[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5192 Introduced in House (IH)]
106th CONGRESS
2d Session
H. R. 5192
To amend titles XIX and XXI of the Social Security Act to improve the
coverage of needy children under the State Children's Health Insurance
Program (SCHIP) and the Medicaid Program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 14, 2000
Mr. Weygand 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 improve the
coverage of needy children under the State Children's Health Insurance
Program (SCHIP) and 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; REFERENCES IN ACT; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Medicaid and SCHIP
Improvement and Flexibility Act of 2000''.
(b) References to Social Security Act.--Except as otherwise
expressly provided, whenever in this Act an amendment or repeal is
expressed in terms of an amendment to, or repeal of, a section or other
provision, the reference shall be considered to be made to a section or
other provision of the Social Security Act.
(c) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; references in Act; table of contents.
Sec. 2. Simplified outreach and enrollment.
Sec. 3. Family friendly coverage and enrollment.
Sec. 4. Expanded coverage options.
Sec. 5. Availability of fiscal year 1998 and fiscal year 1999
allotments under SCHIP.
Sec. 6. Permitting increased share of SCHIP funds to be expended for
prevention programs that ensure healthy
childhoods and quality prenatal health
care.
Sec. 7. Use of SCHIP funds for enhanced matching rate for coverage of
additional children under the medicaid
program.
SEC. 2. SIMPLIFIED OUTREACH AND ENROLLMENT.
(a) Use of Uniform Application and Coordinated Enrollment
Process.--
(1) SCHIP program.--Section 2102 (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 State agency in order to determine whether a child is
eligible for benefits under this title or title XIX and to
apply for such benefits.''.
(2) Medicaid conforming amendment.--
(A) In general.--Section 1902(a) (42 U.S.C.
1396a(a)) is amended--
(i) by striking the period at the end of
paragraph (65) and inserting ``; and'', and
(ii) by inserting after paragraph (65) the
following new paragraph:
``(66) 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 paragraph, in the case of a State with a
State child health plan under title XXI for--
``(A) 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 XXI; and
``(B) establishment and operation of an enrollment
process that is coordinated with that under title XXI
so that a family need only interact with a single State
agency in order to determine whether a child is
eligible for benefits under this title or title XXI and
to apply for such benefits.''.
(B) Effective date.--The amendments made by
subparagraph (A) apply to calendar quarters beginning
more than 6 months after the date of the enactment of
this Act.
(b) Financial Incentives To Promote Appropriate Enrollment.--
(1) Expanded availability of funding for administrative
costs related to outreach and eligibility determinations.--
Section 1931(h) (42 U.S.C. 1396u-1(h)), as amended by section
602 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act
of 1999 (113 Stat. 1501A-394), as enacted into law by section
1000(a)(6) of Public Law 106-113 is amended--
(A) in the matter preceding paragraph (1), by
striking ``Transitional'' and all that follows through
``Costs'' and inserting ``Increased Federal Matching
Rate for Administrative Costs Related to Certain
Outreach and Eligibility Determinations'';
(B) in paragraph (2), by inserting ``either'' after
``attributable'' and by inserting before the period at
the end the following: ``or to administrative costs of
determinations of the eligibility of children and
pregnant women for benefits under the State plan under
this title or title XXI, outreach to children and
pregnant women likely to be eligible for such benefits,
and such other outreach- and eligibility-related
activities as the Secretary may approve''; and
(C) by adding at the end the following new
paragraph:
``(4) Encouraging use of local and community-based
organizations in outreach and enrollment activities.--The
Secretary shall establish a procedure under which, if States do
not otherwise obligate the amounts made available under this
subsection, local and community-based public or nonprofit
organizations (including local and county governments, public
health departments, community health centers, children's
hospitals, and disproportionate share hospitals) may seek to
have administrative costs relating to outreach and enrollment
of children and pregnant women under this title and title XXI
be treated and reimbursed as administrative costs of a State
described in section 1903(a)(7), if such organizations have the
permission of the State involved. A State may require such an
organization to provide payment of such amounts as the State
would otherwise be responsible for in order to obtain payment
under this paragraph.''.
(2) Use of 3 percent of schip funds at 90 percent federal
match for enrollment and outreach activities.--Section 2105(b)
(42 U.S.C. 1397ee(b)) is amended--
(A) by designating the matter following the dash as
a paragraph (1) with appropriate indentation and with
the heading ``(1) In general'';
(B) by inserting ``subject to paragraph (2)'' after
``(a)'';
(C) by striking ``(1)'' and ``(2)'' and inserting
``(A)'' and ``(B)'', respectively; and
(D) by adding at the end the following paragraph:
``(2) Special rule for certain enrollment and outreach
activities.--
``(A) In general.--For purposes of subsection (a),
in the case of a State that meets the requirement of
subparagraph (B), and subject to subparagraph (C), the
`enhanced FMAP' is equal to 90 percent with respect to
amounts expended on enrollment and outreach activities.
``(B) Requirements.--Subparagraph (A) shall only
apply to a State if the State meets the following
requirements:
``(i) No asset test.--The State does not
impose an asset test for eligibility under the
State child health plan or under section
1902(l) with respect to children.
``(ii) Compliance with outstationing
requirement.--The Secretary finds that the
State is providing for the receipt and initial
processing of applications of certain
individuals at facilities defined as
disproportionate share hospitals under section
1923(a)(1)(A) and Federally-qualified health
centers described in section 1905(1)(2)(B)
consistent with the requirements of section
1902(a)(55).
``(iii) Compliance with simplified outreach
and enrollment provisions.--The Secretary finds
that the State is providing for outreach and
enrollment under this title and title XIX
consistent with the requirements of sections
2102(c), 2102(d), and 1902(a)(66).
``(iv) Allowing mail and telephone
applications.--The State allows applications
for children under this title and title XIX to
be submitted by mail or through telephone.
``(C) Limitation to 3 percent of annual
allotment.--Subparagraph (A) shall not apply to amounts
expended by a State in a fiscal year in excess of 3
percent of the amount of the amount of its allotment
under section 2104 for that 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 expenditures made on or after the date of the enactment of
this Act.
(d) Additional Entities Qualified To Determine Medicaid Presumptive
Eligibility for Low-Income Children.--Section 1920A(b)(3)(A)(i) (42
U.S.C. 1396r-1a(b)(3)(A)(i)) is amended--
(1) by striking ``or (II)'' and inserting ``, (II)''; and
(2) by inserting ``eligibility of a child for medical
assistance under the State plan under this title, or
eligibility of a child for child health assistance under the
program funded under title XXI, (III) is an elementary school
or secondary school, as such terms are defined in section 14101
of the Elementary and Secondary Education Act of 1965 (20
U.S.C. 8801), an elementary or secondary school operated or
supported by the Bureau of Indian Affairs, a State child
support enforcement agency, a child care resource and referral
agency, or a State office or private contractor that accepts
applications for or administers a program funded under part A
of title IV or that determines eligibility for any assistance
or benefits provided under any program of public or assisted
housing that receives Federal funds, including the program under
section 8 or any other section of the United States Housing Act of 1937
(42 U.S.C. 1437 et seq.), or (IV) any other entity the State so deems''
before the semicolon.
SEC. 3. FAMILY FRIENDLY COVERAGE AND ENROLLMENT.
(a) Prohibition of Waiting Periods.--
(1) In general.--Section 2102(b)(1)(B) (42 U.S.C.
1397bb(b)(1)(B)) is amended--
(A) by striking ``and'' at the end of clause (i);
(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) shall not permit the use of any
mandatory waiting period (including any such
period in order to carry out paragraph (3)(C)),
unless the Secretary finds that the imposition
of such a period would not be contrary to the
provisions of this title.''.
(2) Effective date.--The amendments made by paragraph (1)
apply to assistance furnished on or after the date of the
enactment of this Act.
(b) Grace Period Before Disenrollment for Nonpayment of Premiums.--
(1) In general.--Section 2103(e) (42 U.S.C. 1397ee(e)) is
amended by adding at the end the following new paragraph:
``(5) Good cause waiver of disenrollment for nonpayment of
premiums.--The State child health plan shall establish rules
allowing waiver for good cause of termination of enrollment for
nonpayment of premiums and shall establish an appeals process
that includes a hearing and a 3-month grace period prior to
termination of coverage and includes waiver of any late payment
penalties when premium payments are made in full.''.
(2) Effective date.--The amendment made by paragraph (1)
applies to disenrollments occurring on or after the date that
is 30 days after the date of the enactment of this Act.
SEC. 4. EXPANDED COVERAGE OPTIONS.
(a) Automatic Reassessment of Eligibility for SCHIP and Medicaid
Benefits for Children Losing Medicaid or SCHIP Eligibility.--
(1) Loss of medicaid eligibility.--Section 1902(a)(66) (42
U.S.C. 1396a(a)(66)), as inserted by section 2(a)(2), is
amended--
(A) by striking ``and'' at the end of subparagraph
(B),
(B) by striking the period at the end of
subparagraph (C) and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(D) the automatic assessment, in the case of a
child who loses eligibility for medical assistance
under this title on the basis of changes in income,
assets, or age, of whether the child is eligible for
benefits under title XXI.''.
(2) Loss of schip eligibility.--Section 2102(b)(3) (42
U.S.C. 1397bb(b)(3)) is amended by redesignating subparagraphs
(D) and (E) as subparagraphs (E) and (F), respectively, and by
inserting after subparagraph (C) the following new
subparagraph:
``(D) that there is an automatic assessment, in the
case of a child who loses eligibility for child health
assistance under this title on the basis of changes in
income, assets, or age, of whether the child is
eligible for medical assistance under title XIX;''.
(3) Effective date.--The amendments made by paragraphs (1)
and (2) apply to children who lose eligibility under the
medicaid program under title XIX, or under a State child health
insurance plan under title XXI, respectively, of the Social
Security Act on or after the date that is 30 days after the
date of the enactment of this Act.
(b) Optional Coverage of Low-Income, Uninsured Pregnant Women Under
a State Child Health Plan.--
(1) In general.--Title XXI 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 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.''.
(2) State option to use enhanced fmap for coverage of
additional pregnant women under the medicaid program.--Section
1905 (42 U.S.C. 1396d) is amended--
(A) 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,'';
(B) by redesignating paragraph (4) of subsection
(u) as paragraph (5); and
(C) 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 185
percent of the income official poverty line.''.
(3) Conforming amendments.--Section 2102(b)(1)(B) (42
U.S.C. 1397bb(b)(1)(B)) is amended--
(A) by striking ``and'' at the end of clause (i);
(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 child who is pregnant, if the State
provides for coverage of pregnancy-related
assistance for targeted low-income pregnant
women in accordance section 2111.''.
(4) Effective date.--The amendments made by this subsection
take effect on the date of the enactment of this Act and apply
to allotments for all fiscal years.
(c) State Option for Coverage of Qualified Alien Children Under
Medicaid and Children's Health Insurance Programs.--
(1) Medicaid.--
(A) Categorically needy.--Section
1902(a)(10)(a)(ii) (42 U.S.C. 1396a(a)(10)(A)(ii)) is
amended--
(i) by striking ``or'' at the end of
subclause (XIII);
(ii) by adding ``or'' at the end of
subclause (XIV); and
(iii) by adding at the end the following
new subclause:
``(XV) who are described in section
1905(a)(i) and who would be eligible
for medical assistance (or for a
greater amount of medical assistance)
under the State plan under this title
but for the provisions of section 403
or section 421 of Public Law 104-193,
but the State may not exercise the
option of providing medical assistance
under this subclause with respect to a
subcategory of individuals described in
this subclause;''.
(B) Medically needy.--Section 1902(a)(10)(C)(i)(I)
(42 U.S.C. 1396a(a)(10)(C)(i)(I)) is amended by
inserting ``(and such criteria may provide for
eligibility of individuals described in subparagraph
(A)(ii)(XV))'' after ``medical assistance''.
(2) Children's health insurance program.--Section 2110(b)
(42 U.S.C. 1397jj(b)) is amended--
(A) in paragraph (1)(A), by inserting before the
semicolon ``(including, at the option of the State, a
child described in paragraph (3)(B))''; and
(B) in paragraph (3)--
(i) by striking ``Special rule.--'' and
inserting ``Special rules.--
``(i) Health insurance coverage.--'' by
indenting the remainder of the text
accordingly; and
(ii) by adding at the end the following new
subparagraph:
``(B) Eligibility for qualified alien children.--
For purposes of paragraph (1)(A), a child is described
in this subparagraph if--
``(i) the child would be determined
eligible for child health assistance under this
title but for any or all of the provisions of
sections 403 and 421 of Public Law 104-193; and
``(ii) the State exercises the option to
provide medical assistance to the category of
individuals described in section
1902(a)(10)(A)(ii)(XV).''.
(3) Prohibition on seeking support from sponsor.--Section
213A(b) of the Immigration and Nationality Act (8 U.S.C.
1183a(b)) is amended by adding at the end the following new
paragraph:
``(4) Exception for child medicaid or schip assistance.--
The preceding provisions of this subsection shall not apply
to--
``(A) medical assistance furnished under the State
plan under title XIX of the Social Security Act to an
individual eligible for such assistance because of
subclause (XV) of paragraph (10)(A)(ii) of section
1902(a) of such Act (42 U.S.C. 1396a(a)) or because of
the reference to such subclause in paragraph (10)(C) of
such section; or
``(B) child health assistance furnished under the
State child health plan under title XXI of such Act to
a child eligible for such assistance because of the
provisions of section 2110(b)(3)(B) of such Act (42
U.S.C. 1397jj(b)(3)(B)).''.
(d) Elimination of Funding Offset for Exercise of Presumptive
Eligibility Option.--
(1) In general.--Section 2104(d) (42 U.S.C. 1397dd(d)) is
amended by striking ``shall be reduced by the sum of'' and all
that follows through ``(2) the amount of payments under such
section'' and inserting ``shall be reduced by the amount of
payments under section 1903(a)(1)''.
(2) Effective date.--The amendment made by paragraph (1)
first applies for allotments for fiscal year 2001.
(f) Program Coordination With the Maternal and Child Health Program
(Title V).--
(1) In general.--Section 2102(b)(3) (42 U.S.C.
1397bb(b)(3)) is amended--
(A) by striking ``and'' at the end of subparagraph
(D);
(B) by striking the period at the end of
subparagraph (E) 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) (42
U.S.C. 1306a(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, 2001.
SEC. 5. AVAILABILITY OF FISCAL YEAR 1998 AND FISCAL YEAR 1999
ALLOTMENTS UNDER SCHIP.
Notwithstanding subsection (e) of section 2104 of the Social
Security Act (42 U.S.C. 1397dd), amounts allotted to a State under that
section for each of fiscal years 1998 and 1999 shall remain available
through September 30, 2002.
SEC. 6. PERMITTING INCREASED SHARE OF SCHIP FUNDS TO BE EXPENDED FOR
PREVENTION PROGRAMS THAT ENSURE HEALTHY CHILDHOODS AND
QUALITY PRENATAL HEALTH CARE.
Section 2105(c)(2) (42 U.S.C. 1397ee(c)(2)) is amended by adding at
the end the following new subparagraph:
``(C) Exception for outreach and prevention
programs in states with substantial enrollment and that
would not otherwise use full allotment.--
``(i) In general.--In the case of a State
described in clause (ii)--
``(I) the limitation under
subparagraph (A) on expenditures for
items described in subparagraphs (B) or
(C) of subsection (a)(2) shall not
apply, but only up to 30 percent of the
sum described in subparagraph (A); and
``(II) in applying subparagraph (B)
of subsection (a)(2), activities
undertaken by the State in conjunction
with the Centers for Disease Control
and Prevention to carry out
activities to promote health pregnancies and healthy children shall be
treated as expenditures described in such subparagraph, subject to the
limitation under subclause (I) of this clause.
``(ii) State described.--A State described
in this clause is a State that establishes to
the satisfaction of the Secretary that--
``(I) the State provides for an
income level under section
2110(b)(1)(B)(i)(I) that is not less
than 200 percent of the poverty line;
``(II) the State does not provide
for any waiting list for enrollment
under this title;
``(III) the State has enrolled
under this title and title XIX at least
70 percent of the children eligible for
enrollment under such titles; and
``(IV) without the application of
this subparagraph, the State will not
be able to expend all the funds
allotted to it under this title.
The Secretary may waive the requirement of
subclause (III) where the State demonstrates to
the satisfaction of the Secretary that the
State has made all possible efforts to achieve
the enrollment level specified in the
subclause.
``(iii) Public-private partnerships.--In
conducting activities under clause (i), a State
may build partnerships with outside
organization whose primary goal involves the
healthy development of mothers and children and
may act to otherwise eradicate illnesses and
environmental factors that impact these groups.
``(iv) Additional payments.--The provisions
of this subparagraph apply in addition to the
expenditures permitted under subparagraph (A)
for items described in subparagraphs (B) and
(C) of subsection (a)(2).''.
SEC. 7. USE OF SCHIP FUNDS FOR ENHANCED MATCHING RATE FOR COVERAGE OF
ADDITIONAL CHILDREN UNDER THE MEDICAID PROGRAM.
(a) In General.--Section 1905 (42 U.S.C. 1396d), as amended by
section 4(b)(2), is amended--
(1) in subsection (b), by striking ``or subsection (u)(3)''
and inserting ``, subsection (u)(3), or subsection (u)(5)(A)'';
and
(2) in subsection (u)--
(A) by redesignating paragraph (5) as paragraph
(6); and
(B) by inserting after paragraph (4) the following
new paragraph:
``(5)(A) For purposes of subsection (b), the expenditures described
in this subparagraph are expenditures for medical assistance for
waivered low-income children described in subparagraph (B) but--
``(i) only in the case of children residing in a State
described in subparagraph (C); and
``(ii) only to the extent the number of full-year
equivalent waivered low-income children enrolled under the
State plan under this title for the fiscal year exceeds the
number of waivered low-income children described in
subparagraph (D)(i) for the State for the fiscal year.
``(B) For purposes of this paragraph, the term `waivered low-income
child' means a child whose family income exceeds the minimum income
level required to be established for the age of such child under
section 1902(l)(2) in order for the child to be eligible for medical
assistance under this title, but does not exceed the medicaid
applicable income level (as defined in section 2110(b)(4) but
determined as if `June 1, 1997' were substituted for `March 31, 1997')
for that child.
``(C) A State described in this subparagraph is a State that--
``(i) has under a waiver authorized by the Secretary or
under section 1902(r)(2) established and is using a medicaid
applicable income level (as defined in section 2110(b)(4) but
determined as if `June 1, 1997' were substituted for `March 31,
1997') for children under 19 years of age residing in the State
that is at or above 200 percent of the poverty line; and
``(ii) demonstrates to the satisfaction of the Secretary
that the State has taken all of the following actions to reach
and enroll children who are eligible for, but not enrolled
under, the State plan:
``(I) Eliminating the assets test for eligibility
of waivered low-income children.
``(II) Using shortened and simplified applications
for such children.
``(III) Allowing applications for such children to
be submitted by mail or through telephone.
``(IV) Outstationing State eligibility workers at
sites that are frequented by families with children,
including schools, child care centers, churches,
centers providing Head Start services, local offices of
the special supplemental food program for women,
infants and young children (WIC) established under
section 17 of the Child Nutrition Act of 1966,
community centers, Job Corps centers established under
part B of title IV of the Job Training Partnership Act
or subtitle C of title I of the Workforce Investment
Act of 1998, sites offering the recognized equivalent
of a secondary school degree, offices of tribal
organizations (as defined in section 4(l) of the Indian
Self-Determination and Education Assistance Act), and
Social Security Administration field offices.
``(V) Using presumptive eligibility for waivered
low-income children.
``(VI) Collaborating with public and private
entities to conduct outreach campaigns to enroll such
children.
``(D)(i) For purposes of subparagraph (A)(ii), the number of
waivered low-income children for a State described in this clause for--
``(I) fiscal year 1998, is equal to the number of full-year
equivalent waivered low-income children enrolled under the
State plan under this title for fiscal year 1997; and
``(II) fiscal year 1999 or a succeeding fiscal year, is
equal to the number of waivered low-income children determined
under this clause for the preceding fiscal year increased by
the number of percentage points determined under clause (ii)
for the State for the fiscal year involved.
``(ii) The number of percentage points determined under this clause
for a State for a fiscal year is equal to the number of percentage
points by which--
``(I) the arithmetic average of the total number of
children in the State set forth in the 3 most recent March
supplements to the Current Population Survey of the Bureau of
the Census before the beginning of the fiscal year; exceeds
``(II) the arithmetic average of such total number set
forth in the second, third, and fourth most recent March
supplements to such Survey before the beginning of the fiscal
year.
``(E) Each State shall submit to the Secretary such information, at
such time and in such manner, as the Secretary determines is necessary
to ensure that the requirements of this paragraph are satisfied. The
Secretary shall ensure that information is provided under this
subsection in a manner that is consistent with other reporting
requirements for information required to be submitted by a State under
this title and title XXI, and avoids duplication of reporting
requirements.
``(F) The Secretary shall regularly examine the payments made to a
State for the expenditures described in subparagraph (A) to confirm
that the payments are attributable to expenditures described in such
subparagraph.''.
(b) Conforming Amendment.--Section 1902(a)(10)(A)(ii)(XIV) (42
U.S.C. 1396a(a)(10)(A)(ii)(XIV)) is amended by striking
``1905(u)(2)(C)'' and inserting ``1905(u)(2)(B)''.
(c) Effective Date.--The amendments made by this section shall be
effective as if included in the enactment of section 4911 of the
Balanced Budget Act of 1997 (Public Law 105-33; 111 Stat. 570).
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