[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4932 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4932

To amend titles XIX and XXI of the Social Security Act to expand access 
                      of children to health care.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 24, 2000

  Mr. Klink introduced the following bill; which was referred to the 
                         Committee on Commerce

_______________________________________________________________________

                                 A BILL


 
To amend titles XIX and XXI of the Social Security Act to expand access 
                      of children to health care.

    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 ``Medikid Health 
Care Expansion Act of 2000''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Permitting States to increase SCHIP eligibility to up to 250 
                            percent of poverty line.
Sec. 3. Allowing higher income families to buy into program.
Sec. 4. Simplified outreach and enrollment.
Sec. 5. Expediting eligibility process.
Sec. 6. Availability of enrollment performance incentive bonuses from 
                            reallotment.
Sec. 7. Encouraging school-based outreach.
Sec. 8. Extending authorization of graduate medical education funding 
                            for children's hospitals.
Sec. 9. Optional coverage of low-income, uninsured pregnant women under 
                            a state child health plan.

SEC. 2. PERMITTING STATES TO INCREASE SCHIP ELIGIBILITY TO UP TO 250 
              PERCENT OF POVERTY LINE.

    (a) In General.--Section 2110(c)(4) of the Social Security Act (42 
U.S.C. 1397jj(c)(4)) is amended by inserting ``(or, at the option of 
the State, a higher percent not to exceed 250 percent)'' after ``200 
percent''.
    (b) Effective Date.--The amendment made by subsection (a) takes 
effect as of the date of the enactment of this Act.

SEC. 3. ALLOWING HIGHER INCOME FAMILIES TO BUY INTO PROGRAM.

    Title XXI of the Social Security Act is amended by adding at the 
end the following new section:

``SEC. 2111. OPTIONAL STATE BUY-IN PERMITTED FOR OTHER CHILDREN.

    ``Nothing in this title shall be construed as preventing a State 
from permitting families of children who are not low-income children to 
enroll in the State child health plan in return for payment of such 
premium as the State may establish.''.

SEC. 4. SIMPLIFIED OUTREACH AND ENROLLMENT.

    Section 2102 of the Social Security Act (42 U.S.C. 1397bb) is 
amended by adding at the end the following new subsection:
    ``(d) Development and Use of Uniform Application Forms and 
Coordinated Enrollment Process.--A State child health plan shall 
provide, by not later than the first day of the first month that begins 
more than 6 months after the date of the enactment of this subsection, 
for--
          ``(1) the development and use of a uniform, simplified 
        application form which is used both for purposes of 
        establishing eligibility for benefits under this title and also 
        under title XIX; and
            ``(2) an enrollment process that is coordinated with that 
        under title XIX 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 XIX.''.

SEC. 5. EXPEDITING ELIGIBILITY PROCESS.

    (a) Application of Presumptive Eligibility Under SCHIP and 
Reduction of State Match for Outreach if Elect Presumptive 
Eligibility.--
            (1) In general.--Section 2102 of the Social Security Act 
        (42 U.S.C. 1397bb), as amended by section 4, is further amended 
        by adding at the end the following new subsection:
    ``(e) Application of Presumptive Eligibility Provisions.--A State 
may elect to apply the provisions of section 1920A under this title in 
the same manner as the State may elect to apply such provisions under 
title XIX.''.
            (2) Reduction of state matching requirement.--Section 2105 
        of such Act (42 U.S.C. 1397ee) is amended--
                    (A) in subsection (b), by inserting ``subject to 
                subsection (g),'' after ``For purposes of subsection 
                (a),''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(g) 90 Percent Federal Match for Additional Outreach Expenditures 
if State Elects To Use Presumptive Eligibility for Both Medicaid and 
SCHIP.--The enhanced FMAP with respect to child health assistance for 
outreach services described in section 2102(c)(1) for a State shall be, 
with respect to expenditures for such services above the level of such 
expenditures in fiscal year 2000, equal to 90 percent if the State has 
both--
            ``(1) elected to apply the provisions of section 1920A 
        under title XIX for the entire fiscal year; and
            ``(2) elected under section 2102(e) to apply the provisions 
        of section 1920A under this title for the entire fiscal 
        year.''.
            (3) Effective date.--The amendments made by this subsection 
        take effect on the date of the enactment of this Act and apply 
        to fiscal years beginning on or after such date.
    (b) Clarification of Use of SCHIP Funds To Provide Enrolling 
Centers With Incentives To Enroll Low-Income Children.--
            (1) In general.--Section 2105 of such Act (42 U.S.C. 
        1397ee), as amended by subsection (b), is further amended--
                    (A) in subsection (g), by inserting ``and for 
                expenditures described in subsection (h)'' after 
                ``described in section 2102(c)(1)''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(h) Treatment of Enrollment Incentives.--Reasonable expenditures 
to enrolling centers to provide an incentive to enroll targeted low-
income children under this title shall be treated as reasonable costs 
incurred by the State to administer the plan for purposes of subsection 
(a)(2)(D).''.
            (2) Effective date.--The amendments made by paragraph (1) 
        apply to expenditures made on or after the date of the 
        enactment of this Act.

SEC. 6. AVAILABILITY OF ENROLLMENT PERFORMANCE INCENTIVE BONUSES FROM 
              REALLOTMENT.

    Section 2105 of the Social Security Act (42 U.S.C. 1397ee), as 
amended by section 5(a)(2), is amended by adding at the end the 
following new subsection:
    ``(h) Enrollment Performance Incentive Bonus Payments.--
            ``(1) In general.--In the case of a bonus eligible State 
        described in paragraph (2), the Secretary shall pay to the 
        State, from the amount of an allotment redistributed to the 
        State under section 2104(f) during a fiscal year (beginning 
        with fiscal year 2001), an incentive performance bonus payment 
        equal to such percent (not less than 2 percent, and not to 
        exceed 5 percent) of the amount of such allotment as the 
        Secretary determines appropriate based on the State's 
        performance in meeting or exceeding objectives referred to in 
        paragraph (2)(B).
            ``(2) Bonus eligible state.--A bonus eligible State 
        described in this paragraph for a fiscal year is a State that--
                    ``(A) has not had any allotment for any previous 
                fiscal year redistributed to another State under 
                section 2104(f); and
                    ``(B) meets or exceeds reasonable objectives 
                established by the Secretary for the enrollment of low-
                income children under this title (and title XIX).
            ``(3) Treatment of payment.--The amount paid under 
        paragraph (1)--
                    ``(A) shall be paid without the need for any non-
                Federal contribution under subsection (a);
                    ``(B) may be used for any expenditures permitted 
                under subsection (b)(1) and without regard to any 
                limitations under paragraphs (2) and (3) of subsection 
                (b); but
                    ``(C) may not be included in determining the amount 
                of non-Federal contributions otherwise required under 
                subsection (a).''.

SEC. 7. ENCOURAGING SCHOOL-BASED OUTREACH.

    (a) In General.--Section 2102(c)(1) of such Act (42 U.S.C. 
1397bb(c)(1)) is amended by adding at the end the following: ``Such 
outreach shall include school-based programs targeted at schools with 
high rates of uninsured children.''.
    (b) Effective Date.--The amendment made by subsection (a) takes 
effect on October 1, 2000.

SEC. 8. EXTENDING AUTHORIZATION OF GRADUATE MEDICAL EDUCATION FUNDING 
              FOR CHILDREN'S HOSPITALS.

    Section 340E of the Public Health Service Act (42 U.S.C. 256e) is 
amended--
            (1) in subsection (a), by striking ``and 2001'' and 
        inserting ``through 2005''; and
            (2) in subsection (f)--
                    (A) in paragraph (1)(A)(ii), by striking ``for 
                fiscal year 2001'' and inserting ``for each of fiscal 
                years 2001 through 2005'';
                    (B) in paragraph (1)(B), by striking ``for fiscal 
                year 2000 shall remain available for obligation through 
                the end of fiscal year 2001'' and inserting ``for a 
                fiscal year shall remain available for obligation 
                through the end of the succeeding fiscal year''; and
                    (C) in paragraph (2)(B), by striking ``for fiscal 
                year 2001'' and inserting ``for each of fiscal years 
                2001 through 2005''.

SEC. 9. OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED PREGNANT WOMEN UNDER 
              A STATE CHILD HEALTH PLAN.

    (a) In General.--Title XXI of the Social Security Act, as amended 
by section 3, is further amended by adding at the end the following new 
section:

``SEC. 2112. OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED PREGNANT WOMEN.

    ``(a) Optional Coverage.--Notwithstanding any other provision of 
this title, a State child health plan 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 and shall not include prepregnancy 
        services and supplies.
            ``(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 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. 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 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 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,'';
            (2) by redesignating paragraph (4) of subsection (u) as 
        paragraph (5); and
            (3) by inserting after paragraph (3) of subsection (u) 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 than 
185 percent of the income official poverty line.''.
    (c) Conforming Amendments.--Section 2102(b)(1)(B) of the Social 
Security Act (42 U.S.C. 1397bb(b)(1)(B)) is amended--
            (1) by striking ``and'' at the end of clause (i);
            (2) by striking the period at the end of clause (ii) and 
        inserting ``; and''; and
            (3) 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 child who is pregnant, if the State 
                        provides for coverage of pregnancy-related 
                        assistance for targeted low-income pregnant 
                        women in accordance section 2112.''.
    (d) Effective Date.--The amendments made by this section take 
effect on the date of the enactment of this Act and apply to allotments 
for all fiscal years.
                                 <all>