[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 3172 Introduced in Senate (IS)]







106th CONGRESS
  2d Session
                                S. 3172

     To provide access to affordable health care for all Americans.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

            October 5 (legislative day, September 22), 2000

  Mr. Kennedy introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
     To provide access to affordable health care for all Americans.

    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 ``Basic Access to 
Secure Health Insurance Coverage Health Plan (BASIC Health Plan) Act''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
     TITLE I--AFFORDABLE HEALTH INSURANCE FOR PARENTS AND CHILDREN

Sec. 101. Coverage of parents and children under the medicaid program 
                            and CHIP.
Sec. 102. Coverage of legal immigrants under the medicaid program.
Sec. 103. Coverage of children through age 20 under the medicaid 
                            program and title XXI.
Sec. 104. Application of simplified title XXI procedures under the 
                            medicaid program.
Sec. 105. Expansion of basic services required for benchmark-equivalent 
                            coverage under CHIP.
Sec. 106. Elimination of 100 hour rule and other AFDC-related 
                            eligibility restrictions.
Sec. 107. Limitations on conflicts of interest.
Sec. 108. Demonstration programs to improve medicaid and CHIP outreach 
                            to homeless individuals and families.
         TITLE II--ACCESS TO AFFORDABLE CARE FOR ALL AMERICANS

Sec. 201. Extension of coverage to single individuals.
                    TITLE III--ADDITIONAL PROVISIONS

Sec. 301. Availability of unsubsidized coverage.

     TITLE I--AFFORDABLE HEALTH INSURANCE FOR PARENTS AND CHILDREN

SEC. 101. COVERAGE OF PARENTS AND CHILDREN UNDER THE MEDICAID PROGRAM 
              AND CHIP.

    (a) Requirement To Provide Coverage for Medicaid Participation.--
Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is 
amended--
            (1) in paragraph (64), by striking ``and'' at the end;
            (2) in paragraph (65), by striking the period and inserting 
        a semicolon; and
            (3) by inserting after paragraph (65), the following new 
        paragraph:
            ``(66) provide that the State will provide medical 
        assistance under paragraph (10)(A)(ii)((XVIII) or health 
        coverage under section 2111 for families described in 
        subsection (k)(1) in accordance with the conditions described 
        in subsection (k)(2).''.
    (b) Coverage Under Medicaid.--
            (1) In general.--Section 1902(a)(10)(A)(ii) of the Social 
        Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--
                    (A) by striking ``or'' at the end of subclause 
                (XVI);
                    (B) by adding ``or'' at the end of subclause 
                (XVII); and
                    (C) by adding at the end the following new 
                subclause:
                                    ``(XVIII) who are families 
                                described in subsection (k)(1);''.
            (2) Conditions for coverage.--Section 1902 of such Act is 
        further amended by inserting after subsection (j) the following 
        new subsection:
    ``(k)(1) The families described in this paragraph are families 
(consisting of individuals who are under 21 years of age and parents of 
such individuals)--
            ``(i) who are not otherwise eligible for medical assistance 
        under subsection(a)(10)(A); and
            ``(ii) whose income is at least--
                    ``(I) with respect to fiscal year 2001, 200 percent 
                of the poverty line; and
                    ``(II) with respect to each subsequent fiscal year, 
                300 percent of the poverty line.
    ``(2) The conditions described in this paragraph are as follows:
            ``(A) The State provides that families described in 
        paragraph (1) remain eligible for medical assistance for a 
        period (of at least 12 months) following the eligibility 
        determination required under such paragraph.
            ``(B) The State has a State child health plan under title 
        XXI which (whether implemented under such title or under this 
        title) does not limit the acceptance of applications for 
        families described in paragraph (1), does not use a waiting 
        list for such families who meet eligibility standards to 
        qualify for assistance (under this title or under title XXI), 
        and provides benefits to all families in the State who apply 
        for and meet eligibility standards.
            ``(C) The State does not cover families described in 
        paragraph (1) with higher family income without covering 
        families with a lower family income.
    ``(3) In the case of a parent in a family described in paragraph 
(1) who is also the parent of a child who is eligible and enrolled for 
medical assistance under this title or for child health assistance 
under title XXI, the State may elect (on a uniform basis) to enroll the 
parent in the same program as the child. If such a parent has children 
enrolled under both programs, the State may elect (on such basis) which 
program to enroll the parent in.''.
    ``(4) In this subsection, the term `parent' has the meaning given 
the term `caretaker' for purposes of carrying out section 1931.''.
            (3) Application of presumptive eligibility provisions.--
        Section 1920A of such Act (42 U.S.C. 1396r-1a) is amended by 
        adding at the end the following new subsection:
    ``(e) In accordance with regulations, a State shall apply the 
previous provisions of this section to provide for a period of 
presumptive eligibility for medical assistance for a parent of a child 
with respect to whom such a period is provided under this section.''.
            (4) Conforming amendments.--
                    (A) Eligibility categories.--Section 1905(a) of 
                such Act (42 U.S.C. 1396d(a)) is amended in the matter 
                before paragraph (1)--
                            (i) by striking ``or'' at the end of clause 
                        (x);
                            (ii) by inserting ``or'' at the end of 
                        clause (xi); and
                            (iii) by inserting after clause (xi) the 
                        following new clause:
            ``(xii) who are families described in section 
        1902(k)(1),''.
                    (B) Income limitations.--Section 1903(f)(4) of such 
                Act (42 U.S.C. 1396b(f)(4)) is amended by inserting 
                ``1902(a)(10)(A)(ii)(XVIII),'' after 
                ``1902(a)(10)(A)(ii)(XVI),''.
    (c) Coverage Under CHIP.--
            (1) In general.--Title XXI of such Act (42 U.S.C. 1397aa et 
        seq.) is amended by adding at the end the following new 
        section:

``SEC. 2111. COVERAGE OF FAMILIES.

    ``(a) In General.--Notwithstanding any other provision of this 
title, with respect to a State that does not provide medical assistance 
under section 1902(a)(10)(A)(ii)(XVIII) for families described in 
section 1902(k)(1), the State shall provide health coverage under this 
title for such families through an amendment to its State child health 
plan under section 2102 in accordance with this section and the 
conditions described in section 1902(k)(2).
    ``(b) Definitions.--For purposes of this section:
            ``(1) Health coverage.--The term `health coverage' 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 families described in section 1902(k)(1).
            ``(2) Treatment of pregnant women as parents.--A State 
        child health plan shall treat a pregnant woman who is not 
        otherwise a parent as a parent in a family described in section 
        1902(k)(1) for purposes of this section.
    ``(c) References to Terms and Special Rules.--In the case of, and 
with respect to, a State providing health coverage for families 
described in section 1902(k)(1) 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 family described in section 1902(k)(1).
            ``(2) Any such reference to child health assistance with 
        respect to such families is deemed a reference to health 
        coverage (as defined in subsection (b)(1)).
            ``(3) In applying section 2103(e)(3)(B) in the case of a 
        family provided coverage under this section, the limitation on 
        total annual aggregate cost-sharing shall be applied to the 
        entire family.
            ``(4) Section 1905(u)(2)(A) shall be applied as if any 
        reference to optional targeted low-income children includes a 
        reference to a family described in section 1902(k)(1).''.
            (2) Enhanced matching funds.--
                    (A) In general.--Section 1905 of such Act (42 
                U.S.C. 1396d) is amended--
                            (i) in the fourth sentence of subsection 
                        (b), by striking ``or subsection (u)(3)'' and 
                        inserting ``, (u)(3), or (u)(4)''; and
                            (ii) in subsection (u)--
                                    (I) by redesignating paragraph (4) 
                                as paragraph (5), and
                                    (II) by inserting after paragraph 
                                (3) the following new paragraph:
    ``(4) For purposes of subsection (b) and section 2105(a)(1):
            ``(A) Families.--The expenditures described in this 
        subparagraph are the following:
                    ``(i) Families.--Expenditures for medical 
                assistance made available under section 
                1902(a)(10)(A)(ii)(XVIII) for families described in 
                section 1902(k)(1), the income of which exceeds the 
                income level applicable under such section 1931 to a 
                family of the size involved as of January 1, 2000.
                    ``(ii) Certain pregnant women.--Expenditures for 
                medical assistance for pregnant women under section 
                1902(l)(1)(A) in a family the income of which exceeds 
                the income level applicable under section 1902(l)(2)(A) 
                to a family of the size involved as of January 1, 
                2000.''.
                    (B) Post fy 2006 expansion of availability of 
                enhanced match under medicaid for pre-chip 
                expansions.--Effective October 1, 2005, paragraph (4) 
                of section 1905(u) of such Act (42 U.S.C. 1396d(u)), as 
                inserted by subparagraph (A)(ii)(II), is amended--
                            (i) by amending clause (ii) of subparagraph 
                        (A) to read as follows:
                    ``(ii) Certain pregnant women.--Expenditures for 
                medical assistance for pregnant women under section 
                1902(l)(1)(A) in a family the income of which exceeds 
                the 133 percent of the income official poverty line.''; 
                and
                            (ii) by adding at the end the following new 
                        subparagraphs:
            ``(B) Parents with income above 100 percent of poverty but 
        below january 1, 2000 income level.--The expenditures described 
        in this subparagraph are expenditures for medical assistance 
        made available for any parents described in section 
        1902(a)(10)(A)(i)(VIII), whose income exceeds 100 percent of 
        the income official poverty line applicable to a family of the 
        size involved but does not exceed the applicable income level 
        established under this title (under section 1931 or otherwise) 
        for a parent in a family of the size involved as of January 1, 
        2000.
            ``(C) Children in families with income above medicaid 
        mandatory level not previously described.--The expenditures 
        described in this subparagraph are expenditures (other than 
        expenditures described in paragraph (2) or (3)) for medical 
        assistance made available to any child who is eligible for 
        assistance under section 1902(a)(10)(A) and the income of whose 
        family exceeds the minimum income level required under 
        subsection 1902(l)(2) for a child of the age involved (treating 
any child who is 19 or 20 years of age as being 18 years of age).''.
            (3) Transformation of chip into permanent entitlement.--
                    (A) Elimination of allotments and capped 
                appropriations.--Section 2104 of the Social Security 
                Act (42 U.S.C. 1397dd) is amended to read as follows:

``SEC. 2104. APPROPRIATION.

    ``For the purpose of making payments to States under this title, 
there is appropriated, out of any money in the Treasury not otherwise 
appropriated, such sums as may be necessary for fiscal year 2001 and 
each fiscal year thereafter.''.
                    (B) Conforming amendments.--
                            (i) Section 1905 of the Social Security Act 
                        (42 U.S.C. 1396d) is amended--
                                    (I) in subsection (b), in the 
                                fourth sentence, by striking ``, and 
                                that do not exceed the amount of the 
                                State's allotment under section 2104 
                                (not taking into account reductions 
                                under section 2104(d)(2)) for the 
                                fiscal year reduced by the amount of 
                                any payments made under section 2105 to 
                                the State from such allotment for such 
                                fiscal year''; and
                                    (II) by striking subsection (u)(1) 
                                and inserting the following:
    ``(u)(1) The condition described in this paragraph for a State plan 
is that the State is complying with the requirement of section 
2105(d)(1).''.
                            (ii) Section 2105(a) of such Act (42 U.S.C. 
                        1397ee(a)) is amended by striking ``from its 
                        allotment under section 2104 (taking into 
                        account any adjustment under section 
                        2104(d)),''.
            (4) 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: ``and for pregnancy-related services''.
            (5) Conforming amendment relating to no waiting period for 
        certain women.--Section 2102(b)(1)(B) of such 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 targeted low-
                        income women who are pregnant.''.
            (6) Automatic enrollment of children born to title xxi 
        parents.--Section 2102(b)(1) of the Social Security Act (42 
        U.S.C. 1397bb(b)(1)) is amended by adding at the end the 
        following new subparagraph:
                    ``(C) Automatic eligibility of children born to a 
                parent being provided health coverage.--Such 
                eligibility standards shall provide for automatic 
                coverage of a child born to an individual who is 
                provided health coverage (as defined in section 
                2111(b)(1)) under this title in the same manner as 
                medical assistance would be provided under section 
                1902(e)(4) to a child described in such section.''.
            (7) Application of presumptive eligibility.--
                    (A) In general.--Section 2107(e)(1) of such Act (42 
                U.S.C. 1397gg(e)(1)) is amended by adding at the end 
                the following new subparagraph:
                    ``(D) Sections 1920 and 1920A (relating to 
                presumptive eligibility).''.
                    (B) Exception from limitation on administrative 
                expenses.--Section 2105(c)(2) of such 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 1920A 
                (pursuant to section 2107(e)(1)(D)), regardless of 
                whether the child is determined to be ineligible for 
                the program under this title or title XIX.''.
    (d) Effective Date.--The amendments made by this section take 
effect on October 1, 2000.

SEC. 102. COVERAGE OF LEGAL IMMIGRANTS UNDER THE MEDICAID PROGRAM.

    (a) Medicaid Program.--Section 1903(v) of the Social Security Act 
(42 U.S.C. 1396b(v)) is amended--
            (1) in paragraph (1), by striking ``paragraph (2)'' and 
        inserting ``paragraphs (2) and (4)''; and
            (2) by adding at the end the following new paragraph:
    ``(4)(A) A State shall (through a plan amendment under this title) 
provide medical assistance under this title, notwithstanding sections 
401(a), 402(b), 403, and 421 of the Personal Responsibility and Work 
Opportunity Reconciliation Act of 1996, for aliens who are lawfully 
residing in the United States (including battered aliens described in 
section 431(c) of such Act) and who are otherwise eligible for such 
assistance.
    ``(B) No debt may be accrued under an affidavit of support against 
any sponsor of an alien provided medical assistance under subparagraph 
(A).''.
    (b) Title XXI.--Section 2107(e)(1) of such Act (42 U.S.C. 
1397gg(e)(1)), as amended by section 101(c)(7)(A), is amended by adding 
at the end the following new subparagraph:
                    ``(E) Section 1903(v)(4) (relating to optional 
                coverage of categories of lawfully residing alien 
                children and parents).''.
    (c) Effective Date.--The amendments made by this section take 
effect on October 1, 2000, and apply to medical assistance furnished on 
or after such date.

SEC. 103. COVERAGE OF CHILDREN THROUGH AGE 20 UNDER THE MEDICAID 
              PROGRAM AND TITLE XXI.

    (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 striking 
        ``19'' and inserting ``20''.
            (2) Conforming amendments.--
                    (A) Section 1902(e)(3)(A) of such Act (42 U.S.C. 
                1396a(e)(3)(A)) is amended by striking ``18'' and 
                inserting ``20''.
                    (B) Section 1902(e)(12) of such Act (42 U.S.C. 
                1396a(e)(12)) is amended by striking ``19'' and 
                inserting ``20''.
                    (C) Section 1920A(b)(1) of such Act (42 U.S.C. 
                1396r-1a(b)(1)) is amended by striking ``19'' and 
                inserting ``20''.
                    (D) Section 1928(h)(1) of such Act (42 U.S.C. 
                1396s(h)(1)) is amended by striking ``18'' and 
                inserting ``20''.
                    (E) Section 1932(a)(2)(A) of such Act (42 U.S.C. 
                1396u-2(a)(2)(A)) is amended by striking ``19'' and 
                inserting ``20''.
    (b) Title XXI.--Section 2110(c)(1) of such Act (42 U.S.C. 
1397jj(c)(1)) is amended by striking ``19'' and inserting ``20''.
    (c) Effective Date.--The amendments made by this section take 
effect on October 1, 2000, and apply to medical assistance and child 
health assistance provided on or after such date.

SEC. 104. APPLICATION OF SIMPLIFIED TITLE XXI PROCEDURES UNDER THE 
              MEDICAID PROGRAM.

    (a) Application Under Medicaid.--
            (1) In general.--Section 1902(l) of the Social Security Act 
        (42 U.S.C. 1396a(l)) is amended--
                    (A) in paragraph (3), by inserting ``subject to 
                paragraph (5)'', after ``Notwithstanding subsection 
                (a)(17),''; and
                    (B) by adding at the end the following new 
                paragraph:
    ``(5) With respect to determining the eligibility of individuals 
under 20 years of age for medical assistance under subsection 
(a)(10)(A) and, separately, with respect to determining the eligibility 
of individuals for medical assistance under subsection 
(a)(10)(A)(i)(VIII) or (a)(10)(A)(ii)(XVIII), notwithstanding any other 
provision of this title, if the State has established a State child 
health plan under title XXI--
            ``(A) the State may not apply a resource standard if the 
        State does not apply such a standard under such child health 
        plan with respect to such individuals;
            ``(B) the State shall use the same simplified eligibility 
        form (including, if applicable, permitting application other 
        than in person) as the State uses under such State child health 
        plan with respect to such individuals;
            ``(C) the State shall provide for initial eligibility 
        determinations and redeterminations of eligibility using the 
        same verification policies, forms, and frequency as the State 
        uses for such purposes under such State child health plan with 
        respect to such individuals; and
            ``(D) the State shall not require a face-to-face interview 
        for purposes of initial eligibility determinations and 
        redeterminations unless the State requires such an interview 
        for such purposes under such child health plan with respect to 
        such individuals.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        apply to determinations of eligibility made on or after the 
        date that is 1 year after the date of the enactment of this 
        Act.
    (b) Additional Entities Qualified To Determine Medicaid Presumptive 
Eligibility for Low-income Children.--
            (1) In general.--Section 1920A(b)(3)(A)(i) of such Act (42 
        U.S.C. 1396r-1a(b)(3)(A)(i)) is amended--
                    (A) by striking ``or (II)'' and inserting ``, 
                (II)''; and
                    (B) 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 or tribal child support enforcement agency, a 
                child care resource and referral agency, an 
                organization that is providing emergency food and 
                shelter under a grant under the Stewart B. McKinney 
                Homeless Assistance Act, or a State or tribal office or 
                entity involved in enrollment in the program under this 
                title, under part A of title IV, under title XXI, 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 under the Native American Housing Assistance 
                and Self-Determination Act of 1996 (25 U.S.C. 4101 et 
                seq.), or (IV) any other entity the State so deems, as 
                approved by the Secretary'' before the semicolon.
            (2) Technical amendments.--Section 1920A of such Act (42 
        U.S.C. 1396r-1a) is amended--
                    (A) in subsection (b)(3)(A)(ii), by striking 
                ``paragraph (1)(A)'' and inserting ``paragraph 
                (2)(A)''; and
                    (B) in subsection (c)(2), in the matter preceding 
                subparagraph (A), by striking ``subsection (b)(1)(A)'' 
                and inserting ``subsection (b)(2)(A)''.
            (3) Application to presumptive eligibility for pregnant 
        women under medicaid.--Section 1920(b) of such 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).''.
    (c) Automatic Reassessment of Eligibility for Title XXI and 
Medicaid Benefits for Children Losing Medicaid or Title XXI 
Eligibility.--
            (1) Loss of medicaid eligibility.--Section 1902(a) of the 
        Social Security Act (42 U.S.C. 1396a(a)), as amended by section 
        101(a), is amended--
                    (A) by striking the period at the end of paragraph 
                (66) and inserting ``; and'', and
                    (B) by inserting after paragraph (66) the following 
                new paragraph:
            ``(67) provide, by not later than the first day of the 
        first month that begins more than 1 year after the date of the 
        enactment of this paragraph and in the case of a State with a 
        State child health plan under title XXI, that before medical 
        assistance to a child (or a parent of a child) is discontinued 
        under this title, a determination of whether the child (or 
        parent) is eligible for benefits under title XXI shall be made 
        and, if determined to be so eligible, the child (or parent) 
        shall be automatically enrolled in the program under such title 
        without the need for a new application.''.
            (2) Loss of title xxi 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 before child health assistance to a 
                child (or health coverage to a parent of a child) is 
                discontinued under this title, a determination of 
                whether the child (or parent) is eligible for benefits 
                under title XIX is made and, if determined to be so 
                eligible, the child (or parent) is automatically 
                enrolled in the program under such title without the 
                need for a new application;''.
            (3) Effective date.--The amendments made by paragraphs (1) 
        and (2) apply to individuals 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 60 days after the 
        date of the enactment of this Act.
    (d) Provision of Medicaid and CHIP Applications and Information 
Under the School Lunch Program.--Section 9(b)(2)(B) of the Richard B. 
Russell National School Lunch Act (42 U.S.C. 1758(b)(2)(B)) is 
amended--
            (1) by striking ``(B) Applications'' and inserting ``(B)(i) 
        Applications''; and
            (2) by adding at the end the following new clause:
    ``(ii)(I) Applications for free and reduced price lunches that are 
distributed pursuant to clause (i) to parents or guardians of children 
in attendance at schools participating in the school lunch program 
under this Act shall also contain information on the availability of 
medical assistance under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) (commonly referred to as the `medicaid program') 
and of child health assistance and health coverage under title XXI of 
such Act (commonly referred to as `CHIP'), including information on how 
to obtain an application for assistance under such program.
    ``(II) Information on the medicaid program and CHIP under subclause 
(I) shall be provided on a form separate from the application form for 
free and reduced price lunches under clause (i).''.

SEC. 105. EXPANSION OF BASIC SERVICES REQUIRED FOR BENCHMARK-EQUIVALENT 
              COVERAGE UNDER CHIP.

    (a) Addition of Vision, Hearing, and Dental Services.--
            (1) In general.--Section 2103(c)(1) of the Social Security 
        Act (42 U.S.C. 1397cc(c)(1)) is amended by adding at the end 
        the following:
                    ``(E) Vision services for children.
                    ``(F) Hearing services for children.
                    ``(G) Dental services for children.''.
            (2) Exclusion From Determination of Actuarial Value.--
        Section 2103(c)(4) of such Act (42 U.S.C. 1397cc(c)(4)) is 
        amended by adding at the end the following new sentence: ``The 
        categories of basic services described in subparagraphs (E), 
        (F), and (G) of paragraph (1) shall not be taken into account 
        for purposes of determining the actuarial value of coverage 
        under this paragraph.''.
            (3) Conforming Amendments.--Section 2103(c)(2) of such Act 
        (42 U.S.C. 1397cc(c)(2)) is amended by striking subparagraphs 
        (C) and (D).
    (b) No Limitation on Scope or Duration For Certain Services.--
Section 2103(a) of such Act (42 U.S.C. 1397cc(a)) is amended by adding 
at the end the following new paragraph:
            ``(5) No limitation on scope or duration for fehbp-
        equivalent children's health insurance coverage.--With respect 
        to coverage that is equivalent to the benchmark benefit package 
        described in subsection (b)(1), or that is actuarially 
        equivalent to such package and otherwise meets the requirements 
        of paragraph (2)--
                    ``(A) services otherwise provided under such 
                coverage that are medically necessary to maintain, 
                improve, or prevent the deterioration of the physical, 
                developmental, or mental health of the child may not be 
                limited with respect to scope or duration, except to 
                the degree that such services are not medically 
                necessary; and
                    ``(B) such coverage shall include the option to 
                identify medically necessary appropriate alternatives 
                to traditional care or extra contractual services 
                determined by the health plan to be a more cost 
                effective alternative than covered items or 
                services.''.

SEC. 106. ELIMINATION OF 100 HOUR RULE AND OTHER AFDC-RELATED 
              ELIGIBILITY RESTRICTIONS.

    (a) In General.--Section 1931(b)(1)(A)(ii) of the Social Security 
Act (42 U.S.C. 1396u-1(b)(1)(A)(ii)) is amended by inserting ``other 
than the requirement that the child be deprived of parental support or 
care by reason of the death, continued absence from the home, 
incapacity, or unemployment of a parent,'' after ``section 407(a),''.
    (b) Conforming Amendment.--Section 1905(a) of such Act (42 U.S.C. 
1396d(a)) is amended, in the matter before paragraph (1), in clause 
(ii), by striking ``if such child is (or would, if needy, be) a 
dependent child under part A of title IV''.
    (c) Effective Date.--The amendments made by this section apply to 
eligibility determinations made on or after October 1, 2000.

SEC. 107. LIMITATIONS ON CONFLICTS OF INTEREST.

    (a) Limitation on Conflicts of Interest in Marketing Activities.--
            (1) Title xxi.--Section 2105(c) of the Social Security Act 
        (42 U.S.C. 300aa-5(c)) is amended by adding at the end the 
        following new paragraph:
            ``(8) Limitation on expenditures for marketing 
        activities.--Amounts expended by a State for the use of an 
        administrative vendor in marketing health benefits coverage to 
        low-income children under this title shall not be considered, 
        for purposes of subsection (a)(2)(D), to be reasonable costs to 
        administer the plan unless the following conditions are met 
        with respect to the vendor:
                    ``(A) The vendor is independent of any entity 
                offering the coverage in the same area of the State in 
                which the vendor is conducting marketing activities.
                    ``(B) No person who is an owner, employee, 
                consultant, or has a contract with the vendor either 
                has any direct or indirect financial interest with such 
                an entity or has been excluded from participation in 
                the program under this title or title XVIII or XIX or 
                debarred by any Federal agency, or subject to a civil 
                money penalty under this Act.''.
    (b) Prohibition of Affiliation With Debarred Individuals.--
            (1) Medicaid.--Section 1903(i) of such Act (42 U.S.C. 
        1396b(i))is amended--
                    (A) by striking the period at the end of paragraph 
                (20) and inserting ``; or''; and
                    (B) by inserting after paragraph (20) the following 
                new paragraph:
            ``(21) with respect to any amounts expended for an entity 
        that receives payments under the plan unless--
                    ``(A) no person with an ownership or control 
                interest (as defined in section 1124(a)(3)) in the 
                entity is a person that is debarred, suspended, or 
                otherwise excluded from participating in procurement or 
                non-procurement activities under the Federal 
                Acquisition Regulation; and
                    ``(B) such entity has not entered into an 
                employment, consulting, or other agreement for the 
                provision of items or services that are material to 
                such entity's obligations under the plan with a person 
                described in subparagraph (A).''.
            (2) Title xxi.--Section 2107(e)(1) of such Act (42 U.S.C. 
        1397gg(e)(1)), as amended by section 102(b), is further amended 
        by adding at the end the following new subparagraph:
                    ``(F) Section 1903(i)(21) (relating to prohibition 
                of affiliation with debarred individuals).''.
    (c) Effective Date.--The amendments made by this section shall 
apply to expenditures made on or after the date of the enactment of 
this Act.

SEC. 108. DEMONSTRATION PROGRAMS TO IMPROVE MEDICAID AND CHIP OUTREACH 
              TO HOMELESS INDIVIDUALS AND FAMILIES.

    (a) Authority.--The Secretary of Health and Human Services may 
award demonstration grants to not more than 7 States (or other 
qualified entities) to conduct innovative programs that are designed to 
improve outreach to homeless individuals and families under the 
programs described in subsection (b) with respect to enrollment of such 
individuals and families under such programs and the provision of 
services (and coordinating the provision of such services) under such 
programs.
    (b) Programs for Homeless Described.--The programs described in 
this subsection are as follows:
            (1) Medicaid.--The program under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.).
            (2) CHIP.--The program under title XXI of such Act (42 
        U.S.C. 1397aa et seq.).
            (3) TANF.--The program under part of A of title IV of such 
        Act (42 U.S.C. 601 et seq.).
            (4) SAMHSA block grants.--The program of grants under part 
        B of title XIX of the Public Health Service Act (42 U.S.C. 
        300x-1 et seq.).
            (5) Food stamp program.--The program under the Food Stamp 
        Act of 1977 (7 U.S.C. 2011 et seq.).
            (6) Workforce investment act.--The program under the 
        Workforce Investment Act of 1999 (29 U.S.C. 2801 et seq.).
            (7) Welfare-to-work.--The welfare-to-work program under 
        section 403(a)(5) of the Social Security Act (42 U.S.C. 
        603(a)(5)).
            (8) Other programs.--Other public and private benefit 
        programs that serve low-income individuals.
    (c) Appropriations.--For the purposes of carrying out this section, 
there is appropriated, out of any funds in the Treasury not otherwise 
appropriated, $10,000,000, to remain available until expended.

         TITLE II--ACCESS TO AFFORDABLE CARE FOR ALL AMERICANS

SEC. 201. EXTENSION OF COVERAGE TO SINGLE INDIVIDUALS.

    (a) Requirement to Extend Coverage to Single Individuals.--Section 
1902(a)(66) of the Social Security Act (42 U.S.C. 1396a(a)(66)), as 
added by section 101(a), is amended--
            (1) by striking ``under paragraph (10)(A)(ii)((XVIII)'' and 
        inserting ``under--
                    ``(A) paragraph (10)(A)(ii)((XVIII)'';
            (2) by striking the period and inserting ``; and''; and
            (3) by adding at the end the following:
                    ``(B) paragraph (10)(A)(ii)(XIX) for individuals 
                described in subsection (aa)(1) in accordance with the 
                conditions described in paragraphs (2), (3), (4), (5), 
                and (6) of subsection (aa).''.
    (b) Coverage Under Medicaid.--
            (1) In general.--Section 1902(a)(10)(A)(ii) of the Social 
        Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)), as amended by 
        section 101(b), is amended--
                    (A) by striking ``or'' at the end of subclause 
                (XVII);
                    (B) by adding ``or'' at the end of subclause 
                (XVIII); and
                    (C) by adding at the end the following new 
                subclause:
                                    ``(XIX) who are individuals 
                                described in subsection (aa)(1);''.
            (2) Conditions for coverage.--Section 1902 of such Act is 
        amended by adding at the end the following new subsection:
    ``(aa)(1) The individuals described in this paragraph are 
individuals--
            ``(A) who are not otherwise eligible for medical assistance 
        under subsection (a)(10)(A); and
            ``(B) whose income is at least--
                    ``(i) with respect to fiscal year 2003, 50 percent 
                of the poverty line;
                    ``(ii) with respect to fiscal year, 2004, 100 
                percent of the poverty line;
                    ``(iii) with respect to fiscal year 2005, 150 
                percent of the poverty line;
                    ``(iv) with respect to fiscal year 2006, 200 
                percent of the poverty line;
                    ``(v) with respect to fiscal year 2007, 250 percent 
                of the poverty line; and
                    ``(vi) with respect to fiscal year 2008, 300 
                percent of the poverty line.
    ``(2) At State option, clause (iii), (iv), (v), or (vi) of 
paragraph (1)(B) shall not apply but only if the State provides health 
coverage for an individual who would be described in any such clause in 
accordance with section 2111.
    ``(3) The State provides that individuals described in paragraph 
(1) remain eligible for medical assistance for a period (of at least 12 
months) following the eligibility determination required under such 
paragraph.
    ``(4) The State has a State child health plan under title XXI which 
(whether implemented under such title or under this title) does not 
limit the acceptance of applications for individuals described in 
paragraph (1), does not use a waiting list for such individuals who 
meet eligibility standards to qualify for assistance (under this title 
or, if the State offers such individuals assistance under section 
2111(a)(2), title XXI), and provides benefits to all such individuals 
in the State who apply for and meet eligibility standards.
    ``(5) The State does not cover individuals described in paragraph 
(1) with higher family income without covering such individuals with a 
lower family income.
    ``(6) Section 1920A(e) shall apply to individuals described in 
paragraph (1) in the same manner as such section applies to parents 
described in that section.''.
            (3) Conforming amendments.--
                    (A) Eligibility categories.--Section 1905(a) of 
                such Act (42 U.S.C. 1396d(a)), as amended by section 
                101(b)(4)(A), is amended, in the matter before 
                paragraph (1)--
                            (i) by striking ``or'' at the end of clause 
                        (xi);
                            (ii) by inserting ``or'' at the end of 
                        clause (xii); and
                            (iii) by inserting after clause (xii) the 
                        following new clause:
            ``(xiii) who are individuals described in section 
        1902(aa)(1),''.
                    (B) Income limitations.--Section 1903(f)(4) of such 
                Act (42 U.S.C. 1396b(f)(4)), as amended by section 
                101(b)(4)(B), is amended by inserting 
                ``1902(a)(10)(A)(ii)(XIX),'' after 
                ``1902(a)(10)(A)(ii)(XVIII),''.
    (c) Coverage Under SCHIP.--
            (1) In general.--Section 2111 of such Act, as added by 
        section 101(c), is amended--
                    (A) in the heading, by inserting ``and single 
                adults'' before the period;
                    (B) in subsection (a)--
                            (i) by striking ``Notwithstanding'' and 
                        inserting the following:
            ``(1) Families.--Notwithstanding''; and
                            (ii) by adding at the end the following:
            ``(2) Certain single individuals.--Notwithstanding any 
        other provision of this title, with respect to a State that 
        does not provide medical assistance under section 
        1902(a)(10)(A)(ii)(XIX) for an individual described in clause 
        (iii), (iv), (v), or (vi) of section 1902(aa)(1)(B), the State 
        shall provide health coverage under this title for such an 
        individual through an amendment to its State child health plan 
        under section 2102 in accordance with this section and the 
        conditions described in paragraphs (3) and (4) of section 
        1902(aa).''; and
                    (C) in subsection (b), by adding at the end the 
                following new paragraph:
            ``(3) Treatment of certain single individuals.--A State 
        child health plan shall treat, and shall apply this section to, 
        an individual described in subsection (a)(2) in the same manner 
        as such plan treats and applies this section to a family 
        described in section 1902(k)(1).''.

                    TITLE III--ADDITIONAL PROVISIONS

SEC. 301. AVAILABILITY OF UNSUBSIDIZED COVERAGE.

    (a) Requirement To Offer Coverage.--
            (1) In general.--Title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.) is amended--
                    (A) by redesignating section 1935 as section 1936; 
                and
                    (B) by adding at the end the following new section:

                       ``availability of coverage

    ``Sec. 1936. (a) In General.--Beginning with calendar year 2002, 
each State with a plan approved under this title shall make available 
to any individual or family with income that exceeds 300 percent of the 
poverty line (as defined in section 673(2) of the Community Services 
Block Grant Act (42 U.S.C. 9902(2)), including any revision required by 
such section) medical assistance provided under this title or health 
coverage under section 2111 through payment of a premium determined in 
accordance with subsection (b).
    ``(b) Determination of Premiums.--
            ``(1) In general.--Premiums for coverage under this title 
        shall be based on the pooled average cost of medical assistance 
        provided under this title for the relevant comparison group for 
        the individual purchasing such coverage.
            ``(2) No adjustment for health status.--Premiums imposed 
        under this section may not be adjusted for the health status of 
        the individual.
            ``(3) Application of HIPAA.--The provisions of title XXVII 
        of the Public Health Service Act (42 U.S.C. 300gg et seq.) 
        apply to coverage made available under this section.
    ``(c) Comparability of Coverage.--Medical assistance made available 
under this section shall be provided to an individual or family 
purchasing such coverage in the same amount, duration, and scope as 
such assistance is made available for an individual or family who is 
eligible for such assistance under section 1902(a)(10)(A).
    ``(d) Presumptive Eligibility.--Each individual that indicates on a 
form described in paragraph (2) of section 301(c) of Basic Access to 
Secure Health Insurance Coverage Health Plan (BASIC Health Plan) Act 
that the individual believes he or she (and the individual's family, if 
applicable) is eligible for medical assistance under this section, and 
that is forwarded to a State agency in accordance with paragraph (1)(B) 
of such section, shall be provided with a period of presumptive 
eligibility for coverage under this section (in the same manner as such 
a period is imposed under sections 1920 and 1920A) until such time as 
the State makes a determination as to such eligibility.
    ``(e) No Effect on Coverage Offered Under a Waiver.--Nothing in 
this section shall be construed as affecting any medical assistance 
made available under a waiver of the requirements of this title (under 
section 1115 or otherwise) to an individual or family described in 
subsection (a).''.
            (2) Establishment of optional eligibility category.--
                    (A) In general.--Section 1902(a)(10)(A)(ii) of the 
                Social Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)), as 
                amended by section 201(b)(1)(C), is amended--
                            (i) by striking ``or'' at the end of 
                        subclause (XVIII);
                            (ii) by striking the semicolon at the end 
                        of subclause (XIX) and inserting ``, or''; and
                            (iii) by adding at the end the following 
                        new subclause:
                                    ``(XX) who are individuals 
                                described in section 1936 (subject to 
                                payment of a premium determined in 
                                accordance with that section);''.
                    (B) Conforming amendments.--
                            (i) Eligibility categories.--Section 
                        1905(a) of such Act (42 U.S.C. 1396d(a)), as 
                        amended by section 201(b)(3), is amended, in 
                        the matter before paragraph (1)--
                                    (I) by striking ``or'' at the end 
                                of clause (xii);
                                    (II) by inserting ``or'' at the end 
                                of clause (xiii); and
                                    (III) by inserting after clause 
                                (xiii) the following new clause:
            ``(xiv) who are individuals described in section 
        1902(aa)(1),''.
                            (ii) Income limitations.--Section 
                        1903(f)(4) of such Act (42 U.S.C. 1396b(f)(4)), 
                        as amended by section 201(b)(3)(B), is amended 
                        by inserting ``1902(a)(10)(A)(ii)(XX),'' after 
                        ``1902(a)(10)(A)(ii)(XIX),''.
    (b) Coverage Under SCHIP.--Section 2111 of such Act, as amended by 
section 201(c), is amended--
            (1) in subsection (a), by adding at the end the following 
        new paragraph:
            ``(3) Other individuals and families.--
                    ``(A) In general.--Notwithstanding any other 
                provision of this title, with respect to a State that 
                does not provide medical assistance under section 1936 
                for an individual or family described in subsection (a) 
                of that section, the State shall make available through 
                the payment of a premium determined in accordance with 
                section 1936(b), health coverage under this title for 
                such an individual or family through an amendment to 
                its State child health plan under section 2102 in 
                accordance with this section and the requirements of 
                section 1936.
                    ``(B) Determination of premium.--For purposes of 
                determining a premium for the purchase of health 
                coverage under this title, paragraph (1) of section 
                1936(b) shall be applied by substituting `pooled 
                average cost of health coverage' for `pooled average 
                cost of medical assistance'.''; and
            (2) in subsection (b), by adding at the end the following 
        new paragraph:
            ``(4) Treatment of other individuals and families.--A State 
        child health plan shall treat, and shall apply this section to, 
        an individual or family described in subsection (a)(3) in the 
        same manner as such plan treats and applies this section to a 
        family described in section 1902(k)(1).''.
    (c) Employer Responsibilities.--
            (1) In general.--Beginning with calendar year 2002, each 
        covered employer shall--
                    (A) inform, through the use of the form described 
                in paragraph (2), each individual in the person's 
                employ who is not eligible for health benefits coverage 
                provided by such employer, of the opportunity to 
                purchase health benefits coverage under section 1936 or 
                2111 of the Social Security Act;
                    (B) forward all such forms on which an individual 
                indicates that the individual believes they are 
                eligible for coverage under such sections of the Social 
                Security Act to the appropriate State agency, unless 
                the individual specifically declines such coverage on 
                such form; and
                    (C) with respect to each such individual who 
                purchases such coverage (for such individual or their 
                family), withhold an amount equal to the premium 
                required by the State for the coverage from the 
                individual's wages and forward such amount to the 
                appropriate place (as determined by the State).
            (2) Form described.--The form described in this paragraph 
        is a form that--
                    (A) is developed by the State in which the covered 
                employer resides in accordance with guidelines issued 
                by the Secretary of Health and Human Services;
                    (B) describes the health benefits coverage 
                available under sections 1936 and 2111 of the Social 
                Security Act; and
                    (C) provides an individual with an opportunity to 
                indicate on the form if the individual believes that 
                they are eligible for such coverage or to decline such 
                coverage.
            (3) Annual provision.--In the case of any employee who 
        declines coverage under section 1936 or 2111 of the Social 
        Security Act on the form described in paragraph (2), a covered 
        employer shall provide such form to each such individual not 
        less than annually to allow the individual to revoke such 
        declination.
            (4) Definition of covered employer.--In this section, the 
        term `covered employer' means, for any calendar year, any 
        person on whom an excise tax is imposed under section 3111 or 
        1401 of the Internal Revenue Code of 1986 with respect to 
        having an individual in the person's employ to whom wages are 
        paid by such person during such calendar year.
                                 <all>