Medicaid Child Health Amendments of 1990

Medicaid Child Health Amendments of 1990 - Amends title XIX (Medicaid) of the Social Security Act to phase-in mandatory Medicaid coverage of children whose family income is below the Federal poverty level.

Permits States to provide Medicaid coverage to children who have attained age one but not age six and whose family income does not exceed 185 percent of the Federal poverty level. (Currently, States are required to cover children between such ages whose family income does not exceed 133 percent of the Federal poverty level.)

Requires States to: (1) process Medicaid applications at locations which include locations other than those used for applications under part A (Aid to Families with Dependent Children) (AFDC) of title IV of the Social Security Act; and (2) use applications other than those used under the AFDC program.

Permits States to provide an additional 12 months of extended Medicaid coverage to families whose AFDC eligibility ends due to the caretaker relative's employment. (Currently, States are required to provide 12 months of such extended coverage.)

Requires States which provide prospective Medicaid payments to hospitals to reimburse hospitals which serve a disproportionate share of low-income patients for exceptionally costly or lengthy stays by children.

Directs States to provide Medicaid coverage for disabled children who are eligible for benefits under title XVI (Supplemental Security Income) of the Social Security Act.

Prohibits the discontinuance of a child's Medicaid benefits until he or she is determined not to be eligible for such benefits on any basis.

Allows States to extend Medicaid coverage to foster care children whose incomes are above State cash assistance eligibility levels but below the Federal poverty level.

 
HR 3932 IH
101st CONGRESS
2d Session
 H. R. 3932
To amend title XIX of the Social Security Act to improve access to basic
health care services to needy children.
IN THE HOUSE OF REPRESENTATIVES
February 1, 1990
Mr. SLATTERY (for himself, Mr. WAXMAN, Mr. MILLER of California, Mr. SCHEUER,
Mr. WALGREN, Mr. WYDEN, Mr. SIKORSKI, Mr. BATES, Mr. BRUCE, Mrs. COLLINS,
Mr. TOWNS, Mr. MARKEY, Mr. BOUCHER, Mr. DURBIN, Mr. BERMAN, Mr. WILLIAMS,
Mr. MCDERMOTT, Mr. FRANK, Mr. RANGEL, Mr. FAUNTROY, Ms. SCHNEIDER, Mr. PAYNE
of New Jersey, Ms. PELOSI, Mr. WHEAT, Mr. JOHNSTON of Florida, Mr. FOGLIETTA,
Mr. DE LUGO, Mr. CROCKETT, Mr. ACKERMAN, and Mr. HAWKINS) introduced the
following bill; which was referred to the Committee on Energy and Commerce
A BILL
To amend title XIX of the Social Security Act to improve access to basic
health care services to needy children.
  Be it enacted by the Senate and House of Representatives of the United
  States of America in Congress assembled,
TITLE I--SHORT TITLE
SECTION 101. SHORT TITLE.
  This Act may be cited as the `Medicaid Child Health Amendments of 1990'.
TITLE II--CHILD HEALTH AMENDMENTS
SEC. 201. PHASED-IN MANDATORY COVERAGE OF CHILDREN UP TO 100 PERCENT OF
POVERTY LEVEL.
  (a) IN GENERAL- Section 1902 of the Social Security Act (42 U.S.C. 1396a),
  as amended by section 6401(a) of the Omnibus Budget Reconciliation Act of
  1989, is amended--
  (1) in subsection (a)(10)(A)(i)--
  (A) by striking `or' at the end of subclause (V),
  (B) by striking the semicolon at the end of subclause (VI) and inserting
  `, or', and
  (C) by adding at the end the following new subclause:
  `(VII) who are described in subparagraph (D) of subsection (l)(1) and whose
  family income does not exceed the income level the State is required to
  establish under subsection (l)(2)(C) for such a family;';
  (2) in subsection (a)(10)(A)(ii)(IX), by striking `or clause (i)(VI)'
  and inserting `, clause (i)(VI), or clause (i)(VII)';
  (3) in subsection (l)--
  (A) by amending subparagraph (D) of paragraph (1) to read as follows:
  `(D) children born after September 30, 1983, who have attained one year
  of age but have not attained 18 years of age,';
  (B) by striking subparagraph (C) of paragraph (2) and inserting the
  following:
  `(C) For purposes of paragraph (1) with respect to individuals described
  in subparagraph (D) of that paragraph, the State shall establish an income
  level which is equal to the 100 percent of the income official poverty line
  described in subparagraph (A) applicable to a family of the size involved.';
  (C) in paragraph (3)--
  (i) by inserting `, (a)(10)(A)(i)(VII),' after `(a)(10)(A)(i)(VI)', and
  (ii) in subparagraph (E), by striking `the methodology employed' and
  inserting `a methodology which is no more restrictive than the methodology
  employed';
  (D) in paragraph (4)(A), by inserting `or subsection (a)(10)(A)(i)(VII)'
  after `(a)(10)(A)(i)(VI)'; and
  (E) in paragraph (4)(B), by striking `or (a)(10)(A)(i)(VI)' after `,
  (a)(10)(A)(i)(VI), or (a)(10)(A)(i)(VII)'; and
  (4) in subsection (r)(2)(A), by inserting `(a)(10)(A)(i)(VII),' after
  `(a)(10)(A)(i)(VI),'.
  (b) CONFORMING AMENDMENT TO QUALIFIED CHILDREN- Section 1905(n)(2) of
  such Act (42 U.S.C. 1396d(n)(2)) is amended by striking `age of 7 (or
  any age designated by the State that exceeds 7 but does not exceed 8)'
  and inserting `age of 18'.
  (c) ADDITIONAL CONFORMING AMENDMENTS-
  (1) Section 1903(f)(4) of such Act (42 U.S.C. 1396b(f)(4)) is amended--
  (A) by striking `1902(a)(10)(A)(i)(IV),' and inserting
  `1902(a)(10)(A)(i)(III), 1902(a)(10)(A)(i)(IV), 1902(a)(10)(A)(i)(V),', and
  (B) by inserting after `1902(a)(10)(A)(i)(VI),' the following:
  `1902(a)(10)(A)(i)(VII), 1902(a)(1)(A)(ii)(I),'.
  (2) Subsections (a)(3)(C) and (b)(3)(C)(i) of section 1925 of such Act (42
  U.S.C. 1396r-6), as amended by section 6411(i)(3) of the Omnibus Budget
  Reconciliation Act of 1989, are each amended by inserting `(i)(VII),'
  after `(i)(VI)'.
  (d) EFFECTIVE DATE- (1) The amendments made by this section apply (except
  as otherwise provided in this subsection) to payments under title XIX of
  the Social Security Act for calendar quarters beginning on or after July 1,
  1991, without regard to whether or not final regulations to carry out such
  amendments have been promulgated by such date.
  (2)(A) In the case of a State plan for medical assistance under title XIX
  of the Social Security Act which the Secretary of Health and Human Services
  determines requires State legislation (other than legislation authorizing
  or appropriating funds) in order for the plan to meet the additional
  requirements imposed by the amendments made by this section, 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 the 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 such session shall be deemed to be a separate regular
  session of the State legislature.
  (B) In the case of the State of Texas, the State plan shall not be
  regarded as failing to comply with the requirements of title XIX of
  the Social Security Act solely on the basis of its failure to meet the
  additional requirements imposed by the amendments made by this section
  before September 1, 1991.
SEC. 202. OPTIONAL COVERAGE OF CHILDREN UP TO AGE 6 WITH INCOME BELOW 185
PERCENT OF THE POVERTY LEVEL.
  (a) IN GENERAL- Section 1902 of the Social Security Act, as amended
  by section 6401(a) of the Omnibus Budget Reconciliation Act of 1989,
  is amended--
  (1) in subsection (a)(10)(A)(i)(VI), by inserting `minimum' before `income
  level', and
  (2) in subsection (l)(2)(B), by striking `133 percent' and inserting `a
  percentage (established by the State, which is not less than 133 percent
  and not more than 185 percent)'.
  (b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply to
  payments under title XIX of the Social Security Act for calendar quarters
  beginning on or after January 1, 1991, with respect to eligibility for
  medical assistance on or after such date, without regard to whether or
  not final regulations to carry out such amendments have been promulgated
  by such date.
SEC. 203. APPLICATIONS USING OUTREACH LOCATIONS.
  (a) IN GENERAL- Section 1902(a) of the Social Security Act (42
  U.S.C. 1396a(a)), as amended by section 6406(a) of the Omnibus Budget
  Reconciliation Act of 1989, is amended--
  (1) by striking `and' at the end of paragraph (52),
  (2) by striking the period at the end of paragraph (53) and inserting `;
  and', and
  (3) by inserting after paragraph (53) the following new paragraph:
  `(54) provide for receipt and initial processing of applications of
  individuals for medical assistance under subsections (a)(10)(A)(i)(IV),
  (a)(10)(A)(i)(VI), (a)(10)(A)(i)(VII), or (a)(10)(A)(ii)(IX)--
  `(A) at locations which include locations (such as hospitals or clinics
  providing covered services to such individuals, without discrimination
  based on whether the hospital or clinic is public or private) which are
  other than those used for the receipt and processing of applications for
  aid under part A of title IV, and
  `(B) using applications which are other than those used for applications
  for aid under such part.'.
  (b) EFFECTIVE DATE- The amendments made by subsection (a) apply to payments
  under title XIX of the Social Security Act for calendar quarters beginning
  on or after July 1, 1991, without regard to whether or not final regulations
  to carry out such amendments have been promulgated by such date.
SEC. 204. EXTENSION OF MEDICAID TRANSITION COVERAGE.
  (a) OPTIONAL ADDITIONAL 12-MONTH EXTENSION- Section 1925(b) of the Social
  Security Act (42 U.S.C. 1396s(b)) is amended--
  (1) in the heading, by striking `6-MONTH';
  (2) in paragraph (1), by striking `the succeeding 6-month period' and
  inserting `the succeeding period of 6 months (or, at the State option as
  specified by the State, of 9 months, 12 months, 15 months, or 18 months)';
  (3) in paragraph (2)(A)(ii), by inserting `(and, if applicable, 6th, 9th,
  12th, and 15th month)' after `3rd month';
  (4) in paragraph (2)(B)(ii), by inserting `(and, if applicable, 7th, 10th,
  13th, and 16th month)' after `4th month';
  (5) in paragraph (3)(A), in the matter before clause (i), by striking
  `6-month';
  (6) in paragraph (3)(A)(iii), by striking `of the 6-month period' and
  inserting `(or, if applicable, the 7th, 10th, 13th, or 16th month) of the
  period'; and
  (7) in paragraph (5)(D)(i), by striking `of the 6-month additional extension
  period' and inserting `(or, if applicable, the 7th, 10th, 13th, or 16th
  month) of the additional extension period'.
  (b) REPEAL OF SUNSET PROVISION- Subsection (f) of section 1925 of such
  Act is repealed.
  (c) EFFECTIVE DATES- The amendments made by this section shall take effect
  on April 1, 1990.
SEC. 205. EXTENSION OF PAYMENT PROVISIONS FOR MEDICALLY NECESSARY SERVICES
IN DISPROPORTIONATE SHARE HOSPITALS TO CHILDREN UNDER 18 YEARS OF AGE.
  (a) COVERAGE OF MEDICALLY NECESSARY SERVICES FOR CHILDREN- Section
  1902(a)(10) of the Social Security Act (42 U.S.C. 1396a(a)(10)) is amended,
  in the subdivision (X) following subparagraph (E), by striking `under one
  year of age' and inserting `under 18 years of age'.
  (b) ASSURING ADEQUATE PAYMENT FOR INPATIENT HOSPITAL SERVICES FOR CHILDREN
  IN DISPROPORTIONATE SHARE HOSPITALS- Section 1923(a)(2) of such Act
  (42 U.S.C. 1396r-4) is amended by adding at the end the following new
  subparagraph:
  `(D) If a State plan under this title provides for payments for inpatient
  hospital services on a prospective basis (whether per diem, per case,
  or otherwise), in order for the plan to be considered to have met such
  requirement of section 1902(a)(13)(A) as of July 1, 1991, the State must
  submit to the Secretary by not later than April 1, 1991, a State plan
  amendment that provides, in the case of hospitals defined by the State as
  disproportionate share hospitals under paragraph (1)(A), for an outlier
  adjustment in payment amounts for medically necessary inpatient hospital
  services provided on or after July 1, 1991, involving exceptionally high
  costs or exceptionally long lengths of stay for individuals one year of
  age or older, but under 18 years of age.'.
  (c) EFFECTIVE DATES- (1)(A) The amendment made by subsection (a) applies
  (except as provided under subparagraph (B)) to payments under title XIX of
  the Social Security Act for calendar quarters beginning on or after July 1,
  1991, without regard to whether or not final regulations to carry out such
  amendment have been promulgated by such date.
  (B) In the case of a State plan for medical assistance under title XIX of
  the Social Security Act which the Secretary of Health and Human Services
  determines requires State legislation (other than legislation authorizing or
  appropriating funds) in order for the plan to meet the additional requirement
  imposed by the amendment made by subsection (a), 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 this 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 the 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 such session shall be deemed to be a separate regular session of the
  State legislature.
  (2) The amendment made by subsection (b) shall take effect on the date of
  the enactment of this Act.
SEC. 206. REQUIRING `SECTION 209(B)' STATES TO PROVIDE MEDICAL ASSISTANCE
TO DISABLED CHILDREN RECEIVING SSI BENEFITS.
  (a) IN GENERAL- Section 1902(f) of the Social Security Act (42
  U.S.C. 1396a(f)) is amended--
  (1) by inserting `paragraph (2) of this subsection and' after `, except
  as provided in',
  (2) by striking `(1)' and `(2)' and inserting `(A)' and `(B)', respectively,
  (3) by inserting `(1)' after `(f)', and
  (4) by adding at the end the following new paragraph:
  `(2) A State shall provide medical assistance to any individual under 18
  years of age with respect to whom supplemental security income benefits
  are payable under title XVI.'.
  (b) EFFECTIVE DATE- (1) The amendments made by subsection (a) apply
  (except as provided under paragraph (2)) to payments under title XIX of
  the Social Security Act for calendar quarters beginning on or after July 1,
  1991, without regard to whether or not final regulations to carry out such
  amendments have been promulgated by such date.
  (2) In the case of a State plan for medical assistance under title XIX of
  the Social Security Act which the Secretary of Health and Human Services
  determines requires State legislation (other than legislation authorizing
  or appropriating funds) in order for the plan to meet the additional
  requirement imposed by the amendments made by subsection (a), 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 this 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 the 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 such session shall be deemed to be a separate regular
  session of the State legislature.
SEC. 207. MANDATORY CONTINUATION OF COVERAGE FOR CHILDREN OTHERWISE QUALIFIED
FOR BENEFITS UNTIL REDETERMINATION.
  (a) IN GENERAL- Section 1902(e) of the Social Security Act (42
  U.S.C. 1396a(e)) is amended by adding at the end the following new paragraph:
  `(11) With respect to an individual who has not attained the age of 18,
  who is receiving medical assistance under this title, and who is determined
  to be no longer eligible for such assistance, the State may not discontinue
  such assistance until the State has determined that the individual is not
  eligible for assistance under this title on any basis.'.
  (b) CONFORMING AMENDMENT TO QUALITY CONTROL- Section 1903(u)(1)(D) of
  such Act (42 U.S.C. 1396b(u)(1)(D)) is amended by adding at the end the
  following new clause:
  `(vi) In determining the amount of erroneous excess payments for quarters
  beginning on or after July 1, 1991, there shall not be included any erroneous
  payments which are attributable to individuals described in section
  1902(e)(11) who are determined to be no longer eligible for assistance
  but whose assistance has not been discontinued because a determination on
  other bases for such assistance has not been made.'.
  (c) EFFECTIVE DATE- The amendment made by subsection (a) shall become
  effective with respect to eligibility determinations for medical assistance
  under title XIX of the Social Security Act on or after July 1, 1991,
  without regard to whether or not final regulations to carry out such
  amendment have been promulgated by such date.
SEC. 208. OPTIONAL MEDICAID COVERAGE FOR FOSTER CHILDREN.
  (a) IN GENERAL- Section 1902 of the Social Security Act (42 U.S.C. 1396a)
  is amended--
  (1) in subsection (a)(10)(A)(ii)--
  (A) by striking `or' at the end of subclause (X),
  (B) by inserting `or' at the end of subclause (XI), and
  (C) by adding at the end the following new subclause:
  `(XII) who are described in subsection (s)(1);';
  (2) in subsection (a)(17), by striking `and (m)(4)' and inserting `(m)(4),
  and (s)(1)'; and
  (3) by adding at the end the following new subsection:
  `(s)(1) Individuals described in this paragraph are individuals for whom
  a public agency assumes full or partial financial responsibility--
  `(A) who have not attained the age of 18,
  `(B) who reside in a foster home, group home, or private institution, and
  `(C) whose incomes do not exceed 100 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 Omnibus Budget Reconciliation
  Act of 1981) applicable to a family of one.
  `(2) Notwithstanding subsection (a)(17), for individuals who are eligible
  for medical assistance because of subsection (a)(10)(A)(ii)(XII)--
  `(A) no resource standard or methodology shall be applied,
  `(B) the income standard to be applied is the income standard described
  in paragraph (1)(C), and
  `(C) income for these individuals shall be determined in accordance with
  a methodology which is no more restrictive than the methodology employed
  under the State plan under part E of title IV.'.
  (b) EFFECTIVE DATE- The amendments made by this section shall become
  effective with respect to payments under title XIX of the Social Security
  Act for calendar quarters beginning on or after July 1, 1991, without
  regard to whether or not final regulations to carry out such amendments
  have been promulgated by such date.