110th CONGRESS
1st Session
S. 158
To expand access to affordable health care and to strengthen the
health care safety net and make health care services more available in rural
and underserved areas.
IN THE SENATE OF THE UNITED STATES
January 4, 2007
Ms. COLLINS (for herself and Ms. LANDRIEU) introduced the following bill;
which was read twice and referred to the Committee on Finance
A BILL
To expand access to affordable health care and to strengthen the
health care safety net and make health care services more available in rural
and underserved areas.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title- This Act may be cited as the `Access to Affordable Health
Care Act'.
(b) Table of Contents- The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I--EXPANSION OF ACCESS TO AFFORDABLE HEALTH CARE FOR SMALL BUSINESSES
Subtitle A--Small Business Tax Credit
Sec. 101. Credit for employee health insurance expenses.
Subtitle B--Grants to States for Small Business Purchasing Groups
Sec. 121. Grants for small employer purchasing groups.
Sec. 122. Qualified small employer purchasing groups.
Subtitle C--Health Benefits Information for Small Employers
Sec. 131. Grant program to facilitate health benefits information for
small employers.
Subtitle D--Grant Program to Encourage State Innovation
Sec. 141. Grant program to encourage State innovation.
TITLE II--EXPANSION OF ACCESS TO AFFORDABLE HEALTH CARE FOR INDIVIDUALS
AND FAMILIES
Subtitle A--Internal Revenue Code Provisions
Sec. 201. Refundable health insurance costs credit.
Sec. 202. Advance Payment of credit to issuers of qualified health insurance.
Subtitle B--Elimination of SCHIP Funding Shortfalls
Sec. 206. Elimination of SCHIP funding shortfalls for fiscal year 2007.
Subtitle C--FamilyCare
Sec. 211. Renaming of title XXI program.
Sec. 212. FamilyCare coverage of parents under the medicaid program and
title XXI.
Sec. 213. Optional coverage of children through age 20 under the medicaid
program and title XXI.
Sec. 214. Sense of the Senate Regarding Authority To Use SCHIP Funds To
Purchase Family Coverage.
Subtitle D--Simplified Enrollment
Sec. 221. Automatic enrollment of children born to title XXI parents.
Sec. 222. Application of simplified title XXI procedures under the medicaid
program.
Subtitle E--State Option to Extend Medicaid Coverage to Certain Low-Income
Individuals
Sec. 231. State option to extend medicaid coverage to certain low-income
individuals.
Subtitle F--Grants to Promote Innovative Outreach and Enrollment Under
Medicaid and SCHIP
Sec. 251. Grants to promote innovative outreach and enrollment under medicaid
and SCHIP.
Sec. 252. State option to provide for simplified determinations of a child's
financial eligibility for medical assistance under medicaid or child health
assistance under SCHIP.
Subtitle G--Demonstration Programs to Improve Medicaid and SCHIP Outreach
to Homeless Individuals and Families
Sec. 261. Demonstration programs to improve medicaid and SCHIP outreach
to homeless individuals and families.
TITLE III--STRENGTHENING THE HEALTH CARE SAFETY NET
Sec. 301. Increase in funding for the consolidated health Centers program.
TITLE IV--EXPANSION OF ACCESS TO HEALTH CARE IN RURAL AND UNDERSERVED
AREAS
Sec. 401. Expansion of funding.
Sec. 402. Loan repayment and scholarship programs.
TITLE V--EXPANDED ACCESS TO AFFORDABLE LONG-TERM CARE
Sec. 501. Treatment of premiums on qualified Long-Term care insurance
contracts.
Sec. 502. Credit for taxpayers with Long-Term care needs.
Sec. 503. Additional consumer protections for Long-Term care insurance.
TITLE VI--PROMOTING HEALTHIER LIFESTYLES
Sec. 601. Community partnerships to promote healthy lifestyles.
Sec. 602. Worksite wellness grant program.
Sec. 603. Comprehensive school health education.
TITLE VII--MEDICARE FAIRNESS
Subtitle A--Medicare Value and Quality Demonstration
Sec. 702. Demonstration project to encourage the provision of high-quality,
cost-effective inpatient hospital services.
Sec. 703. Demonstration project to encourage the provision of high-quality,
cost-effective physicians' services.
Subtitle B--Graduate Medical Education Demonstration
Sec. 711. Clinical rotation demonstration project.
TITLE I--EXPANSION OF ACCESS TO AFFORDABLE HEALTH CARE FOR SMALL BUSINESSES
Subtitle A--Small Business Tax Credit
SEC. 101. CREDIT FOR EMPLOYEE HEALTH INSURANCE EXPENSES.
(a) In General- Subpart D of part IV of subchapter A of chapter 1 of the
Internal Revenue Code of 1986 (relating to business-related credits) is
amended by inserting after section 45M the following:
`SEC. 45N. EMPLOYEE HEALTH INSURANCE EXPENSES.
`(a) General Rule- For purposes of section 38, in the case of an employer,
the employee health insurance expenses credit determined under this section
is an amount equal to the applicable percentage of the amount paid by the
taxpayer during the taxable year for qualified employee health insurance
expenses.
`(b) Applicable Percentage- For purposes of subsection (a), the applicable
percentage is equal to--
`(1) 50 percent in the case of an employer with less than 10 employees,
`(2) 30 percent in the case of an employer with more than 9 but less than
26 employees, and
`(3) zero percent for any other employer.
`(c) Per Employee Dollar Limitation- The amount of qualified employee health
insurance expenses taken into account under subsection (a) with respect
to any qualified employee for any taxable year shall not exceed--
`(1) $2,000 in the case of self-only coverage, and
`(2) $4,000 in the case of family coverage (as defined in section 223(c)(4)).
`(d) Special Rules and Definitions- For purposes of this section--
`(1) ELIGIBILITY FOR CREDIT- No credit shall be allowed under subsection
(a) with respect to any employer for any period if more than 20 percent
of the number of employees employed by the employer during the period
are highly compensated employees (within the meaning of section 414(q)).
`(2) DETERMINATION OF EMPLOYMENT-
`(A) IN GENERAL- An employer shall be considered an employer described
in paragraph (1) or (2) of subsection (b) if such employer employed
an average of the number of employees described in such paragraph on
business days during either of the 2 preceding calendar years. For purposes
of the preceding sentence, a preceding calendar year may be taken into
account only if the employer was in existence throughout such year.
`(B) EMPLOYERS NOT IN EXISTENCE IN PRECEDING YEAR- In the case of an
employer which was not in existence throughout the 1st preceding calendar
year, the determination under subparagraph (A) shall be based on the
average number of employees that it is reasonably expected such employer
will employ on business days in the current calendar year.
`(3) QUALIFIED EMPLOYEE HEALTH INSURANCE EXPENSES-
`(A) IN GENERAL- The term `qualified employee health insurance expenses'
means any amount paid by an employer for health insurance coverage to
the extent such amount--
`(i) is attributable to coverage provided to any employee while such
employee is a qualified employee; and
`(ii) is at least 50 percent of the premium for such coverage.
`(B) EXCEPTION FOR AMOUNTS PAID UNDER SALARY REDUCTION ARRANGEMENTS-
No amount paid or incurred for health insurance coverage pursuant to
a salary reduction arrangement shall be taken into account under subparagraph
(A).
`(C) HEALTH INSURANCE COVERAGE- The term `health insurance coverage'
has the meaning given such term by section 9832(b)(1).
`(A) IN GENERAL- The term `qualified employee' means, with respect to
any period, an employee of an employer if the total amount of wages
paid or incurred by such employer to such employee at an annual rate
during the taxable year is not less than $5,000.
`(B) TREATMENT OF CERTAIN EMPLOYEES- For purposes of subparagraph (A),
the term `employee'--
`(i) shall not include an employee within the meaning of section 401(c)(1),
but
`(ii) shall include a leased employee within the meaning of section
414(n).
`(C) WAGES- The term `wages' has the meaning given such term by section
3121(a) (determined without regard to any dollar limitation contained
in such section).
`(e) Certain Rules Made Applicable- For purposes of this section, rules
similar to the rules of section 52 shall apply.
`(f) Denial of Double Benefit- No deduction or credit under any other provision
of this chapter shall be allowed with respect to qualified employee health
insurance expenses taken into account under subsection (a).'.
(b) Credit To Be Part of General Business Credit- Section 38(b) of the Internal
Revenue Code of 1986 (relating to current year business credit) is amended
by striking `plus' at the end of paragraph (29), by striking the period
at the end of paragraph (30) and inserting `, plus', and by inserting after
paragraph (30) the following:
`(31) the employee health insurance expenses credit determined under section
45N.'.
(c) Clerical Amendment- The table of sections for subpart D of part IV of
subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended
by adding at the end the following:
`Sec. 45N. Employee health insurance expenses.'.
(d) Effective Date- The amendments made by this section shall apply to amounts
paid or incurred in taxable years beginning after December 31, 2007.
Subtitle B--Grants to States for Small Business Purchasing Groups
SEC. 121. GRANTS FOR SMALL EMPLOYER PURCHASING GROUPS.
(a) In General- The Secretary of Labor (referred to in this section as the
`Secretary') shall award grants to States to assist such States in planning,
developing, and operating qualified small employer purchasing groups.
(b) Application Requirements- To be eligible to receive a grant under this
section, a State shall prepare and submit to the Secretary an application
in such form, at such time, and containing such information, certifications,
and assurances as the Secretary shall reasonably require.
(c) Use of Funds- Amounts awarded under this section may be used to finance
the costs associated with planning, developing, and operating a qualified
small employer purchasing group that meets the requirements of section 122.
Such costs may include the costs associated with--
(1) engaging in education and outreach efforts to inform small employers,
insurers, and the public about the small employer purchasing group;
(2) soliciting bids and negotiating with insurers to make available group
health plans;
(3) preparing the documentation required to receive certification by the
Secretary as a qualified small employer purchasing group; and
(4) such other activities determined appropriate by the Secretary.
(d) Authorization of Appropriations- There are authorized to be appropriated
to carry out this section, such sums as may be necessary for each of fiscal
years 2008 through 2012.
SEC. 122. QUALIFIED SMALL EMPLOYER PURCHASING GROUPS.
(a) Qualified Small Employer Purchasing Groups Described-
(1) IN GENERAL- A qualified small employer purchasing group is an entity
that--
(A) is a nonprofit entity certified under State law;
(B) has a membership consisting solely of small employers;
(C) is administered solely under the authority and control of its member
employers;
(D) with respect to each State in which its members are located, consists
of not fewer than the number of small employers established by the State
as appropriate for such a group;
(E) offers a program under which group health plans are offered to eligible
employees and eligible individuals (including the dependents of such
employees and individuals) through its member employers; and
(F) an insurer, agent, broker, or any other individual or entity engaged
in the sale of insurance--
(i) does not form or underwrite; and
(ii) does not hold or control any right to vote with respect to.
(2) SPECIAL RULE- Notwithstanding paragraph (1)(B), an employer member
of a small employer purchasing group that has been certified by the State
as meeting the requirements of paragraph (1) may retain its membership
in the group if the number of employees of the employer increases such
that the employer is no longer a small employer.
(b) Board of Directors- Each qualified small employer purchasing group established
under this section shall be governed by a board of directors or have active
input from an advisory board consisting of individuals and businesses participating
in the group.
(1) IN GENERAL- A qualified small employer purchasing group shall accept
all small employers residing within the area served by the group as members
if such employers request such membership.
(2) VOTING- Members of a qualified small employer purchasing group shall
have voting rights consistent with the rules established by the State.
(d) Duties of Qualified Small Employer Purchasing Groups- Each qualified
small employer purchasing group shall--
(1) enter into agreements with insurers offering qualified group health
plans;
(2) enter into agreements with small employers for the purchase of health
insurance;
(3) enroll only eligible employees, eligible individuals, and the dependents
of such employees and individuals in group health plans; and
(4) provide enrollee information to the State.
(e) Limitation on Activities- A qualified small employer purchasing group
shall not--
(1) perform any activity involving approval or enforcement of payment
rates for providers;
(2) assume financial risk in relation to any such health plan; or
(3) perform other activities identified by the State as being inconsistent
with the performance of its duties.
(f) Rules of Construction-
(1) ESTABLISHMENT NOT REQUIRED- Nothing in this section shall be construed
as requiring that a State organize, operate, or otherwise establish a
qualified small employer purchasing group, or otherwise require the establishment
of purchasing groups.
(2) VOLUNTARY PARTICIPATION- Nothing in this section shall be construed
as requiring any individual or small employer to purchase a group health
plan exclusively through a qualified small employer purchasing group.
(g) Definition- In this subtitle, the term `small employer' means an employer
that employs at least 1, but not more than 50, employees. Such term shall
include sole proprietorships and self-employed individuals.
Subtitle C--Health Benefits Information for Small Employers
SEC. 131. GRANT PROGRAM TO FACILITATE HEALTH BENEFITS INFORMATION FOR
SMALL EMPLOYERS.
(a) In General- The Small Business Administration shall award grants to
1 or more States, local governments, and nonprofit organizations for the
purposes of--
(1) demonstrating new and effective ways to provide information about
the benefits of health insurance to small employers, including tax benefits,
increased productivity of employees, and decreased turnover of employees;
(2) making small employers aware of their current rights in the marketplace
under Federal and State health insurance reform laws; and
(3) making small employers aware of the tax treatment of insurance premiums.
(b) Authorization- There is authorized to be appropriated to carry out this
section, such sums as may be necessary for each of fiscal years 2008 through
2012.
Subtitle D--Grant Program To Encourage State Innovation
SEC. 141. GRANT PROGRAM TO ENCOURAGE STATE INNOVATION.
(a) In General- The Secretary of Health and Human Services (in this section
referred to as the `Secretary') shall establish a program (in this section
referred to as the `program') to award demonstration grants under this section
to States to allow States to demonstrate the effectiveness of innovative
ways to increase access to health insurance through market reforms and other
innovative means. Such innovative means may include any of the following:
(1) Alternative group purchasing or pooling arrangements, such as purchasing
cooperatives for small businesses, reinsurance pools, or high risk pools.
(2) Individual or small group market reforms.
(3) Consumer education and outreach.
(4) Subsidies to individuals, employers, or both, in obtaining health
insurance.
(b) Scope; Duration- The program shall be limited to not more than 10 States
and to a total period of 5 years, beginning on the date the first demonstration
grant is made.
(c) Conditions for Demonstration Grants-
(1) IN GENERAL- The Secretary may not provide for a demonstration grant
to a State under the program unless the Secretary finds that under the
proposed demonstration grant--
(A) the State will provide for demonstrated increase of access for some
portion of the existing uninsured population through a market innovation
(other than merely through a financial expansion of a program initiated
before the date of enactment of this Act);
(B) the State will comply with applicable Federal laws;
(C) the State will not discriminate among participants on the basis
of any health status-related factor (as defined in section 2791(d)(9)
of the Public Health Service Act (42 U.S.C. 300gg-91(d)(9)), except
to the extent a State wishes to focus on populations that otherwise
would not obtain health insurance because of such factors; and
(D) the State will provide for such evaluation, in coordination with
the evaluation required under subsection (d), as the Secretary may specify.
(2) APPLICATION- The Secretary shall not provide a demonstration grant
under the program to a State unless--
(A) the State submits to the Secretary such an application, in such
a form and manner, as the Secretary specifies;
(B) the application includes information regarding how the demonstration
grant will address issues such as governance, targeted population, expected
cost, and the continuation after the completion of the demonstration
grant period; and
(C) the Secretary determines that the demonstration grant will be used
consistent with this section.
(3) FOCUS- A demonstration grant proposal under this section need not
cover all uninsured individuals in a State or all health care benefits
with respect to such individuals.
(d) Evaluation- The Secretary shall enter into a contract with an appropriate
entity outside the Department of Health and Human Services to conduct an
overall evaluation of the program at the end of the program period. Such
evaluation shall include an analysis of improvements in access, costs, quality
of care, or choice of coverage, under different demonstration grants.
(e) Option To Provide for Initial Planning Grants- Notwithstanding the previous
provisions of this section, under the program the Secretary may provide
for a portion of the amounts appropriated under subsection (f) (not to exceed
$5,000,000) to be made available to any State for initial planning grants
to permit States to develop demonstration grant proposals under the previous
provisions of this section.
(f) Authorization of Appropriations- There are authorized to be appropriated
such sums as may be necessary to carry out this section. Amounts appropriated
under this subsection shall remain available until expended.
(g) State Defined- In this section, the term `State' has the meaning given
such term for purposes of title XIX of the Social Security Act (42 U.S.C.
1396 et seq.).
TITLE II--EXPANSION OF ACCESS TO AFFORDABLE HEALTH CARE FOR INDIVIDUALS
AND FAMILIES
Subtitle A--Internal Revenue Code Provisions
SEC. 201. REFUNDABLE HEALTH INSURANCE COSTS CREDIT.
(1) IN GENERAL- Subpart C of part IV of subchapter A of chapter 1 of the
Internal Revenue Code of 1986 (relating to refundable personal credits)
is amended by redesignating section 36 as section 37 and inserting after
section 35 the following:
`SEC. 36. HEALTH INSURANCE COSTS FOR UNINSURED ELIGIBLE INDIVIDUALS.
`(a) Allowance of Credit- In the case of an uninsured eligible individual,
there shall be allowed as a credit against the tax imposed by this subtitle
for the taxable year an amount equal to the amount paid by the taxpayer
during such taxable year for qualified health insurance for the taxpayer
and the taxpayer's spouse and dependents.
`(1) IN GENERAL- The amount allowed as a credit under subsection (a) to
the taxpayer for the taxable year shall not exceed the lesser of--
`(A) the sum of the monthly limitations for coverage months during such
taxable year for the individuals referred to in subsection (a) for whom
the taxpayer paid during the taxable year any amount for coverage under
qualified health insurance, or
`(B) 90 percent of the amount paid by the taxpayer during such taxable
year for qualified health insurance for such individuals.
`(A) IN GENERAL- The monthly limitation for an individual for each coverage
month of such individual during the taxable year is the amount equal
to 1/12 of--
`(i) $1,000 if such individual is the taxpayer,
`(I) such individual is the spouse of the taxpayer,
`(II) the taxpayer and such spouse are married as of the first day
of such month, and
`(III) the taxpayer files a joint return for the taxable year, and
`(iii) $500 if such individual is an individual for whom a deduction
under section 151(c) is allowable to the taxpayer for such taxable
year.
`(B) LIMITATION TO 2 DEPENDENTS- Not more than 2 individuals may be
taken into account by the taxpayer under subparagraph (A)(iii).
`(C) SPECIAL RULE FOR MARRIED INDIVIDUALS- In the case of an individual--
`(i) who is married (within the meaning of section 7703) as of the
close of the taxable year but does not file a joint return for such
year, and
`(ii) who does not live apart from such individual's spouse at all
times during the taxable year,
the limitation imposed by subparagraph (B) shall be divided equally
between the individual and the individual's spouse unless they agree
on a different division.
`(A) IN GENERAL- The amount which would (but for this paragraph) be
taken into account under subsection (a) shall be reduced (but not below
zero) by the amount determined under subparagraph (B).
`(B) AMOUNT OF REDUCTION- The amount determined under this subparagraph
is the amount which bears the same ratio to the amount which would be
so taken into account for the taxable year as--
`(I) the taxpayer's modified adjusted gross income for the preceding
taxable year, over
`(II) $15,000 ($25,000 in the case of family coverage), bears to
`(ii) $15,000 ($35,000 in the case of family coverage).
`(C) MODIFIED ADJUSTED GROSS INCOME- The term `modified adjusted gross
income' means adjusted gross income determined--
`(i) without regard to this section and sections 911, 931, and 933,
and
`(ii) after application of sections 86, 135, 137, 219, 221, and 469.
`(4) COVERAGE MONTH- For purposes of this subsection--
`(A) IN GENERAL- The term `coverage month' means, with respect to an
individual, any month if--
`(i) as of the first day of such month such individual is covered
by qualified health insurance, and
`(ii) the premium for coverage under such insurance for such month
is paid by the taxpayer.
`(B) EMPLOYER-SUBSIDIZED COVERAGE-
`(i) IN GENERAL- Such term shall not include any month for which such
individual is eligible to participate in any subsidized health plan
(within the meaning of section 162(l)(2)) maintained by any employer
of the taxpayer or of the spouse of the taxpayer.
`(ii) PREMIUMS TO NONSUBSIDIZED PLANS- If an employer of the taxpayer
or the spouse of the taxpayer maintains a health plan which is not
a subsidized health plan (as so defined) and which constitutes qualified
health insurance, employee contributions to the plan shall be treated
as amounts paid for qualified health insurance.
`(C) CAFETERIA PLAN AND FLEXIBLE SPENDING ACCOUNT BENEFICIARIES- Such
term shall not include any month during a taxable year if any amount
is not includible in the gross income of the taxpayer for such year
under section 106 with respect to--
`(i) a benefit chosen under a cafeteria plan (as defined in section
125(d)), or
`(ii) a benefit provided under a flexible spending or similar arrangement.
`(D) MEDICARE AND MEDICAID- Such term shall not include any month with
respect to an individual if, as of the first day of such month, such
individual--
`(i) is entitled to any benefits under title XVIII of the Social Security
Act, or
`(ii) is a participant in the program under title XIX or XXI of such
Act.
`(E) CERTAIN OTHER COVERAGE- Such term shall not include any month during
a taxable year with respect to an individual if, at any time during
such year, any benefit is provided to such individual under--
`(i) chapter 89 of title 5, United States Code,
`(ii) chapter 55 of title 10, United States Code,
`(iii) chapter 17 of title 38, United States Code, or
`(iv) any medical care program under the Indian Health Care Improvement
Act.
`(F) PRISONERS- Such term shall not include any month with respect to
an individual if, as of the first day of such month, such individual
is imprisoned under Federal, State, or local authority.
`(G) INSUFFICIENT PRESENCE IN UNITED STATES- Such term shall not include
any month during a taxable year with respect to an individual if such
individual is present in the United States on fewer than 183 days during
such year (determined in accordance with section 7701(b)(7)).
`(5) COORDINATION WITH DEDUCTION FOR HEALTH INSURANCE COSTS OF SELF-EMPLOYED
INDIVIDUALS- In the case of a taxpayer who is eligible to deduct any amount
under section 162(l) for the taxable year, this section shall apply only
if the taxpayer elects not to claim any amount as a deduction under such
section for such year.
`(c) Qualified Health Insurance- For purposes of this section, the term
`qualified health insurance' means health insurance coverage (as defined
in section 9832(b)(1)), including coverage under a COBRA continuation provision
(as defined in section 9832(d)(1)).
`(d) Archer MSA Contributions- If a deduction would be allowed under section
220 to the taxpayer for a payment for the taxable year to the Archer MSA
of an individual, subsection (a) shall not apply to the taxpayer for such
taxable year.
`(1) COORDINATION WITH MEDICAL EXPENSE DEDUCTION- The amount which would
(but for this paragraph) be taken into account by the taxpayer under section
213 for the taxable year shall be reduced by the credit (if any) allowed
by this section to the taxpayer for such year.
`(2) DENIAL OF CREDIT TO DEPENDENTS- No credit shall be allowed under
this section to any individual with respect to whom a deduction under
section 151 is allowable to another taxpayer for a taxable year beginning
in the calendar year in which such individual's taxable year begins.
`(3) COORDINATION WITH ADVANCE PAYMENT- Rules similar to the rules of
section 32(g) shall apply to any credit to which this section applies.
`(f) Expenses Must Be Substantiated- A payment for insurance to which subsection
(a) applies may be taken into account under this section only if the taxpayer
substantiates such payment in such form as the Secretary may prescribe.
`(g) Regulations- The Secretary shall prescribe such regulations as may
be necessary to carry out the purposes of this section.'.
(b) Information Reporting-
(1) IN GENERAL- Subpart B of part III of subchapter A of chapter 61 of
the Internal Revenue Code of 1986 (relating to information concerning
transactions with other persons) is amended by inserting after section
6050V the following:
`SEC. 6050W. RETURNS RELATING TO PAYMENTS FOR QUALIFIED HEALTH INSURANCE.
`(a) In General- Any person who, in connection with a trade or business
conducted by such person, receives payments during any calendar year from
any individual for coverage of such individual or any other individual under
creditable health insurance, shall make the return described in subsection
(b) (at such time as the Secretary may by regulations prescribe) with respect
to each individual from whom such payments were received.
`(b) Form and Manner of Returns- A return is described in this subsection
if such return--
`(1) is in such form as the Secretary may prescribe, and
`(A) the name, address, and TIN of the individual from whom payments
described in subsection (a) were received,
`(B) the name, address, and TIN of each individual who was provided
by such person with coverage under creditable health insurance by reason
of such payments and the period of such coverage,
`(C) the aggregate amount of payments described in subsection (a),
`(D) the qualified health insurance credit advance amount (as defined
in section 7527A(e)) received by such person with respect to the individual
described in subparagraph (A), and
`(E) such other information as the Secretary may reasonably prescribe.
`(c) Creditable Health Insurance- For purposes of this section, the term
`creditable health insurance' means qualified health insurance (as defined
in section 36(c)).
`(d) Statements To Be Furnished to Individuals With Respect to Whom Information
Is Required- Every person required to make a return under subsection (a)
shall furnish to each individual whose name is required under subsection
(b)(2)(A) to be set forth in such return a written statement showing--
`(1) the name and address of the person required to make such return and
the phone number of the information contact for such person,
`(2) the aggregate amount of payments described in subsection (a) received
by the person required to make such return from the individual to whom
the statement is required to be furnished,
`(3) the information required under subsection (b)(2)(B) with respect
to such payments, and
`(4) the qualified health insurance credit advance amount (as defined
in section 7528(e)) received by such person with respect to the individual
described in paragraph (2).
The written statement required under the preceding sentence shall be furnished
on or before January 31 of the year following the calendar year for which
the return under subsection (a) is required to be made.
`(e) Returns Which Would Be Required To Be Made by 2 or More Persons- Except
to the extent provided in regulations prescribed by the Secretary, in the
case of any amount received by any person on behalf of another person, only
the person first receiving such amount shall be required to make the return
under subsection (a).'.
(2) ASSESSABLE PENALTIES-
(A) Subparagraph (B) of section 6724(d)(1) of such Code (relating to
definitions) is amended by striking `and' at the end of clause (xx)
and by inserting after clause (xx) the following:
`(xxi) section 6050U (relating to returns relating to payments for
qualified health insurance), and'.
(B) Paragraph (2) of section 6724(d) of such Code is amended by striking
`or' at the end of subparagraph (BB), by striking the period at the
end of the subparagraph (CC) and inserting `, or', and by adding at
the end the following:
`(DD) section 6050U(d) (relating to returns relating to payments for
qualified health insurance).'.
(3) CLERICAL AMENDMENT- The table of sections for subpart B of part III
of subchapter A of chapter 61 of such Code is amended by inserting after
the item relating to section 6050V the following:
`Sec. 6050W. Returns relating to payments for qualified health insurance.'.
(c) Criminal Penalty for Fraud- Subchapter B of chapter 75 of the Internal
Revenue Code of 1986 (relating to other offenses) is amended by adding at
the end the following:
`SEC. 7276. PENALTIES FOR OFFENSES RELATING TO HEALTH INSURANCE TAX CREDIT.
`Any person who knowingly misuses Department of the Treasury names, symbols,
titles, or initials to convey the false impression of association with,
or approval or endorsement by, the Department of the Treasury of any insurance
products or group health coverage in connection with the credit for health
insurance costs under section 36 shall on conviction thereof be fined not
more than $10,000, or imprisoned not more than 1 year, or both.'.
(d) Conforming Amendments-
(1) Section 162(l) of the Internal Revenue Code of 1986 is amended by
adding at the end the following:
`(6) ELECTION TO HAVE SUBSECTION APPLY- No deduction shall be allowed
under paragraph (1) for a taxable year unless the taxpayer elects to have
this subsection apply for such year.'.
(2) Paragraph (2) of section 1324(b) of title 31, United States Code,
is amended by inserting before the period `, or from section 36 of such
Code'.
(3) The table of sections for subpart C of part IV of subchapter A of
chapter 1 of the Internal Revenue Code of 1986 is amended by striking
the last item and inserting the following:
`Sec. 36. Health insurance costs for uninsured eligible individuals.
`Sec. 37. Overpayments of tax.'.
(4) The table of sections for subchapter B of chapter 75 of such Code
is amended by adding at the end the following:
`Sec. 7276. Penalties for offenses relating to health insurance tax credit.'.
(1) IN GENERAL- Except as provided in paragraph (2), the amendments made
by this section shall apply to taxable years beginning after December
31, 2006, without regard to whether final regulations to carry out such
amendments have been promulgated by such date.
(2) PENALTIES- The amendments made by subsections (c) and (d)(4) shall
take effect on the date of the enactment of this Act.
SEC. 202. ADVANCE PAYMENT OF CREDIT TO ISSUERS OF QUALIFIED HEALTH INSURANCE.
(a) In General- Chapter 77 of the Internal Revenue Code of 1986 (relating
to miscellaneous provisions) is amended by inserting after section 7527
the following:
`SEC. 7527A. ADVANCE PAYMENT OF HEALTH INSURANCE CREDIT FOR PURCHASERS
OF QUALIFIED HEALTH INSURANCE.
`(a) General Rule- Every plan sponsor of a group health plan providing,
or qualified health insurance issuer of, qualified health insurance to an
eligible individual shall--
`(1) make qualified premium payments with respect to such individual in
an amount equal to the qualified health insurance credit advance amount,
and
`(2) treat such payments in the manner provided in subsection (g).
`(b) Eligible Individual- For purposes of this section, the term `eligible
individual' means any individual--
`(1) who purchases qualified health insurance (as defined in section 36(c)),
and
`(2) for whom a qualified health insurance credit eligibility certificate
is in effect.
`(c) Definitions- For purposes of this section--
`(1) QUALIFIED HEALTH INSURANCE ISSUER- The term `qualified health insurance
issuer' means a health insurance issuer described in section 9832(b)(2)
(determined without regard to the last sentence thereof) offering coverage
in connection with a group health plan.
`(2) GROUP HEALTH PLAN- The term `group health plan' has the meaning given
such term by section 5000(b)(1) (determined without regard to subsection
(d) thereof).
`(3) QUALIFIED PREMIUM PAYMENTS- The term `qualified premium payments'
means any amount paid or incurred, cost incurred, or health coverage value
provided, with respect to qualified health insurance for an eligible individual
and the individual's spouse and dependents. For purposes of the preceding
sentence, in the case of a group health plan, the health coverage value
is equal to the applicable premium under the plan for the qualified health
insurance coverage provided to an eligible individual and the individual's
spouse and dependents, as determined under section 4980B.
`(d) Qualified Health Insurance Credit Eligibility Certificate- For purposes
of this section, a qualified health insurance credit eligibility certificate
is a statement furnished by an individual to a plan sponsor of a group health
plan or qualified health insurance issuer which--
`(1) certifies that the individual will be eligible to receive the credit
provided by section 36 for the taxable year,
`(2) estimates the amount of such credit for such taxable year, and
`(3) provides such other information as the Secretary may require for
purposes of this section.
`(e) Qualified Health Insurance Credit Advance Amount- For purposes of this
section, the term `qualified health insurance credit advance amount' means,
with respect to any plan sponsor of a group health plan providing, or qualified
health insurance issuer of, qualified health insurance, the amount of credit
allowable under section 36 to the individual for the taxable year which
is attributable to the insurance provided to the individual by such sponsor
or issuer.
`(f) Required Documentation for Receipt of Payments of Advance Amount- No
payment of a qualified health insurance credit advance amount with respect
to any eligible individual may be made under subsection (a) unless the plan
sponsor of the group health plan or qualified health insurance issuer provides
to the Secretary--
`(1) the qualified health insurance credit eligibility certificate of
such individual, and
`(2) the return relating to such individual under section 6050W.
`(g) Qualified Premium Payments To Be Treated as Payments of Withholding
Amounts and Certain Employer Tax-
`(1) IN GENERAL- For purposes of this title, qualified premium payments
made or costs incurred by the sponsor of a group health plan, or any entity
designated by the sponsor to make such payments or incur such costs--
`(A) shall not be treated as compensation, and
`(B) shall be treated, in such manner as provided by the Secretary,
as made out of--
`(i) amounts required to be deposited by the taxpayer as estimated
income tax under section 6654 or 6655,
`(ii) amounts required to be deducted and withheld under section 3401
(relating to wage withholding),
`(iii) amounts of the taxes imposed under section 3111(a) or 50 percent
of taxes imposed under section 1401(a) (relating to FICA employer
taxes), or
`(iv) amounts required to be deducted under section 3102 with respect
to taxes imposed under section 3101(a) or 50 percent of taxes imposed
under section 1401(a) (relating to FICA employee taxes),
as if such sponsor, or such designated entity, had paid to the Secretary
an amount equal to such payments.
`(2) QUALIFIED PREMIUM PAYMENTS EXCEED TAXES DUE- In the case of any entity,
if for any time period the aggregate qualified premium payments exceed
the amounts described in paragraph (1)(B), the Secretary shall reduce
amounts described in such paragraph for any succeeding time period as
necessary to reflect such excess.
`(3) FAILURE TO MAKE QUALIFIED PREMIUM PAYMENTS- For purposes of this
title (including penalties), failure to make a qualified premium payment
with respect to an eligible individual at the time provided therefor shall
be treated as the failure at such time to deduct and withhold under chapter
24 of such Code in an amount equal to the amount of such qualified premium
payments.
`(h) Regulations- The Secretary shall prescribe such regulations as may
be necessary to carry out the purposes of this section.'.
(b) Clerical Amendment- The table of sections for chapter 77 of the Internal
Revenue Code of 1986 is amended by inserting after the item relating to
section 7527 the following:
`Sec. 7527A. Advance payment of health insurance credit for purchasers
of qualified health insurance.'.
(c) Effective Date- The amendments made by this section shall take effect
on January 1, 2008, without regard to whether final regulations to carry
out such amendments have been promulgated by such date.
Subtitle B--Elimination of SCHIP Funding Shortfalls
SEC. 206. ELIMINATION OF SCHIP FUNDING SHORTFALLS FOR FISCAL YEAR 2007.
(a) In General- Section 2104(h) of the Social Security Act (42 U.S.C. 1397dd(h)),
as added by section 201 of the National Institutes of Health Reform Act
of 2006, is amended to read as follows:
`(h) Special Rule for Redistribution of Unspent Fiscal Year 2004 Allotments
and Additional Allotments To Eliminate Fiscal Year 2007 Funding Shortfalls-
`(1) SPECIAL RULE FOR REDISTRIBUTION OF FISCAL YEAR 2004 ALLOTMENTS-
`(A) IN GENERAL- In the case of a State that expends all of its allotment
under subsection (b) or (c) of this section for fiscal year 2004 by
the end of fiscal year 2006 and is an initial shortfall State described
in subparagraph (B), the Secretary shall redistribute to the State under
subsection (f) of this section (from the fiscal year 2004 allotments
of other States) the following amount:
`(i) STATE- In the case of one of the 50 States or the District of
Columbia, the amount specified in subparagraph (C)(i) (less the total
of the amounts under clause (ii)), multiplied by the ratio of the
amount specified in subparagraph (C)(ii) for the State to the amount
specified in subparagraph (C)(iii).
`(ii) TERRITORY- In the case of a commonwealth or territory described
in subsection (c)(3), an amount that bears the same ratio to 1.05
percent of the amount specified in subparagraph (C)(i) as the ratio
of the commonwealth's or territory's fiscal year 2004 allotment under
subsection (c) bears to the total of all such allotments for such
fiscal year under such subsection.
`(B) INITIAL SHORTFALL STATE DESCRIBED- For purposes of subparagraph
(A), an initial shortfall State 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 as of the
date of the enactment of this subsection, that the projected Federal
expenditures under such plan for such State for fiscal year 2007 will
exceed the sum of--
`(i) the amount of the State's allotments for each of fiscal years
2005 and 2006 that will not be expended by the end of fiscal year
2006; and
`(ii) the amount of the State's allotment for fiscal year 2007.
`(C) AMOUNTS USED IN COMPUTING REDISTRIBUTIONS FOR FISCAL YEAR 2004
ALLOTMENTS- For purposes of subparagraph (A)(i)--
`(i) the amount specified in this clause is the total amount of unspent
fiscal year 2004 allotments available for redistribution under subsection
(f);
`(ii) the amount specified in this clause for an initial shortfall
State is the amount the Secretary determines will eliminate the estimated
shortfall described in subparagraph (B) for the State; and
`(iii) the amount specified in this clause is the total sum of the
amounts specified in clause (ii) for all initial shortfall States.
`(2) ADDITIONAL ALLOTMENTS TO ELIMINATE FISCAL YEAR 2007 FUNDING SHORTFALLS
REMAINING AFTER REDISTRIBUTION OF UNSPENT FISCAL YEAR 2004 ALLOTMENTS-
`(A) IN GENERAL- In addition to the allotments provided under subsection
(b) and (c) for fiscal year 2007, the Secretary shall allot to each
remaining shortfall State described in subparagraph (B) such amount
as the Secretary determines will eliminate the estimated shortfall described
in such subparagraph for the State.
`(B) REMAINING SHORTFALL STATE DESCRIBED- For purposes of subparagraph
(A), a remaining shortfall State is a State (including a commonwealth
or territory described in subsection (c)(3)) 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 as of the
date of the enactment of this subsection, that the projected Federal
expenditures under such plan for such State for fiscal year 2007 will
exceed the sum of--
`(i) the amount of the State's allotments for each of fiscal years
2005 and 2006 that will not be expended by the end of fiscal year
2006;
`(ii) the amount of the State's allotment for fiscal year 2007; and
`(iii) the amount, if any, of unspent allotments for fiscal year 2004
that are to be redistributed to the State during fiscal year 2007
in accordance with subsection (f) and paragraph (1).
`(C) 1-year AVAILABILITY; NO REDISTRIBUTION OF UNEXPENDED ADDITIONAL
ALLOTMENTS- Notwithstanding subsections (e) and (f), amounts allotted
to a remaining shortfall State pursuant to this paragraph shall only
remain available for expenditure by the State through September 30,
2007. Any amounts of such allotments that remain unexpended as of such
date shall not be subject to redistribution under subsection (f) and
shall revert to the Treasury on October 1, 2007.
`(D) APPROPRIATION; ALLOTMENT AUTHORITY- For the purpose of providing
additional allotments to remaining shortfall States under this paragraph
there is appropriated, out of any funds in the Treasury not otherwise
appropriated, such sums as are necessary for fiscal year 2007.'.
(b) Effective Date- The amendments made by this section apply to items and
services furnished on or after October 1, 2006, without regard to whether
or not regulations implementing such amendments have been issued.
(c) Period of Effectiveness- Section 2104(h)(2) of the Social Security Act
(as added by subsection (a)) shall terminate on September 30, 2007, and
shall be considered to have expired notwithstanding section 257 of the Balanced
Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 907).
(d) Effect on Provisions Added by the National Institutes of Health Reform
Act of 2006- The Social Security Act shall be administered as if section
2104(h) of such Act, as added by section 201(a) of the National Institutes
of Health Reform Act, had not been enacted.
Subtitle C--FamilyCare
SEC. 211. RENAMING OF TITLE XXI PROGRAM.
(a) In General- The heading of title XXI of the Social Security Act (42
U.S.C. 1397aa et seq.) is amended to read as follows:
`TITLE XXI--FAMILYCARE PROGRAM'.
(b) Program References- Any reference in any provision of Federal law or
regulation to `SCHIP' or `State children's health insurance program' under
title XXI of the Social Security Act shall be deemed a reference to the
FamilyCare program under such title.
SEC. 212. FAMILYCARE COVERAGE OF PARENTS UNDER THE MEDICAID PROGRAM AND
TITLE XXI.
(a) Incentives To Implement FamilyCare Coverage-
(A) ESTABLISHMENT OF NEW OPTIONAL ELIGIBILITY CATEGORY- Section 1902(a)(10)(A)(ii)
of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--
(i) by striking `or' at the end of subclause (XVIII);
(ii) by adding `or' at the end of subclause (XIX); and
(iii) by adding at the end the following:
`(XX) who are individuals described in subsection (k)(1) (relating
to parents of categorically eligible children);'.
(B) PARENTS DESCRIBED- Section 1902 of the Social Security Act is further
amended by inserting after subsection (j) the following:
`(k)(1)(A) Individuals described in this paragraph are individuals--
`(i) who are the parents of an individual who is under 19 years of age
(or such higher age as the State may have elected under section 1902(l)(1)(D))
and who is eligible for medical assistance under subsection (a)(10)(A);
`(ii) who are not otherwise eligible for medical assistance under such
subsection, under section 1931, or under a waiver approved under section
1115 or otherwise (except under subsection (a)(10)(A)(ii)(XX)); and
`(iii) whose family income exceeds the income level applicable under the
State plan under part A of title IV as in effect as of July 16, 1996,
but does not exceed the highest income level applicable to a child in
the family under this title.
`(B) In establishing an income eligibility level for individuals described
in this paragraph, a State may vary such level consistent with the various
income levels established under subsection (l)(2) based on the ages of children
described in subsection (l)(1) in order to ensure, to the maximum extent
possible, that such individuals shall be enrolled in the same program as
their children.
`(C) An individual may not be treated as being described in this paragraph
unless, at the time of the individual's enrollment under this title, the
child referred to in subparagraph (A)(i) of the individual is also enrolled
under this title.
`(D) In this subsection, the term `parent' includes an individual treated
as a caregiver for purposes of carrying out section 1931.
`(2) In the case of a parent described in paragraph (1) who is also the
parent of a child who is eligible for child health assistance under title
XXI, the State may elect (on a uniform basis) to cover all such parents
under section 2111 or under this title.'.
(C) ENHANCED MATCHING FUNDS AVAILABLE IF CERTAIN CONDITIONS MET- Section
1905 of the Social Security Act (42 U.S.C. 1396d) is amended--
(i) in the fourth sentence of subsection (b), by striking `or subsection
(u)(3)' and inserting `, (u)(3), or (u)(4)'; and
(I) by redesignating paragraph (4) as paragraph (6), and
(II) by inserting after paragraph (3) the following:
`(4) For purposes of subsection (b) and section 2105(a)(1)--
`(A) FAMILYCARE PARENTS- The expenditures described in this subparagraph
are the expenditures described in the following clauses (i) and (ii):
`(i) PARENTS- If the conditions described in clause (iii) are met, expenditures
for medical assistance for parents described in section 1902(k)(1) and
for parents who would be described in such section but for the fact
that they are eligible for medical assistance under section 1931 or
under a waiver approved under section 1115.
`(ii) CERTAIN PREGNANT WOMEN- Expenditures for medical assistance for
pregnant women under section 1902(l)(1)(A) in a family the income of
which exceeds the income level applicable under section 1902(l)(2)(A)
to a family of the size involved as of January 1, 2007.
`(iii) CONDITIONS- The conditions described in this clause are the following:
`(I) The State has a State child health plan under title XXI which
(whether implemented under such title or under this title) has an
effective income level for children that is at least 200 percent of
the poverty line.
`(II) Such State child health plan does not limit the acceptance of
applications, does not use a waiting list for children who meet eligibility
standards to qualify for assistance, and provides benefits to all
children in the State who apply for and meet eligibility standards.
`(III) The State plans under this title and title XXI do not provide
coverage for parents with higher family income without covering parents
with a lower family income.
`(IV) The State does not apply an income level for parents that is
lower than the effective income level (expressed as a percent of the
poverty line) that has been specified under the State plan under title
XIX (including under a waiver authorized by the Secretary or under
section 1902(r)(2)), as of January 1, 2007, to be eligible for medical
assistance as a parent under this title.
`(iv) DEFINITIONS- For purposes of this subsection:
`(I) The term `parent' has the meaning given such term for purposes
of section 1902(k)(1).
`(II) The term `poverty line' has the meaning given such term in section
2110(c)(5).'.
(D) APPROPRIATION FROM TITLE XXI ALLOTMENT FOR CERTAIN MEDICAID EXPANSION
COSTS- Section 2105(a)(1) of the Social Security Act is amended by striking
`and' at the end of subparagraph (C), by striking the period at the
end of subparagraph (D) and inserting `; and', and by adding at the
end the following:
`(E) for making expenditures for medical assistance that is attributable
to expenditures described in section 1905(u)(4)(A).'.
(E) ONLY COUNTING ENHANCED PORTION FOR COVERAGE OF ADDITIONAL PREGNANT
WOMEN- Section 1905 of the Social Security Act (42 U.S.C. 1396d) is
amended--
(i) in the fourth sentence of subsection (b), by inserting `(except
in the case of expenditures described in subsection (u)(5))' after
`do not exceed'; and
(ii) in subsection (u), by inserting after paragraph (4) (as inserted
by subparagraph (C)), the following:
`(5) For purposes of the fourth sentence of subsection (b) and section 2105(a),
the following payments under this title do not count against a State's allotment
under section 2104:
`(A) REGULAR FMAP FOR EXPENDITURES FOR PREGNANT WOMEN WITH INCOME ABOVE
JANUARY 1, 2007 INCOME LEVEL AND BELOW 185 PERCENT OF POVERTY- The portion
of the payments made for expenditures described in paragraph (4)(A)(ii)
that represents the amount that would have been paid if the enhanced FMAP
had not been substituted for the Federal medical assistance percentage.'.
(A) FAMILYCARE COVERAGE- Title XXI of the Social Security Act (42 U.S.C.
1397aa et seq.) is amended by adding at the end the following:
`SEC. 2111. OPTIONAL FAMILYCARE COVERAGE OF PARENTS OF TARGETED LOW-INCOME
CHILDREN.
`(a) Optional Coverage- Notwithstanding any other provision of this title,
a State child health plan may provide for coverage, through an amendment
to its State child health plan under section 2102, of FamilyCare assistance
for individuals who are targeted low-income parents in accordance with this
section, but only if--
`(1) the State meets the conditions described in section 1905(u)(4)(A)(iii);
and
`(2) the State elects to provide medical assistance under section 1902(a)(10)(A)(ii)(XX),
under section 1931, or under a waiver under section 1115 to individuals
described in section 1902(k)(1)(A)(i) and elects an applicable income
level for such individuals that consistent with paragraphs (1)(B) and
(2) of section 1902(k), ensures to the maximum extent possible, that those
individuals shall be enrolled in the same program as their children if
their children are eligible for coverage under title XIX (including under
a waiver authorized by the Secretary or under section 1902(r)(2)).'.
`(b) Definitions- For purposes of this title:
`(1) FAMILYCARE ASSISTANCE- The term `FamilyCare assistance' has the meaning
given the term child health assistance in section 2110(a) as if any reference
to targeted low-income children were a reference to targeted low-income
parents.
`(2) TARGETED LOW-INCOME PARENT- The term `targeted low-income parent'
has the meaning given the term targeted low-income child in section 2110(b)
as if the reference to a child were deemed a reference to a parent (as
defined in paragraph (3)) of the child; except that in applying such section--
`(A) there shall be substituted for the income level described in paragraph
(1)(B)(ii)(I) the applicable income level in effect for a targeted low-income
child;
`(B) in paragraph (3), January 1, 2007, shall be substituted for July
1, 1997; and
`(C) in paragraph (4), January 1, 2007, shall be substituted for March
31, 1997.
`(3) PARENT- The term `parent' includes an individual treated as a caregiver
for purposes of carrying out section 1931.
`(4) OPTIONAL TREATMENT OF PREGNANT WOMEN AS PARENTS- A State child health
plan may treat a pregnant woman who is not otherwise a parent as a targeted
low-income parent for purposes of this section but only if the State has
established an income level under section 1902(l)(2)(A)(i) for pregnant
women that is at least 185 percent of the income official poverty line
described in such section.
`(c) References to Terms and Special Rules- In the case of, and with respect
to, a State providing for coverage of FamilyCare assistance to targeted
low-income parents under subsection (a), the following special rules apply:
`(1) Any reference in this title (other than subsection (b)) to a targeted
low-income child is deemed to include a reference to a targeted low-income
parent.
`(2) Any such reference to child health assistance with respect to such
parents is deemed a reference to FamilyCare assistance.
`(3) In applying section 2103(e)(3)(B) in the case of a family provided
coverage under this section, the limitation on total annual aggregate
cost-sharing shall be applied to the entire family.
`(4) In applying section 2110(b)(4), any reference to `section 1902(l)(2)
or 1905(n)(2) (as selected by a State)' is deemed a reference to the income
level applicable to parents under section 1931 or under a waiver approved
under section 1115, or, in the case of a pregnant woman described in subsection
(b)(4), the income level established under section 1902(l)(2)(A).
`(5) In applying section 2102(b)(3)(B), any reference to children is deemed
a reference to parents.'.
(B) ADDITIONAL ALLOTMENT FOR STATES PROVIDING FAMILYCARE-
(i) IN GENERAL- Section 2104 of the Social Security Act (42 U.S.C.
1397dd), as amended by this Act, is amended by inserting after subsection
(h) the following:
`(i) Additional Allotments for State Providing FamilyCare-
`(1) APPROPRIATION; TOTAL ALLOTMENT- For the purpose of providing additional
allotments to States to provide FamilyCare coverage under section 2111,
there is appropriated, out of any money in the Treasury not otherwise
appropriated--
`(A) such sums as may be necessary to provide such coverage for fiscal
year 2008, and
`(B) for fiscal year 2008 and each fiscal year thereafter, the amount
of the allotment provided under this paragraph for the preceding fiscal
year increased by the percentage increase (if any) in the medical care
expenditure category of the Consumer Price Index for All Urban Consumers
(United States city average).
`(2) STATE AND TERRITORIAL ALLOTMENTS-
`(A) IN GENERAL- In addition to the allotments provided under subsections
(b), (c), (d), and (h), subject to paragraphs (3) and (4), of the amount
available for the additional allotments under paragraph (1) for a fiscal
year, the Secretary shall allot to each State with a State child health
plan approved under this title--
`(i) in the case of such a State other than a commonwealth or territory
described in clause (ii), the same proportion as the proportion of
the State's allotment under subsection (b) (determined without regard
to subsection (f)) to 98.95 percent of the total amount of the allotments
under such section for such States eligible for an allotment under
this subparagraph for such fiscal year; and
`(ii) in the case of a commonwealth or territory described in subsection
(c)(3), the same proportion as the proportion of the commonwealth's
or territory's allotment under subsection (c) (determined without
regard to subsection (f)) to 1.05 percent of the total amount of the
allotments under such section for commonwealths and territories eligible
for an allotment under this subparagraph for such fiscal year.
`(B) AVAILABILITY AND REDISTRIBUTION OF UNUSED ALLOTMENTS- In applying
subsections (e) and (f) with respect to additional allotments made available
under this subsection, the procedures established under such subsections
shall ensure such additional allotments are only made available to States
which have elected to provide coverage under section 2111.
`(3) USE OF ADDITIONAL ALLOTMENT- Additional allotments provided under
this subsection are not available for amounts expended before October
1, 2007. Such amounts are available for amounts expended on or after such
date for child health assistance for targeted low-income children, as
well as for FamilyCare assistance.
`(4) REQUIRING ELECTION TO PROVIDE FAMILYCARE COVERAGE- No payments may
be made to a State under this title from an allotment provided under this
subsection unless the State has made an election to provide FamilyCare
assistance.'.
(ii) CONFORMING AMENDMENTS- Section 2104 of the Social Security Act
(42 U.S.C. 1397dd) is amended--
(I) in subsection (a), by inserting `or subsection (i),' after `subsection
(d),';
(II) in subsection (b)(1), by striking `subsection (d)' and inserting
`subsections (d) and (i)'; and
(III) in subsection (c)(1), by inserting `or subsection (i),' after
`subsection (d)'.
(C) NO COST-SHARING FOR PREGNANCY-RELATED BENEFITS- Section 2103(e)(2)
of the Social Security Act (42 U.S.C. 1397cc(e)(2)) is amended--
(i) in the heading, by inserting `and pregnancy-related services'
after `preventive services'; and
(ii) by inserting before the period at the end the following: `and
for pregnancy-related services'.
(3) EFFECTIVE DATE- The amendments made by this subsection apply to items
and services furnished on or after October 1, 2007, whether or not regulations
implementing such amendments have been issued.
(b) Optional Application of Presumptive Eligibility Provisions to Parents-
Section 1920A of the Social Security Act (42 U.S.C. 1396r-1a) is amended
by adding at the end the following:
`(e) A State may elect to apply the previous provisions of this section
to provide for a period of presumptive eligibility for medical assistance
for a parent (as defined for purposes of section 1902(k)(1)) of a child
with respect to whom such a period is provided under this section.'.
(c) Conforming Amendments-
(1) ELIGIBILITY CATEGORIES- Section 1905(a) of the Social Security Act
(42 U.S.C. 1396d(a)) is amended, in the matter before paragraph (1)--
(A) by striking `or' at the end of clause (xii);
(B) by inserting `or' at the end of clause (xiii); and
(C) by inserting after clause (xiii) the following:
`(xiv) who are parents described (or treated as if described) in section
1902(k)(1),'.
(2) INCOME LIMITATIONS- Section 1903(f)(4) of the Social Security Act
(42 U.S.C. 1396b(f)(4)) is amended by inserting `1902(a)(10)(A)(ii)(XX),'
after `1902(a)(10)(A)(ii)(XVIII),'.
(3) CONFORMING AMENDMENT RELATING TO NO WAITING PERIOD FOR PREGNANT WOMEN-
Section 2102(b)(1)(B) of the Social Security Act (42 U.S.C. 1397bb(b)(1)(B))
is amended--
(A) by striking `, and' at the end of clause (i) and inserting a semicolon;
(B) by striking the period at the end of clause (ii) and inserting `;
and'; and
(C) by adding at the end the following:
`(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
parent who is pregnant.'.
SEC. 213. OPTIONAL COVERAGE OF CHILDREN THROUGH AGE 20 UNDER THE MEDICAID
PROGRAM AND TITLE XXI.
(1) IN GENERAL- Section 1902(l)(1)(D) of the Social Security Act (42 U.S.C.
1396a(l)(1)(D)) is amended by inserting `(or, at the election of a State,
20 or 21 years of age)' after `19 years of age'.
(2) CONFORMING AMENDMENTS-
(A) Section 1902(e)(3)(A) of the Social Security Act (42 U.S.C. 1396a(e)(3)(A))
is amended by inserting `(or 1 year less than the age the State has
elected under subsection (l)(1)(D))' after `18 years of age'.
(B) Section 1902(e)(12) of the Social Security Act (42 U.S.C. 1396a(e)(12))
is amended by inserting `or such higher age as the State has elected
under subsection (l)(1)(D)' after `19 years of age'.
(C) Section 1920A(b)(1) of the Social Security Act (42 U.S.C. 1396r-1a(b)(1))
is amended by inserting `or such higher age as the State has elected
under section 1902(l)(1)(D)' after `19 years of age'.
(D) Section 1928(h)(1) of the Social Security Act (42 U.S.C. 1396s(h)(1))
is amended by inserting `or 1 year less than the age the State has elected
under section 1902(l)(1)(D)' before the period at the end.
(E) Section 1932(a)(2)(A) of the Social Security Act (42 U.S.C. 1396u-2(a)(2)(A))
is amended by inserting `(or such higher age as the State has elected
under section 1902(l)(1)(D))' after `19 years of age'.
(b) Title XXI- Section 2110(c)(1) of the Social Security Act (42 U.S.C.
1397jj(c)(1)) is amended by inserting `(or such higher age as the State
has elected under section 1902(l)(1)(D))'.
(c) Effective Date- The amendments made by this section take effect on October
1, 2007, and apply to medical assistance and child health assistance provided
on or after such date, whether or not regulations implementing such amendments
have been issued.
SEC. 214. SENSE OF THE SENATE REGARDING AUTHORITY TO USE SCHIP FUNDS TO
PURCHASE FAMILY COVERAGE.
It is the sense of the Senate that section 2105(c)(3) of the Social Security
Act (42 U.S.C. 1397ee(c)(3)) permits States to use funds provided under
the State children's health insurance program established under title XXI
of that Act (42 U.S.C. 1397aa et seq.) to help low-income working families
and pregnant women eligible for assistance under that program pay their
share of employer-sponsored health insurance coverage.
Subtitle D--Simplified Enrollment
SEC. 221. AUTOMATIC ENROLLMENT OF CHILDREN BORN TO TITLE XXI PARENTS.
Section 2102(b)(1) of the Social Security Act (42 U.S.C. 1397bb(b)(1)) is
amended by adding at the end the following:
`(C) AUTOMATIC ELIGIBILITY OF CHILDREN BORN TO A PARENT BEING PROVIDED
FAMILYCARE- Such eligibility standards shall provide for automatic coverage
of a child born to an individual who is provided assistance under this
title in the same manner as medical assistance would be provided under
section 1902(e)(4) to a child described in such section.'.
SEC. 222. APPLICATION OF SIMPLIFIED TITLE XXI PROCEDURES UNDER THE MEDICAID
PROGRAM.
(a) Application Under Medicaid-
(1) IN GENERAL- Section 1902(l) of the Social Security Act (42 U.S.C.
1396a(l)) is amended--
(A) in paragraph (3), by inserting `subject to paragraph (5),', after
`Notwithstanding subsection (a)(17),'; and
(B) by adding at the end the following:
`(5) With respect to determining the eligibility of individuals under 19
years of age (or such higher age as the State has elected under paragraph
(1)(D)) for medical assistance under subsection (a)(10)(A) and, separately,
with respect to determining the eligibility of individuals for medical assistance
under subsection (a)(10)(A)(ii)(XX), notwithstanding any other provision
of this title, if the State has established a State child health plan under
title XXI--
`(A) the State may not apply a resource standard;
`(B) the State shall use the same simplified eligibility form (including,
if applicable, permitting application other than in person) as the State
uses under such State child health plan with respect to such individuals;
`(C) the State shall provide for initial eligibility determinations and
redeterminations of eligibility using verification policies, forms, and
frequency that are no less restrictive than the policies, forms, and frequency
the State uses for such purposes under such State child health plan with
respect to such individuals; and
`(D) the State shall not require a face-to-face interview for purposes
of initial eligibility determinations and redeterminations unless the
State requires such an interview for such purposes under such child health
plan with respect to such individuals.'.
(2) EFFECTIVE DATE- The amendments made by paragraph (1) apply to determinations
of eligibility made on or after the date that is 1 year after the date
of enactment of this Act, whether or not regulations implementing such
amendments have been issued.
(b) Presumptive Eligibility-
(1) IN GENERAL- Section 1920A(b)(3)(A)(i) of the Social Security Act (42
U.S.C. 1396r-1a(b)(3)(A)(i)) is amended by inserting `a child care resource
and referral agency,' after `a State or tribal child support enforcement
agency,'.
(2) APPLICATION TO PRESUMPTIVE ELIGIBILITY FOR PREGNANT WOMEN UNDER MEDICAID-
Section 1920(b) of the Social Security Act (42 U.S.C. 1396r-1(b)) is amended
by adding at the end after and below paragraph (2) the following flush
sentence:
`The term `qualified provider' includes a qualified entity as defined in
section 1920A(b)(3).'.
(3) APPLICATION UNDER TITLE XXI-
(A) IN GENERAL- Section 2107(e)(1)(D) of the Social Security Act (42
U.S.C. 1397gg(e)(1)) is amended to read as follows:
`(D) Sections 1920 and 1920A (relating to presumptive eligibility).'.
(B) CONFORMING ELIMINATION OF RESOURCE TEST- Section 2102(b)(1)(A) of
such Act (42 U.S.C. 1397bb(b)(1)(A)) is amended--
(i) by striking `and resources (including any standards relating to
spenddowns and disposition of resources)'; and
(ii) by adding at the end the following: `Effective 1 year after the
date of enactment of the Access to Affordable Health Care Act, such
standards may not include the application of a resource standard or
test.'.
(c) Automatic Reassessment of Eligibility for Title XXI and Medicaid Benefits
for Children Losing Medicaid or Title XXI Eligibility-
(1) LOSS OF MEDICAID ELIGIBILITY- Section 1902(a) of the Social Security
Act (42 U.S.C. 1396a(a)) is amended--
(A) by striking `and' at the end of paragraph (69),
(B) by striking the period at the end of paragraph (70) and inserting
`; and', and
(C) by inserting after paragraph (70) the following:
`(71) provide, in the case of a State with a State child health plan under
title XXI, that before medical assistance to a child (or a parent of a
child) is discontinued under this title, a determination of whether the
child (or parent) is eligible for benefits under title XXI shall be made
and, if determined to be so eligible, the child (or parent) shall be automatically
enrolled in the program under such title without the need for a new application.'.
(2) LOSS OF TITLE XXI ELIGIBILITY AND COORDINATION WITH MEDICAID- Section
2102(b) (42 U.S.C. 1397bb(b)) is amended--
(A) in paragraph (3), by redesignating subparagraphs (D) and (E) as
subparagraphs (E) and (F), respectively, and by inserting after subparagraph
(C) the following:
`(D) that before health assistance to a child (or a parent of a child)
is discontinued under this title, a determination of whether the child
(or parent) is eligible for benefits under title XIX is made and, if
determined to be so eligible, the child (or parent) is automatically
enrolled in the program under such title without the need for a new
application;';
(B) by redesignating paragraph (4) as paragraph (5); and
(C) by inserting after paragraph (3) the following new paragraph:
`(4) COORDINATION WITH MEDICAID- The State shall coordinate the screening
and enrollment of individuals under this title and under title XIX consistent
with the following:
`(A) Information that is collected under this title or under title XIX
which is needed to make an eligibility determination under the other
title shall be transmitted to the appropriate administering entity under
such other title in a timely manner so that coverage is not delayed
and families do not have to submit the same information twice. Families
shall be provided the information they need to complete the application
process for coverage under both titles and be given appropriate notice
of any determinations made on their applications for such coverage.
`(B) If a State does not use a joint application under this title and
such title, the State shall--
`(i) promptly inform a child's parent or caretaker in writing and,
if appropriate, orally, that a child has been found likely to be eligible
under title XIX;
`(ii) provide the family with an application for medical assistance
under such title and offer information about what (if any) further
information, documentation, or other steps are needed to complete
such application process;
`(iii) offer assistance in completing such application process; and
`(iv) promptly transmit the separate application under this title
or the information obtained through such application, and all other
relevant information and documentation, including the results of the
screening process, to the State agency under title XIX for a final
determination on eligibility under such title.
`(C) Applicants are notified in writing of--
`(i) benefits (including restrictions on cost-sharing) under title
XIX; and
`(ii) eligibility rules that prohibit children who have been screened
eligible for medical assistance under such title from being enrolled
under this title, other than provisional temporary enrollment while
a final eligibility determination is being made under such title.
`(D) If the agency administering this title is different from the agency
administering a State plan under title XIX, such agencies shall coordinate
the screening and enrollment of applicants for such coverage under both
titles.
`(E) The coordination procedures established between the program under
this title and under title XIX shall apply not only to the initial eligibility
determination of a family but also to any renewals or redeterminations
of such eligibility.'.
(3) EFFECTIVE DATE- The amendments made by paragraphs (1) and (2) apply
to individuals who lose eligibility under the medicaid program under title
XIX, or under a State child health insurance plan under title XXI, respectively,
of the Social Security Act on or after October 1, 2007 (or, if later,
60 days after the date of enactment of this Act), whether or not regulations
implementing such amendments have been issued.
(d) Provision of Medicaid and CHIP Applications and Information Under the
School Lunch Program- Section 9(b)(2)(B)(iii) of the Richard B. Russell
National School Lunch Act (42 U.S.C. 1758(b)(2)(B)(iii)) is amended by adding
at the end the following:
`(III) NOTICE OF AVAILABILITY OF HEALTH BENEFITS UNDER MEDICAID
AND CHIP- Descriptive material distributed in accordance with clause
(i) shall also contain information (provided on a form separate
from the application form for free and reduced price lunches) on
the availability of medical assistance under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) and of child health and FamilyCare
assistance under title XXI of such Act, including information on
how to obtain an application for assistance under such programs.'.
(e) 12 Months of Continuous Eligibility-
(1) MEDICAID- Section 1902(e)(12) of the Social Security Act (42 U.S.C.
1396a(e)(12)) is amended--
(A) by striking `At the option of the State, the plan may' and inserting
`The plan shall';
(B) by striking `an age specified by the State (not to exceed 19 years
of age)' and inserting `19 years of age (or such higher age as the State
has elected under subsection (l)(1)(D)) or, at the option of the State,
who is eligible for medical assistance as the parent of such a child';
and
(C) in subparagraph (A), by striking `a period (not to exceed 12 months)'
and inserting `the 12-month period beginning on the date'.
(2) TITLE XXI- Section 2102(b)(2) of such Act (42 U.S.C. 1397bb(b)(2))
is amended by adding at the end the following: `Such methods shall provide
12 months of continuous eligibility for children under this title in the
same manner that section 1902(e)(12) provides 12 months of continuous
eligibility for children described in such section under title XIX. If
a State has elected to apply section 1902(e)(12) to parents, such methods
may provide 12 months of continuous eligibility for parents under this
title in the same manner that such section provides 12 months of continuous
eligibility for parents described in such section under title XIX.'.
(A) IN GENERAL- The amendments made by this subsection take effect on
October 1, 2007 (or, if later, 60 days after the date of enactment of
this Act), whether or not regulations implementing such amendments have
been issued.
Subtitle E--State Option To Extend Medicaid Coverage to Certain Low-Income
Individuals
SEC. 231. STATE OPTION TO EXTEND MEDICAID COVERAGE TO CERTAIN LOW-INCOME
INDIVIDUALS.
(a) State Option- Section 1902(a)(10)(A)(ii) of the Social Security Act
(42 U.S.C. 1396a(a)(10)(A)(ii)), as amended by section 212(a)(1)(A), is
amended--
(1) by striking `or' at the end of subclause (XIX);
(2) by adding `or' at the end of subclause (XX); and
(3) by adding at the end the following:
`(XXI) who are individuals who are not otherwise eligible for medical
assistance under this subparagraph, or under a waiver approved under
section 1115, or otherwise, as of the date of enactment of this
subclause and whose family income does not exceed 125 percent of
the income official poverty line (as defined by the Office of Management
and Budget and revised annually in accordance with section 673(2)
of the Omn
