sec. 502. Mental health parity in CHIP plans.
Sec. 503. Application of prospective payment system for services provided
by Federally-qualified health centers and rural health clinics.
Sec. 504. Premium grace period.
Sec. 505. Demonstration projects relating to diabetes prevention.
Sec. 506. Clarification of coverage of services provided through school-based
health centers.
TITLE VI--PROGRAM INTEGRITY AND OTHER MISCELLANEOUS PROVISIONS
Subtitle A--Program Integrity and Data Collection
Sec. 601. Payment error rate measurement (`PERM').
Sec. 602. Improving data collection.
Sec. 603. Updated Federal evaluation of CHIP.
Sec. 604. Access to records for IG and GAO audits and evaluations.
Sec. 605. No Federal funding for illegal aliens; disallowance for unauthorized
expenditures.
Subtitle B--Miscellaneous Health Provisions
Sec. 611. Deficit Reduction Act technical corrections.
Sec. 612. References to title XXI.
Sec. 613. Prohibiting initiation of new health opportunity account demonstration
programs.
Sec. 614. County Medicaid health insuring organizations; GAO report
on Medicaid managed care payment rates.
Sec. 615. Adjustment in computation of Medicaid FMAP to disregard an
extraordinary employer pension contribution.
Sec. 616. Moratorium on certain payment restrictions.
Sec. 617. Medicaid DSH allotments for Tennessee and Hawaii.
Sec. 618. Clarification treatment of regional medical center.
Sec. 619. Extension of SSI web-based asset demonstration project to
the Medicaid program.
Subtitle C--Other Provisions
Sec. 621. Support for injured servicemembers.
Sec. 622. Outreach regarding health insurance options available to children.
Sec. 623. Sense of Senate regarding access to affordable and meaningful
health insurance coverage.
TITLE VII--REVENUE PROVISIONS
Sec. 701. Increase in excise tax rate on tobacco products.
Sec. 702. Administrative improvements.
Sec. 703. Time for payment of corporate estimated taxes.
SEC. 2. PURPOSE.
It is the purpose of this Act to provide dependable and stable funding
for children's health insurance under titles XXI and XIX of the Social
Security Act in order to enroll all six million uninsured children who
are eligible, but not enrolled, for coverage today through such titles.
SEC. 3. GENERAL EFFECTIVE DATE; EXCEPTION FOR STATE LEGISLATION; CONTINGENT
EFFECTIVE DATE; RELIANCE ON LAW.
(a) General Effective Date- Unless otherwise provided in this Act, subject
to subsections (b) through (d), this Act (and the amendments made by this
Act) shall take effect on October 1, 2007, and shall apply to child health
assistance and medical assistance provided on or after that date.
(b) Exception for State Legislation- In the case of a State plan under
title XIX or State child health plan under XXI of the Social Security
Act, which the Secretary of Health and Human Services determines requires
State legislation in order for the respective plan to meet one or more
additional requirements imposed by amendments made by this Act, the respective
plan shall not be regarded as failing to comply with the requirements
of such title solely on the basis of its failure to meet such an additional
requirement before the first day of the first calendar quarter beginning
after the close of the first regular session of the State legislature
that begins after the date of enactment of this Act. For purposes of the
previous sentence, in the case of a State that has a 2-year legislative
session, each year of the session shall be considered to be a separate
regular session of the State legislature.
(c) Contingent Effective Date for CHIP Funding for Fiscal Year 2008- Notwithstanding
any other provision of law, if funds are appropriated under any law (other
than this Act) to provide allotments to States under CHIP for all (or
any portion) of fiscal year 2008--
(1) any amounts that are so appropriated that are not so allotted and
obligated before the date of the enactment of this Act are rescinded;
and
(2) any amount provided for CHIP allotments to a State under this Act
(and the amendments made by this Act) for such fiscal year shall be
reduced by the amount of such appropriations so allotted and obligated
before such date.
(d) Reliance on Law- With respect to amendments made by this Act (other
than title VII) that become effective as of a date--
(1) such amendments are effective as of such date whether or not regulations
implementing such amendments have been issued; and
(2) Federal financial participation for medical assistance or child
health assistance furnished under title XIX or XXI, respectively, of
the Social Security Act on or after such date by a State in good faith
reliance on such amendments before the date of promulgation of final
regulations, if any, to carry out such amendments (or before the date
of guidance, if any, regarding the implementation of such amendments)
shall not be denied on the basis of the State's failure to comply with
such regulations or guidance.
TITLE I--FINANCING
Subtitle A--Funding
SEC. 101. EXTENSION OF CHIP.
Section 2104(a) (42 U.S.C. 1397dd(a)) is amended--
(1) in paragraph (9), by striking `and' at the end;
(2) in paragraph (10), by striking the period at the end and inserting
a semicolon; and
(3) by adding at the end the following new paragraphs:
`(11) for fiscal year 2008, $9,125,000,000;
`(12) for fiscal year 2009, $10,675,000,000;
`(13) for fiscal year 2010, $11,850,000,000;
`(14) for fiscal year 2011, $13,750,000,000; and
`(15) for fiscal year 2012, for purposes of making 2 semi-annual allotments--
`(A) $1,150,000,000 for the period beginning on October 1, 2011, and
ending on March 31, 2012, and
`(B) $1,150,000,000 for the period beginning on April 1, 2012, and
ending on September 30, 2012.'.
SEC. 102. ALLOTMENTS FOR STATES AND TERRITORIES FOR FISCAL YEARS 2008
THROUGH 2012.
Section 2104 (42 U.S.C. 1397dd) is amended--
(1) in subsection (b)(1), by striking `subsection (d)' and inserting
`subsections (d) and (i)';
(2) in subsection (c)(1), by striking `subsection (d)' and inserting
`subsections (d) and (i)(4)'; and
(3) by adding at the end the following new subsection:
`(i) Allotments for Fiscal Years 2008 Through 2012-
`(1) FOR FISCAL YEAR 2008-
`(A) FOR THE 50 STATES AND THE DISTRICT OF COLUMBIA- Subject to the
succeeding provisions of this paragraph and paragraph (4), the Secretary
shall allot for fiscal year 2008 from the amount made available under
subsection (a)(11), to each of the 50 States and the District of Columbia
110 percent of the highest of the following amounts for such State
or District:
`(i) The total Federal payments to the State under this title for
fiscal year 2007, multiplied by the allotment increase factor determined
under paragraph (5) for fiscal year 2008.
`(ii) The Federal share of the amount allotted to the State for
fiscal year 2007 under subsection (b), multiplied by the allotment
increase factor determined under paragraph (5) for fiscal year 2008.
`(iii) Only in the case of--
`(I) a State that received a payment, redistribution, or allotment
under paragraph (1), (2), or (4) of subsection (h), the amount
of the projected total Federal payments to the State under this
title for fiscal year 2007, as determined on the basis of the
November 2006 estimates certified by the State to the Secretary;
`(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; or
`(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,
multiplied by the allotment increase factor determined under paragraph
(5) for fiscal year 2008.
`(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.
`(B) FOR THE COMMONWEALTHS AND TERRITORIES- Subject to the succeeding
provisions of this paragraph and paragraph (4), the Secretary shall
allot for fiscal year 2008 from the amount made available under subsection
(a)(11) to each of the commonwealths and territories described in
subsection (c)(3) an amount equal to the highest amount of Federal
payments to the commonwealth or territory under this title for any
fiscal year occurring during the period of fiscal years 1998 through
2007, multiplied by the allotment increase factor determined under
paragraph (5) for fiscal year 2008, except that subparagraph (B) thereof
shall be applied by substituting `the United States' for `the State'.
`(C) DEADLINE AND DATA FOR DETERMINING FISCAL YEAR 2008 ALLOTMENTS-
In computing the amounts under subparagraphs (A) and (B) that determine
the allotments to States for fiscal year 2008, the Secretary shall
use the most recent data available to the Secretary before the start
of that fiscal year. The Secretary may adjust such amounts and allotments,
as necessary, on the basis of the expenditure data for the prior year
reported by States on CMS Form 64 or CMS Form 21 not later than November
30, 2007, but in no case shall the Secretary adjust the allotments
provided under subparagraph (A) or (B) for fiscal year 2008 after
December 31, 2007.
`(D) ADJUSTMENT FOR QUALIFYING STATES- In the case of a qualifying
State described in paragraph (2) of section 2105(g), the Secretary
shall permit the State to submit revised projection described in subparagraph
(A)(iv) in order to take into account changes in such projections
attributable to the application of paragraph (4) of such section.
`(2) FOR FISCAL YEARS 2009 THROUGH 2011-
`(A) IN GENERAL- Subject to paragraphs (4) and (6), from the amount
made available under paragraphs (12) through (14) of subsection (a)
for each of fiscal years 2009 through 2011, respectively, the Secretary
shall compute a State allotment for each State (including the District
of Columbia and each commonwealth and territory) for each such fiscal
year as follows:
`(i) GROWTH FACTOR UPDATE FOR FISCAL YEAR 2009- For fiscal year
2009, the allotment of the State is equal to the sum of--
`(I) the amount of the State allotment under paragraph (1) for
fiscal year 2008; and
`(II) the amount of any payments made to the State under subsection
(j) for fiscal year 2008,
multiplied by the allotment increase factor under paragraph (5)
for fiscal year 2009.
`(ii) REBASING IN FISCAL YEAR 2010- For fiscal year 2010, the allotment
of the State is equal to the Federal payments to the State that
are attributable to (and countable towards) the total amount of
allotments available under this section to the State in fiscal year
2009 (including payments made to the State under subsection (j)
for fiscal year 2009 as well as amounts redistributed to the State
in fiscal year 2009), multiplied by the allotment increase factor
under paragraph (5) for fiscal year 2010.
`(iii) GROWTH FACTOR UPDATE FOR FISCAL YEAR 2011- For fiscal year
2011, the allotment of the State is equal to the sum of--
`(I) the amount of the State allotment under clause (ii) for fiscal
year 2010; and
`(II) the amount of any payments made to the State under subsection
(j) for fiscal year 2010,
multiplied by the allotment increase factor under paragraph (5)
for fiscal year 2011.
`(3) FOR FISCAL YEAR 2012-
`(A) FIRST HALF- Subject to paragraphs (4) and (6), from the amount
made available under subparagraph (A) of paragraph (15) of subsection
(a) for the semi-annual period described in such paragraph, increased
by the amount of the appropriation for such period under section 108
of the Children's Health Insurance Program Reauthorization Act of
2007, the Secretary shall compute a State allotment for each State
(including the District of Columbia and each commonwealth and territory)
for such semi-annual period in an amount equal to the first half ratio
(described in subparagraph (D)) of the amount described in subparagraph
(C).
`(B) SECOND HALF- Subject to paragraphs (4) and (6), from the amount
made available under subparagraph (B) of paragraph (15) of subsection
(a) for the semi-annual period described in such paragraph, the Secretary
shall compute a State allotment for each State (including the District
of Columbia and each commonwealth and territory) for such semi-annual
period in an amount equal to the amount made available under such
subparagraph, multiplied by the ratio of--
`(i) the amount of the allotment to such State under subparagraph
(A); to
`(ii) the total of the amount of all of the allotments made available
under such subparagraph.
`(C) FULL YEAR AMOUNT BASED ON REBASED AMOUNT- The amount described
in this subparagraph for a State is equal to the Federal payments
to the State that are attributable to (and countable towards) the
total amount of allotments available under this section to the State
in fiscal year 2011 (including payments made to the State under subsection
(j) for fiscal year 2011 as well as amounts redistributed to the State
in fiscal year 2011), multiplied by the allotment increase factor
under paragraph (5) for fiscal year 2012.
`(D) FIRST HALF RATIO- The first half ratio described in this subparagraph
is the ratio of--
`(I) the amount made available under subsection (a)(15)(A); and
`(II) the amount of the appropriation for such period under section
108 of the Children's Health Insurance Program Reauthorization
Act of 2007; to
`(I) amount described in clause (i); and
`(II) the amount made available under subsection (a)(15)(B).
`(4) PRORATION RULE- If, after the application of this subsection without
regard to this paragraph, the sum of the allotments determined under
paragraph (1), (2), or (3) for a fiscal year (or, in the case of fiscal
year 2012, for a semi-annual period in such fiscal year) exceeds the
amount available under subsection (a) for such fiscal year or period,
the Secretary shall reduce each allotment for any State under such paragraph
for such fiscal year or period on a proportional basis.
`(5) ALLOTMENT INCREASE FACTOR- The allotment increase factor under
this paragraph for a fiscal year is equal to the product of the following:
`(A) PER CAPITA HEALTH CARE GROWTH FACTOR- 1 plus the percentage increase
in the projected per capita amount of National Health Expenditures
from the calendar year in which the previous fiscal year ends to the
calendar year in which the fiscal year involved ends, as most recently
published by the Secretary before the beginning of the fiscal year.
`(B) CHILD POPULATION GROWTH FACTOR- 1 plus the percentage increase
(if any) in the population of children in the State from July 1 in
the previous fiscal year to July 1 in the fiscal year involved, as
determined by the Secretary based on the most recent published estimates
of the Bureau of the Census before the beginning of the fiscal year
involved, plus 1 percentage point.
`(6) INCREASE IN ALLOTMENT TO ACCOUNT FOR APPROVED PROGRAM EXPANSIONS-
In the case of one of the 50 States or the District of Columbia that--
`(A) has submitted to the Secretary, and has approved by the Secretary,
a State plan amendment or waiver request relating to an expansion
of eligibility for children or benefits under this title that becomes
effective for a fiscal year (beginning with fiscal year 2009 and ending
with fiscal year 2012); and
`(B) has submitted to the Secretary, before the August 31 preceding
the beginning of the fiscal year, a request for an expansion allotment
adjustment under this paragraph for such fiscal year that specifies--
`(i) the additional expenditures that are attributable to the eligibility
or benefit expansion provided under the amendment or waiver described
in subparagraph (A), as certified by the State and submitted to
the Secretary by not later than August 31 preceding the beginning
of the fiscal year; and
`(ii) the extent to which such additional expenditures are projected
to exceed the allotment of the State or District for the year,
subject to paragraph (4), the amount of the allotment of the State or
District under this subsection for such fiscal year shall be increased
by the excess amount described in subparagraph (B)(i). A State or District
may only obtain an increase under this paragraph for an allotment for
fiscal year 2009 or fiscal year 2011.
`(7) AVAILABILITY OF AMOUNTS FOR SEMI-ANNUAL PERIODS IN FISCAL YEAR
2012- Each semi-annual allotment made under paragraph (3) for a period
in fiscal year 2012 shall remain available for expenditure under this
title for periods after the end of such fiscal year in the same manner
as if the allotment had been made available for the entire fiscal year.'.
SEC. 103. CHILD ENROLLMENT CONTINGENCY FUND.
Section 2104 (42 U.S.C. 1397dd), as amended by section 102, is amended
by adding at the end the following new subsection:
`(j) Child Enrollment Contingency Fund-
`(1) ESTABLISHMENT- There is hereby established in the Treasury of the
United States a fund which shall be known as the `Child Enrollment Contingency
Fund' (in this subsection referred to as the `Fund'). Amounts in the
Fund shall be available without further appropriations for payments
under this subsection.
`(A) INITIAL AND SUBSEQUENT APPROPRIATIONS- Subject to subparagraphs
(B) and (D), out of any money in the Treasury of the United States
not otherwise appropriated, there are appropriated to the Fund--
`(i) for fiscal year 2008, an amount equal to 20 percent of the
amount made available under paragraph (11) of subsection (a) for
the fiscal year; and
`(ii) for each of fiscal years 2009 through 2011 (and for each of
the semi-annual allotment periods for fiscal year 2012), such sums
as are necessary for making payments to eligible States for such
fiscal year or period, but not in excess of the aggregate cap described
in subparagraph (B).
`(B) AGGREGATE CAP- The total amount available for payment from the
Fund for each of fiscal years 2009 through 2011 (and for each of the
semi-annual allotment periods for fiscal year 2012), taking into account
deposits made under subparagraph (C), shall not exceed 20 percent
of the amount made available under subsection (a) for the fiscal year
or period.
`(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.
`(D) AVAILABILITY OF EXCESS FUNDS FOR PERFORMANCE BONUSES- Any amounts
in excess of the aggregate cap described in subparagraph (B) for a
fiscal year or period shall be made available for purposes of carrying
out section 2105(a)(3) for any succeeding fiscal year and the Secretary
of the Treasury shall reduce the amount in the Fund by the amount
so made available.
`(3) CHILD ENROLLMENT CONTINGENCY FUND PAYMENTS-
`(A) IN GENERAL- If a State's expenditures under this title in fiscal
year 2008, fiscal year 2009, fiscal year 2010, fiscal year 2011, or
a semi-annual allotment period for fiscal year 2012, exceed the total
amount of allotments available under this section to the State in
the fiscal year or period (determined without regard to any redistribution
it receives under subsection (f) that is available for expenditure
during such fiscal year or period, but including any carryover from
a previous fiscal year) and if the average monthly unduplicated number
of children enrolled under the State plan under this title (including
children receiving health care coverage through funds under this title
pursuant to a waiver under section 1115) during such fiscal year or
period exceeds its target average number of such enrollees (as determined
under subparagraph (B)) for that fiscal year or period, subject to
subparagraph (D), the Secretary shall pay to the State from the Fund
an amount equal to the product of--
`(i) the amount by which such average monthly caseload exceeds such
target number of enrollees; and
`(ii) the projected per capita expenditures under the State child
health plan (as determined under subparagraph (C) for the fiscal
year), multiplied by the enhanced FMAP (as defined in section 2105(b))
for the State and fiscal year involved (or in which the period occurs).
`(B) TARGET AVERAGE NUMBER OF CHILD ENROLLEES- In this paragraph,
the target average number of child enrollees for a State--
`(i) for fiscal year 2008 is equal to the monthly average unduplicated
number of children enrolled in the State child health plan under
this title (including such children receiving health care coverage
through funds under this title pursuant to a waiver under section
1115) during fiscal year 2007 increased by the population growth
for children in that State for the year ending on June 30, 2006
(as estimated by the Bureau of the Census) plus 1 percentage point;
or
`(ii) for a subsequent fiscal year (or semi-annual period occurring
in a fiscal year) is equal to the target average number of child
enrollees for the State for the previous fiscal year increased by
the child population growth factor described in subsection (i)(5)(B)
for the State for the prior fiscal year.
`(C) PROJECTED PER CAPITA EXPENDITURES- For purposes of subparagraph
(A)(ii), the projected per capita expenditures under a State child
health plan--
`(i) for fiscal year 2008 is equal to the average per capita expenditures
(including both State and Federal financial participation) under
such plan for the targeted low-income children counted in the average
monthly caseload for purposes of this paragraph during fiscal year
2007, increased by the annual percentage increase in the projected
per capita amount of National Health Expenditures (as estimated
by the Secretary) for 2008; or
`(ii) for a subsequent fiscal year (or semi-annual period occurring
in a fiscal year) is equal to the projected per capita expenditures
under such plan for the previous fiscal year (as determined under
clause (i) or this clause) increased by the annual percentage increase
in the projected per capita amount of National Health Expenditures
(as estimated by the Secretary) for the year in which such subsequent
fiscal year ends.
`(D) PRORATION RULE- If the amounts available for payment from the
Fund for a fiscal year or period are less than the total amount of
payments determined under subparagraph (A) for the fiscal year or
period, the amount to be paid under such subparagraph to each eligible
State shall be reduced proportionally.
`(E) TIMELY PAYMENT; RECONCILIATION- Payment under this paragraph
for a fiscal year or period shall be made before the end of the fiscal
year or period based upon the most recent data for expenditures and
enrollment and the provisions of subsection (e) of section 2105 shall
apply to payments under this subsection in the same manner as they
apply to payments under such section.
`(F) CONTINUED REPORTING- For purposes of this paragraph and subsection
(f), the State shall submit to the Secretary the State's projected
Federal expenditures, even if the amount of such expenditures exceeds
the total amount of allotments available to the State in such fiscal
year or period.
`(G) APPLICATION TO COMMONWEALTHS AND TERRITORIES- No payment shall
be made under this paragraph to a commonwealth or territory described
in subsection (c)(3) until such time as the Secretary determines that
there are in effect methods, satisfactory to the Secretary, for the
collection and reporting of reliable data regarding the enrollment
of children described in subparagraphs (A) and (B) in order to accurately
determine the commonwealth's or territory's eligibility for, and amount
of payment, under this paragraph.'.
SEC. 104. CHIP PERFORMANCE BONUS PAYMENT TO OFFSET ADDITIONAL ENROLLMENT
COSTS RESULTING FROM ENROLLMENT AND RETENTION EFFORTS.
Section 2105(a) (42 U.S.C. 1397ee(a)) is amended by adding at the end
the following new paragraphs:
`(3) PERFORMANCE BONUS PAYMENT TO OFFSET ADDITIONAL MEDICAID AND CHIP
CHILD ENROLLMENT COSTS RESULTING FROM ENROLLMENT AND RETENTION EFFORTS-
`(A) IN GENERAL- In addition to the payments made under paragraph
(1), for each fiscal year (beginning with fiscal year 2008 and ending
with fiscal year 2012), the Secretary shall pay from amounts made
available under subparagraph (E), to each State that meets the condition
under paragraph (4) for the fiscal year, an amount equal to the amount
described in subparagraph (B) for the State and fiscal year. The payment
under this paragraph shall be made, to a State for a fiscal year,
as a single payment not later than the last day of the first calendar
quarter of the following fiscal year. Payments made under this paragraph
may only be used to reduce the number of low-income children who do
not have health insurance coverage in the State.
`(B) AMOUNT FOR ABOVE BASELINE MEDICAID CHILD ENROLLMENT COSTS- Subject
to subparagraph (E), the amount described in this subparagraph for
a State for a fiscal year is equal to the sum of the following amounts:
`(i) FIRST TIER ABOVE BASELINE MEDICAID ENROLLEES- An amount equal
to the number of first tier above baseline child enrollees (as determined
under subparagraph (C)(i)) under title XIX for the State and fiscal
year, multiplied by 15 percent of the projected per capita State
Medicaid expenditures (as determined under subparagraph (D)) for
the State and fiscal year under title XIX.
`(ii) SECOND TIER ABOVE BASELINE MEDICAID ENROLLEES- An amount equal
to the number of second tier above baseline child enrollees (as
determined under subparagraph (C)(ii)) under title XIX for the State
and fiscal year, multiplied by 62.5 percent of the projected per
capita State Medicaid expenditures (as determined under subparagraph
(D)) for the State and fiscal year under title XIX.
`(C) NUMBER OF FIRST AND SECOND TIER ABOVE BASELINE CHILD ENROLLEES;
BASELINE NUMBER OF CHILD ENROLLEES- For purposes of this paragraph:
`(i) FIRST TIER ABOVE BASELINE CHILD ENROLLEES- The number of first
tier above baseline child enrollees for a State for a fiscal year
under title XIX is equal to the number (if any, as determined by
the Secretary) by which--
`(I) the monthly average unduplicated number of qualifying children
(as defined in subparagraph (F)) enrolled during the fiscal year
under the State plan under title XIX; exceeds
`(II) the baseline number of enrollees described in clause (iii)
for the State and fiscal year under title XIX;
but not to exceed 3 percent of the baseline number of enrollees
described in subclause (II).
`(ii) SECOND TIER ABOVE BASELINE CHILD ENROLLEES- The number of
second tier above baseline child enrollees for a State for a fiscal
year under title XIX is equal to the number (if any, as determined
by the Secretary) by which--
`(I) the monthly average unduplicated number of qualifying children
(as defined in subparagraph (F)) enrolled during the fiscal year
under title XIX as described in clause (i)(I); exceeds
`(II) the sum of the baseline number of child enrollees described
in clause (iii) for the State and fiscal year title XIX, as described
in clause (i)(II), and the maximum number of first tier above
baseline child enrollees for the State and fiscal year under title
XIX, as determined under clause (i).
`(iii) BASELINE NUMBER OF CHILD ENROLLEES- Subject to subparagraph
(H), the baseline number of child enrollees for a State under title
XIX--
`(I) for fiscal year 2008 is equal to the monthly average unduplicated
number of qualifying children enrolled in the State plan under
title XIX during fiscal year 2007 increased by the population
growth for children in that State for the year ending on June
30, 2006 (as estimated by the Bureau of the Census) plus 1 percentage
point; or
`(II) for a subsequent fiscal year is equal to the baseline number
of child enrollees for the State for the previous fiscal year
under title XIX, increased by the population growth for children
in that State for the year ending on June 30 before the beginning
of the fiscal year (as estimated by the Bureau of the Census)
plus 1 percentage point.
`(D) PROJECTED PER CAPITA STATE MEDICAID EXPENDITURES- For purposes
of subparagraph (B), the projected per capita State Medicaid expenditures
for a State and fiscal year under title XIX is equal to the average
per capita expenditures (including both State and Federal financial
participation) for children under the State plan under such title,
including under waivers but not including such children eligible for
assistance by virtue of the receipt of benefits under title XVI, for
the most recent fiscal year for which actual data are available (as
determined by the Secretary), increased (for each subsequent fiscal
year up to and including the fiscal year involved) by the annual percentage
increase in per capita amount of National Health Expenditures (as
estimated by the Secretary) for the calendar year in which the respective
subsequent fiscal year ends and multiplied by a State matching percentage
equal to 100 percent minus the Federal medical assistance percentage
(as defined in section 1905(b)) for the fiscal year involved.
`(E) AMOUNTS AVAILABLE FOR PAYMENTS-
`(i) INITIAL APPROPRIATION- Out of any money in the Treasury not
otherwise appropriated, there are appropriated $3,000,000,000 for
fiscal year 2008 for making payments under this paragraph, to be
available until expended.
`(ii) TRANSFERS- Notwithstanding any other provision of this title,
the following amounts shall also be available, without fiscal year
limitation, for making payments under this paragraph:
`(I) UNOBLIGATED NATIONAL ALLOTMENT-
`(aa) FISCAL YEARS 2008 THROUGH 2011- As of December 31 of fiscal
year 2008, and as of December 31 of each succeeding fiscal year through
fiscal year 2011, the portion, if any, of the amount appropriated under
subsection (a) for such fiscal year that is unobligated for allotment
to a State under subsection (i) for such fiscal year or set aside under
subsection (a)(3) or (b)(2) of section 2111 for such fiscal year.
`(bb) FIRST HALF OF FISCAL YEAR 2012- As of December 31 of fiscal
year 2012, the portion, if any, of the sum of the amounts appropriated
under subsection (a)(15)(A) and under section 108 of the Children's Health
Insurance Reauthorization Act of 2007 for the period beginning on October
1, 2011, and ending on March 31, 2012, that is unobligated for allotment
to a State under subsection (i) for such fiscal year or set aside under
subsection (b)(2) of section 2111 for such fiscal year.
`(cc) SECOND HALF OF FISCAL YEAR 2012- As of June 30 of fiscal
year 2012, the portion, if any, of the amount appropriated under subsection
(a)(15)(B) for the period beginning on April 1, 2012, and ending on September
30, 2012, that is unobligated for allotment to a State under subsection
(i) for such fiscal year or set aside under subsection (b)(2) of section
2111 for such fiscal year.
`(II) UNEXPENDED ALLOTMENTS NOT USED FOR REDISTRIBUTION- As of
November 15 of each of fiscal years 2009 through 2012, the total
amount of allotments made to States under section 2104 for the
second preceding fiscal year (third preceding fiscal year in the
case of the fiscal year 2006 and 2007 allotments) that is not
expended or redistributed under section 2104(f) during the period
in which such allotments are available for obligation.
`(III) EXCESS CHILD ENROLLMENT CONTINGENCY FUNDS- As of October
1 of each of fiscal years 2009 through 2012, any amount in excess
of the aggregate cap applicable to the Child Enrollment Contingency
Fund for the fiscal year under section 2104(j).
`(iii) PROPORTIONAL REDUCTION- If the sum of the amounts otherwise
payable under this paragraph for a fiscal year exceeds the amount
available for the fiscal year under this subparagraph, the amount
to be paid under this paragraph to each State shall be reduced proportionally.
`(F) QUALIFYING CHILDREN DEFINED- For purposes of this subsection,
the term `qualifying children' means children who meet the eligibility
criteria (including income, categorical eligibility, age, and immigration
status criteria) in effect as of July 1, 2007, for enrollment under
title XIX, taking into account criteria applied as of such date under
title XIX pursuant to a waiver under section 1115.
`(G) APPLICATION TO COMMONWEALTHS AND TERRITORIES- The provisions
of subparagraph (G) of section 2104(j)(3) shall apply with respect
to payment under this paragraph in the same manner as such provisions
apply to payment under such section.
`(H) APPLICATION TO STATES THAT IMPLEMENT A MEDICAID EXPANSION FOR
CHILDREN AFTER FISCAL YEAR 2007- In the case of a State that provides
coverage under paragraph (1) or (2) of section 115(b) of the Children's
Health Insurance Program Reauthorization Act of 2007 for any fiscal
year after fiscal year 2007--
`(i) any child enrolled in the State plan under title XIX through
the application of such an election shall be disregarded from the
determination for the State of the monthly average unduplicated
number of qualifying children enrolled in such plan during the first
3 fiscal years in which such an election is in effect; and
`(ii) in determining the baseline number of child enrollees for
the State for any fiscal year subsequent to such first 3 fiscal
years, the baseline number of child enrollees for the State under
title XIX for the third of such fiscal years shall be the monthly
average unduplicated number of qualifying children enrolled in the
State plan under title XIX for such third fiscal year.
`(4) ENROLLMENT AND RETENTION PROVISIONS FOR CHILDREN- For purposes
of paragraph (3)(A), a State meets the condition of this paragraph for
a fiscal year if it is implementing at least 5 of the following enrollment
and retention provisions (treating each subparagraph as a separate enrollment
and retention provision) throughout the entire fiscal year:
`(A) CONTINUOUS ELIGIBILITY- The State has elected the option of continuous
eligibility for a full 12 months for all children described in section
1902(e)(12) under title XIX under 19 years of age, as well as applying
such policy under its State child health plan under this title.
`(B) LIBERALIZATION OF ASSET REQUIREMENTS- The State meets the requirement
specified in either of the following clauses:
`(i) ELIMINATION OF ASSET TEST- The State does not apply any asset
or resource test for eligibility for children under title XIX or
this title.
`(ii) ADMINISTRATIVE VERIFICATION OF ASSETS- The State--
`(I) permits a parent or caretaker relative who is applying on
behalf of a child for medical assistance under title XIX or child
health assistance under this title to declare and certify by signature
under penalty of perjury information relating to family assets
for purposes of determining and redetermining financial eligibility;
and
`(II) takes steps to verify assets through means other than by
requiring documentation from parents and applicants except in
individual cases of discrepancies or where otherwise justified.
`(C) ELIMINATION OF IN-PERSON INTERVIEW REQUIREMENT- The State does
not require an application of a child for medical assistance under
title XIX (or for child health assistance under this title), including
an application for renewal of such assistance, to be made in person
nor does the State require a face-to-face interview, unless there
are discrepancies or individual circumstances justifying an in-person
application or face-to-face interview.
`(D) USE OF JOINT APPLICATION FOR MEDICAID AND CHIP- The application
form and supplemental forms (if any) and information verification
process is the same for purposes of establishing and renewing eligibility
for children for medical assistance under title XIX and child health
assistance under this title.
`(E) AUTOMATIC RENEWAL (USE OF ADMINISTRATIVE RENEWAL)-
`(i) IN GENERAL- The State provides, in the case of renewal of a
child's eligibility for medical assistance under title XIX or child
health assistance under this title, a pre-printed form completed
by the State based on the information available to the State and
notice to the parent or caretaker relative of the child that eligibility
of the child will be renewed and continued based on such information
unless the State is provided other information. Nothing in this
clause shall be construed as preventing a State from verifying,
through electronic and other means, the information so provided.
`(ii) SATISFACTION THROUGH DEMONSTRATED USE OF EX PARTE PROCESS-
A State shall be treated as satisfying the requirement of clause
(i) if renewal of eligibility of children under title XIX or this
title is determined without any requirement for an in-person interview,
unless sufficient information is not in the State's possession and
cannot be acquired from other sources (including other State agencies)
without the participation of the applicant or the applicant's parent
or caretaker relative.
`(F) PRESUMPTIVE ELIGIBILITY FOR CHILDREN- The State is implementing
section 1920A under title XIX as well as, pursuant to section 2107(e)(1),
under this title.
`(G) EXPRESS LANE- The State is implementing the option described
in section 1902(e)(13) under title XIX as well as, pursuant to section
2107(e)(1), under this title.
`(H) PREMIUM ASSISTANCE SUBSIDIES- The State is implementing the option
of providing premium assistance subsidies under section 2105(c)(11)
or section 1906A.'.
SEC. 105. TWO-YEAR INITIAL AVAILABILITY OF CHIP ALLOTMENTS.
Section 2104(e) (42 U.S.C. 1397dd(e)) is amended to read as follows:
`(e) Availability of Amounts Allotted-
`(1) IN GENERAL- Except as provided in paragraph (2), amounts allotted
to a State pursuant to this section--
`(A) for each of fiscal years 1998 through 2007, shall remain available
for expenditure by the State through the end of the second succeeding
fiscal year; and
`(B) for fiscal year 2008 and each fiscal year thereafter, shall remain
available for expenditure by the State through the end of the succeeding
fiscal year.
`(2) AVAILABILITY OF AMOUNTS REDISTRIBUTED- Amounts redistributed to
a State under subsection (f) shall be available for expenditure by the
State through the end of the fiscal year in which they are redistributed.'.
SEC. 106. MAKING PERMANENT REDISTRIBUTION OF UNUSED FISCAL YEAR 2005
ALLOTMENTS TO ADDRESS STATE FUNDING SHORTFALLS; CONFORMING EXTENSION OF
QUALIFYING STATE AUTHORITY; REDISTRIBUTION OF UNUSED ALLOTMENTS FOR SUBSEQUENT
FISCAL YEARS.
(a) Redistribution of Unused Fiscal Year 2005 Allotments; Extension of
Qualifying State Authority- Section 136(e) of Public Law 110-92 is amended
to read as follows:
`(1) REDISTRIBUTION OF UNUSED FISCAL YEAR 2005 ALLOTMENTS- The amendment
made by subsection (c) shall apply without regard to any limitation
under section 106.
`(2) EXTENSION OF QUALIFYING STATE AUTHORITY- The amendment made by
subsection (d) shall be in effect through the date of the enactment
of the Children's Health Insurance Program Reauthorization Act of 2007.'.
(b) Redistributions of Unused Allotments for Fiscal Years After Fiscal
Year 2005- Section 2104(f) (42 U.S.C. 1397dd(f)) is amended--
(1) by striking `The Secretary' and inserting the following:
`(1) IN GENERAL- The Secretary';
(2) by striking `States that have fully expended the amount of their
allotments under this section.' and inserting `States that the Secretary
determines with respect to the fiscal year for which unused allotments
are available for redistribution under this subsection, are shortfall
States described in paragraph (2) for such fiscal year, but not to exceed
the amount of the shortfall described in paragraph (2)(A) for each such
State (as may be adjusted under paragraph (2)(C)).'; and
(3) by adding at the end the following new paragraph:
`(2) SHORTFALL STATES DESCRIBED-
`(A) IN GENERAL- For purposes of paragraph (1), with respect to a
fiscal year, a shortfall State described in this subparagraph is a
State with a State child health plan approved under this title for
which the Secretary estimates on the basis of the most recent data
available to the Secretary, that the projected expenditures under
such plan for the State for the fiscal year will exceed the sum of--
`(i) the amount of the State's allotments for any preceding fiscal
years that remains available for expenditure and that will not be
expended by the end of the immediately preceding fiscal year;
`(ii) the amount (if any) of the child enrollment contingency fund
payment under subsection (j); and
`(iii) the amount of the State's allotment for the fiscal year.
`(B) PRORATION RULE- If the amounts available for redistribution under
paragraph (1) for a fiscal year are less than the total amounts of
the estimated shortfalls determined for the year under subparagraph
(A), the amount to be redistributed under such paragraph for each
shortfall State shall be reduced proportionally.
`(C) RETROSPECTIVE ADJUSTMENT- The Secretary may adjust the estimates
and determinations made under paragraph (1) and this paragraph with
respect to a fiscal year as necessary on the basis of the amounts
reported by States not later than November 30 of the succeeding fiscal
year, as approved by the Secretary.'.
SEC. 107. OPTION FOR QUALIFYING STATES TO RECEIVE THE ENHANCED PORTION
OF THE CHIP MATCHING RATE FOR MEDICAID COVERAGE OF CERTAIN CHILDREN.
Section 2105(g) (42 U.S.C. 1397ee(g)) is amended--
(1) in paragraph (1)(A), as amended by section 136(d) of Public Law
110-92--
(A) by inserting `subject to paragraph (4),' after `Notwithstanding
any other provision of law,'; and
(B) by striking `2007, or 2008' and inserting `or 2007'; and
(2) by adding at the end the following new paragraph:
`(4) OPTION FOR ALLOTMENTS FOR FISCAL YEARS 2008 THROUGH 2012-
`(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)).
`(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.'.
SEC. 108. ONE-TIME APPROPRIATION.
There is appropriated to the Secretary, out of any money in the Treasury
not otherwise appropriated, $13,700,000,000 to accompany the allotment
made for the period beginning on October 1, 2011, and ending on March
31, 2012, under section 2104(a)(15)(A) of the Social Security Act (42
U.S.C. 1397dd(a)(15)(A)) (as added by section 101), to remain available
until expended. Such amount shall be used to provide allotments to States
under paragraph (3) of section 2104(i) of the Social Security Act (42
U.S.C. 1397dd(i)), as added by section 102, for the first 6 months of
fiscal year 2012 in the same manner as allotments are provided under subsection
(a)(15)(A) of such section 2104 and subject to the same terms and conditions
as apply to the allotments provided from such subsection (a)(15)(A).
SEC. 109. IMPROVING FUNDING FOR THE TERRITORIES UNDER CHIP AND MEDICAID.
(a) Removal of Federal Matching Payments for Data Reporting Systems From
the Overall Limit on Payments to Territories Under Title XIX- Section
1108(g) (42 U.S.C. 1308(g)) is amended by adding at the end the following
new paragraph:
`(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.'.
(b) GAO Study and Report- Not later than September 30, 2009, the Comptroller
General of the United States shall submit a report to the Committee on
Finance of the Senate and the Committee on Energy and Commerce of the
House of Representatives regarding Federal funding under Medicaid and
CHIP for Puerto Rico, the United States Virgin Islands, Guam, American
Samoa, and the Northern Mariana Islands. The report shall include the
following:
(1) An analysis of all relevant factors with respect to--
(A) eligible Medicaid and CHIP populations in such commonwealths and
territories;
(B) historical and projected spending needs of such commonwealths
and territories and the ability of capped funding streams to respond
to those spending needs;
(C) the extent to which Federal poverty guidelines are used by such
commonwealths and territories to determine Medicaid and CHIP eligibility;
and
(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.
(2) Recommendations regarding methods for the collection and reporting
of reliable data regarding the enrollment under Medicaid and CHIP of
children in such commonwealths and territories.
(3) Recommendations for improving Federal funding under Medicaid and
CHIP for such commonwealths and territories.
Subtitle B--Focus on Low-Income Children and Pregnant Women
SEC. 111. STATE OPTION TO COVER LOW-INCOME PREGNANT WOMEN UNDER CHIP
THROUGH A STATE PLAN AMENDMENT.
(a) In General- Title XXI (42 U.S.C. 1397aa et seq.), as amended by section
112(a), is amended by adding at the end the following new section:
`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.
`(b) Conditions- A State may only elect the option under subsection (a)
if the following conditions are satisfied:
`(1) MINIMUM INCOME ELIGIBILITY LEVELS FOR PREGNANT WOMEN AND CHILDREN-
The State has established an income eligibility level--
`(A) for pregnant women under subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV),
or (l)(1)(A) of section 1902 that is at least 185 percent (or such
higher percent as the State has in effect with regard to pregnant
women under this title) of the poverty line applicable to a family
of the size involved, but in no case lower than the percent in effect
under any such subsection as of July 1, 2007; and
`(B) for children under 19 years of age under this title (or title
XIX) that is at least 200 percent of the poverty line applicable to
a family of the size involved.
`(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.
`(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.
`(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.
`(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.
`(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.
`(7) NO WAITING LIST FOR CHILDREN- The State does not impose, with respect
to the enrollment under the State child health plan of targeted low-income
children during the quarter, any enrollment cap or other numerical limitation
on enrollment, any waiting list, any procedures designed to delay the
consideration of applications for enrollment, or similar limitation
with respect to enrollment.
`(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.
`(d) Definitions- For purposes of this section:
`(1) PREGNANCY-RELATED ASSISTANCE- The term `pregnancy-related assistance'
has the meaning given the term `child health assistance' in section
2110(a) with respect to an individual during the period described in
paragraph (2)(A).
`(2) TARGETED LOW-INCOME PREGNANT WOMAN- The term `targeted low-income
pregnant woman' means an individual--
`(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;
`(B) whose family income exceeds 185 percent (or, if higher, the percent
applied under subsection (b)(1)(A)) of the poverty line applicable
to a family of the size involved, but does not exceed the income eligibility
level established under the State child health plan under this title
for a targeted low-income child; and
`(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.
`(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).
`(f) States Providing Assistance Through Other Options-
`(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--
`(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)), or
`(B) pregnancy-related services through the application of any waiver
authority (as in effect on June 1, 2007).
`(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.
`(3) NO INFERENCE- Nothing in this subsection shall be construed--
`(A) to infer congressional intent regarding the legality or illegality
of the content of the sections specified in paragraph (1)(A); or
`(B) to modify the authority to provide pregnancy-related services
under a waiver specified in paragraph (1)(B).'.
(b) Additional Conforming Amendments-
(1) NO COST SHARING FOR PREGNANCY-RELATED BENEFITS- Section 2103(e)(2)
(42 U.S.C. 1397cc(e)(2)) is amended--
(A) in the heading, by inserting `or pregnancy-related assistance'
after `preventive services'; and
(B) by inserting before the period at the end the following: `or for
pregnancy-related assistance'.
(2) NO WAITING PERIOD- Section 2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B))
is amended--
(A) in clause (i), by striking `, and' at the end and inserting a
semicolon;
(B) in clause (ii), by striking the period at the end and inserting
`; and'; and
(C) by adding at the end the following new clause:
`(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.'.
SEC. 112. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS ADULTS UNDER
CHIP; CONDITIONS FOR COVERAGE OF PARENTS.
(1) IN GENERAL- Title XXI (42 U.S.C. 1397aa et seq.) is amended by adding
at the end the following new section:
`SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS ADULTS; CONDITIONS
FOR COVERAGE OF PARENTS.
`(a) Termination of Coverage for Nonpregnant Childless Adults-
`(1) NO NEW CHIP WAIVERS; AUTOMATIC EXTENSIONS AT STATE OPTION THROUGH
2008- Notwithstanding section 1115 or any other provision of this title,
except as provided in this subsection--
`(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; and
`(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, 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.
`(2) TERMINATION OF CHIP COVERAGE UNDER APPLICABLE EXISTING WAIVERS
AT THE END OF 2008-
`(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 December 31, 2008.
`(B) EXTENSION UPON STATE REQUEST- If an applicable existing waiver
described in subparagraph (A) would otherwise expire before January
1, 2009, and the State requests an extension of such waiver, the Secretary
shall grant such an extension, but only through December 31, 2008.
`(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, 2008.
`(3) STATE OPTION TO APPLY FOR MEDICAID WAIVER TO CONTINUE COVERAGE
FOR NONPREGNANT CHILDLESS ADULTS-
`(A) IN GENERAL- Each State for which coverage under an applicable
existing waiver is terminated under paragraph (2)(A) may submit, not
later than September 30, 2008, 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').
`(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 December 31, 2008, on the application
of a State for a Medicaid nonpregnant childless adults waiver that
was submitted to the Secretary by September 30, 2008, the application
shall be deemed approved.
`(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--
`(i) in the case of 2009, 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 2008, increased
by the percentage increase (if any) in the projected nominal per
capita amount of National Health Expenditures for 2009 over 2008,
as most recently published by the Secretary; and
`(ii) in the case of any succeeding year, allow such expenditures
to not exceed the amount in effect under this subparagraph for the
preceding year, increased by the percentage increase (if any) in
the projected nominal per capita amount of National Health Expenditures
for the year involved over the preceding year, as most recently
published by the Secretary.
`(b) Rules and Conditions for Coverage of Parents of Targeted Low-Income
Children-
`(1) TWO-YEAR TRANSITION PERIOD; AUTOMATIC EXTENSION AT STATE OPTION
THROUGH FISCAL YEAR 2009-
`(A) NO NEW CHIP WAIVERS- Notwithstanding section 1115 or any other
provision of this title, except as provided in this subsection--
`(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; and
`(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.
`(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.
`(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.
`(2) RULES FOR FISCAL YEARS 2010 THROUGH 2012-
`(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).
`(B) TERMS AND CONDITIONS-
`(i) BLOCK GRANT SET ASIDE FROM STATE ALLOTMENT- If the State makes
an election under subparagraph (A), the Secretary shall set aside
for the State for each such fiscal year an amount equal to the Federal
share of 110 percent of the State's projected expenditures under
the applicable existing waiver for providing child health assistance
or health benefits coverage to all parents of targeted low-income
children enrolled under such waiver for the fiscal year (as certified
by the State and submitted to the Secretary by not later than August
31 of the preceding fiscal year). In the case of fiscal year 2012,
the set aside for any State shall be computed separately for each
period described in subparagraphs (A) and (B) of section 2104(a)(15)
and any reduction in the allotment for either such period under
section 2104(i)(4) shall be allocated on a pro rata basis to such
set aside.
`(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.
`(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--
`(I) the enhanced FMAP determined under section 2105(b) in the
case of a State that meets the outreach or coverage benchmarks
described in any of subparagraph (A), (B), or (C) of paragraph
(3) for fiscal year 2009; or
`(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.
`(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--
`(I) the REMAP percentage if--
`(aa) the applicable percentage for the State under clause (iii)
was the enhanced FMAP for fiscal year 2009; and
`(bb) the State met either of the coverage benchmarks described
in subparagraph (B) or (C) of paragraph (3) for the preceding fiscal year;
or
`(II) the Federal medical assistance percentage (as so determined)
in the case of any State to which subclause (I) does not apply.
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.
`(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.
`(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.
`(3) OUTREACH OR COVERAGE BENCHMARKS- For purposes of paragraph (2),
the outreach or coverage benchmarks described in this paragraph are
as follows:
`(A) SIGNIFICANT CHILD OUTREACH CAMPAIGN- The State--
`(i) was awarded a grant under section 2113 for fiscal year 2009;
`(ii) implemented 1 or more of the enrollment and retention provisions
described in section 2105(a)(4) for such fiscal year; or
`(iii) has submitted a specific plan for outreach for such fiscal
year.
`(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.
`(C) STATE INCREASING ENROLLMENT OF LOW-INCOME CHILDREN- The State
qualified for a performance bonus payment under section 2105(a)(3)(B)
for the most recent fiscal year applicable under such section.
`(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.
`(c) Applicable Existing Waiver- For purposes of this section--
`(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--
`(A) would allow funds made available under this title to be used
to provide child health assistance or other health benefits coverage
to--
`(i) a parent of a targeted low-income child;
