[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3729 Introduced in House (IH)]







107th CONGRESS
  2d Session
                                H. R. 3729

 To amend titles XIX and XXI of the Social Security Act to improve the 
health benefits coverage of infants and children under the Medicaid and 
   State children's health insurance program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 12, 2002

 Mr. Strickland (for himself, Mr. Ney, Ms. DeGette, Mrs. Morella, Mr. 
Crowley, Ms. Waters, Mr. McNulty, Mr. Blagojevich, Mr. Towns, Mr. Wynn, 
 Mr. Waxman, Mr. Schiff, Mr. Pascrell, Mr. Green of Texas, Mr. Stupak, 
 Mr. Frost, Ms. Eshoo, Mr. Rush, Mr. Evans, Mr. Dooley of California, 
Mr. Conyers, Mr. Owens, Mrs. Christensen, Mr. Capuano, Mr. LaFalce, and 
  Mr. Brady of Pennsylvania) introduced the following bill; which was 
            referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To amend titles XIX and XXI of the Social Security Act to improve the 
health benefits coverage of infants and children under the Medicaid and 
   State children's health insurance program, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Start Healthy, 
Stay Healthy Act''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
                         TITLE I--START HEALTHY

Sec. 101. Enhanced Federal medicaid match for States that opt to 
                            continuously enroll infants during the 
                            first year of life without regard to the 
                            mother's eligibility status.
Sec. 102. Optional coverage of low-income, uninsured pregnant women 
                            under a State child health plan.
Sec. 103. Increase in SCHIP income eligibility.
                         TITLE II--STAY HEALTHY

Sec. 201. Enhanced Federal medicaid match for increased expenditures 
                            for medical assistance for children.
Sec. 202. Increase in SCHIP appropriations.
Sec. 203. Optional coverage of children through age 20 under the 
                            medicaid program and SCHIP.

                         TITLE I--START HEALTHY

SEC. 101. ENHANCED FEDERAL MEDICAID MATCH FOR STATES THAT OPT TO 
              CONTINUOUSLY ENROLL INFANTS DURING THE FIRST YEAR OF LIFE 
              WITHOUT REGARD TO THE MOTHER'S ELIGIBILITY STATUS.

    (a) State Option.--Section 1902(e)(4) of the Social Security Act 
(42 U.S.C. 1396a(e)(4)) is amended by adding at the end the following 
new sentence: ``A State may elect (through a State plan amendment) to 
apply the first sentence of this paragraph without regard to the 
requirements that the child remain a member of the woman's household 
and the woman remains (or would remain if pregnant) eligible for 
medical assistance.''.
    (b) Enhanced FMAP.--The first sentence of section 1905(b) of the 
Social Security Act (42 U.S.C. 1396d(b)) is amended--
            (1) by inserting ``(A)'' after ``only''; and
            (2) by inserting ``, or (B) on the basis of a State 
        election made under the third sentence of section 1902(e)(4)'' 
        before the period.
    (c) Effective Date.--The amendments made by this section apply to 
medical assistance provided on or after October 1, 2002.

SEC. 102. OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED PREGNANT WOMEN 
              UNDER A STATE CHILD HEALTH PLAN.

    (a) In General.--Title XXI of the Social Security Act (42 U.S.C. 
1397aa et seq.) 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 (whether implemented under this 
title or title XIX) 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.
            ``(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. 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 and SCHIP Allotment 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 the fourth sentence of 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,''; and
            (2) in subsection (u)--
                    (A) by redesignating paragraph (4) as paragraph 
                (5); and
                    (B) by inserting after paragraph (3) 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.''.
    (c) No Waiting Periods or Cost-Sharing.--
            (1) No waiting period.--Section 2102(b)(1)(B) of the Social 
        Security 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 a targeted 
                        low-income pregnant woman, if the State 
                        provides for coverage of pregnancy-related 
                        assistance for such women in accordance with 
                        section 2111.''.
            (2) 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: ``or for pregnancy-related services, if the 
                State provides for coverage of pregnancy-related 
                assistance for targeted low-income pregnant women in 
                accordance section 2111''.
    (d) Presumptive Eligibility.--
            (1) In general.--Section 1920A(b)(3)(A)(i)(III) of the 
        Social Security Act (42 U.S.C. 1396r-1a(b)(3)(A)(i)(III)) is 
        amended by inserting ``a child care resource and referral 
        agency,'' after ``a State or tribal child support enforcement 
        agency,''.
            (2) Application to presumptive eligibility for pregnant 
        women under medicaid.--Section 1920(b) of the Social Security 
        Act (42 U.S.C. 1396r-1(b)) is amended by adding at the end 
        after and below paragraph (2) the following flush sentence:
``The term `qualified provider' includes a qualified entity as defined 
in section 1920A(b)(3).''.
            (3) Application under title xxi.--
                    (A) In general.--Section 2107(e)(1)(D) of the 
                Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended 
                to read as follows:
                    ``(D) Sections 1920 and 1920A (relating to 
                presumptive eligibility).''.
                    (B) Exception from limitation on administrative 
                expenses.--Section 2105(c)(2) of the Social Security 
                Act (42 U.S.C. 1397ee(c)(2)) is amended by adding at 
                the end the following new subparagraph:
                    ``(C) Exception for presumptive eligibility 
                expenditures.--The limitation under subparagraph (A) on 
                expenditures shall not apply to expenditures 
                attributable to the application of section 1920 or 
                1920A (pursuant to section 2107(e)(1)(D)), regardless 
                of whether the child or pregnant woman is determined 
to be ineligible for the program under this title or title XIX.''.
    (e) Program Coordination With the Maternal and Child Health Program 
(Title V).--
            (1) In general.--Section 2102(b)(3) of the Social Security 
        Act (42 U.S.C. 1397bb(b)(3)) is amended--
                    (A) in subparagraph (D), by striking ``and'' at the 
                end;
                    (B) in subparagraph (E), by striking the period 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) of 
        such Act (42 U.S.C. 1396a(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, 2003.
    (f) Application of Annual Aggregate Cost-Sharing Limit.--Section 
2103(e)(3)(B) of the Social Security Act (42 U.S.C. 1397cc(e)(3)(B)) is 
amended by adding at the end the following new sentence: ``In the case 
of a targeted low-income pregnant woman provided coverage under section 
2111, or the parents of a targeted low-income child provided coverage 
under this title under an 1115 waiver or otherwise, the limitation on 
total annual aggregate cost-sharing described in the preceding sentence 
shall be applied to the entire family of such woman or parents.''.
    (g) Effective Date.--Except as provided in subsection (e), the 
amendments made by this section take effect on the date of the 
enactment of this Act and apply to expenditures incurred on or after 
that date.

SEC. 103. INCREASE IN SCHIP INCOME ELIGIBILITY.

    (a) Definition of Low-Income Child.--Section 2110(c)(4) of the 
Social Security Act (42 U.S.C. 42 U.S.C. 1397jj(c)(4)) is amended by 
striking ``200'' and inserting ``250''.
    (b) Effective Date.--The amendment made by subsection (a) applies 
to child health assistance provided, and allotments determined under 
section 2104 of the Social Security Act (42 U.S.C. 1397dd), for fiscal 
years beginning with fiscal year 2003.

                         TITLE II--STAY HEALTHY

SEC. 201. ENHANCED FEDERAL MEDICAID MATCH FOR INCREASED EXPENDITURES 
              FOR MEDICAL ASSISTANCE FOR CHILDREN.

    (a) Enhanced FMAP.--Section 1905(b) of the Social Security Act (42 
U.S.C. 1396d(b)) is amended by adding at the end the following new 
sentence: ``Notwithstanding the first sentence of this subsection, in 
the case of a State plan that meets at least 7 of the conditions 
described in subsection (x)(1) (as determined by the Secretary in 
consultation with States (including the State agencies responsible for 
the administration of this title and title V), beneficiaries under this 
title, providers of services under this title, and advocates for 
children), with respect to expenditures described in subsection (x)(2) 
for the State for a fiscal year, the Federal medical assistance 
percentage is equal to the percentage determined for the State under 
subsection (x)(3).''.
    (b) Conditions and Expenditures Described.--Section 1905 of the 
Social Security Act (42 U.S.C. 1396d) is amended by adding at the end 
the following new subsection:
    ``(x)(1) For purposes of subsection (b), the conditions described 
in this subsection are the following:
            ``(A) Highest schip income eligibility.--The State has a 
        State child health plan under title XXI which (whether 
        implemented under such title or under this title) has the 
        highest income eligibility standard permitted under title XXI 
        as of January 1, 2002, does not limit the acceptance of 
        applications, and provides benefits to all children in the 
        State who apply for and meet eligibility standards.
            ``(B) Uniform, simplified application form.--With respect 
        to children under age 19 (or such higher age as the State has 
        elected under section 1902(l)(1)(D)) who are eligible for 
        medical assistance under section 1902(a)(10)(A), the State uses 
        the same uniform, simplified application form (including, if 
        applicable, permitting application other than in person) for 
        purposes of establishing eligibility for benefits under this 
        title and also under title XXI.
            ``(C) Coordinated enrollment process.--The State has an 
        enrollment process that is coordinated with that under title 
        XXI 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 XXI, and that allows for the transfer 
        of enrollment, without a gap in coverage, for a child whose 
        income eligibility status changes but who remains eligible for 
        benefits under either title.
            ``(D) Same verification and redetermination policies; 
        automatic reassessment of eligibility.--With respect to 
        children under age 19 (or such higher age as the State has 
        elected under section 1902(l)(1)(D)) who are eligible for 
        medical assistance under section 1902(a)(10)(A), the State 
        provides for initial eligibility determinations and 
        redeterminations of eligibility using the same verification 
        policies (including with respect to face-to-face interviews), 
        forms, and frequency as the State uses for such purposes under 
        title XXI, and, as part of such redeterminations, provides for 
the automatic reassessment of the eligibility of such children for 
assistance under this title and title XXI.
            ``(E) No asset test.--The State does not impose an asset 
        test for eligibility under section 1902(l) or title XXI with 
        respect to children.
            ``(F) 12-month continuous enrollment.--The State has 
        elected the option of continuing enrollment under section 
        1902(e)(12) and has elected a 12-month period under 
        subparagraph (A) of such section.
            ``(G) Compliance with outstationing requirement.--The State 
        is providing for the receipt and initial processing of 
        applications of children for medical assistance under this 
        title at facilities defined as disproportionate share hospitals 
        under section 1923(a)(1)(A) and Federally-qualified health 
        centers described in subsection (l)(2)(B) of this section 
        consistent with the requirements of section 1902(a)(55).
            ``(H) No waiting period longer than 6 months.--The State 
        does not impose a waiting period for children who meet 
        eligibility standards to qualify for assistance under such plan 
        that exceeds 6 months (and may impose a shorter period or no 
        period) for purposes of complying with regulations promulgated 
        under title XXI to ensure that the insurance provided under the 
        State child health plan under such title does not substitute 
        for coverage under group health plans.
            ``(I) Sufficient provider payment rates.--The State 
        demonstrates that it is meeting the requirements of section 
        1902(a)(30)(A) through payment rates sufficient to enlist 
        enough providers so that care and pediatric, obstetrical, 
        gynecologic, and dental services are available under the plan 
        at least to the extent that such care and services are 
        available to the general population in the geographic area.
    ``(2)(A) For purposes of subsection (b), the expenditures described 
in this paragraph are expenditures for medical assistance for children 
described in subparagraph (B) for a fiscal year, but only to the extent 
that such expenditures exceed the base expenditure amount, as defined 
in subparagraph (C).
    ``(B) For purposes of subparagraph (A), the children described in 
this subparagraph are--
            ``(i) individuals who are under 19 years of age (or such 
        higher age as the State may have elected under section 
        1902(l)(1)(D)) who are eligible and enrolled for medical 
        assistance under this title; and
            ``(ii) individuals who--
                    ``(I) would be described in clause (i) but for 
                having family income that exceeds the highest income 
                eligibility level applicable to such individuals under 
                the State plan; and
                    ``(II) would be considered disabled under section 
                1614(a)(3)(C) (determined without regard to the 
                reference to age in that section but for having 
                earnings or deemed income or resources (as determined 
                under title XVI for children) that exceed the 
                requirements for receipt of supplemental security 
                income benefits.
    ``(C) For purposes of subparagraph (A), the term `base expenditure 
amount' means the total expenditures for medical assistance for 
children described in subparagraph (B) for fiscal year 1996.
    ``(3) For purposes of subsection (b), the Federal medical 
assistance percentage with respect to expenditures described in 
paragraph (2) for a fiscal year is equal to the following:
            ``(A) In the case of a State that meets 7 of the conditions 
        described in paragraph (1), the Federal medical assistance 
        percentage (as defined in the first sentence of subsection (b)) 
for the State increased by a number of percentage points equal to 50 
percent of the number of percentage points by which (1) such Federal 
medical assistance percentage for the State is less than (2) the 
enhanced FMAP for the State described in section 2105(b).
            ``(B) In the case of a State that meets 8 of the conditions 
        described in paragraph (1), the Federal medical assistance 
        percentage (as so defined) for the State increased by a number 
        of percentage points equal to 75 percent of the number of 
        percentage points by which (1) such Federal medical assistance 
        percentage for the State is less than (2) the enhanced FMAP for 
        the State (as so described).
            ``(C) In the case of a State that meets all of the 
        conditions described in paragraph (1), the enhanced FMAP (as so 
        described).''.
    (c) Collection of Data.--The Secretary of Health and Human Services 
shall modify such data collection and reporting requirements under 
title XIX of the Social Security Act as are necessary to determine the 
expenditures and base expenditure amount described in section 
1905(x)(2) of that Act (as added by subsection (b)), particularly with 
respect to expenditures and the base expenditure amount related to 
children described in section 1905(x)(2)(B)(ii) of that Act.
    (d) Effective Date.--The amendments made by subsections (a) and (b) 
apply to medical assistance provided on or after October 1, 2001.

SEC. 202. INCREASE IN SCHIP APPROPRIATIONS.

    Section 2104(a) of the Social Security Act (42 U.S.C. 1397dd(a)) is 
amended by striking paragraphs (5) through (9) and inserting the 
following:
            ``(5) for fiscal year 2003, $3,500,000,000;
            ``(6) for fiscal year 2004, $4,000,000,000;
            ``(7) for fiscal year 2005, $4,300,000,000;
            ``(8) for fiscal year 2006, $4,500,000,000;
            ``(9) for fiscal year 2007, $4,500,000,000; and''.

SEC. 203. OPTIONAL COVERAGE OF CHILDREN THROUGH AGE 20 UNDER THE 
              MEDICAID PROGRAM AND SCHIP.

    (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 inserting 
        ``(or, at the election of a State, 20 or 21 years of age)'' 
        after ``19 years of age''.
            (2) Conforming amendments.--
                    (A) Section 1902(e)(3)(A) of such Act (42 U.S.C. 
                1396a(e)(3)(A)) is amended by inserting ``(or 1 year 
                less than the age the State has elected under 
                subsection (l)(1)(D))'' after ``18 years of age''.
                    (B) Section 1902(e)(12) of such Act (42 U.S.C. 
                1396a(e)(12)) is amended by inserting ``or such higher 
                age as the State has elected under subsection 
                (l)(1)(D)'' after ``19 years of age''.
                    (C) Section 1920A(b)(1) of such Act (42 U.S.C. 
                1396r-1a(b)(1)) is amended by inserting ``or such 
                higher age as the State has elected under section 
                1902(l)(1)(D)'' after ``19 years of age''.
                    (D) Section 1928(h)(1) of such Act (42 U.S.C. 
                1396s(h)(1)) is amended by inserting ``or 1 year less 
                than the age the State has elected under section 
                1902(l)(1)(D)'' before the period at the end.
                    (E) Section 1932(a)(2)(A) of such Act (42 U.S.C. 
                1396u-2(a)(2)(A)) is amended by inserting ``(or such 
                higher age as the State has elected under section 
                1902(l)(1)(D))'' after ``19 years of age''.
    (b) Title XXI.--Section 2110(c)(1) of such Act (42 U.S.C. 
1397jj(c)(1)) is amended by inserting ``(or such higher age as the 
State has elected under section 1902(l)(1)(D))''.
    (c) Effective Date.--The amendments made by this section take 
effect on October 1, 2002, and apply to medical assistance and child 
health assistance provided on or after such date.
                                 <all>