Amends SSA title XXI to give certain States the option of providing pregnancy-related assistance for targeted low-income pregnant women in accordance with this Act, which includes: (1) automatic enrollment for children born to women receiving such pregnancy-related assistance; (2) additional allotments for providing coverage of pregnant women; and (3) no cost-sharing for pregnancy-related services.
Provides for coordination of SCHIP with the program under SSA title V (Maternal and Child Health Services).
Increases the income eligibility for low-income children under SCHIP.
Amends SSA title XVI (Supplemental Security Income) to direct the Commissioner of Social Security to review determinations, made by State agencies in connection with applications for benefits under this title on the basis of blindness or disability, that individuals who have attained 18 years of age are blind or disabled as of a specified onset date.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2268 Introduced in House (IH)]
108th CONGRESS
1st Session
H. R. 2268
To amend titles XIX and XXI of the Social Security Act to expand or add
coverage of pregnant women under the Medicaid and State children's
health insurance program, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 22, 2003
Mr. Strickland (for himself, Mr. Ney, Mrs. Napolitano, Mr. Towns, Mrs.
Christensen, Mr. McNulty, and Mr. Farr) introduced the following bill;
which was referred to the Committee on Energy and Commerce, and in
addition to the Committee on Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend titles XIX and XXI of the Social Security Act to expand or add
coverage of pregnant women 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.
This Act may be cited as the ``Start Healthy, Stay Healthy Act of
2003''.
SEC. 2. STATE OPTION TO EXPAND OR ADD COVERAGE OF CERTAIN PREGNANT
WOMEN UNDER MEDICAID AND SCHIP.
(a) Medicaid.--
(1) Authority to expand coverage.--Section 1902(l)(2)(A)(i)
of the Social Security Act (42 U.S.C. 1396a(l)(2)(A)(i)) is
amended by inserting ``(or such higher percent as the State may
elect for purposes of expenditures for medical assistance for
pregnant women described in section 1905(u)(4)(A))'' after
``185 percent''.
(2) Enhanced matching funds available if certain conditions
met.--Section 1905 of the Social Security Act (42 U.S.C. 1396d)
is amended--
(A) in the fourth sentence of subsection (b), by
striking ``or subsection (u)(3)'' and inserting ``,
(u)(3), or (u)(4)''; and
(B) in subsection (u)--
(i) by redesignating paragraph (4) as
paragraph (5); and
(ii) by inserting after paragraph (3) the
following:
``(4) For purposes of the fourth sentence of subsection (b) and
section 2105(a), the expenditures described in this paragraph are the
following:
``(A) Certain pregnant women.--If the conditions described
in subparagraph (B) are met, expenditures for medical
assistance for pregnant women described in subsection (n) or
under section 1902(l)(1)(A) in a family the income of which
exceeds the effective income level (expressed as a percent of
the poverty line and considering applicable income disregards)
that has been specified under subsection (a)(10)(A)(i)(III) or
(l)(2)(A) of section 1902, as of January 1, 2003, but does not
exceed the income eligibility level established under title XXI
for a targeted low-income child.
``(B) Conditions.--The conditions described in this
subparagraph are the following:
``(i) The State plans under this title and title
XXI do not provide coverage for pregnant women
described in subparagraph (A) with higher family income
without covering such pregnant women with a lower
family income.
``(ii) The State does not apply an effective income
level for pregnant women that is lower than the
effective income level (expressed as a percent of the
poverty line and considering applicable income
disregards) that has been specified under the State
plan under subsection (a)(10)(A)(i)(III) or (l)(2)(A)
of section 1902, as of January 1, 2003, to be eligible for medical
assistance as a pregnant woman.
``(C) Definition of poverty line.--In this subsection, the
term `poverty line' has the meaning given such term in section
2110(c)(5).''.
(3) Payment from title xxi allotment for medicaid expansion
costs; elimination of counting medicaid child presumptive
eligibility costs against title xxi allotment.--Section
2105(a)(1) of the Social Security Act (42 U.S.C. 1397ee(a)(1))
is amended--
(A) in the matter preceding subparagraph (A), by
striking ``(or, in the case of expenditures described
in subparagraph (B), the Federal medical assistance
percentage (as defined in the first sentence of section
1905(b)))''; and
(B) by striking subparagraph (B) and inserting the
following:
``(B) for the provision of medical assistance that
is attributable to expenditures described in section
1905(u)(4)(A);''.
(4) Additional amendments to medicaid.--
(A) Eligibility of a newborn.--Section 1902(e)(4)
of the Social Security Act (42 U.S.C. 1396a(e)(4)) is
amended in the first sentence by striking ``so long as
the child is a member of the woman's household and the
woman remains (or would remain if pregnant) eligible
for such assistance''.
(B) Application of qualified entities 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).''.
(b) SCHIP.--
(1) 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 COVERAGE OF TARGETED LOW-INCOME PREGNANT WOMEN.
``(a) Optional Coverage.--Notwithstanding any other provision of
this title, a State may provide for coverage, through an amendment to
its State child health plan under section 2102, of pregnancy-related
assistance for targeted low-income pregnant women in accordance with
this section, but only if the State meets the conditions described in
section 1905(u)(4)(B).
``(b) Definitions.--For purposes of this title:
``(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 services described in
section 1905(a)(4)(C)) and to other conditions that may
complicate pregnancy.
``(2) Targeted low-income pregnant woman.--The term
`targeted low-income pregnant woman' means a woman--
``(A) during pregnancy and through the end of the
month in which the 60-day period (beginning on the last
day of her pregnancy) ends;
``(B) whose family income exceeds the effective
income level (expressed as a percent of the poverty
line and considering applicable income disregards) that
has been specified under subsection (a)(10)(A)(i)(III)
or (l)(2)(A) of section 1902, as of January 1, 2003, to
be eligible for medical assistance as a pregnant woman
under title XIX but does not exceed the income
eligibility level established under the State child
health plan under this title for a targeted low-income
child; and
``(C) who satisfies the requirements of paragraphs
(1)(A), (1)(C), (2), and (3) of section 2110(b).
``(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 in 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)(A).
``(4) In applying section 2102(b)(3)(B), any reference to
children found through screening to be eligible for medical
assistance under the State medicaid plan under title XIX is
deemed a reference to pregnant women.
``(5) There shall be no exclusion of benefits for services
described in subsection (b)(1) based on any preexisting
condition and no waiting period (including any waiting period
imposed to carry out section 2102(b)(3)(C)) shall apply.
``(6) 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)(C) is deemed not to require, in such case,
compliance with the requirements of section 2103(a).
``(7) In applying section 2103(e)(3)(B) in the case of a
pregnant woman provided coverage under this section, the
limitation on total annual aggregate cost-sharing shall be
applied to the entire family of such pregnant woman.
``(d) Automatic Enrollment for Children Born to Women Receiving
Pregnancy-Related Assistance.--If a child is born to a targeted low-
income pregnant woman who was receiving pregnancy-related assistance
under this section on the date of the child's birth, the child shall be
deemed to have applied for child health assistance under the State
child health plan and to have been found eligible for such assistance
under such plan or to have applied for medical assistance under title
XIX and to have been found eligible for such assistance under such
title, as appropriate, on the date of such birth and to remain eligible
for such assistance until the child attains 1 year of age. During the
period in which a child is deemed under the preceding sentence to be
eligible for child health or medical assistance, the child health or
medical assistance eligibility identification number of the mother
shall also serve as the identification number of the child, and all
claims shall be submitted and paid under such number (unless the State
issues a separate identification number for the child before such
period expires).''.
(2) Additional allotments for providing coverage of
pregnant women.--
(A) In general.--Section 2104 of the Social
Security Act (42 U.S.C. 1397dd) is amended by inserting
after subsection (c) the following:
``(d) Additional Allotments for Providing Coverage of Pregnant
Women.--
``(1) Appropriation; total allotment.--For the purpose of
providing additional allotments to States under this title,
there is appropriated, out of any money in the Treasury not
otherwise appropriated, for each of fiscal years 2004 through 2007,
$200,000,000.
``(2) State and territorial allotments.--In addition to the
allotments provided under subsections (b) and (c), 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--
``(A) in the case of such a State other than a
commonwealth or territory described in subparagraph
(B), the same proportion as the proportion of the
State's allotment under subsection (b) (determined
without regard to subsection (f)) to the total amount
of the allotments under subsection (b) for such States
eligible for an allotment under this paragraph for such
fiscal year; and
``(B) 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 the total amount of the
allotments under subsection (c) for commonwealths and
territories eligible for an allotment under this
paragraph for such fiscal year.
``(3) Use of additional allotment.--Additional allotments
provided under this subsection are not available for amounts
expended before October 1, 2003. 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
pregnancy-related assistance for targeted low-income pregnant
women.
``(4) No payments unless election to expand coverage of
pregnant women.--No payments may be made to a State under this
title from an allotment provided under this subsection unless
the State provides pregnancy-related assistance for targeted
low-income pregnant women under this title, or provides medical
assistance for pregnant women under title XIX, whose family
income exceeds the effective income level applicable under
subsection (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902 to a
family of the size involved as of January 1, 2003.''.
(B) Conforming amendments.--Section 2104 of the
Social Security Act (42 U.S.C. 1397dd) is amended--
(i) in subsection (a), in the matter
preceding paragraph (1), by inserting ``subject
to subsection (d),'' after ``under this
section,'';
(ii) in subsection (b)(1), by inserting
``and subsection (d)'' after ``Subject to
paragraph (4)''; and
(iii) in subsection (c)(1), by inserting
``subject to subsection (d),'' after ``for a
fiscal year,''.
(3) Presumptive eligibility under title xxi.--
(A) Application to pregnant women.--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.''.
(4) Additional amendments to title xxi.--
(A) No cost-sharing for pregnancy-related
services.--Section 2103(e)(2) of the Social Security
Act (42 U.S.C. 1397cc(e)(2)) is amended--
(i) in the heading, by inserting ``or
pregnancy-related services'' after ``preventive
services''; and
(ii) by inserting before the period at the
end the following: ``or for pregnancy-related
services''.
(B) No waiting period.--Section 2102(b)(1)(B) of
the Social Security Act (42 U.S.C. 1397bb(b)(1)(B)) is
amended--
(i) by striking ``, and'' at the end of
clause (i) and inserting a semicolon;
(ii) by striking the period at the end of
clause (ii) and inserting ``; and''; and
(iii) 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 pregnant woman.''.
(c) Effective Date.--The amendments made by this section apply to
items and services furnished on or after October 1, 2003, without
regard to whether regulations implementing such amendments have been
promulgated.
SEC. 3. COORDINATION WITH THE MATERNAL AND CHILD HEALTH PROGRAM.
(a) In General.--Section 2102(b)(3) of the Social Security Act (42
U.S.C. 1397bb(b)(3)) is amended--
(1) in subparagraph (D), by striking ``and'' at the end;
(2) in subparagraph (E), by striking the period and
inserting ``; and''; and
(3) 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.''.
(b) Conforming Medicaid Amendment.--Section 1902(a)(11) of such Act
(42 U.S.C. 1396a(a)(11)) is amended--
(1) by striking ``and'' before ``(C)''; and
(2) 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''.
(c) Effective Date.--The amendments made by this section take
effect on January 1, 2004.
SEC. 4. 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 2004.
SEC. 5. REVIEW OF STATE AGENCY BLINDNESS AND DISABILITY DETERMINATIONS.
Section 1633 of the Social Security Act (42 U.S.C. 1383b) is
amended by adding at the end the following:
``(e)(1) The Commissioner of Social Security shall review
determinations, made by State agencies pursuant to subsection (a) in
connection with applications for benefits under this title on the basis
of blindness or disability, that individuals who have attained 18 years
of age are blind or disabled as of a specified onset date. The
Commissioner of Social Security shall review such a determination
before any action is taken to implement the determination.
``(2)(A) In carrying out paragraph (1), the Commissioner of Social
Security shall review--
``(i) at least 25 percent of all determinations referred to
in paragraph (1) that are made in fiscal year 2004; and
``(ii) at least 50 percent of all such determinations that
are made in fiscal year 2005 or thereafter.
``(B) In carrying out subparagraph (A), the Commissioner of Social
Security shall, to the extent feasible, select for review the
determinations which the Commissioner of Social Security identifies as
being the most likely to be incorrect.''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Human Resources.
Referred to the Subcommittee on Health.
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