[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1012 Introduced in Senate (IS)]






108th CONGRESS
  1st Session
                                S. 1012

To amend title XIX of the Social Security Act to provide fiscal relief 
and program simplification to States, to improve coverage and services 
           to medicaid beneficiaries, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 7, 2003

 Mr. Bingaman (for himself, Mr. Corzine, Mrs. Clinton, Mr. Kerry, Mr. 
Lautenberg, Mr. Dayton, and Mr. Johnson) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XIX of the Social Security Act to provide fiscal relief 
and program simplification to States, to improve coverage and services 
           to medicaid beneficiaries, 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 ``Strengthening Our 
States Act of 2003'' or the ``SOS Act of 2003''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
      TITLE I--STRENGTHENING FEDERAL RESPONSIBILITY FOR MEDICARE 
                             BENEFICIARIES

Sec. 101. Assuming Federal responsibility for all medicare cost-
                            sharing.
Sec. 102. Expanded protections for low income medicare beneficiaries.
                TITLE II--PROVIDING STATES FISCAL RELIEF

Sec. 201. Temporary increase of medicaid FMAP.
Sec. 202. Temporary grants for State fiscal relief.
Sec. 203. Increasing medicaid DSH allotments.
Sec. 204. Increased State access to unspent SCHIP funds.
Sec. 205. Federal responsibility for emergency care for illegal 
                            immigrants.
Sec. 206. Increased Federal responsibility for translation services.
Sec. 207. Increased Federal matching rates for certain services.
  TITLE III--HELPING STATES WITH COMMITMENT TO ELDERLY AND DISABLED; 
                         FAMILY OPPORTUNITY ACT

           Subtitle A--Elderly and Persons With Disabilities

Sec. 301. Full accounting of savings in determining cost-effectiveness.
Sec. 302. Extension of medicaid coverage under the ticket to work 
                            program to cover spouses.
Sec. 303. Encouraging transition to home and community care.
Sec. 304. Enhanced matching rate for disabled individuals awaiting 
                            medicare eligibility.
Sec. 305. Providing initial term of 5 years for section 1915 waivers.
Sec. 306. Optional coverage of community-based attendant services and 
                            supports under the medicaid program.
                   Subtitle B--Family Opportunity Act

Sec. 311. Short title.
Sec. 312. Opportunity for families of disabled children to purchase 
                            medicaid coverage for such children.
Sec. 313. Treatment of inpatient psychiatric hospital services for 
                            individuals under age 21 in home or 
                            community-based services waivers.
Sec. 314. Demonstration of coverage under the medicaid program of 
                            children with potentially severe 
                            disabilities.
Sec. 315. Development and support of family-to-family health 
                            information centers.
Sec. 316. Restoration of medicaid eligibility for certain SSI 
                            beneficiaries.
 TITLE IV--FACILITATING PROGRAM ADMINISTRATION AND PRESERVING COVERAGE

Sec. 401. Allowing uniform coverage of all low income Americans.
Sec. 402. Facilitating coverage of families.
Sec. 403. Assistance with coverage of legal immigrants under the 
                            medicaid program and SCHIP.
Sec. 404. Flexibility in eligibility determinations.

      TITLE I--STRENGTHENING FEDERAL RESPONSIBILITY FOR MEDICARE 
                             BENEFICIARIES

SEC. 101. ASSUMING FEDERAL RESPONSIBILITY FOR ALL MEDICARE COST-
              SHARING.

    (a) In General.--Section 1905(b) of the Social Security Act (42 
U.S.C. 1396d(b)) is amended--
            (1) by striking ``and'' before ``(4)''; and
            (2) by inserting before the period the following: ``, and 
        (5) the Federal medical assistance percentage shall be 100 
        percent with respect to medical assistance provided with costs 
        described in section 1905(p)(3)''.
    (b) Conforming Amendment.--Section 1902 of such Act (42 U.S.C. 
1396a) is amended by striking subsection (n).
    (c) Effective Date.--The amendments made by this section shall 
apply to medical assistance for medicare cost-sharing for months 
beginning with July 2003.

SEC. 102. EXPANDED PROTECTIONS FOR LOW INCOME MEDICARE BENEFICIARIES.

    (a) In General.--Section 1902(a)(10)(E) of the Social Security Act 
(42 U.S.C. 1396a(a)(10)(E)) is amended--
            (1) by adding ``and'' at the end of clause (ii);
            (2) in clause (iii), by striking ``110 percent in 1993 and 
        1994, and 120 percent in 1995 and years'' and inserting ``135 
        percent''; and
            (3) by striking clause (iv).
    (b) Conforming Amendment.--Section 1933 of such Act (42 U.S.C. 
1396v) is repealed.
    (c) Effective Date.--The amendments made by subsection (a), and the 
repeal made by subsection (b), shall apply to months after September 
2003.

                TITLE II--PROVIDING STATES FISCAL RELIEF

SEC. 201. TEMPORARY INCREASE OF MEDICAID FMAP.

    (a) Permitting Maintenance of Fiscal Year 2002 FMAP for Last 2 
Calendar Quarters of Fiscal Year 2003.--Notwithstanding any other 
provision of law, but subject to subsection (e), if the FMAP determined 
without regard to this section for a State for fiscal year 2003 is less 
than the FMAP as so determined for fiscal year 2002, the FMAP for the 
State for fiscal year 2002 shall be substituted for the State's FMAP 
for the third and fourth calendar quarters of fiscal year 2003, before 
the application of this section.
    (b) Permitting Maintenance of Fiscal Year 2003 FMAP for Fiscal Year 
2004.--Notwithstanding any other provision of law, but subject to 
subsection (e), if the FMAP determined without regard to this section 
for a State for fiscal year 2004 is less than the FMAP as so determined 
for fiscal year 2003, the FMAP for the State for fiscal year 2003 shall 
be substituted for the State's FMAP for each calendar quarter of fiscal 
year 2004, before the application of this section.
    (c) General 3.73 Percentage Points Increase for Last 2 Calendar 
Quarters of Fiscal Year 2003 and Fiscal Year 2004.--Notwithstanding any 
other provision of law, but subject to subsections (e) and (f), for 
each State for the third and fourth calendar quarters of fiscal year 
2003 and each calendar quarter of fiscal year 2004, the FMAP (taking 
into account the application of subsections (a) and (b)) shall be 
increased by 3.73 percentage points.
    (d) Increase in Cap on Medicaid Payments to Territories.--
Notwithstanding any other provision of law, but subject to subsection 
(f), with respect to the third and fourth calendar quarters of fiscal 
year 2003 and each calendar quarter of fiscal year 2004, the amounts 
otherwise determined for Puerto Rico, the Virgin Islands, Guam, the 
Northern Mariana Islands, and American Samoa under subsections (f) and 
(g) of section 1108 of the Social Security Act (42 U.S.C. 1308) shall 
each be increased by an amount equal to 7.46 percent of such amounts.
    (e) Scope of Application.--The increases in the FMAP for a State 
under this section shall apply only for purposes of title XIX of the 
Social Security Act and shall not apply with respect to--
            (1) disproportionate share hospital payments described in 
        section 1923 of such Act (42 U.S.C. 1396r-4); or
            (2) payments under title IV or XXI of such Act (42 U.S.C. 
        601 et seq. and 1397aa et seq.).
    (f) State Eligibility.--
            (1) In general.--Subject to paragraph (2), a State is 
        eligible for an increase in its FMAP under subsection (c) or an 
        increase in a cap amount under subsection (d) only if the 
        eligibility under its State plan under title XIX of the Social 
        Security Act (including any waiver under such title or under 
        section 1115 of such Act (42 U.S.C. 1315)) is no more 
        restrictive than the eligibility under such plan (or waiver) as 
        in effect on September 2, 2003.
            (2) State reinstatement of eligibility permitted.--A State 
        that has restricted eligibility under its State plan under 
        title XIX of the Social Security Act (including any waiver 
        under such title or under section 1115 of such Act (42 U.S.C. 
        1315)) after September 2, 2003, but prior to the date of 
        enactment of this Act is eligible for an increase in its FMAP 
        under subsection (c) or an increase in a cap amount under 
        subsection (d) in the first calendar quarter (and subsequent 
        calendar quarters) in which the State has reinstated 
        eligibility that is no more restrictive than the eligibility 
        under such plan (or waiver) as in effect on September 2, 2003.
            (3) Rule of construction.--Nothing in paragraph (1) or (2) 
        shall be construed as affecting a State's flexibility with 
        respect to benefits offered under the State medicaid program 
        under title XIX of the Social Security Act (42 U.S.C. 1396 et 
        seq.) (including any waiver under such title or under section 
        1115 of such Act (42 U.S.C. 1315)).
    (g) Definitions.--In this section:
            (1) FMAP.--The term ``FMAP'' means the Federal medical 
        assistance percentage, as defined in section 1905(b) of the 
        Social Security Act (42 U.S.C. 1396d(b)).
            (2) State.--The term ``State'' has the meaning given such 
        term for purposes of title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.).
    (h) Repeal.--Effective as of October 1, 2004, this section is 
repealed.

SEC. 202. TEMPORARY GRANTS FOR STATE FISCAL RELIEF.

    (a) In General.--Title XX of the Social Security Act (42 U.S.C. 
1397-1397f) is amended by adding at the end the following:

``SEC. 2008. ADDITIONAL TEMPORARY GRANTS FOR STATE FISCAL RELIEF.

    ``(a) In General.--For the purpose of providing State fiscal relief 
allotments to States under this section, there are hereby appropriated, 
out of any funds in the Treasury not otherwise appropriated, 
$15,000,000,000. Such funds shall be available for obligation by the 
State through June 30, 2005, and for expenditure by the State through 
September 30, 2005. This section constitutes budget authority in 
advance of appropriations Acts and represents the obligation of the 
Federal Government to provide for the payment to States of amounts 
provided under this section.
    ``(b) Allotment.--Funds appropriated under subsection (a) shall be 
allotted by the Secretary among the States in accordance with the 
following table:

      

------------------------------------------------------------------------
               ``State                       Allotment (in dollars)
------------------------------------------------------------------------
 Alabama                                $170,940,139
 Alaska                                 $42,076,374
 Amer. Samoa                            $414,007
 Arizona                                $261,264,449
 Arkansas                               $133,398,723
 California                             $1,583,851,051
 Colorado                               $143,030,332
 Connecticut                            $207,204,156
 Delaware                               $38,537,434
 District of Columbia                   $65,034,813
 Florida                                $624,655,953
 Georgia                                $368,582,068
 Guam                                   $669,845
 Hawaii                                 $46,337,939
 Idaho                                  $48,659,904
 Illinois                               $543,631,283
 Indiana                                $271,629,605
 Iowa                                   $130,309,854
 Kansas                                 $94,370,028
 Kentucky                               $212,122,967
 Louisiana                              $239,827,085
 Maine                                  $92,781,591
 Maryland                               $236,000,265
 Massachusetts                          $472,765,757
 Michigan                               $435,451,207
 Minnesota                              $302,429,550
 Mississippi                            $176,956,163
 Missouri                               $302,534,081
 Montana                                $36,437,168
 Nebraska                               $79,550,313
 Nevada                                 $52,331,624
 New Hampshire                          $54,101,351
 New Jersey                             $411,954,920
 New Mexico                             $112,850,197
 New York                               $2,383,327,447
 North Carolina                         $439,742,488
 North Dakota                           $27,253,781
 N. Mariana Islands                     $233,880
 Ohio                                   $616,448,513
 Oklahoma                               $146,240,811
 Oregon                                 $167,002,460
 Pennsylvania                           $745,862,667
 Puerto Rico                            $18,916,230
 Rhode Island                           $80,098,624
 South Carolina                         $184,217,430
 South Dakota                           $30,302,145
 Tennessee                              $350,273,887
 Texas                                  $814,722,031
 Utah                                   $63,422,131
 Vermont                                $40,549,714
 Virgin Islands                         $624,499
 Virginia                               $215,155,129
 Washington                             $298,697,312
 West Virginia                          $95,818,709
 Wisconsin                              $270,901,128
 Wyoming                                $17,496,788
------------------------------------------------------------------------
 Total                                  $15,000,000,000
------------------------------------------------------------------------

    ``(c) Use of Funds.--Funds appropriated under this section may be 
used by a State for services directed at the goals set forth in section 
2001, subject to the requirements of this title.
    ``(d) Payment to States.--Not later than 30 days after amounts are 
appropriated under subsection (a), in addition to any payment made 
under section 2002 or 2007, the Secretary shall make a lump sum payment 
to a State of the total amount of the allotment for the State as 
specified in subsection (b).
    ``(e) Definition.--For purposes of this section, the term `State' 
means the 50 States, the District of Columbia, and the territories 
contained in the list under subsection (b).''.
    (b) Repeal.--Effective as of October 1, 2005, section 2008 of the 
Social Security Act, as added by subsection (a), is repealed.
    (c) GAO Study and Report.--
            (1) Study.--The Comptroller General of the United States 
        shall conduct a study to determine an appropriate index that 
        could be used to temporarily adjust the Federal medical 
        assistance percentage for purposes of programs authorized under 
        the Social Security Act either with respect to all States 
        during a period of national recession or with respect to a 
        specific State when the State's economy takes a significant 
        turn for the worse.
            (2) Report.--Not later than 1 year after the date of the 
        enactment of this Act, the Comptroller General of the United 
        States shall submit a report to Congress on the study conducted 
        under paragraph (1).

SEC. 203. INCREASING MEDICAID DSH ALLOTMENTS.

    (a) Continuation of Medicaid DSH Allotment Adjustments Under BIPA 
2000.--
            (1) In general.--Section 1923(f) of the Social Security Act 
        (42 U.S.C. 1396r-4(f))--
                    (A) in paragraph (2)--
                            (i) in the heading, by striking ``through 
                        2002'' and inserting ``through 2000'';
                            (ii) by striking ``ending with fiscal year 
                        2002'' and inserting ``ending with fiscal year 
                        2000''; and
                            (iii) in the table in such paragraph, by 
                        striking the columns labeled ``FY 01'' and 
                        ``FY02'';
                    (B) in paragraph (3)(A), by striking ``paragraph 
                (2)'' and inserting ``paragraph (4)''; and
                    (C) in paragraph (4), as added by section 701(a)(1) 
                of the Medicare, Medicaid, and SCHIP Benefits 
                Improvement and Protection Act of 2000 (as enacted into 
                law by section 1(a)(6) of Public Law 106-554)--
                            (i) by striking ``for fiscal years 2001 and 
                        2002'' in the heading;
                            (ii) in subparagraph (A), by striking 
                        ``Notwithstanding paragraph (2), the'' and 
                        inserting ``The'';
                            (iii) in subparagraph (C)--
                                    (I) by striking ``No application'' 
                                and inserting ``Application''; and
                                    (II) by striking ``without regard 
                                to'' and inserting ``taking into 
                                account''.
            (2) Increase in medicaid dsh allotment for the district of 
        columbia.--
                    (A) In general.--Effective for DSH allotments 
                beginning with fiscal year 2003, the item in the table 
                contained in section 1923(f)(2) of the Social Security 
                Act (42 U.S.C. 1396r-4(f)(2)) for the District of 
                Columbia for the DSH allotment for FY 00 (fiscal year 
                2000) is amended by striking ``32'' and inserting 
                ``49''.
                    (B) Construction.--Nothing in subparagraph (A) 
                shall be construed as preventing the application of 
                section 1923(f)(4) of the Social Security Act (as 
                amended by subsection (a)) to the District of Columbia 
                for fiscal year 2003 and subsequent fiscal years.
            (3) Effective date.--The amendments made by this subsection 
        shall apply to DSH allotments for fiscal years beginning with 
        fiscal year 2003.
    (b) Increase in Floor for Treatment as an Extremely Low DSH State 
to 3 Percent in Fiscal Year 2003.--
            (1) Increase in dsh floor.--Section 1923(f)(5) of the 
        Social Security Act (42 U.S.C. 1396r-4(f)(5)) is amended--
                    (A) by striking ``fiscal year 1999'' and inserting 
                ``fiscal year 2001'';
                    (B) by striking ``August 31, 2000'' and inserting 
                ``August 31, 2002'';
                    (C) by striking ``1 percent'' each place it appears 
                and inserting ``3 percent''; and
                    (D) by striking ``fiscal year 2001'' and inserting 
                ``fiscal year 2003''.
            (2) Effective date.--The amendments made by paragraph (1) 
        take effect as if enacted on October 1, 2002, and apply to DSH 
        allotments under title XIX of the Social Security Act for 
        fiscal year 2003 and each fiscal year thereafter.

SEC. 204. INCREASED STATE ACCESS TO UNSPENT SCHIP FUNDS.

    (a) Retained and Redistributed Allotments for Fiscal Years 1998 and 
1999.--Paragraphs (2)(A)(i) and (2)(A)(ii) of section 2104(g) of the 
Social Security Act (42 U.S.C. 1397dd(g)) are each amended by striking 
``fiscal year 2002'' and inserting ``fiscal year 2004''.
    (b) Extension and Revision of Retained and Redistributed Allotments 
for Fiscal Year 2000.--
            (1) Permitting and extending retention of portion of fiscal 
        year 2000 allotment.--Paragraph (2) of such section 2104(g) is 
        amended--
                    (A) in the heading, by striking ``and 1999'' and 
                inserting ``through 2000''; and
                    (B) by adding at the end of subparagraph (A) the 
                following:
                            ``(iii) Fiscal year 2000 allotment.--Of the 
                        amounts allotted to a State pursuant to this 
                        section for fiscal year 2000 that were not 
                        expended by the State by the end of fiscal year 
                        2002, 50 percent of that amount shall remain 
                        available for expenditure by the State through 
                        the end of fiscal year 2004.''.
            (2) Redistributed allotments.--Paragraph (1) of such 
        section 2104(g) is amended--
                    (A) in subparagraph (A), by inserting ``or for 
                fiscal year 2000 by the end of fiscal year 2002,'' 
                after ``fiscal year 2001,'';
                    (B) in subparagraph (A), by striking ``1998 or 
                1999'' and inserting ``1998, 1999, or 2000'';
                    (C) in subparagraph (A)(i)--
                            (i) by striking ``or'' at the end of 
                        subclause (I),
                            (ii) by striking the period at the end of 
                        subclause (II) and inserting ``; or''; and
                            (iii) by adding at the end the following 
                        new subclause:
                                    ``(III) the fiscal year 2000 
                                allotment, the amount specified in 
                                subparagraph (C)(i) (less the total of 
                                the amounts under clause (ii) for such 
                                fiscal year), multiplied by the ratio 
                                of the amount specified in subparagraph 
                                (C)(ii) for the State to the amount 
                                specified in subparagraph (C)(iii).'';
                    (D) in subparagraph (A)(ii), by striking ``or 
                1999'' and inserting ``, 1999, or 2000'';
                    (E) in subparagraph (B), by striking ``with respect 
                to fiscal year 1998 or 1999'';
                    (F) in subparagraph (B)(ii)--
                            (i) by inserting ``with respect to fiscal 
                        year 1998, 1999, or 2000,'' after ``subsection 
                        (e),''; and
                            (ii) by striking ``2002'' and inserting 
                        ``2004''; and
                    (G) by adding at the end the following new 
                subparagraph:
                    ``(C) Amounts used in computing redistributions for 
                fiscal year 2000.--For purposes of subparagraph 
                (A)(i)(III)--
                            ``(i) the amount specified in this clause 
                        is the amount specified in paragraph 
                        (2)(B)(i)(I) for fiscal year 2000, less the 
                        total amount remaining available pursuant to 
                        paragraph (2)(A)(iii);
                            ``(ii) the amount specified in this clause 
                        for a State is the amount by which the State's 
                        expenditures under this title in fiscal years 
                        2000, 2001, and 2002 exceed the State's 
                        allotment for fiscal year 2000 under subsection 
                        (b); and
                            ``(iii) the amount specified in this clause 
                        is the sum, for all States entitled to a 
                        redistribution under subparagraph (A) from the 
                        allotments for fiscal year 2000, of the amounts 
                        specified in clause (ii).''.
            (3) Conforming amendments.--Such section 2104(g) is further 
        amended--
                    (A) in its heading, by striking ``and 1999'' and 
                inserting ``, 1999, and 2000''; and
                    (B) in paragraph (3)--
                            (i) by striking ``or fiscal year 1999'' and 
                        inserting ``, fiscal year 1999, or fiscal year 
                        2000''; and
                            (ii) by striking ``or November 30, 2001'' 
                        and inserting ``November 30, 2001, or November 
                        30, 2002'', respectively.
    (c) Extension and Revision of Retained and Redistributed Allotments 
for Fiscal Year 2001.--
            (1) Permitting and extending retention of portion of fiscal 
        year 2001 allotment.--Paragraph (2) of such section 2104(g), as 
        amended in subsection (b)(1)(B), is further amended--
                    (A) in the heading, by striking ``2000'' and 
                inserting ``2001''; and
                    (B) by adding at the end of subparagraph (A) the 
                following:
                            ``(iv) Fiscal year 2001 allotment.--Of the 
                        amounts allotted to a State pursuant to this 
                        section for fiscal year 2001 that were not 
                        expended by the State by the end of fiscal year 
                        2003, 50 percent of that amount shall remain 
                        available for expenditure by the State through 
                        the end of fiscal year 2005.''.
            (2) Redistributed allotments.--Paragraph (1) of such 
        section 2104(g), as amended in subsection (b)(2), is further 
        amended--
                    (A) in subparagraph (A), by inserting ``or for 
                fiscal year 2001 by the end of fiscal year 2003,'' 
                after ``fiscal year 2002,'';
                    (B) in subparagraph (A), by striking ``1999, or 
                2000'' and inserting ``1999, 2000, or 2001'';
                    (C) in subparagraph (A)(i)--
                            (i) by striking ``or'' at the end of 
                        subclause (II),
                            (ii) by striking the period at the end of 
                        subclause (III) and inserting ``; or''; and
                            (iii) by adding at the end the following 
                        new subclause:
                                    ``(IV) the fiscal year 2001 
                                allotment, the amount specified in 
                                subparagraph (D)(i) (less the total of 
                                the amounts under clause (ii) for such 
                                fiscal year), multiplied by the ratio 
                                of the amount specified in subparagraph 
                                (D)(ii) for the State to the amount 
                                specified in subparagraph (D)(iii).'';
                    (D) in subparagraph (A)(ii), by striking ``or 
                2000'' and inserting ``2000, or 2001'';
                    (E) in subparagraph (B)--
                            (i) by striking ``and'' at the end of 
                        clause (ii);
                            (ii) by redesignating clause (iii) as 
                        clause (iv); and
                            (iii) by inserting after clause (ii) the 
                        following new clause:
                            ``(iii) notwithstanding subsection (e), 
                        with respect to fiscal year 2001, shall remain 
                        available for expenditure by the State through 
                        the end of fiscal year 2005; and''; and
                    (F) by adding at the end the following new 
                subparagraph:
                    ``(D) Amounts used in computing redistributions for 
                fiscal year 2001.--For purposes of subparagraph 
                (A)(i)(IV)--
                            ``(i) the amount specified in this clause 
                        is the amount specified in paragraph 
                        (2)(B)(i)(I) for fiscal year 2001, less the 
                        total amount remaining available pursuant to 
                        paragraph (2)(A)(iv);
                            ``(ii) the amount specified in this clause 
                        for a State is the amount by which the State's 
                        expenditures under this title in fiscal years 
                        2001, 2002, and 2003 exceed the State's 
                        allotment for fiscal year 2001 under subsection 
                        (b); and
                            ``(iii) the amount specified in this clause 
                        is the sum, for all States entitled to a 
                        redistribution under subparagraph (A) from the 
                        allotments for fiscal year 2001, of the amounts 
                        specified in clause (ii).''.
            (3) Conforming amendments.--Such section 2104(g) is further 
        amended--
                    (A) in its heading, by striking ``and 2000'' and 
                inserting ``2000, and 2001''; and
                    (B) in paragraph (3)--
                            (i) by striking ``or fiscal year 2000'' and 
                        inserting ``fiscal year 2000, or fiscal year 
                        2001''; and
                            (ii) by striking ``or November 30, 2002,'' 
                        and inserting ``November 30, 2002, or November 
                        30, 2003,'', respectively.
    (d) Authority for Qualifying States To Use Portion of SCHIP Funds 
for Medicaid Expenditures.--Section 2105 of the Social Security Act (42 
U.S.C. 1397ee) is amended by adding at the end the following:
    ``(g) Authority for Qualifying States To Use Certain Funds for 
Medicaid Expenditures.--
            ``(1) State option.--
                    ``(A) In general.--Notwithstanding any other 
                provision of law, with respect to allotments for fiscal 
                years 1998, 1999, 2000, 2001, for fiscal years in which 
                such allotments are available under subsections (e) and 
                (g) of section 2104, a qualifying State (as defined in 
                paragraph (2)) may elect to use not more than 20 
                percent of such allotments (instead of for expenditures 
                under this title) for payments for such fiscal year 
                under title XIX in accordance with subparagraph (B).
                    ``(B) Payments to states.--
                            ``(i) In general.--In the case of a 
                        qualifying State that has elected the option 
                        described in subparagraph (A), subject to the 
                        total amount of funds described with respect to 
                        the State in subparagraph (A), the Secretary 
                        shall pay the State an amount each quarter 
                        equal to the additional amount that would have 
                        been paid to the State under title XIX for 
                        expenditures of the State for the fiscal year 
                        described in clause (ii) if the enhanced FMAP 
                        (as determined under subsection (b)) had been 
                        substituted for the Federal medical assistance 
                        percentage (as defined in section 1905(b)) of 
                        such expenditures.
                            ``(ii) Expenditures described.--For 
                        purposes of clause (i), the expenditures 
                        described in this clause are expenditures for 
                        such fiscal years for providing medical 
                        assistance under title XIX to individuals who 
                        have not attained age 19 and whose family 
                        income exceeds 150 percent of the poverty line.
                            ``(iii) No impact on determination of 
                        budget neutrality for waivers.--In the case of 
                        a qualifying State that uses amounts paid under 
                        this subsection for expenditures described in 
                        clause (ii) that are incurred under a waiver 
                        approved for the State, any budget neutrality 
                        determinations with respect to such waiver 
                        shall be determined without regard to such 
                        amounts paid.
            ``(2) Qualifying state.--In this subsection, the term 
        `qualifying State' means a State that--
                    ``(A) as of April 15, 1997, has an income 
                eligibility standard with respect to any 1 or more 
                categories of children (other than infants) who are 
                eligible for medical assistance under section 
                1902(a)(10)(A) or under a waiver under section 1115 
                implemented on January 1, 1994, that is up to 185 
                percent of the poverty line or above; and
                    ``(B) satisfies the requirements described in 
                paragraph (3).
            ``(3) Requirements.--The requirements described in this 
        paragraph are the following:
                    ``(A) SCHIP income eligibility.--The State has a 
                State child health plan that (whether implemented under 
                title XIX or this title)--
                            ``(i) as of January 1, 2001, has an income 
                        eligibility standard that is at least 200 
                        percent of the poverty line or has an income 
                        eligibility standard that exceeds 200 percent 
                        of the poverty line under a waiver under 
                        section 1115 that is based on a child's lack of 
                        health insurance;
                            ``(ii) subject to subparagraph (B), does 
                        not limit the acceptance of applications for 
                        children; and
                            ``(iii) provides benefits to all children 
                        in the State who apply for and meet eligibility 
                        standards on a statewide basis.
                    ``(B) No waiting list imposed.--With respect to 
                children whose family income is at or below 200 percent 
                of the poverty line, the State does not impose any 
                numerical limitation, waiting list, or similar 
                limitation on the eligibility of such children for 
                child health assistance under such State plan.
                    ``(C) Additional requirements.--The State has 
                implemented at least 3 of the following policies and 
                procedures (relating to coverage of children under 
                title XIX and this title):
                            ``(i) Uniform, simplified application 
                        form.--With respect to children 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 
                        title XIX and this title.
                            ``(ii) Elimination of asset test.--The 
                        State does not apply any asset test for 
                        eligibility under section 1902(l) or this title 
                        with respect to children.
                            ``(iii) Adoption of 12-month continuous 
                        enrollment.--The State provides that 
                        eligibility shall not be regularly redetermined 
                        more often than once every year under this 
                        title or for children described in section 
                        1902(a)(10)(A).
                            ``(iv) Same verification and 
                        redetermination policies; automatic 
                        reassessment of eligibility.--With respect to 
                        children 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 this title, 
                        and, as part of such redeterminations, provides 
                        for the automatic reassessment of the 
                        eligibility of such children for assistance 
                        under title XIX and this title.
                            ``(v) Outstationing enrollment staff.--The 
                        State provides for the receipt and initial 
                        processing of applications for benefits under 
                        this title and for children under title XIX at 
                        facilities defined as disproportionate share 
                        hospitals under section 1923(a)(1)(A) and 
                        Federally-qualified health centers described in 
                        section 1905(l)(2)(B) consistent with section 
                        1902(a)(55).''.
    (e) Effective Date.--Subsections (a) through (c), and the 
amendments made by such subsections, shall be effective as if this 
section had been enacted on September 30, 2002, and amounts under title 
XXI of the Social Security Act (42 U.S.C. 1397aa et seq.) from 
allotments for fiscal years 1998 through 2000 are available for 
expenditure on and after October 1, 2002, under the amendments made by 
such subsections as if this section had been enacted on September 30, 
2002.

SEC. 205. FEDERAL RESPONSIBILITY FOR EMERGENCY CARE FOR ILLEGAL 
              IMMIGRANTS.

    (a) In General.--Section 1903(a)(3) of the Social Security Act (42 
U.S.C. 1396b(a)(3)) is amended--
            (1) in subparagraph (D), by striking ``plus'' at the end 
        and inserting ``and''; and
            (2) by adding at the end the following:
                    ``(E) 100 percent of the sums expended with respect 
                to costs incurred during such quarter as are 
                attributable to the provision of care and services that 
                are furnished to an alien described in subsection 
                (v)(1) that are necessary for the treatment of an 
                emergency medical condition, as defined in subsection 
                (v)(3); and''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on July 1, 2003.

SEC. 206. INCREASED FEDERAL RESPONSIBILITY FOR TRANSLATION SERVICES.

    (a) In General.--Section 1903(a)(3) of the Social Security Act (42 
U.S.C. 1396b(a)(3)), as amended by section 205(a), is amended by adding 
at the end the following:
                    ``(F) 90 percent of the sums expended with respect 
                to costs incurred during such quarter as are 
                attributable to the provision of language services, 
                including oral interpretation, translations of written 
                materials, and other language services, for individuals 
                with limited English proficiency who apply for, or 
                receive, medical assistance under the State plan; 
                and''.
    (b) SCHIP.--Section 2105(A)(1) of the Social Security Act (42 
U.S.C.1397ee(a)(1)) is amended--
            (1) in the matter preceding subparagraph (A), by striking 
        ``section 1905(b))'' and inserting ``section 1905(b)) or, in 
        the case of expenditures described in subparagraph (D)(iv), 90 
        percent''; and
            (2) in subparagraph (D)--
                    (A) in clause (iii), by striking ``and'' at the 
                end;
                    (B) by redesignating clause (iv) as clause (v); and
                    (C) by inserting after clause (iii) the following:
                    ``(D) for expenditures attributable to the 
                provision of language services, including oral 
                interpretation, translations of written materials, and 
                other language services, for individuals with limited 
                English proficiency who apply for, or receive, child 
                health assistance under the plan; and''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on July 1, 2003.

SEC. 207. INCREASED FEDERAL MATCHING RATES FOR CERTAIN SERVICES.

    (a) Outstationed Workers.--Section 1903(a)(3) of the Social 
Security Act (42 U.S.C. 1396b(a)(3)), as amended by sections 205(a) and 
206(a), is amended by adding at the end the following:
                    ``(G) 90 percent of the sums expended with respect 
                to costs incurred during such quarter as are 
                attributable to providing for the receipt and initial 
                processing of applications of children and pregnant 
                women for medical assistance consistent with the 
                requirements of section 1902(a)(55); plus''.
    (b) 100 Percent Matching Rate for Urban Indian Health Services.--
The third sentence of section 1905(b) of the Social Security Act (42 
U.S.C. 1396d(b)) is amended--
            (1) by inserting ``or program'' after ``facility'';
            (2) by striking ``or by'' and inserting ``, by''; and
            (3) by inserting ``, or by an urban Indian organization 
        pursuant to a grant or contract with the Indian Health Service 
        under title V of the Indian Health Care Improvement Act'' 
        before the period.
    (c) Effective Date.--The amendments made by this section shall take 
effect on July 1, 2003.

 TITLE III--STRENGTHENING STATE AND FEDERAL COMMITMENT TO THE ELDERLY 
         AND PERSONS WITH DISABILITIES; FAMILY OPPORTUNITY ACT

           Subtitle A--Elderly and Persons With Disabilities

SEC. 301. FULL ACCOUNTING OF SAVINGS IN DETERMINING COST-EFFECTIVENESS.

    (a) In General.--Section 1915(c)(2)(D) of the Social Security Act 
(42 U.S.C. 1396n(c)(2)(D)) is amended by inserting ``(reduced by 
average per capita reductions in spending under other Federal mandatory 
spending programs resulting from operation of the waiver)'' after 
``with respect to such individuals''.
    (b) Effective Date.--The amendment made by subsection shall take 
effect on the date of the enactment of this Act.

SEC. 302. EXTENSION OF MEDICAID COVERAGE UNDER THE TICKET TO WORK 
              PROGRAM TO COVER SPOUSES.

    (a) In General.--Section 1902(a)(10)(A)(ii) of the Social Security 
Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--
            (1) in clause (i)(II), by inserting before the comma at the 
        end the following: ``, and at the option of a State, any 
        individual who is the spouse of such an individual'';
            (2) in clause (ii)(XIII), by inserting before the semicolon 
        at the end the following: ``, and at the option of a State, any 
        individual who is the spouse of such an individual'';
            (3) in subclause (XV), by inserting before the semicolon at 
        the end the following: ``, and at the option of a State, any 
        individual who is the spouse of such an individual''; and
            (4) in subclause (XVI), by inserting before the semicolon 
        at the end the following: ``, and at the option of a State, any 
        individual who is the spouse of such an individual''.
    (b) Conforming Amendment.--Section 1905(a)(xii) of such Act (42 
U.S.C. 1396d(a)(xii)) is amended by inserting ``and spouses described 
in clauses (i)(II), (ii)(XIII), (ii)(XV), and (ii)(XVI) of section 
1902(a)(10)(A)'' after ``subsection (v))''.
    (c) Effective Date.--The amendments made by this section take 
effect on October 1, 2003, whether or not regulations implementing such 
amendments have been issued.

SEC. 303. ENCOURAGING TRANSITION TO HOME AND COMMUNITY CARE.

    (a) In General.--Section 1905(b) of the Social Security Act (42 
U.S.C. 1396d(b)), as amended by section 101(a), is amended--
            (1) by striking ``and'' before ``(5)''; and
            (2) by inserting before the period the following: ``, and 
        (6) the Federal medical assistance percentage shall be equal to 
        the enhanced FMAP described in section 2105(b) with respect to 
        medical assistance provided under a waiver under section 
        1915(c)''.
    (b) Conforming Amendment.--Section 1915(c) of such Act (42 U.S.C. 
1396n(c)) is amended by adding at the end the following new paragraph:
    ``(11) For purposes of determining the amount of expenditures under 
this section or a State plan for purposes of applying any test of cost-
effectiveness or similar test in carrying out this subsection, the 
provisions of section 1905(b)(6) shall not be taken into account.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to medical assistance for items and services furnished on or 
after July 1, 2003, regardless of whether the waiver under which such 
assistance is provided was approved before, on, or after the date of 
the enactment of this Act.

SEC. 304. ENHANCED MATCHING RATE FOR DISABLED INDIVIDUALS AWAITING 
              MEDICARE ELIGIBILITY.

    (a) In General.--Section 1905(b) of the Social Security Act (42 
U.S.C. 1396d(b)), as amended by sections 101(a) and 303(a), is 
amended--
            (1) by striking ``and'' before ``(6)''; and
            (2) by inserting before the period the following: ``, and 
        (7) the Federal medical assistance percentage shall be equal to 
        100 percent with respect to medical assistance provided to 
        individuals who are not entitled to benefits under part A of 
        title XVIII pursuant to section 226(b) but who would be 
        entitled to such benefits pursuant to such section but for the 
        application of a 24-month waiting period under such section''.
    (b) Effective Date.--The amendments made by this section shall 
apply to medical assistance for items and services furnished on or 
after October 1, 2003.

SEC. 305. PROVIDING INITIAL TERM OF 5 YEARS FOR SECTION 1915 WAIVERS.

    (a) In General.--Subsections (d)(3) and (e)(3) of section 1915 of 
the Social Security Act (42 U.S.C. 1396n) are each amended by striking 
``3 years'' and inserting ``5 years''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to waivers granted on or after the date of the enactment of this 
Act.

SEC. 306. OPTIONAL COVERAGE OF COMMUNITY-BASED ATTENDANT SERVICES AND 
              SUPPORTS UNDER THE MEDICAID PROGRAM.

    (a) Optional Coverage.--Section 1902(a)(10)(D) of the Social 
Security Act (42 U.S.C. 1396a(a)(10)(D)) is amended--
            (1) by inserting ``(i)'' after ``(D)'';
            (2) by adding ``and'' after the semicolon; and
            (3) by adding at the end the following new clause:
                    ``(ii) at the option of the State and subject to 
                section 1935, for the inclusion of community-based 
                attendant services and supports for any individual 
                who--
                            ``(I) is eligible for medical assistance 
                        under the State plan;
                            ``(II) with respect to whom there has been 
                        a determination that the individual requires 
                        the level of care provided in a nursing 
                        facility or an intermediate care facility for 
                        the mentally retarded (whether or not coverage 
                        of such intermediate care facility is provided 
                        under the State plan); and
                            ``(III) who chooses to receive such 
                        services and supports;
                insofar as such services are appropriate for the 
                individual's condition according to the individual's 
                plan of care;''.
    (b) Community-Based Attendant Services and Supports Option.--
            (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 inserting after section 1934 the following:

           ``community-based attendant services and supports

    ``Sec. 1935. (a) Coverage.--
            ``(1) In general.--A State may provide through a plan 
        amendment for the inclusion of community-based attendant 
        services and supports (as defined in subsection (g)(1)) for 
        individuals described in section 1902(a)(10)(D)(ii) in 
        accordance with this section.
            ``(2) Enhanced fmap for coverage.--Notwithstanding section 
        1905(b), in the case of a State with an approved plan amendment 
        under this section during that period that also satisfies the 
        requirements of subsection (c) the Federal medical assistance 
        percentage shall be equal to the enhanced FMAP described in 
        section 2105(b) with respect to medical assistance in the form 
        of community-based attendant services and supports provided to 
        individuals described in section 1902(a)(10)(D)(ii) in 
        accordance with this section.
    ``(b) Development and Implementation of Benefit.--In order for a 
State plan amendment to be approved under this section, a State shall 
develop and implement the proposal through a public process which 
includes individuals with disabilities, elderly individuals, their 
representatives, and providers, and include in that proposed plan 
amendment--
            ``(1) a State process to notify and inform individuals 
        (including individuals who live in nursing facilities, 
        individuals who live in intermediate care facilities for the 
        mentally retarded, and individuals who live in the community 
        and who have an unmet need for such services) of the 
        availability of such services and supports under this title, 
        and of other items and services that may be provided to the 
        individual under this title or title XVIII; and
            ``(2) a quality assurance program that will maximize 
        consumer independence and consumer control and will--
                    ``(A) train consumers to appropriately manage their 
                own attendant;
                    ``(B) provide a quality review process; and
                    ``(C) provide for investigation and resolution of 
                allegations of neglect, abuse, or exploitation in 
                connection with the provision of such services and 
                supports.
    ``(c) No Effect on Ability To Provide Coverage Under a Waiver.--
            ``(1) In general.--Nothing in this section shall be 
        construed as affecting the ability of a State to provide 
        coverage under the State plan for community-based attendant 
        services and supports (or similar coverage) under a waiver 
        approved under section 1915, section 1115, or otherwise.
            ``(2) Eligibility for enhanced match.--In the case of a 
        State that provides coverage for such services and supports 
        under a waiver, the State shall not be eligible under section 
        1935 for the enhanced FMAP for the provision of such coverage 
        under this unless the State submits a plan amendment to the 
        Secretary that meets the requirements of this section.
    ``(d) Definitions.--In this title:
            ``(1) Community-based attendant services and supports.--
                    ``(A) In general.--The term `community-based 
                attendant services and supports' may include one or 
                more of the following: attendant services and supports 
                furnished to an individual, as needed, to assist in 
                accomplishing activities of daily living, instrumental 
                activities of daily living, and health-related 
                functions through hands-on assistance, supervision, or 
                cueing--
                            ``(i) under a plan of services and supports 
                        that is based on an assessment of functional 
                        need and that is agreed to by the individual 
                        or, as appropriate, the individual's 
                        representative;
                            ``(ii) in a home or community setting, 
                        which may include a school, workplace, or 
                        recreation or religious facility, but does not 
                        include a nursing facility or an intermediate 
                        care facility for the mentally retarded;
                            ``(iii) under an agency-provider model or 
                        other model (as defined in paragraph (2)(C)); 
                        and
                            ``(iv) the furnishing of which is selected, 
                        managed, and dismissed by the individual, or, 
                        as appropriate, with assistance from the 
                        individual's representative.
                    ``(B) Included services and supports.--Such term 
                may include one or more of the following:
                            ``(i) Tasks necessary to assist an 
                        individual in accomplishing activities of daily 
                        living, instrumental activities of daily 
                        living, and health-related functions.
                            ``(ii) The acquisition, maintenance, and 
                        enhancement of skills necessary for the 
                        individual to accomplish activities of daily 
                        living, instrumental activities of daily 
                        living, and health-related functions.
                            ``(iii) Backup systems or mechanisms (such 
                        as the use of beepers), as defined by the State 
                        according to the client's needs, to ensure 
                        continuity of services and supports.
                            ``(iv) Voluntary training on how to select, 
                        manage, and dismiss attendants.
                    ``(C) Excluded services and supports.--Subject to 
                subparagraph (D), such term does not include--
                            ``(i) the provision of room and board for 
                        the individual;
                            ``(ii) special education and related 
                        services provided under the Individuals with 
                        Disabilities Education Act and vocational 
                        rehabilitation services provided under the 
                        Rehabilitation Act of 1973;
                            ``(iii) assistive technology devices and 
                        assistive technology services;
                            ``(iv) durable medical equipment; or
                            ``(v) home modifications.
                    ``(D) Flexibility in transition to community-based 
                home setting.--Such term may include expenditures for 
                transitional costs required for an individual to make 
                the transition from a nursing facility or intermediate 
                care facility for the mentally retarded to a community-
                based home setting where the individual resides.
                    ``(E) Clarification of permitting payment of 
                relatives for providing services and supports.--Nothing 
                in this section shall be construed as preventing 
                community-based attendant services and supports from 
                being furnished to an individual by others who are 
                related to that individual and for such others being 
                paid for so furnishing such services and supports.
            ``(2) Additional definitions.--
                    ``(A) Activities of daily living.--The term 
                `activities of daily living' includes eating, 
                toileting, grooming, dressing, bathing, and 
                transferring.
                    ``(B) Consumer controlled.--The term `consumer 
                controlled' means a method of providing services and 
                supports that allow the individual, or where 
                appropriate, the individual's representative, maximum 
                control of the community-based attendant services and 
                supports, regardless of who acts as the employer of 
                record.
                    ``(C) Delivery models.--
                            ``(i) Agency-provider model.--The term 
                        `agency-provider model' means, with respect to 
                        the provision of community-based attendant 
                        services and supports for an individual, a 
                        method of providing consumer controlled 
                        services and supports under which entities 
                        contract for the provision of such services and 
                        supports.
                            ``(ii) Other models.--The term `other 
                        models' means methods, other than an agency-
                        provider model, for the provision of consumer 
                        controlled services and supports. Such models 
                        may include direct cash payments or use of a 
                        fiscal agent to assist in obtaining services.
                    ``(D) Health-related functions.--The term `health-
                related functions' means functions that can be 
                delegated or assigned by licensed health-care 
                professionals under State law to be performed by an 
                attendant.
                    ``(E) Instrumental activities of daily living.--The 
                term `instrumental activities of daily living' includes 
                meal planning and preparation, managing finances, 
                shopping for food, clothing, and other essential items, 
                performing essential household chores, communicating by 
                phone and other media, and other activities needed to 
                participate in the community, as appropriate.
                    ``(F) Individual's representative.--The term 
                `individual's representative' means a parent, a family 
                member, a guardian, an advocate, or an authorized 
                representative of an individual.''.
    (c) Investigation by State.--Section 1903(q)(4)(A)(i) of such Act 
(42 U.S.C. 1396b(q)(4)(A)(i)) is amended by inserting ``and for 
investigation and resolution of allegations of neglect, abuse, or 
exploitation in connection with the provision of community-based 
attendant services and supports under section 1935(b)(2)(C)'' before 
the semicolon.
    (d) Effective Date.--The amendments made by this section take 
effect on October 1, 2003, and apply to medical assistance provided for 
community-based attendant services and supports described in section 
1935 of the Social Security Act furnished on or after that date.

                   Subtitle B--Family Opportunity Act

SEC. 311. SHORT TITLE.

    This subtitle may be cited as the ``Family Opportunity Act of 
2003'' or the ``Dylan Lee James Act''.

SEC. 312. OPPORTUNITY FOR FAMILIES OF DISABLED CHILDREN TO PURCHASE 
              MEDICAID COVERAGE FOR SUCH CHILDREN.

    (a) State Option To Allow Families of Disabled Children To Purchase 
Medicaid Coverage for Such Children.--
            (1) In general.--Section 1902 (42 U.S.C. 1396a) is 
        amended--
                    (A) in subsection (a)(10)(A)(ii)--
                            (i) by striking ``or'' at the end of 
                        subclause (XVII);
                            (ii) by adding ``or'' at the end of 
                        subclause (XVIII); and
                            (iii) by adding at the end the following 
                        new subclause:
                                    ``(XIX) who are disabled children 
                                described in subsection (cc)(1);''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(cc)(1) Individuals described in this paragraph are individuals--
            ``(A) who have not attained 18 years of age;
            ``(B) who 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; and
            ``(C) whose family income does not exceed such income level 
        as the State establishes and does not exceed--
                    ``(i) 300 percent of the income official poverty 
                line (as defined by the Office of Management and 
                Budget, and revised annually in accordance with section 
                673(2) of the Omnibus Budget Reconciliation Act of 
                1981) applicable to a family of the size involved; or
                    ``(ii) such higher percent of such poverty line as 
                a State may establish, except that no Federal financial 
                participation shall be provided under section 1903(a) 
                for any medical assistance provided to an individual 
                who would not be described in this subsection but for 
                this clause.''.
            (2) Interaction with employer-sponsored family coverage.--
        Section 1902(cc) (42 U.S.C. 1396a(cc)), as added by paragraph 
        (1), is amended by adding at the end the following new 
        paragraph:
    ``(2)(A) If an employer of a parent of an individual described in 
paragraph (1) offers family coverage under a group health plan (as 
defined in section 2791(a) of the Public Health Service Act), the State 
may--
            ``(i) require such parent to apply for, enroll in, and pay 
        premiums for, such coverage as a condition of such parent's 
        child being or remaining eligible for medical assistance under 
        subsection (a)(10)(A)(ii)(XIX) if the parent is determined 
        eligible for such coverage and the employer contributes at 
        least 50 percent of the total cost of annual premiums for such 
        coverage; and
            ``(ii) if such coverage is obtained--
                    ``(I) subject to paragraph (2) of section 1916(h), 
                reduce the premium imposed by the State under that 
                section (if any) in an amount that reasonably reflects 
                the premium contribution made by the parent for private 
                coverage on behalf of a child with a disability; and
                    ``(II) treat such coverage as a third party 
                liability under subsection (a)(25).
    ``(B) In the case of a parent to which subparagraph (A) applies, if 
the family income of such parent does not exceed 300 percent of the 
income official poverty line (referred to in paragraph (1)(C)(i)), a 
State may provide for payment of any portion of the annual premium for 
such family coverage that the parent is required to pay. Any payments 
made by the State under this subparagraph shall be considered, for 
purposes of section 1903(a), to be payments for medical assistance.''.
    (b) State Option To Impose Income-Related Premiums.--Section 1916 
(42 U.S.C. 1396o) is amended--
            (1) in subsection (a), by striking ``subsection (g)'' and 
        inserting ``subsections (g) and (h)''; and
            (2) by adding at the end the following new subsection:
    ``(h)(1) With respect to disabled children provided medical 
assistance under section 1902(a)(10)(A)(ii)(XIX), subject to paragraph 
(2), a State may (in a uniform manner for such children) require the 
families of such children to pay monthly premiums set on a sliding 
scale based on family income.
    ``(2) A premium requirement imposed under paragraph (1) may only 
apply to the extent that--
            ``(A) the aggregate amount of such premium and any premium 
        that the parent is required to pay for family coverage under 
        section 1902(cc)(2)(A)(i) does not exceed 5 percent of the 
        family's income; and
            ``(B) the requirement is imposed consistent with section 
        1902(cc)(2)(A)(ii)(I).
    ``(3) A State shall not require prepayment of a premium imposed 
pursuant to paragraph (1) and shall not terminate eligibility of a 
child under section 1902(a)(10)(A)(ii)(XIX) for medical assistance 
under this title on the basis of failure to pay any such premium until 
such failure continues for a period of not less than 60 days from the 
date on which the premium became past due. The State may waive payment 
of any such premium in any case where the State determines that 
requiring such payment would create an undue hardship.''.
    (c) Conforming Amendment.--Section 1903(f)(4) (42 U.S.C. 
1396b(f)(4)) is amended in the matter preceding subparagraph (A) by 
inserting ``1902(a)(10)(A)(ii)(XIX),'' after 
``1902(a)(10)(A)(ii)(XVIII),''.
    (d) Effective Date.--The amendments made by this section shall 
apply to medical assistance for items and services furnished on or 
after January 1, 2004.

SEC. 313. TREATMENT OF INPATIENT PSYCHIATRIC HOSPITAL SERVICES FOR 
              INDIVIDUALS UNDER AGE 21 IN HOME OR COMMUNITY-BASED 
              SERVICES WAIVERS.

    (a) In General.--Section 1915(c) (42 U.S.C. 1396n(c)) is amended--
            (1) in paragraph (1)--
                    (A) in the first sentence, by inserting ``, or 
                inpatient psychiatric hospital services for individuals 
                under age 21,'' after ``intermediate care facility for 
                the mentally retarded''; and
                    (B) in the second sentence, by inserting ``, or 
                inpatient psychiatric hospital services for individuals 
                under age 21'' before the period;
            (2) in paragraph (2)(B), by striking ``or services in an 
        intermediate care facility for the mentally retarded'' each 
        place it appears and inserting ``, services in an intermediate 
care facility for the mentally retarded, or inpatient psychiatric 
hospital services for individuals under age 21'';
            (3) by striking paragraph (2)(C) and inserting the 
        following:
            ``(C) such individuals who are determined to be likely to 
        require the level of care provided in a hospital, nursing 
        facility, or intermediate care facility for the mentally 
        retarded, or inpatient psychiatric hospital services for 
        individuals under age 21, are informed of the feasible 
        alternatives, if available under the waiver, at the choice of 
        such individuals, to the provision of inpatient hospital 
        services, nursing facility services, services in an 
        intermediate care facility for the mentally retarded, or 
        inpatient psychiatric hospital services for individuals under 
        age 21;''; and
            (4) in paragraph (7)(A)--
                    (A) by inserting ``, or inpatient psychiatric 
                hospital services for individuals under age 21,'' after 
                ``intermediate care facility for the mentally 
                retarded''; and
                    (B) by inserting ``, or who would require inpatient 
                psychiatric hospital services for individuals under age 
                21'' before the period.
    (b) Effective Date.--The amendments made by subsection (a) apply 
with respect to medical assistance provided on or after January 1, 
2003.

SEC. 314. DEMONSTRATION OF COVERAGE UNDER THE MEDICAID PROGRAM OF 
              CHILDREN WITH POTENTIALLY SEVERE DISABILITIES.

    (a) State Application.--A State may apply to the Secretary of 
Health and Human Services (in this section referred to as the 
``Secretary'') for approval of a demonstration project (in this section 
referred to as a ``demonstration project'') under which up to a 
specified maximum number of children with a potentially severe 
disability (as defined in subsection (b)) are provided medical 
assistance under the State medicaid plan under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.).
    (b) Child With a Potentially Severe Disability Defined.--
            (1) In general.--In this section, the term ``child with a 
        potentially severe disability'' means, with respect to a 
        demonstration project, an individual who--
                    (A) has not attained 21 years of age;
                    (B) has a physical or mental condition, disease, 
                disorder (including a congenital birth defect or a 
                metabolic condition), injury, or developmental 
                disability that was incurred before the individual 
                attained such age; and
                    (C) is reasonably expected, but for the receipt of 
                medical assistance under the State medicaid plan, to 
                reach the level of disability defined under section 
                1614(a)(3) of the Social Security Act (42 U.S.C. 
                1382c(a)(3)), (determined without regard to the 
                reference to age in subparagraph (C) of that section).
            (2) Exception.--Such term does not include an individual 
        who would be considered disabled under section 1614(a)(3)(C) of 
        the Social Security Act (42 U.S.C. 1382c(a)(3)(C)) (determined 
        without regard to the reference to age in that section).
    (c) Approval of Demonstration Projects.--
            (1) In general.--Subject to paragraph (3), the Secretary 
        shall approve applications under subsection (a) that meet the 
        requirements of paragraph (2) and such additional terms and 
        conditions as the Secretary may require. The Secretary may 
        waive the requirement of section 1902(a)(1) of the Social 
        Security Act (42 U.S.C. 1396a(a)(1)) to allow for sub-State 
        demonstrations.
            (2) Terms and conditions of demonstration projects.--The 
        Secretary may not approve a demonstration project under this 
        section unless the State provides assurances satisfactory to 
        the Secretary that the following conditions are or will be met:
                    (A) Independent evaluation.--The State provides for 
                an independent evaluation of the project to be 
                conducted during fiscal year 2006.
                    (B) Consultation for development of criteria.--The 
                State consults with appropriate pediatric health 
                professionals in establishing the criteria for 
                determining whether a child has a potentially severe 
                disability.
                    (C) Annual report.--The State submits an annual 
                report to the Secretary (in a uniform form and manner 
                established by the Secretary) on the use of funds 
                provided under the grant that includes the following:
                            (i) Enrollment and financial statistics 
                        on--
                                    (I) the total number of children 
                                with a potentially severe disability 
                                enrolled in the demonstration project, 
                                disaggregated by disability;
                                    (II) the services provided by 
                                category or code and the cost of each 
                                service so categorized or coded; and
                                    (III) the number of children 
                                enrolled in the demonstration project 
                                who also receive services through 
                                private insurance.
                            (ii) With respect to the report submitted 
                        for fiscal year 2006, the results of the 
                        independent evaluation conducted under 
                        subparagraph (A).
                            (iii) Such additional information as the 
                        Secretary may require.
            (3) Limitations on federal funding.--
                    (A) Appropriation.--
                            (i) In general.--Out of any funds in the 
                        Treasury not otherwise appropriated, there is 
                        appropriated to carry out this section--
                                    (I) $16,666,000 for each of fiscal 
                                years 2002 and 2003; and
                                    (II) $16,667,000 for each of fiscal 
                                years 2004 through 2007.
                            (ii) Budget authority.--Clause (i) 
                        constitutes budget authority in advance 
of appropriations Acts and represents the obligation of the Federal 
Government to provide for the payment of the amounts appropriated under 
clause (i).
                    (B) Limitation on payments.--In no case may--
                            (i) the aggregate amount of payments made 
                        by the Secretary to States under this section 
                        exceed $100,000,000;
                            (ii) the aggregate amount of payments made 
                        by the Secretary to States for administrative 
                        expenses relating to the evaluations and annual 
                        reports required under subparagraphs (A) and 
                        (C) of paragraph (2) exceed $2,000,000 of such 
                        $100,000,000; or
                            (iii) payments be provided by the Secretary 
                        for a fiscal year after fiscal year 2010.
                    (C) Funds allocated to states.--
                            (i) In general.--The Secretary shall 
                        allocate funds to States based on their 
                        applications and the availability of funds. In 
                        making such allocations, the Secretary shall 
                        ensure an equitable distribution of funds among 
                        States with large populations and States with 
                        small populations.
                            (ii) Availability.--Funds allocated to a 
                        State under a grant made under this section for 
                        a fiscal year shall remain available until 
                        expended.
                    (D) Funds not allocated to states.--Funds not 
                allocated to States in the fiscal year for which they 
                are appropriated shall remain available in succeeding 
                fiscal years for allocation by the Secretary using the 
                allocation formula established under this section.
                    (E) Payments to states.--The Secretary shall pay to 
                each State with a demonstration project approved under 
                this section, from its allocation under subparagraph 
                (C), an amount for each quarter equal to the Federal 
                medical assistance percentage (as defined in section 
                1905(b) of the Social Security Act (42 U.S.C. 
                1395d(b))) of expenditures in the quarter for medical 
                assistance provided to children with a potentially 
                severe disability.
    (d) Recommendation.--Not later than October 1, 2005, the Secretary 
shall submit a recommendation to the Committee on Commerce of the House 
of Representatives and the Committee on Finance of the Senate regarding 
whether the demonstration project established under this section should 
be continued after fiscal year 2007.
    (e) State Defined.--In this section, the term ``State'' has the 
meaning given such term for purposes of title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.).

SEC. 315. DEVELOPMENT AND SUPPORT OF FAMILY-TO-FAMILY HEALTH 
              INFORMATION CENTERS.

    Section 501 (42 U.S.C. 701) is amended by adding at the end the 
following new subsection:
    ``(c)(1) In addition to amounts appropriated under subsection (a) 
and retained under section 502(a)(1) for the purpose of carrying out 
activities described in subsection (a)(2), there is appropriated to the 
Secretary, out of any money in the Treasury not otherwise appropriated, 
for the purpose of enabling the Secretary (through grants, contracts, 
or otherwise) to provide for special projects of regional and national 
significance for the development and support of family-to-family health 
information centers described in paragraph (2), $10,000,000 for each of 
fiscal years 2002 through 2007. Funds appropriated under this paragraph 
shall remain available until expended.
    ``(2) The family-to-family health information centers described in 
this paragraph are centers that--
            ``(A) assist families of children with disabilities or 
        special health care needs to make informed choices about health 
        care in order to promote good treatment decisions, cost-
        effectiveness, and improved health outcomes for such children;
            ``(B) provide information regarding the health care needs 
        of, and resources available for, children with disabilities or 
        special health care needs;
            ``(C) identify successful health delivery models for such 
        children;
            ``(D) develop with representatives of health care 
        providers, managed care organizations, health care purchasers, 
        and appropriate State agencies a model for collaboration 
        between families of such children and health professionals;
            ``(E) provide training and guidance regarding caring for 
        such children;
            ``(F) conduct outreach activities to the families of such 
        children, health professionals, schools, and other appropriate 
        entities and individuals; and
            ``(G) are staffed by families of children with disabilities 
        or special health care needs who have expertise in Federal and 
        State public and private health care systems and health 
        professionals.
    ``(3) The provisions of this title that are applicable to the funds 
made available to the Secretary under section 502(a)(1) apply in the 
same manner to funds made available to the Secretary under paragraph 
(1).''.

SEC. 316. RESTORATION OF MEDICAID ELIGIBILITY FOR CERTAIN SSI 
              BENEFICIARIES.

    (a) In General.--Section 1902(a)(10)(A)(i)(II) (42 U.S.C. 
1396a(a)(10)(A)(i)(II)) is amended--
            (1) by inserting ``(aa)'' after ``(II)'';
            (2) by striking ``or who are'' and inserting ``, (bb) who 
        are''; and
            (3) by inserting before the comma at the end the following: 
        ``, or (cc) who are under 21 years of age and with respect to 
        whom supplemental security income benefits would be paid under 
        title XVI if subparagraphs (A) and (B) of section 1611(c)(7) 
        were applied without regard to the phrase `the first day of the 
        month following'''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to medical assistance for items and services furnished on or 
after the first day of the first calendar quarter that begins after the 
date of enactment of this Act.

 TITLE IV--FACILITATING PROGRAM ADMINISTRATION AND PRESERVING COVERAGE

SEC. 401. ALLOWING UNIFORM COVERAGE OF ALL LOW INCOME AMERICANS.

    (a) In General.--Section 1902(a)(10)(A)(ii) of the Social Security 
Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--
            (1) by striking ``or'' at the end of subclause (XVII);
            (2) by adding ``or'' at the end of subclause (XVIII); and
            (3) by adding at the end the following new subclause:
                                    ``(XIX) any individual age 21 
                                through 64 whose family income does not 
                                exceed 200 percent of the income 
                                official poverty line (as defined by 
                                the Office of Management and Budget, 
                                and revised annually in accordance with 
                                section 673(2) of the Omnibus Budget 
                                Reconciliation Act of 1981) applicable 
                                to a family of the size involved;''.
    (b) Conforming Amendments.--
            (1) Section 1905(a) of such Act (42 U.S.C. 1396d(a)) is 
        amended, in the matter before paragraph (1)--
                    (A) by striking ``or'' at the end of clause (xii);
                    (B) by adding ``or'' at the end of clause (xiii); 
                and
                    (C) by inserting after clause (xiii) the following 
                new clause:
            ``(xii) individuals described in section 
        1902(a)(10)(A)(ii)(XIX),''.
            (2) Section 1903(f)(4) of such Act (42 U.S.C. 1396b(f)(4)) 
        is amended by inserting ``1902(a)(10)(A)(ii)(XIX),'' after 
        ``1902(a)(10)(A)(ii)(XVIII),''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on October 1, 2003.

SEC. 402. FACILITATING COVERAGE OF FAMILIES.

    (a) In General.--Section 1905(b) of the Social Security Act (42 
U.S.C. 1396d(b)), as amended by sections 101(a), 303(a), and 304(a), is 
amended--
            (1) by striking ``and'' before ``(7)''; and
            (2) by inserting before the period the following: ``, and 
        (8) the Federal medical assistance percentage shall be equal to 
        the enhanced FMAP described in section 2105(b) with respect to 
        medical assistance provided for individuals who are covered 
        under section 1925 or section 1931 by virtue of being a parent 
        or other caretaker relative (as defined for purposes of such 
        section) of a child and whose income does not exceed the 
        percentage of the income official poverty line applicable under 
        section 1902(l)(2)(C) to children who are eligible for medical 
        assistance under section 1902(l)(1)(D)''.
    (b) Construction.--Nothing in section 1905(b)(8) of the Social 
Security Act, as added by subsection (a)(2), shall be construed as 
preventing a State from providing medicaid benefits for individuals 
whose income exceeds 100 percent of the Federal poverty line at the 
regular FMAP.
    (c) Effective Date.--The amendments made by this section shall 
apply to medical assistance for items and services furnished on or 
after July 1, 2003.

SEC. 403. ASSISTANCE WITH COVERAGE OF LEGAL IMMIGRANTS UNDER THE 
              MEDICAID PROGRAM AND SCHIP.

    (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 may elect (in a plan amendment under this title) 
to 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, within either or both of the following eligibility 
categories:
            ``(i) Pregnant women.--Women during pregnancy (and during 
        the 60-day period beginning on the last day of the pregnancy).
            ``(ii) Children.--Children (as defined under such plan), 
        including optional targeted low-income children described in 
        section 1905(u)(2)(B).
    ``(B) In the case of a State that has elected to provide medical 
assistance to a category of aliens under subparagraph (A), no debt 
shall accrue under an affidavit of support against any sponsor of such 
an alien on the basis of provision of assistance to such category and 
the cost of such assistance shall not be considered as an unreimbursed 
cost.''.
    (b) SCHIP.--Section 2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)) 
is amended by redesignating subparagraphs (C) and (D) as subparagraph 
(D) and (E), respectively, and by inserting after subparagraph (B) the 
following new subparagraph:
                    ``(C) Section 1903(v)(4) (relating to optional 
                coverage of categories of permanent resident alien 
                children), but only if the State has elected to apply 
                such section to the category of children under title 
                XIX.''.
    (c) Effective Date.--The amendments made by this section take 
effect on October 1, 2003, and apply to medical assistance and child 
health assistance furnished on or after such date.

SEC. 404. FLEXIBILITY IN ELIGIBILITY DETERMINATIONS.

    (a) In General.--Section 1902(e) of the Social Security Act (42 
U.S.C. 1396a(e)) is amended by adding at the end the following:
    ``(13)(A) Subject to the requirements of this paragraph, at the 
option of the State, the plan may provide that financial eligibility 
requirements for medical assistance are met for an individual under 19 
years of age (or such higher age as determined by the State) by using a 
determination (made within a reasonable period, as found by the State, 
before its use for this purpose) of the individual's family or 
household income and resources, notwithstanding any differences in 
budget unit, disregards, deeming, or other methodology, by a Federal or 
State agency (or a public or private entity making such determination 
on behalf of such agency) specified by the plan, provided that such 
agency has fiscal liabilities or responsibilities affected or 
potentially affected by such determinations, provided that all 
information furnished by such agency pursuant to this subparagraph is 
used solely for purposes of determining eligibility for medical 
assistance under the State plan approved under this title or for child 
health assistance under a State plan approved under title XXI.
    ``(B) Any State electing the option under subparagraph (A) shall--
            ``(i) ensure that if an individual is determined under such 
        subparagraph to be not eligible for medical assistance under 
        the State plan approved under this title or for child health 
        assistance under a State plan under title XXI, the State must 
        subsequently determine if such individual is eligible for such 
        assistance using the methodology that would otherwise be 
        applicable in determining eligibility for such an individual; 
        and
            ``(ii) ensure that any information furnished by an agency 
        specified in such subparagraph shall be furnished with 
        reasonable promptness to the agency determining eligibility for 
        medical assistance under the State plan approved under this 
        title or for child health assistance under a State plan 
        approved under Title XXI.
    ``(C) Nothing in subparagraph (A) shall be construed to restrict 
the ability of an individual under 19 years of age (or such higher age 
as specified by the State) to apply for medical assistance under a 
State plan approved under this title or for child health assistance 
under a State plan approved under title XXI under the methodology that 
would otherwise be applicable in determining eligibility for such an 
individual.''.
    (b) Effective Date.--The amendment made by subsection (a) takes 
effect on October 1, 2003.
                                 <all>