110th CONGRESS
1st Session
S. 1075
To amend title XIX of the Social Security Act to expand access
to contraceptive services for women and men under the Medicaid program,
help low income women and couples prevent unintended pregnancies and reduce
abortion, and for other purposes.
IN THE SENATE OF THE UNITED STATES
March 29, 2007
Mrs. CLINTON (for herself, Mr. REID, Mr. LAUTENBERG, Mr. CASEY, Mr. KERRY,
and Mr. SCHUMER) introduced the following bill; which was read twice and
referred to the Committee on Finance
A BILL
To amend title XIX of the Social Security Act to expand access
to contraceptive services for women and men under the Medicaid program,
help low income women and couples prevent unintended pregnancies and reduce
abortion, 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.
This Act may be cited as the `Unintended Pregnancy Reduction Act of 2007'.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Rates of unintended pregnancy in the United States increased by nearly
30 percent among low-income women between 1994 and 2002, and a low-income
woman today is 4 times as likely to have an unintended pregnancy as her
higher income counterpart.
(2) Abortion rates decreased among higher income women but increased among
low income women between 1994 and 2002, and a low income woman is more
than 4 times as likely to have an abortion as her higher income counterpart.
(3) Contraceptive use reduces a woman's probability of having an abortion
by 85 percent.
(4) Levels of contraceptive use among low-income women at risk of unintended
pregnancy declined significantly between 1994 and 2002, from 92 percent
to 86 percent.
(5) Publicly funded contraceptive services have been shown to prevent
1,300,000 unintended pregnancies each year, and in the absence of these
services the United States abortion rate would likely be 40 percent higher
than it is.
(6) By helping couples avoid unintended pregnancy, Medicaid-funded contraceptive
services are highly cost-effective, and every public dollar spent on family
planning saves $3 in the cost of pregnancy-related care alone.
(7) Federal law requires State Medicaid programs to cover pregnancy-related
care for women with incomes up to 133 percent of poverty, and 17 States
have expanded this coverage to women with incomes up to 200 percent of
poverty.
(8) 17 States have expanded Medicaid coverage for family planning services
to at least the same level at which they provide Medicaid funded pregnancy-related
care.
(9) Equalizing the eligibility levels for family planning and pregnancy-related
care nationwide would maximize the cost-savings to both the Federal and
State Governments.
(10) A woman should have equal access to contraceptive services to help
prevent an unintended pregnancy and to pregnancy-related care if she does
become pregnant.
SEC. 3. EXPANSION OF FAMILY PLANNING SERVICES.
(a) Coverage as Mandatory Categorically Needy Group-
(1) IN GENERAL- Section 1902(a)(10)(A)(i) of the Social Security Act (42
U.S.C. 1396a(a)(10)(A)(i)) is amended--
(A) in subclause (VI), by striking `or' at the end;
(B) in subclause (VII), by adding `or' at the end; and
(C) by adding at the end the following new subclause:
`(VIII) who are described in subsection (dd) (relating to individuals
who meet the income standards for pregnant women);'.
(2) GROUP DESCRIBED- Section 1902 of the Social Security Act (42 U.S.C.
1396a) is amended by adding at the end the following new subsection:
`(dd)(1) Individuals described in this subsection are individuals who--
`(A) meet at least the income eligibility standards established under
the State plan as of January 1, 2007, for pregnant women or such higher
income eligibility standard for such women as the State may establish;
and
`(2) At the option of a State, individuals described in this subsection
may include individuals who are determined to meet the income eligibility
standards referred to in paragraph (1)(A) under the terms and conditions
applicable to making eligibility determinations for medical assistance under
this title under a waiver to provide the benefits described in clause (XV)
of the matter following subparagraph (G) of section 1902(a)(10) granted
to the State under section 1115 as of January 1, 2007.'.
(3) LIMITATION ON BENEFITS- Section 1902(a)(10) of the Social Security
Act (42 U.S.C. 1396a(a)(10)) is amended in the matter following subparagraph
(G)--
(A) by striking `and (XIV)' and inserting `(XIV)'; and
(B) by inserting `, and (XV) the medical assistance made available to
an individual described in subsection (dd) who is eligible for medical
assistance only because of subparagraph (A)(10)(i)(VIII) shall be limited
to family planning services and supplies described in 1905(a)(4)(C),
including medical diagnosis or treatment services that are provided
pursuant to a family planning service in a family planning setting provided
during the period in which such an individual is eligible;' after `cervical
cancer'.
(4) CONFORMING AMENDMENTS- Section 1905(a) of the Social Security Act
(42 U.S.C. 1396d(a)) is amended in the matter preceding paragraph (1)--
(A) in clause (xii), by striking `or' at the end;
(B) in clause (xii), by adding `or' at the end; and
(C) by inserting after clause (xiii) the following:
`(xiv) individuals described in section 1902(dd),'.
(b) Presumptive Eligibility-
(1) IN GENERAL- Title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.) is amended by inserting after section 1920B the following:
`PRESUMPTIVE ELIGIBILITY FOR FAMILY PLANNING SERVICES
`Sec. 1920C. (a) State Option- A State plan approved under section 1902
may provide for making medical assistance available to an individual described
in section 1902(dd) (relating to individuals who meet the income eligibility
standard for pregnant women in the State) during a presumptive eligibility
period. In the case of an individual described in section 1902(dd) who is
eligible for medical assistance only because of subparagraph (A)(10)(i)(VIII),
such medical assistance may be limited to family planning services and supplies
described in 1905(a)(4)(C) and, at the State's option, medical diagnosis
or treatment services that are provided in conjunction with a family planning
service in a family planning setting provided during the period in which
such an individual is eligible.
`(b) Definitions- For purposes of this section:
`(1) PRESUMPTIVE ELIGIBILITY PERIOD- The term `presumptive eligibility
period' means, with respect to an individual described in subsection (a),
the period that--
`(A) begins with the date on which a qualified entity determines, on
the basis of preliminary information, that the individual is described
in section 1902(dd); and
`(B) ends with (and includes) the earlier of--
`(i) the day on which a determination is made with respect to the
eligibility of such individual for services under the State plan;
or
`(ii) in the case of such an individual who does not file an application
by the last day of the month following the month during which the
entity makes the determination referred to in subparagraph (A), such
last day.
`(A) IN GENERAL- Subject to subparagraph (B), the term `qualified entity'
means any entity that--
`(i) is eligible for payments under a State plan approved under this
title; and
`(ii) is determined by the State agency to be capable of making determinations
of the type described in paragraph (1)(A).
`(B) REGULATIONS- The Secretary may issue regulations further limiting
those entities that may become qualified entities in order to prevent
fraud and abuse and for other reasons.
`(C) RULE OF CONSTRUCTION- Nothing in this paragraph shall be construed
as preventing a State from limiting the classes of entities that may
become qualified entities, consistent with any limitations imposed under
subparagraph (B).
`(1) IN GENERAL- The State agency shall provide qualified entities with--
`(A) such forms as are necessary for an application to be made by an
individual described in subsection (a) for medical assistance under
the State plan; and
`(B) information on how to assist such individuals in completing and
filing such forms.
`(2) NOTIFICATION REQUIREMENTS- A qualified entity that determines under
subsection (b)(1)(A) that an individual described in subsection (a) is
presumptively eligible for medical assistance under a State plan shall--
`(A) notify the State agency of the determination within 5 working days
after the date on which determination is made; and
`(B) inform such individual at the time the determination is made that
an application for medical assistance is required to be made by not
later than the last day of the month following the month during which
the determination is made.
`(3) APPLICATION FOR MEDICAL ASSISTANCE- In the case of an individual
described in subsection (a) who is determined by a qualified entity to
be presumptively eligible for medical assistance under a State plan, the
individual shall apply for medical assistance by not later than the last
day of the month following the month during which the determination is
made.
`(d) Payment- Notwithstanding any other provision of this title, medical
assistance that--
`(1) is furnished to an individual described in subsection (a)--
`(A) during a presumptive eligibility period;
`(B) by a entity that is eligible for payments under the State plan;
and
`(2) is included in the care and services covered by the State plan, shall
be treated as medical assistance provided by such plan for purposes of
clause (4) of the first sentence of section 1905(b).'.
(2) CONFORMING AMENDMENTS-
(A) Section 1902(a)(47) of the Social Security Act (42 U.S.C. 1396a(a)(47))
is amended by inserting before the semicolon at the end the following:
`and provide for making medical assistance available to individuals
described in subsection (a) of section 1920C during a presumptive eligibility
period in accordance with such section.'.
(B) Section 1903(u)(1)(D)(v) of such Act (42 U.S.C. 1396b(u)(1)(D)(v))
is amended--
(i) by striking `or for' and inserting `, for'; and
(ii) by inserting before the period the following: `, or for medical
assistance provided to an individual described in subsection (a) of
section 1920C during a presumptive eligibility period under such section'.
SEC. 4. CLARIFICATION OF COVERAGE OF FAMILY PLANNING SERVICES AND SUPPLIES.
Section 1937(b) of the Social Security Act (42 U.S.C. 1396u-7(b)) is amended
by adding at the end the following:
`(5) COVERAGE OF FAMILY PLANNING SERVICES AND SUPPLIES- Notwithstanding
the previous provisions of this section, a State may not provide for medical
assistance through enrollment of an individual with benchmark coverage
or benchmark-equivalent coverage under this section unless such coverage
includes for any individual described in section 1905(a)(4)(C), medical
assistance for family planning services and supplies in accordance with
such section.'.
SEC. 5. EFFECTIVE DATE.
(a) In General- Except as provided in paragraph (2), the amendments made
by this Act take effect on October 1, 2007.
(b) Extension of Effective Date for State Law Amendment- In the case of
a State plan under title XIX of the Social Security Act (42 U.S.C. 1396
et seq.) which the Secretary of Health and Human Services determines requires
State legislation in order for the plan to meet the additional requirements
imposed by the amendments made by this Act, the 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 these additional requirements 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 is considered to be a separate regular session of the State
legislature.
END
