Amends SSA title XXI (State Children's Health Insurance Program) (SCHIP) to permit a State child health plan, implemented under either SCHIP or Medicaid, to provide for coverage of pregnancy-related assistance for targeted low-income pregnant women under specified conditions.
Provides for SCHIP and Medicaid coordination with SSA title V (Maternal and Child Health Services).
Increases the SCHIP income eligibility level with respect to a low-income child.
Amends: (1) SSA title XIX to provide for an enhanced Federal Medicaid medical assistance percentage for increased expenditures for medical assistance for children; (2) SSA title XXI to increase SCHIP appropriations; and (3) SSA titles XIX and XXI to permit a State to elect to provide Medicaid and SCHIP coverage of children age 20 or 21.
[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3729 Introduced in House (IH)]
107th CONGRESS
2d Session
H. R. 3729
To amend titles XIX and XXI of the Social Security Act to improve the
health benefits coverage of infants and children under the Medicaid and
State children's health insurance program, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 12, 2002
Mr. Strickland (for himself, Mr. Ney, Ms. DeGette, Mrs. Morella, Mr.
Crowley, Ms. Waters, Mr. McNulty, Mr. Blagojevich, Mr. Towns, Mr. Wynn,
Mr. Waxman, Mr. Schiff, Mr. Pascrell, Mr. Green of Texas, Mr. Stupak,
Mr. Frost, Ms. Eshoo, Mr. Rush, Mr. Evans, Mr. Dooley of California,
Mr. Conyers, Mr. Owens, Mrs. Christensen, Mr. Capuano, Mr. LaFalce, and
Mr. Brady of Pennsylvania) introduced the following bill; which was
referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend titles XIX and XXI of the Social Security Act to improve the
health benefits coverage of infants and children under the Medicaid and
State children's health insurance program, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Start Healthy,
Stay Healthy Act''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--START HEALTHY
Sec. 101. Enhanced Federal medicaid match for States that opt to
continuously enroll infants during the
first year of life without regard to the
mother's eligibility status.
Sec. 102. Optional coverage of low-income, uninsured pregnant women
under a State child health plan.
Sec. 103. Increase in SCHIP income eligibility.
TITLE II--STAY HEALTHY
Sec. 201. Enhanced Federal medicaid match for increased expenditures
for medical assistance for children.
Sec. 202. Increase in SCHIP appropriations.
Sec. 203. Optional coverage of children through age 20 under the
medicaid program and SCHIP.
TITLE I--START HEALTHY
SEC. 101. ENHANCED FEDERAL MEDICAID MATCH FOR STATES THAT OPT TO
CONTINUOUSLY ENROLL INFANTS DURING THE FIRST YEAR OF LIFE
WITHOUT REGARD TO THE MOTHER'S ELIGIBILITY STATUS.
(a) State Option.--Section 1902(e)(4) of the Social Security Act
(42 U.S.C. 1396a(e)(4)) is amended by adding at the end the following
new sentence: ``A State may elect (through a State plan amendment) to
apply the first sentence of this paragraph without regard to the
requirements that the child remain a member of the woman's household
and the woman remains (or would remain if pregnant) eligible for
medical assistance.''.
(b) Enhanced FMAP.--The first sentence of section 1905(b) of the
Social Security Act (42 U.S.C. 1396d(b)) is amended--
(1) by inserting ``(A)'' after ``only''; and
(2) by inserting ``, or (B) on the basis of a State
election made under the third sentence of section 1902(e)(4)''
before the period.
(c) Effective Date.--The amendments made by this section apply to
medical assistance provided on or after October 1, 2002.
SEC. 102. OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED PREGNANT WOMEN
UNDER A STATE CHILD HEALTH PLAN.
(a) In General.--Title XXI of the Social Security Act (42 U.S.C.
1397aa et seq.) is amended by adding at the end the following new
section:
``SEC. 2111. OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED PREGNANT WOMEN.
``(a) Optional Coverage.--Notwithstanding any other provision of
this title, a State child health plan (whether implemented under this
title or title XIX) may provide for coverage of pregnancy-related
assistance for targeted low-income pregnant women in accordance with
this section, but only if the State has established an income
eligibility level under section 1902(l)(2)(A) for women described in
section 1902(l)(1)(A) that is 185 percent of the income official
poverty line.
``(b) Definitions.--For purposes of this section:
``(1) Pregnancy-related assistance.--The term `pregnancy-
related assistance' has the meaning given the term child health
assistance in section 2110(a) as if any reference to targeted
low-income children were a reference to targeted low-income
pregnant women, except that the assistance shall be limited to
services related to pregnancy (which include prenatal,
delivery, and postpartum services) and to other conditions that
may complicate pregnancy.
``(2) Targeted low-income pregnant woman.--The term
`targeted low-income pregnant woman' has the meaning given the
term targeted low-income child in section 2110(b) as if any
reference to a child were deemed a reference to a woman during
pregnancy and through the end of the month in which the 60-day
period (beginning on the last day of her pregnancy) ends.
``(c) References to Terms and Special Rules.--In the case of, and
with respect to, a State providing for coverage of pregnancy-related
assistance to targeted low-income pregnant women 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 pregnant woman.
``(2) Any such reference to child health assistance with
respect to such women is deemed a reference to pregnancy-
related assistance.
``(3) Any such reference to a child is deemed a reference
to a woman during pregnancy and the period described in
subsection (b)(2).
``(4) The medicaid applicable income level is deemed a
reference to the income level established under section
1902(l)(2)(A).
``(5) Subsection (a) of section 2103 (relating to required
scope of health insurance coverage) shall not apply insofar as
a State limits coverage to services described in subsection
(b)(1) and the reference to such section in section 2105(a)(1)
is deemed not to require, in such case, compliance with the
requirements of section 2103(a).
``(6) There shall be no exclusion of benefits for services
described in subsection (b)(1) based on any pre-existing
condition and no waiting period (including any waiting period imposed
to carry out section 2102(b)(3)(C)) shall apply.
``(d) No Impact on Allotments.--Nothing in this section shall be
construed as affecting the amount of any initial allotment provided to
a State under section 2104(b).
``(e) Application of Funding Restrictions.--The coverage under this
section (and the funding of such coverage) is subject to the
restrictions of section 2105(c).
``(f) Automatic Enrollment for Children Born to Women Receiving
Pregnancy-Related Assistance.--Notwithstanding any other provision of
this title or title XIX, if a child is born to a targeted low-income
pregnant woman who was receiving pregnancy-related assistance under
this section on the date of the children's birth, the child shall be
deemed to have applied for child health assistance under the State
child health plan and to have been found eligible for such assistance
under such plan (or, in the case of a State that provides such
assistance through the provision of medical assistance under a plan
under title XIX, to have applied for medical assistance under such
title and to have been found eligible for such assistance under such
title) on the date of such birth and to remain eligible for such
assistance until the child attains 1 year of age. During the period in
which a child is deemed under the preceding sentence to be eligible for
child health or medical assistance, the child health or medical
assistance eligibility identification number of the mother shall also
serve as the identification number of the child, and all claims shall
be submitted and paid under such number (unless the State issues a
separate identification number for the child before such period
expires).''.
(b) State Option To Use Enhanced FMAP and SCHIP Allotment for
Coverage of Additional Pregnant Women Under the Medicaid Program.--
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended--
(1) in the fourth sentence of subsection (b), by inserting
``and in the case of a State plan that meets the condition
described in subsections (u)(1) and (u)(4)(A), with respect to
expenditures described in subsection (u)(4)(B) for the State
for a fiscal year'' after ``for a fiscal year,''; and
(2) in subsection (u)--
(A) by redesignating paragraph (4) as paragraph
(5); and
(B) by inserting after paragraph (3) the following
new paragraph:
``(4)(A) The condition described in this subparagraph for a State
plan is that the plan has established an income level under section
1902(l)(2)(A) with respect to individuals described in section
1902(l)(1)(A) that is 185 percent of the income official poverty line.
``(B) For purposes of subsection (b), the expenditures described in
this paragraph are expenditures for medical assistance for women
described in section 1902(l)(1)(A) whose income exceeds the income
level established for such women under section 1902(l)(2)(A)(i) as of
the date of the enactment of this paragraph but does not exceed 185
percent of the income official poverty line.''.
(c) No Waiting Periods or Cost-Sharing.--
(1) No waiting period.--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 new clause:
``(iii) may not apply a waiting period
(including a waiting period to carry out
paragraph (3)(C)) in the case of a targeted
low-income pregnant woman, if the State
provides for coverage of pregnancy-related
assistance for such women in accordance with
section 2111.''.
(2) No cost-sharing for pregnancy-related benefits.--
Section 2103(e)(2) of such Act (42 U.S.C. 1397cc(e)(2)) is
amended--
(A) in the heading, by inserting ``and pregnancy-
related services'' after ``preventive services''; and
(B) by inserting before the period at the end the
following: ``or for pregnancy-related services, if the
State provides for coverage of pregnancy-related
assistance for targeted low-income pregnant women in
accordance section 2111''.
(d) Presumptive Eligibility.--
(1) In general.--Section 1920A(b)(3)(A)(i)(III) of the
Social Security Act (42 U.S.C. 1396r-1a(b)(3)(A)(i)(III)) 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) Exception from limitation on administrative
expenses.--Section 2105(c)(2) of the Social Security
Act (42 U.S.C. 1397ee(c)(2)) is amended by adding at
the end the following new subparagraph:
``(C) Exception for presumptive eligibility
expenditures.--The limitation under subparagraph (A) on
expenditures shall not apply to expenditures
attributable to the application of section 1920 or
1920A (pursuant to section 2107(e)(1)(D)), regardless
of whether the child or pregnant woman is determined
to be ineligible for the program under this title or title XIX.''.
(e) Program Coordination With the Maternal and Child Health Program
(Title V).--
(1) In general.--Section 2102(b)(3) of the Social Security
Act (42 U.S.C. 1397bb(b)(3)) is amended--
(A) in subparagraph (D), by striking ``and'' at the
end;
(B) in subparagraph (E), by striking the period and
inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(F) that operations and activities under this
title are developed and implemented in consultation and
coordination with the program operated by the State
under title V in areas including outreach and
enrollment, benefits and services, service delivery
standards, public health and social service agency
relationships, and quality assurance and data
reporting.''.
(2) Conforming medicaid amendment.--Section 1902(a)(11) of
such Act (42 U.S.C. 1396a(a)(11)) is amended--
(A) by striking ``and'' before ``(C)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (D) provide that operations and
activities under this title are developed and
implemented in consultation and coordination with the
program operated by the State under title V in areas
including outreach and enrollment, benefits and
services, service delivery standards, public health and
social service agency relationships, and quality
assurance and data reporting''.
(3) Effective date.--The amendments made by this subsection
take effect on January 1, 2003.
(f) Application of Annual Aggregate Cost-Sharing Limit.--Section
2103(e)(3)(B) of the Social Security Act (42 U.S.C. 1397cc(e)(3)(B)) is
amended by adding at the end the following new sentence: ``In the case
of a targeted low-income pregnant woman provided coverage under section
2111, or the parents of a targeted low-income child provided coverage
under this title under an 1115 waiver or otherwise, the limitation on
total annual aggregate cost-sharing described in the preceding sentence
shall be applied to the entire family of such woman or parents.''.
(g) Effective Date.--Except as provided in subsection (e), the
amendments made by this section take effect on the date of the
enactment of this Act and apply to expenditures incurred on or after
that date.
SEC. 103. INCREASE IN SCHIP INCOME ELIGIBILITY.
(a) Definition of Low-Income Child.--Section 2110(c)(4) of the
Social Security Act (42 U.S.C. 42 U.S.C. 1397jj(c)(4)) is amended by
striking ``200'' and inserting ``250''.
(b) Effective Date.--The amendment made by subsection (a) applies
to child health assistance provided, and allotments determined under
section 2104 of the Social Security Act (42 U.S.C. 1397dd), for fiscal
years beginning with fiscal year 2003.
TITLE II--STAY HEALTHY
SEC. 201. ENHANCED FEDERAL MEDICAID MATCH FOR INCREASED EXPENDITURES
FOR MEDICAL ASSISTANCE FOR CHILDREN.
(a) Enhanced FMAP.--Section 1905(b) of the Social Security Act (42
U.S.C. 1396d(b)) is amended by adding at the end the following new
sentence: ``Notwithstanding the first sentence of this subsection, in
the case of a State plan that meets at least 7 of the conditions
described in subsection (x)(1) (as determined by the Secretary in
consultation with States (including the State agencies responsible for
the administration of this title and title V), beneficiaries under this
title, providers of services under this title, and advocates for
children), with respect to expenditures described in subsection (x)(2)
for the State for a fiscal year, the Federal medical assistance
percentage is equal to the percentage determined for the State under
subsection (x)(3).''.
(b) Conditions and Expenditures Described.--Section 1905 of the
Social Security Act (42 U.S.C. 1396d) is amended by adding at the end
the following new subsection:
``(x)(1) For purposes of subsection (b), the conditions described
in this subsection are the following:
``(A) Highest schip income eligibility.--The State has a
State child health plan under title XXI which (whether
implemented under such title or under this title) has the
highest income eligibility standard permitted under title XXI
as of January 1, 2002, does not limit the acceptance of
applications, and provides benefits to all children in the
State who apply for and meet eligibility standards.
``(B) Uniform, simplified application form.--With respect
to children under age 19 (or such higher age as the State has
elected under section 1902(l)(1)(D)) who are eligible for
medical assistance under section 1902(a)(10)(A), the State uses
the same uniform, simplified application form (including, if
applicable, permitting application other than in person) for
purposes of establishing eligibility for benefits under this
title and also under title XXI.
``(C) Coordinated enrollment process.--The State has an
enrollment process that is coordinated with that under title
XXI so that a family need only interact with a single agency in
order to determine whether a child is eligible for benefits
under this title or title XXI, and that allows for the transfer
of enrollment, without a gap in coverage, for a child whose
income eligibility status changes but who remains eligible for
benefits under either title.
``(D) Same verification and redetermination policies;
automatic reassessment of eligibility.--With respect to
children under age 19 (or such higher age as the State has
elected under section 1902(l)(1)(D)) who are eligible for
medical assistance under section 1902(a)(10)(A), the State
provides for initial eligibility determinations and
redeterminations of eligibility using the same verification
policies (including with respect to face-to-face interviews),
forms, and frequency as the State uses for such purposes under
title XXI, and, as part of such redeterminations, provides for
the automatic reassessment of the eligibility of such children for
assistance under this title and title XXI.
``(E) No asset test.--The State does not impose an asset
test for eligibility under section 1902(l) or title XXI with
respect to children.
``(F) 12-month continuous enrollment.--The State has
elected the option of continuing enrollment under section
1902(e)(12) and has elected a 12-month period under
subparagraph (A) of such section.
``(G) Compliance with outstationing requirement.--The State
is providing for the receipt and initial processing of
applications of children for medical assistance under this
title at facilities defined as disproportionate share hospitals
under section 1923(a)(1)(A) and Federally-qualified health
centers described in subsection (l)(2)(B) of this section
consistent with the requirements of section 1902(a)(55).
``(H) No waiting period longer than 6 months.--The State
does not impose a waiting period for children who meet
eligibility standards to qualify for assistance under such plan
that exceeds 6 months (and may impose a shorter period or no
period) for purposes of complying with regulations promulgated
under title XXI to ensure that the insurance provided under the
State child health plan under such title does not substitute
for coverage under group health plans.
``(I) Sufficient provider payment rates.--The State
demonstrates that it is meeting the requirements of section
1902(a)(30)(A) through payment rates sufficient to enlist
enough providers so that care and pediatric, obstetrical,
gynecologic, and dental services are available under the plan
at least to the extent that such care and services are
available to the general population in the geographic area.
``(2)(A) For purposes of subsection (b), the expenditures described
in this paragraph are expenditures for medical assistance for children
described in subparagraph (B) for a fiscal year, but only to the extent
that such expenditures exceed the base expenditure amount, as defined
in subparagraph (C).
``(B) For purposes of subparagraph (A), the children described in
this subparagraph are--
``(i) individuals who are under 19 years of age (or such
higher age as the State may have elected under section
1902(l)(1)(D)) who are eligible and enrolled for medical
assistance under this title; and
``(ii) individuals who--
``(I) would be described in clause (i) but for
having family income that exceeds the highest income
eligibility level applicable to such individuals under
the State plan; and
``(II) would be considered disabled under section
1614(a)(3)(C) (determined without regard to the
reference to age in that section but for having
earnings or deemed income or resources (as determined
under title XVI for children) that exceed the
requirements for receipt of supplemental security
income benefits.
``(C) For purposes of subparagraph (A), the term `base expenditure
amount' means the total expenditures for medical assistance for
children described in subparagraph (B) for fiscal year 1996.
``(3) For purposes of subsection (b), the Federal medical
assistance percentage with respect to expenditures described in
paragraph (2) for a fiscal year is equal to the following:
``(A) In the case of a State that meets 7 of the conditions
described in paragraph (1), the Federal medical assistance
percentage (as defined in the first sentence of subsection (b))
for the State increased by a number of percentage points equal to 50
percent of the number of percentage points by which (1) such Federal
medical assistance percentage for the State is less than (2) the
enhanced FMAP for the State described in section 2105(b).
``(B) In the case of a State that meets 8 of the conditions
described in paragraph (1), the Federal medical assistance
percentage (as so defined) for the State increased by a number
of percentage points equal to 75 percent of the number of
percentage points by which (1) such Federal medical assistance
percentage for the State is less than (2) the enhanced FMAP for
the State (as so described).
``(C) In the case of a State that meets all of the
conditions described in paragraph (1), the enhanced FMAP (as so
described).''.
(c) Collection of Data.--The Secretary of Health and Human Services
shall modify such data collection and reporting requirements under
title XIX of the Social Security Act as are necessary to determine the
expenditures and base expenditure amount described in section
1905(x)(2) of that Act (as added by subsection (b)), particularly with
respect to expenditures and the base expenditure amount related to
children described in section 1905(x)(2)(B)(ii) of that Act.
(d) Effective Date.--The amendments made by subsections (a) and (b)
apply to medical assistance provided on or after October 1, 2001.
SEC. 202. INCREASE IN SCHIP APPROPRIATIONS.
Section 2104(a) of the Social Security Act (42 U.S.C. 1397dd(a)) is
amended by striking paragraphs (5) through (9) and inserting the
following:
``(5) for fiscal year 2003, $3,500,000,000;
``(6) for fiscal year 2004, $4,000,000,000;
``(7) for fiscal year 2005, $4,300,000,000;
``(8) for fiscal year 2006, $4,500,000,000;
``(9) for fiscal year 2007, $4,500,000,000; and''.
SEC. 203. OPTIONAL COVERAGE OF CHILDREN THROUGH AGE 20 UNDER THE
MEDICAID PROGRAM AND SCHIP.
(a) Medicaid.--
(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 such 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 such 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 such 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 such 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 such 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 such 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, 2002, and apply to medical assistance and child
health assistance provided on or after such date.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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