[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 740 Introduced in Senate (IS)]







109th CONGRESS
  1st Session
                                 S. 740

To amend titles XIX and XXI of the Social Security Act to expand or add 
  coverage of pregnant women under the medicaid and State children's 
           health insurance program, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 7, 2005

 Mr. Bingaman (for himself, Mr. Lugar, Mrs. Lincoln, Mrs. Murray, Mr. 
  Kerry, Ms. Cantwell, Mr. Kohl, Mr. Lautenberg, Mrs. Boxer, and Mr. 
   Corzine) introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend titles XIX and XXI of the Social Security Act to expand or add 
  coverage of pregnant women 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.

    This Act may be cited as the ``Start Healthy, Stay Healthy Act of 
2005''.

SEC. 2. STATE OPTION TO EXPAND OR ADD COVERAGE OF CERTAIN PREGNANT 
              WOMEN UNDER MEDICAID AND SCHIP.

    (a) Medicaid.--
            (1) Authority to expand coverage.--Section 1902(l)(2)(A)(i) 
        of the Social Security Act (42 U.S.C. 1396a(l)(2)(A)(i)) is 
        amended by inserting ``(or such higher percent as the State may 
        elect for purposes of expenditures for medical assistance for 
        pregnant women described in section 1905(u)(4)(A))'' after 
        ``185 percent''.
            (2) Enhanced matching funds available if certain conditions 
        met.--Section 1905 of the Social Security Act (42 U.S.C. 1396d) 
        is amended--
                    (A) in the fourth sentence of subsection (b), by 
                striking ``or subsection (u)(3)'' and inserting ``, 
                (u)(3), or (u)(4)''; and
                    (B) in subsection (u)--
                            (i) by redesignating paragraph (4) as 
                        paragraph (5); and
                            (ii) by inserting after paragraph (3) the 
                        following:
    ``(4) For purposes of the fourth sentence of subsection (b) and 
section 2105(a), the expenditures described in this paragraph are the 
following:
            ``(A) Certain pregnant women.--If the conditions described 
        in subparagraph (B) are met, expenditures for medical 
        assistance for pregnant women described in subsection (n) or 
        under section 1902(l)(1)(A) in a family the income of which 
        exceeds the effective income level (expressed as a percent of 
        the poverty line and considering applicable income disregards) 
        that has been specified under subsection (a)(10)(A)(i)(III) or 
        (l)(2)(A) of section 1902, as of January 1, 2005, but does not 
        exceed the income eligibility level established under title XXI 
        for a targeted low-income child.
            ``(B) Conditions.--The conditions described in this 
        subparagraph are the following:
                    ``(i) The State plans under this title and title 
                XXI do not provide coverage for pregnant women 
                described in subparagraph (A) with higher family income 
                without covering such pregnant women with a lower 
                family income.
                    ``(ii) The State does not apply an effective income 
                level for pregnant women that is lower than the 
                effective income level (expressed as a percent of the 
                poverty line and considering applicable income 
                disregards) that has been specified under the State 
                plan under subsection (a)(10)(A)(i)(III) or (l)(2)(A) 
                of section 1902, as of January 1, 2005, to be eligible 
                for medical assistance as a pregnant woman.
            ``(C) Definition of poverty line.--In this subsection, the 
        term `poverty line' has the meaning given such term in section 
        2110(c)(5).''.
            (3) Payment from title xxi allotment for medicaid expansion 
        costs; elimination of counting medicaid child presumptive 
        eligibility costs against title xxi allotment.--Section 
        2105(a)(1) of the Social Security Act (42 U.S.C. 1397ee(a)(1)) 
        is amended--
                    (A) in the matter preceding subparagraph (A), by 
                striking ``(or, in the case of expenditures described 
                in subparagraph (B), the Federal medical assistance 
                percentage (as defined in the first sentence of section 
                1905(b)))''; and
                    (B) by striking subparagraph (B) and inserting the 
                following:
                    ``(B) for the provision of medical assistance that 
                is attributable to expenditures described in section 
                1905(u)(4)(A);''.
            (4) Additional amendments to medicaid.--
                    (A) Eligibility of a newborn.--Section 1902(e)(4) 
                of the Social Security Act (42 U.S.C. 1396a(e)(4)) is 
                amended in the first sentence by striking ``so long as 
                the child is a member of the woman's household and the 
                woman remains (or would remain if pregnant) eligible 
                for such assistance''.
                    (B) Application of qualified entities 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).''.
    (b) SCHIP.--
            (1) Coverage.--Title XXI of the Social Security Act (42 
        U.S.C. 1397aa et seq.) is amended by adding at the end the 
        following:

``SEC. 2111. OPTIONAL COVERAGE OF TARGETED LOW-INCOME PREGNANT WOMEN.

    ``(a) Optional Coverage.--Notwithstanding any other provision of 
this title, a State may provide for coverage, through an amendment to 
its State child health plan under section 2102, of pregnancy-related 
assistance for targeted low-income pregnant women in accordance with 
this section, but only if the State meets the conditions described in 
section 1905(u)(4)(B).
    ``(b) Definitions.--For purposes of this title:
            ``(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 services described in 
        section 1905(a)(4)(C)) and to other conditions that may 
        complicate pregnancy.
            ``(2) Targeted low-income pregnant woman.--The term 
        `targeted low-income pregnant woman' means a woman--
                    ``(A) during pregnancy and through the end of the 
                month in which the 60-day period (beginning on the last 
                day of her pregnancy) ends;
                    ``(B) whose family income exceeds the effective 
                income level (expressed as a percent of the poverty 
                line and considering applicable income disregards) that 
                has been specified under subsection (a)(10)(A)(i)(III) 
                or (l)(2)(A) of section 1902, as of January 1, 2005, to 
                be eligible for medical assistance as a pregnant woman 
                under title XIX but does not exceed the income 
                eligibility level established under the State child 
                health plan under this title for a targeted low-income 
                child; and
                    ``(C) who satisfies the requirements of paragraphs 
                (1)(A), (1)(C), (2), and (3) of section 2110(b).
    ``(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 in 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)(A).
            ``(4) In applying section 2102(b)(3)(B), any reference to 
        children found through screening to be eligible for medical 
        assistance under the State medicaid plan under title XIX is 
        deemed a reference to pregnant women.
            ``(5) There shall be no exclusion of benefits for services 
        described in subsection (b)(1) based on any preexisting 
        condition and no waiting period (including any waiting period 
        imposed to carry out section 2102(b)(3)(C)) shall apply.
            ``(6) 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)(C) is deemed not to require, in such case, 
        compliance with the requirements of section 2103(a).
            ``(7) In applying section 2103(e)(3)(B) in the case of a 
        pregnant woman provided coverage under this section, the 
        limitation on total annual aggregate cost-sharing shall be 
        applied to the entire family of such pregnant woman.
    ``(d) Automatic Enrollment for Children Born to Women Receiving 
Pregnancy-Related Assistance.--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 child'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 to have applied for medical assistance under title 
XIX and to have been found eligible for such assistance under such 
title, as appropriate, 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).''.
            (2) Additional allotments for providing coverage of 
        pregnant women.--
                    (A) In general.--Section 2104 of the Social 
                Security Act (42 U.S.C. 1397dd) is amended by inserting 
                after subsection (c) the following:
    ``(d) Additional Allotments for Providing Coverage of Pregnant 
Women.--
            ``(1) Appropriation; total allotment.--For the purpose of 
        providing additional allotments to States under this title, 
        there is appropriated, out of any money in the Treasury not 
        otherwise appropriated, for each of fiscal years 2006 and 2007, 
        $200,000,000.
            ``(2) State and territorial allotments.--In addition to the 
        allotments provided under subsections (b) and (c), subject to 
        paragraphs (3) and (4), of the amount available for the 
        additional allotments under paragraph (1) for a fiscal year, 
        the Secretary shall allot to each State with a State child 
        health plan approved under this title--
                    ``(A) in the case of such a State other than a 
                commonwealth or territory described in subparagraph 
                (B), the same proportion as the proportion of the 
                State's allotment under subsection (b) (determined 
                without regard to subsection (f)) to the total amount 
                of the allotments under subsection (b) for such States 
                eligible for an allotment under this paragraph for such 
                fiscal year; and
                    ``(B) in the case of a commonwealth or territory 
                described in subsection (c)(3), the same proportion as 
                the proportion of the commonwealth's or territory's 
                allotment under subsection (c) (determined without 
                regard to subsection (f)) to the total amount of the 
                allotments under subsection (c) for commonwealths and 
                territories eligible for an allotment under this 
                paragraph for such fiscal year.
            ``(3) Use of additional allotment.--Additional allotments 
        provided under this subsection are not available for amounts 
        expended before October 1, 2005. Such amounts are available for 
        amounts expended on or after such date for child health 
        assistance for targeted low-income children, as well as for 
        pregnancy-related assistance for targeted low-income pregnant 
        women.
            ``(4) No payments unless election to expand coverage of 
        pregnant women.--No payments may be made to a State under this 
        title from an allotment provided under this subsection unless 
        the State provides pregnancy-related assistance for targeted 
        low-income pregnant women under this title, or provides medical 
        assistance for pregnant women under title XIX, whose family 
        income exceeds the effective income level applicable under 
        subsection (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902 to a 
        family of the size involved as of January 1, 2005.''.
                    (B) Conforming amendments.--Section 2104 of the 
                Social Security Act (42 U.S.C. 1397dd) is amended--
                            (i) in subsection (a), in the matter 
                        preceding paragraph (1), by inserting ``subject 
                        to subsection (d),'' after ``under this 
                        section,'';
                            (ii) in subsection (b)(1), by inserting 
                        ``and subsection (d)'' after ``Subject to 
                        paragraph (4)''; and
                            (iii) in subsection (c)(1), by inserting 
                        ``subject to subsection (d),'' after ``for a 
                        fiscal year,''.
            (3) Presumptive eligibility under title xxi.--
                    (A) Application to pregnant women.--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.''.
            (4) Additional amendments to title xxi.--
                    (A) No cost-sharing for pregnancy-related 
                services.--Section 2103(e)(2) of the Social Security 
                Act (42 U.S.C. 1397cc(e)(2)) is amended--
                            (i) in the heading, by inserting ``or 
                        pregnancy-related services'' after ``Preventive 
                        services''; and
                            (ii) by inserting before the period at the 
                        end the following: ``or for pregnancy-related 
                        services''.
                    (B) No waiting period.--Section 2102(b)(1)(B) of 
                the Social Security Act (42 U.S.C. 1397bb(b)(1)(B)) is 
                amended--
                            (i) by striking ``, and'' at the end of 
                        clause (i) and inserting a semicolon;
                            (ii) by striking the period at the end of 
                        clause (ii) and inserting ``; and''; and
                            (iii) by adding at the end the following:
                            ``(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.''.
    (c) Effective Date.--The amendments made by this section apply to 
items and services furnished on or after October 1, 2005, without 
regard to whether regulations implementing such amendments have been 
promulgated.

SEC. 3. COORDINATION WITH THE MATERNAL AND CHILD HEALTH PROGRAM.

    (a) In General.--Section 2102(b)(3) of the Social Security Act (42 
U.S.C. 1397bb(b)(3)) is amended--
            (1) in subparagraph (D), by striking ``and'' at the end;
            (2) in subparagraph (E), by striking the period and 
        inserting ``; and''; and
            (3) 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.''.
    (b) Conforming Medicaid Amendment.--Section 1902(a)(11) of such Act 
(42 U.S.C. 1396a(a)(11)) is amended--
            (1) by striking ``and'' before ``(C)''; and
            (2) 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''.
    (c) Effective Date.--The amendments made by this section take 
effect on January 1, 2006.

SEC. 4. 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 2006.
                                 <all>