[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1564 Introduced in House (IH)]







105th CONGRESS
  1st Session
                                H. R. 1564

  To amend title XIX of the Social Security Act to permit presumptive 
    eligibility for low-income children under the Medicaid Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 8, 1997

   Ms. DeGette (for herself, Mr. Dingell, Mr. Brown of Ohio, and Mr. 
   Waxman) introduced the following bill; which was referred to the 
                         Committee on Commerce

_______________________________________________________________________

                                 A BILL


 
  To amend title XIX of the Social Security Act to permit presumptive 
    eligibility for low-income children under the Medicaid Program.

    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 ``Medicaid Low-Income Children 
Presumptive Eligibility Amendments of 1997''.

SEC. 2. MEDICAID PRESUMPTIVE ELIGIBILITY FOR LOW-INCOME CHILDREN.

    (a) In General.--Title XIX of the Social Security Act is amended by 
inserting after section 1920 the following new section:

                 ``presumptive eligibility for children

    ``Sec. 1920A. (a) A State plan approved under section 1902 may 
provide for making medical assistance with respect to health care items 
and services covered under the State plan available to a child during a 
presumptive eligibility period.
    ``(b) For purposes of this section:
            ``(1) The term `child' means an individual under 19 years 
        of age.
            ``(2) The term `presumptive eligibility period' means, with 
        respect to a child, the period that--
                    ``(A) begins with the date on which a qualified 
                entity determines, on the basis of preliminary 
                information, that the family income of the child does 
                not exceed the applicable income level of eligibility 
                under the State plan, and
                    ``(B) ends with (and includes) the earlier of--
                            ``(i) the day on which a determination is 
                        made with respect to the eligibility of the 
                        child for medical assistance under the State 
                        plan, or
                            ``(ii) in the case of a child on whose 
                        behalf an application is not filed by the last 
                        day of the month following the month during 
                        which the entity makes the determination 
                        referred to in subparagraph (A), such last day.
            ``(3)(A) Subject to subparagraph (B), the term `qualified 
        entity' means any entity that--
                    ``(i)(I) is eligible for payments under a State 
                plan approved under this title and provides items and 
                services described in subsection (a) or (II) is 
                authorized to determine eligibility of a child to 
                participate in a Head Start program under the Head 
                Start Act (42 U.S.C. 9821 et seq.), eligibility of a 
                child to receive child care services for which 
                financial assistance is provided under the Child Care 
                and Development Block Grant Act of 1990 (42 U.S.C. 9858 
                et seq.), eligibility of an infant or child to receive 
                assistance under the special supplemental nutrition 
                program for women, infants, and children (WIC) under 
                section 17 of the Child Nutrition Act of 1966 (42 
                U.S.C. 1786); and
                    ``(ii) is determined by the State agency to be 
                capable of making determinations of the type described 
                in paragraph (1)(A).
            ``(B) The Secretary may issue regulations further limiting 
        those entities that may become qualified entities in order to 
        prevent fraud and abuse and for other reasons.
            ``(C) Nothing in this section shall be construed as 
        preventing a State from limiting the classes of entities that 
        may become qualified entities, consistent with any limitations 
        imposed under subparagraph (B).
    ``(c)(1) The State agency shall provide qualified entities with--
            ``(A) such forms as are necessary for an application to be 
        made on behalf of a child for medical assistance under the 
        State plan, and
            ``(B) information on how to assist parents, guardians, and 
        other persons in completing and filing such forms.
    ``(2) A qualified entity that determines under subsection (b)(1)(A) 
that a child is presumptively eligible for medical assistance under a 
State plan shall--
            ``(A) notify the State agency of the determination within 5 
        working days after the date on which determination is made, and
            ``(B) inform the parent or custodian of the child at the 
        time the determination is made that an application for medical 
        assistance under the State plan is required to be made by not 
        later than the last day of the month following the month during 
        which the determination is made.
    ``(3) In the case of a child who is determined by a qualified 
entity to be presumptively eligible for medical assistance under a 
State plan, the parent, guardian, or other person shall make 
application on behalf of the child for medical assistance under such 
plan by not later than the last day of the month following the month 
during which the determination is made, which application may be the 
application used for the receipt of medical assistance by individuals 
described in section 1902(l)(1).
    ``(d) Notwithstanding any other provision of this title, medical 
assistance for items and services described in subsection (a) that--
            ``(1) are furnished to a child--
                    ``(A) during a presumptive eligibility period,
                    ``(B) by a entity that is eligible for payments 
                under the State plan; and
            ``(2) are included in the care and services covered by a 
        State plan;
shall be treated as medical assistance provided by such plan for 
purposes of section 1903.''.
    (b) Conforming Amendments.--(1) Section 1902(a)(47) of such Act (42 
U.S.C. 1396a(a)(47)) is amended by inserting before the semicolon at 
the end the following: ``and provide for making medical assistance for 
items and services described in subsection (a) of section 1920A 
available to children during a presumptive eligibility period in 
accordance with such section''.
    (2) Section 1903(u)(1)(D)(v) of such Act (42 U.S.C. 
1396b(u)(1)(D)(v)) is amended by inserting before the period at the end 
the following: ``or for items and services described in subsection (a) 
of section 1920A provided to a child during a presumptive eligibility 
period under such section''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on the date of the enactment of this Act.
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