H.R. 976
2-16-07, Bill Passed House
360-45
8-2-07, Bill Passed Senate 68-31
Vetoed by President
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. 2-year initial availability of CHIP allotments.
Sec. 106. Redistribution of unused allotments to address State funding shortfalls.
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. Limitation on matching rate for States that propose to cover 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.
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. Military family job protection.
Sec. 623. Outreach regarding health insurance options available to children.
Sec. 624. 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) and (c), this Act (and the amendments made by this Act)
shall take effect on October 1, 2007, and shall apply to child health assistance
and medical assistance provided on or after that date without regard to whether
or not final regulations to carry out this Act (or such amendments) have been
promulgated by such date.
(b) Exception for State Legislation- In the case of a State plan under title
XIX or State child health plan under XXI of the Social Security Act, which
the Secretary of Health and Human Services determines requires State legislation
in order for respective plan to meet one or more additional requirements imposed
by amendments made by this Act, the respective State plan shall not be regarded
as failing to comply with the requirements of such title solely on the basis
of its failure to meet such an additional requirement before the first day
of the first calendar quarter beginning after the close of the first regular
session of the State legislature that begins after the date of enactment of
this Act. For purposes of the previous sentence, in the case of a State that
has a 2-year legislative session, each year of the session shall be considered
to be a separate regular session of the State legislature.
(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) $1,750,000,000 for the period beginning on October 1, 2011, and ending
on March 31, 2012, and
`(B) $1,750,000,000 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 any of paragraph (1), (2), or (4) of subsection (h), the amount
of the projected total Federal payments to the State under this title
for fiscal year 2007, as determined on the basis of the November 2006
estimates certified by the State to the Secretary;
`(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 a State is equal to the Federal payments to the State that are attributable
to (and countable towards) the total amount of allotments available
under this section to the State in fiscal year 2009 (including payments
made to the State under subsection (j) for fiscal year 2009 as well
as amounts redistributed to the State in fiscal year 2009) multiplied
by the allotment increase factor under paragraph (5) for fiscal year
2010.
`(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.
`(B) AMOUNT- Subject to subparagraph (E), the amount described in this
subparagraph for a State for a fiscal year is equal to the sum of the
following amounts:
`(i) FOR ABOVE BASELINE MEDICAID CHILD ENROLLMENT COSTS-
`(I) FIRST TIER ABOVE BASELINE MEDICAID ENROLLEES- An amount equal
to the number of first tier above baseline child enrollees (as determined
under subparagraph (C)(i)) under title XIX for the State and fiscal
year multiplied by 15 percent of the projected per capita State Medicaid
expenditures (as determined under subparagraph (D)(i)) for the State
and fiscal year under title XIX.
`(II) SECOND TIER ABOVE BASELINE MEDICAID ENROLLEES- An amount equal
to the number of second tier above baseline child enrollees (as determined
under subparagraph (C)(ii)) under title XIX for the State and fiscal
year multiplied by 60 percent of the projected per capita State Medicaid
expenditures (as determined under subparagraph (D)(i)) for the State
and fiscal year under title XIX.
`(ii) FOR ABOVE BASELINE CHIP ENROLLMENT COSTS-
`(I) FIRST TIER ABOVE BASELINE CHIP ENROLLEES- An amount equal to
the number of first tier above baseline child enrollees under this
title (as determined under subparagraph (C)(i)) for the State and
fiscal year multiplied by 10 percent of the projected per capita State
CHIP expenditures (as determined under subparagraph (D)(ii)) for the
State and fiscal year under this title.
`(II) SECOND TIER ABOVE BASELINE CHIP ENROLLEES- An amount equal to
the number of second tier above baseline child enrollees under this
title (as determined under subparagraph (C)(ii)) for the State and
fiscal year multiplied by 40 percent of the projected per capita State
CHIP expenditures (as determined under subparagraph (D)(ii)) for the
State and fiscal year under this title.
`(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
this title or 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 child health plan under this title or under the State plan
under title XIX, respectively; exceeds
`(II) the baseline number of enrollees described in clause (iii) for
the State and fiscal year under this title or title XIX, respectively;
but not to exceed 3 percent (in the case of title XIX) or 7.5 percent
(in the case of this title) of the baseline number of enrollees described
in subclause (II).
`(ii) SECOND TIER ABOVE BASELINE CHILD ENROLLEES- The number of second
tier above baseline child enrollees for a State for a fiscal year under
this title or title XIX is equal to the number (if any, as determined
by the Secretary) by which--
`(I) the monthly average unduplicated number of qualifying children
(as defined in subparagraph (F)) enrolled during the fiscal year under
this title or under title XIX, respectively, as described in clause
(i)(I); exceeds
`(II) the sum of the baseline number of child enrollees described
in clause (iii) for the State and fiscal year under this title or
title XIX, respectively, as described in clause (i)(II), and the maximum
number of first tier above baseline child enrollees for the State
and fiscal year under this title or title XIX, respectively, as determined
under clause (i).
`(iii) BASELINE NUMBER OF CHILD ENROLLEES- Subject to subparagraph (H),
the baseline number of child enrollees for a State under this title
or title XIX--
`(I) for fiscal year 2008 is equal to the monthly average unduplicated
number of qualifying children enrolled in the State child health plan
under this title or in the State plan under title XIX, respectively,
during fiscal year 2007 increased by the population growth for children
in that State for the year ending on June 30, 2006 (as estimated by
the Bureau of the Census) plus 1 percentage point; 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
this title or title XIX, respectively, increased by the population
growth for children in that State for the year ending on June 30 before
the beginning of the fiscal year (as estimated by the Bureau of the
Census) plus 1 percentage point.
`(D) PROJECTED PER CAPITA STATE EXPENDITURES- For purposes of subparagraph
(B)--
`(i) PROJECTED PER CAPITA STATE MEDICAID EXPENDITURES- The projected
per capita State Medicaid expenditures for a State and fiscal year under
title XIX is equal to the average per capita expenditures (including
both State and Federal financial participation) for children under the
State plan under such title, including under waivers but not including
such children eligible for assistance by virtue of the receipt of benefits
under title XVI, for the most recent fiscal year for which actual data
are available (as determined by the Secretary), increased (for each
subsequent fiscal year up to and including the fiscal year involved)
by the annual percentage increase in per capita amount of National Health
Expenditures (as estimated by the Secretary) for the calendar year in
which the respective subsequent fiscal year ends and multiplied by a
State matching percentage equal to 100 percent minus the Federal medical
assistance percentage (as defined in section 1905(b)) for the fiscal
year involved.
`(ii) PROJECTED PER CAPITA STATE CHIP EXPENDITURES- The projected per
capita State CHIP expenditures for a State and fiscal year under this
title is equal to the average per capita expenditures (including both
State and Federal financial participation) for children under the State
child health plan under this title, including under waivers, for the
most recent fiscal year for which actual data are available (as determined
by the Secretary), increased (for each subsequent fiscal year up to
and including the fiscal year involved) by the annual percentage increase
in per capita amount of National Health Expenditures (as estimated by
the Secretary) for the calendar year in which the respective subsequent
fiscal year ends and multiplied by a State matching percentage equal
to 100 percent minus the enhanced FMAP (as defined in section 2105(b))
for the fiscal year involved.
`(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).
`(IV) UNEXPENDED TRANSITIONAL COVERAGE BLOCK GRANT FOR NONPREGNANT
CHILDLESS ADULTS- As of October 1, 2009, any amounts set aside under
section 2111(a)(3) that are not expended by September 30, 2009.
`(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, with respect to this title or title
XIX, children who meet the eligibility criteria (including income, categorical
eligibility, age, and immigration status criteria) in effect as of July
1, 2007, for enrollment under this title or title XIX, respectively, taking
into account criteria applied as of such date under this title or title
XIX, respectively, pursuant to a waiver under section 1115.
`(G) APPLICATION TO COMMONWEALTHS AND TERRITORIES- The provisions of subparagraph
(H) of section 2104(j)(3) shall apply with respect to payments under this
paragraph in the same manner as such provisions apply to payment under
such section.
`(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 this title or
title XIX for the third of such fiscal years shall be the monthly average
unduplicated number of qualifying children enrolled in the State child
health plan under this title or in the State plan under title XIX, respectively,
for such third fiscal year.
`(4) ENROLLMENT AND RETENTION PROVISIONS FOR CHILDREN- For purposes of paragraph
(3)(A), a State meets the condition of this paragraph for a fiscal year
if it is implementing at least 4 of the following enrollment and retention
provisions (treating each subparagraph as a separate enrollment and retention
provision) throughout the entire fiscal year:
`(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.'.
SEC. 105. 2-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. REDISTRIBUTION OF UNUSED ALLOTMENTS TO ADDRESS STATE FUNDING SHORTFALLS.
(a) Fiscal Year 2005 Allotments-
(1) IN GENERAL- Notwithstanding section 2104(f) of the Social Security Act
(42 U.S.C. 1397dd(f)), subject to paragraph (2), with respect to fiscal
year 2008, the Secretary shall provide for a redistribution under such section
from the allotments for fiscal year 2005 under subsections (b) and (c) of
such section that are not expended by the end of fiscal year 2007, to each
State described in clause (iii) of section 2104(i)(1)(A) of the Social Security
Act, as added by section 102, of an amount that bears the same ratio to
such unexpended fiscal year 2005 allotments as the ratio of the fiscal year
2007 allotment determined for each such State under subsection (b) of section
2104 of such Act for fiscal year 2007 (without regard to any amounts paid,
allotted, or redistributed to the State under section 2104 for any preceding
fiscal year) bears to the total amount of the fiscal year 2007 allotments
for all such States (as so determined).
(2) CONTINGENCY- Paragraph (1) shall not apply if the redistribution described
in such paragraph has occurred as of the date of the enactment of this Act.
(b) Allotments for Subsequent Fiscal Years- 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), by inserting `subject to paragraph (4),' after
`Notwithstanding any other provision of law,'; 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, $12,500,000,000 to accompany the allotment made for
the period beginning on October 1, 2011, and ending on March 31, 2012, under
section 2104(a)(15)(A) of the Social Security Act (42 U.S.C. 1397dd(a)(15)(A))
(as added by section 101), to remain available until expended. Such amount
shall be used to provide allotments to States under paragraph (3) of section
2104(i) of the Social Security Act (42 U.S.C. 1397dd(i)), as added by section
102, for the first 6 months of fiscal year 2012 in the same manner as allotments
are provided under subsection (a)(15)(A) of such section 2104 and subject
to the same terms and conditions as apply to the allotments provided from
such subsection (a)(15)(A).
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)
and includes any medical assistance that the State would provide for a pregnant
woman under the State plan under title XIX during the period described in
paragraph (2)(A).
`(2) TARGETED LOW-INCOME PREGNANT WOMAN- The term `targeted low-income pregnant
woman' means a woman--
`(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 FISCAL
YEAR 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 paragraphs (2) and (3) shall apply for purposes
of any fiscal year beginning on or after October 1, 2008, in determining
the period to which the waiver applies, the individuals eligible to be
covered by the waiver, and the amount of the Federal payment under this
title.
`(2) TERMINATION OF CHIP COVERAGE UNDER APPLICABLE EXISTING WAIVERS AT THE
END OF FISCAL YEAR 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
September 30, 2008.
`(B) EXTENSION UPON STATE REQUEST- If an applicable existing waiver described
in subparagraph (A) would otherwise expire before October 1, 2008, and
the State requests an extension of such waiver, the Secretary shall grant
such an extension, but only through September 30, 2008.
`(C) APPLICATION OF ENHANCED FMAP- The enhanced FMAP determined under
section 2105(b) shall apply to expenditures under an applicable existing
waiver for the provision of child health assistance or other health benefits
coverage to a nonpregnant childless adult during fiscal year 2008.
`(3) OPTIONAL 1-YEAR TRANSITIONAL COVERAGE BLOCK GRANT FUNDED FROM STATE
ALLOTMENT- Subject to paragraph (4)(B), each State for which coverage under
an applicable existing waiver is terminated under paragraph (2)(A) may elect
to provide nonpregnant childless adults who were provided child health assistance
or health benefits coverage under the applicable existing waiver at any
time during fiscal year 2008 with such assistance or coverage during fiscal
year 2009, as if the authority to provide such assistance or coverage under
an applicable existing waiver was extended through that fiscal year, but
subject to the following terms and conditions:
`(A) BLOCK GRANT SET ASIDE FROM STATE ALLOTMENT- The Secretary shall set
aside for the State an amount equal to the Federal share of the State's
projected expenditures under the applicable existing waiver for providing
child health assistance or health benefits coverage to all nonpregnant
childless adults under such waiver for fiscal year 2008 (as certified
by the State and submitted to the Secretary by not later than August 31,
2008, and without regard to whether any such individual lost coverage
during fiscal year 2008 and was later provided child health assistance
or other health benefits coverage under the waiver in that fiscal year),
increased by the annual adjustment for fiscal year 2009 determined under
section 2104(i)(5)(A). The Secretary may adjust the amount set aside under
the preceding sentence, as necessary, on the basis of the expenditure
data for fiscal year 2008 reported by States on CMS Form 64 or CMS Form
21 not later than November 30, 2008, but in no case shall the Secretary
adjust such amount after December 31, 2008.
`(B) NO COVERAGE FOR NONPREGNANT CHILDLESS ADULTS WHO WERE NOT COVERED
DURING FISCAL YEAR 2008-
`(i) FMAP APPLIED TO EXPENDITURES- The Secretary shall pay the State
for each quarter of fiscal year 2009, from the amount set aside under
subparagraph (A), an amount equal to the Federal medical assistance
percentage (as determined under section 1905(b) without regard to clause
(4) of such section) of expenditures in the quarter for providing child
health assistance or other health benefits coverage to a nonpregnant
childless adult but only if such adult was enrolled in the State program
under this title during fiscal year 2008 (without regard to whether
the individual lost coverage during fiscal year 2008 and was reenrolled
in that fiscal year or in fiscal year 2009).
`(ii) FEDERAL PAYMENTS LIMITED TO AMOUNT OF BLOCK GRANT SET-ASIDE- No
payments shall be made to a State for expenditures described in this
subparagraph after the total amount set aside under subparagraph (A)
for fiscal year 2009 has been paid to the State.
`(4) 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
June 30, 2009, an application to the Secretary for a waiver under section
1115 of the State plan under title XIX to provide medical assistance to
a nonpregnant childless adult whose coverage is so terminated (in this
subsection referred to as a `Medicaid nonpregnant childless adults waiver').
`(B) DEADLINE FOR APPROVAL- The Secretary shall make a decision to approve
or deny an application for a Medicaid nonpregnant childless adults waiver
submitted under subparagraph (A) within 90 days of the date of the submission
of the application. If no decision has been made by the Secretary as of
September 30, 2009, on the application of a State for a Medicaid nonpregnant
childless adults waiver that was submitted to the Secretary by June 30,
2009, the application shall be deemed approved.
`(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 fiscal year 2010, allow expenditures for medical
assistance under title XIX for all such adults to not exceed the total
amount of payments made to the State under paragraph (3)(B) for fiscal
year 2009, increased by the percentage increase (if any) in the projected
nominal per capita amount of National Health Expenditures for calendar
year 2010 over calendar year 2009, as most recently published by the
Secretary; and
`(ii) in the case of any succeeding fiscal year, allow such expenditures
to not exceed the amount in effect under this subparagraph for the preceding
fiscal year, increased by the percentage increase (if any) in the projected
nominal per capita amount of National Health Expenditures for the calendar
year that begins during the fiscal year involved over the preceding
calendar year, as most recently published by the Secretary.
`(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;
`(ii) a nonpregnant childless adult; or
`(iii) individuals described in both clauses (i) and (ii); and
`(B) was in effect during fiscal year 2007.
`(A) PARENT- The term `parent' includes a caretaker relative (as such
term is used in carrying out section 1931) and a legal guardian.
`(B) NONPREGNANT CHILDLESS ADULT- The term `nonpregnant childless adult'
has the meaning given such term by section 2107(f).'.
(2) CONFORMING AMENDMENTS-
(A) Section 2107(f) (42 U.S.C. 1397gg(f)) is amended--
(i) by striking `, the Secretary' and inserting `:
(ii) in the first sentence, by inserting `or a parent (as defined in
section 2111(c)(2)(A)), who is not pregnant, of a targeted low-income
child' before the period;
(iii) by striking the second sentence; and
(iv) by adding at the end the following new paragraph:
`(2) The Secretary may not approve, extend, renew, or amend a waiver, experimental,
pilot, or demonstration project with respect to a State after the date of
enactment of the Children's Health Insurance Program Reauthorization Act
of 2007 that would waive or modify the requirements of section 2111.'.
(B) Section 6102(c) of the Deficit Reduction Act of 2005 (Public Law 109-171;
120 Stat. 131) is amended by striking `Nothing' and inserting `Subject
to section 2111 of the Social Security Act, as added by section 112 of
the Children's Health Insurance Program Reauthorization Act of 2007, nothing'.
(b) GAO Study and Report-
(1) IN GENERAL- The Comptroller General of the United States shall conduct
a study of whether--
(A) the coverage of a parent, a caretaker relative (as such term is used
in carrying out section 1931), or a legal guardian of a targeted low-income
child under a State health plan under title XXI of the Social Security
Act increases the enrollment of, or the quality of care for, children,
and
(B) such parents, relatives, and legal guardians who enroll in such a
plan are more likely to enroll their children in such a plan or in a State
plan under title XIX of such Act.
(2) REPORT- Not later than 2 years after the date of the enactment of this
Act, the Comptroller General shall report the results of the study to the
Committee on Finance of the Senate and the Committee on Energy and Commerce
of the House of Representatives, including recommendations (if any) for
changes in legislation.
SEC. 113. ELIMINATION OF COUNTING MEDICAID CHILD PRESUMPTIVE ELIGIBILITY
COSTS AGAINST TITLE XXI ALLOTMENT.
(a) In General- Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)) is amended--
(1) in the matter preceding subparagraph (A), by striking `(or, in the case
of expenditures described in subparagraph (B), the Federal medical assistance
percentage (as defined in the first sentence of section 1905(b)))'; and
(2) by striking subparagraph (B) and inserting the following new subparagraph:
(b) Amendments to Medicaid-
(1) ELIGIBILITY OF A NEWBORN- Section 1902(e)(4) (42 U.S.C. 1396a(e)(4))
is amended in the first sentence by striking `so long as the child is a
member of the woman's household and the woman remains (or would remain if
pregnant) eligible for such assistance'.
(2) APPLICATION OF QUALIFIED ENTITIES TO PRESUMPTIVE ELIGIBILITY FOR PREGNANT
WOMEN UNDER MEDICAID- Section 1920(b) (42 U.S.C. 1396r-1(b)) is amended
by adding after paragraph (2) the following flush sentence:
`The term `qualified provider' also includes a qualified entity, as defined
in section 1920A(b)(3).'.
SEC. 114. LIMITATION ON MATCHING RATE FOR STATES THAT PROPOSE TO COVER CHILDREN
WITH EFFECTIVE FAMILY INCOME THAT EXCEEDS 300 PERCENT OF THE POVERTY LINE.
(a) FMAP Applied to Expenditures- Section 2105(c) (42 U.S.C. 1397ee(c)) is
amended by adding at the end the following new paragraph:
`(8) LIMITATION ON MATCHING RATE FOR EXPENDITURES FOR CHILD HEALTH ASSISTANCE
PROVIDED TO CHILDREN WHOSE EFFECTIVE FAMILY INCOME EXCEEDS 300 PERCENT OF
THE POVERTY LINE-
`(A) FMAP APPLIED TO EXPENDITURES- Except as provided in subparagraph
(B), for fiscal years beginning with fiscal year 2008, the Federal medical
assistance percentage (as determined under section 1905(b) without regard
to clause (4) of such section) shall be substituted for the enhanced FMAP
under subsection (a)(1) with respect to any expenditures for providing
child health assistance or health benefits coverage for a targeted low-income
child whose effective family income would exceed 300 percent of the poverty
line but for the
