[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2055 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 2055

To improve children's access to health care coverage under the Medicaid 
   Program and the State Children's Health Insurance Program (SCHIP).


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 26, 2007

  Ms. Castor introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To improve children's access to health care coverage under the Medicaid 
   Program and the State Children's Health Insurance Program (SCHIP).

    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; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Improving 
Children's Access to Health Care Act of 2007''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents; findings.
Sec. 2. State options for ``express lane'' eligibility.
Sec. 3. Medicaid citizenship documentation requirements.
Sec. 4. Give States the option to allow children of low-income state 
                            employees to enroll in SCHIP.
Sec. 5. Establishment of new base SCHIP allotments that are responsive 
                            to increases in health care costs and 
                            enrollment expansions.
Sec. 6. 2-year initial availability of SCHIP allotments.
Sec. 7. SCHIP Premium grace period.
    (c) Findings.--Congress finds the following:
            (1) 9 million children in the United States under the age 
        of 19 are uninsured.
            (2) 6.8 million of these children are eligible for, but not 
        enrolled in, the Medicaid program or the State Children's 
        Health Insurance Program (SCHIP).
            (3) Two-thirds of the 9 million uninsured children come 
        from working families in which one or both parents are working 
        but were not offered employer-based health insurance or were 
        unable to buy private health insurance.
            (4) Uninsured children are five times less likely than 
        insured children to have a primary care physician, or to have 
        visited a doctor or dentist in the past two years.

SEC. 2. STATE OPTIONS FOR ``EXPRESS LANE'' ELIGIBILITY.

    Notwithstanding any other provision of law, any State with a plan 
under title XIX or XXI of the Social Security Act has the option of 
doing any or all of the following in order to promote enrollment of 
eligible children under the programs under those titles:
            (1) The option to create ``express lane eligibility'' so 
        that children who meet other low-income public program 
        eligibility requirements (such as the WIC program, the school 
        lunch program, and other means-tested programs) are 
        automatically enrolled for benefits under the appropriate plan 
        under such titles, with appropriate notice to the parents of 
        children so enrolled.
            (2) The option to create one enrollment form for all low-
        income public programs, including such programs.
            (3) The option to receive a 75 percent Federal matching 
        percentage under such titles for expenses relating to the 
        implementation of electronic technology needed to make their 
        information and computer system infrastructure facilitate 
        Express Lane eligibility, presumptive eligibility, continuous 
        eligibility, and automatic renewals of coverage for children 
        for whom the State already has data from other programs on 
        income.

SEC. 3. MEDICAID CITIZENSHIP DOCUMENTATION REQUIREMENTS.

    (a) State Option To Require Certain Individuals To Present 
Satisfactory Documentary Evidence of Proof of Citizenship or 
Nationality for Purposes of Eligibility for Medicaid.--
            (1) In general.--Section 1902(a)(46) of the Social Security 
        Act (42 U.S.C. 1396a(a)(46)) is amended--
                    (A) by inserting ``(A)'' after ``(46)'';
                    (B) by adding ``and'' after the semicolon; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(B) at the option of the State and subject to section 
        1903(x), require that, with respect to an individual (other 
        than an individual described in section 1903(x)(1)) who 
        declares to be a citizen or national of the United States for 
        purposes of establishing initial eligibility for medical 
        assistance under this title (or, at State option, for purposes 
        of renewing or redetermining such eligibility to the extent 
        that such satisfactory documentary evidence of citizenship or 
        nationality has not yet been presented), there is presented 
        satisfactory documentary evidence of citizenship or nationality 
        of the individual (using criteria determined by the State, 
        which shall be no more restrictive than the criteria used by 
        the Social Security Administration to determine citizenship, 
        and which shall accept as such evidence a document issued by a 
        federally-recognized Indian tribe evidencing membership or 
        enrollment in, or affiliation with, such tribe (such as a 
        tribal enrollment card or certificate of degree of Indian 
        blood, and, with respect to those federally-recognized Indian 
        tribes located within States having an international border 
        whose membership includes individuals who are not citizens of 
        the United States, such other forms of documentation (including 
        tribal documentation, if appropriate) that the Secretary, after 
        consulting with such tribes, determines to be satisfactory 
        documentary evidence of citizenship or nationality for purposes 
        of satisfying the requirement of this subparagraph));''.
            (2) Limitation on waiver authority.--Notwithstanding any 
        provision of section 1115 of the Social Security Act (42 U.S.C. 
        1315), or any other provision of law, the Secretary of Health 
        and Human Services may not waive the requirements of section 
        1902(a)(46)(B) of such Act (42 U.S.C. 1396a(a)(46)(B)) with 
        respect to a State.
            (3) Conforming amendments.--Section 1903 of such Act (42 
        U.S.C. 1396b) is amended--
                    (A) in subsection (i)--
                            (i) in paragraph (20), by adding ``or'' 
                        after the semicolon;
                            (ii) in paragraph (21), by striking ``; 
                        or'' and inserting a period; and
                            (iii) by striking paragraph (22); and
                    (B) in subsection (x) (as amended by section 
                405(c)(1)(A) of division B of the Tax Relief and Health 
                Care Act of 2006 (Public Law 109-432))--
                            (i) by striking paragraphs (1) and (3);
                            (ii) by redesignating paragraph (2) as 
                        paragraph (1);
                            (iii) in paragraph (1), as so redesignated, 
                        by striking ``paragraph (1)'' and inserting 
                        ``section 1902(a)(46)(B)''; and
                            (iv) by adding at the end the following new 
                        paragraph:
    ``(2) In the case of an individual declaring to be a citizen or 
national of the United States with respect to whom a State requires the 
presentation of satisfactory documentary evidence of citizenship or 
nationality under section 1902(a)(46)(B), the individual shall be 
provided at least the reasonable opportunity to present satisfactory 
documentary evidence of citizenship or nationality under this 
subsection as is provided under clauses (i) and (ii) of section 
1137(d)(4)(A) to an individual for the submittal to the State of 
evidence indicating a satisfactory immigration status.''.
    (b) Clarification of Rules for Children Born in the United States 
to Mothers Eligible for Medicaid.--Section 1903(x) of such Act (42 
U.S.C. 1396b(x)), as amended by subsection (a)(3)(B), is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (C), by striking ``or'' at the 
                end;
                    (B) by redesignating subparagraph (D) as 
                subparagraph (E); and
                    (C) by inserting after subparagraph (C) the 
                following new subparagraph:
            ``(D) pursuant to the application of section 1902(e)(4) 
        (and, in the case of an individual who is eligible for medical 
        assistance on such basis, the individual shall be deemed to 
        have provided satisfactory documentary evidence of citizenship 
        or nationality and shall not be required to provide further 
        documentary evidence on any date that occurs during or after 
        the period in which the individual is eligible for medical 
        assistance on such basis); or''; and
            (2) by adding at the end the following new paragraph:
    ``(3) Nothing in subparagraph (A) or (B) of section 1902(a)(46), 
the preceding paragraphs of this subsection, or the Deficit Reduction 
Act of 2005, including section 6036 of such Act, shall be construed as 
changing the requirement of section 1902(e)(4) that a child born in the 
United States to an alien mother for whom medical assistance for the 
delivery of such child is available as treatment of an emergency 
medical condition pursuant to subsection (v) shall be deemed eligible 
for medical assistance during the first year of such child's life.''.
    (c) Effective Date.--
            (1) Retroactive application.--The amendments made by this 
        section shall take effect as if included in the enactment of 
        the Deficit Reduction Act of 2005 (Public Law 109-171; 120 
        Stat. 4).
            (2) Restoration of eligibility.--In the case of an 
        individual who, during the period that began on July 1, 2006, 
        and ends on the date of enactment of this Act, was determined 
        to be ineligible for medical assistance under a State Medicaid 
        program solely as a result of the application of subsections 
        (i)(22) and (x) of section 1903 of the Social Security Act (as 
        in effect during such period), but who would have been 
        determined eligible for such assistance if such subsections, as 
        amended by subsections (a) and (b), had applied to the 
        individual, a State may deem the individual to be eligible for 
        such assistance as of the date that the individual was 
        determined to be ineligible for such medical assistance on such 
        basis.

SEC. 4. GIVE STATES THE OPTION TO ALLOW CHILDREN OF LOW-INCOME STATE 
              EMPLOYEES TO ENROLL IN SCHIP.

    (a) In General.--Section 2110(b)(2)(B) of the Social Security Act 
(42 U.S.C. 1397jj(b)(2)(B)) is amended by inserting ``at the option of 
a State,'' after ``(B)''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of the enactment of this Act.

SEC. 5. ESTABLISHMENT OF NEW BASE SCHIP ALLOTMENTS THAT ARE RESPONSIVE 
              TO INCREASES IN HEALTH CARE COSTS AND ENROLLMENT 
              EXPANSIONS.

    Section 2104 of the Social Security Act (42 U.S.C. 1397dd) is 
amended--
            (1) in subsection (a)--
                    (A) in paragraph (9), by striking ``and'' at the 
                end;
                    (B) in paragraph (10), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(11) for fiscal year 2008 and each succeeding fiscal 
        year, the sum of the State allotments provided under subsection 
        (i) for such fiscal year.'';
            (2) in each of subsections (b)(1) and (c)(1), by striking 
        ``subsection (d)'' and inserting ``subsections (d) and (i)''; 
        and
            (3) by adding at the end the following new subsection:
    ``(i) Allotments for States and Territories Beginning With Fiscal 
Year 2008.--
            ``(1) General allotment computation.--
                    ``(A) In general.--Subject to the succeeding 
                provisions of this subsection, the Secretary shall 
                compute a State allotment for each State for each 
                fiscal year as follows:
                            ``(i) Rebasing in fiscal year 2008 and each 
                        second succeeding fiscal year.--For fiscal year 
                        2008 and each second succeeding fiscal year, 
                        the allotment of a State is equal to the 
                        Federal payments to the State that are 
                        attributable to (and countable towards) the 
                        allotment under this section for the State for 
                        the previous fiscal year multiplied by the 
                        allotment increase factor under subparagraph 
                        (B) for the fiscal year involved.
                            ``(ii) Using projections for fiscal year 
                        2009 and each second succeeding fiscal year.--
                        For fiscal year 2009 and each second succeeding 
                        fiscal year, the allotment of a State is equal 
                        to the amount of the State allotment under this 
                        subparagraph for the previous fiscal year 
                        multiplied by the allotment increase factor 
                        under subparagraph (B) for the fiscal year 
                        involved.
                    ``(B) Allotment increase factor.--The allotment 
                increase factor under this subparagraph for a fiscal 
                year is equal to the product of the following:
                            ``(i) Per capita health care growth 
                        factor.--One plus the percentage increase in 
                        the projected per capita amount of National 
                        Health Expenditures from the second previous 
                        fiscal year to the previous fiscal year, as 
                        most recently published by the Secretary before 
                        the beginning of the fiscal year involved.
                            ``(ii) Child population growth factor.--One 
                        plus the percentage increase in the population 
                        of children under 20 years of age in the State 
                        from July 1 in such second previous fiscal year 
                        to July 1 in the previous fiscal year, as 
                        determined by the Secretary based on the most 
                        recent published estimates of the Bureau of the 
                        Census before the beginning of the fiscal year 
                        involved.
                    ``(C) Outreach adjustment.--
                            ``(i) In general.--If a State's 
                        expenditures under this title in a fiscal year 
                        (beginning with fiscal year 2008) exceeds the 
                        allotment provided under this section 
                        (determined without regard to any reallotment 
                        it receives that is available for expenditure 
                        during such fiscal year) and if the average 
                        number of enrollees in the State under this 
                        title for such fiscal year exceeds its target 
                        number of enrollees for that year, for the 
                        subsequent fiscal year the allotment under this 
                        section for the State shall be increased by the 
                        amount by which--
                                    ``(I) the product of--
                                            ``(aa) such additional 
                                        number of enrollees; and
                                            ``(bb) the projected per 
                                        capita Federal expenditures 
                                        under the State child health 
                                        plan (as determined under 
                                        clause (iii) for such 
                                        subsequent fiscal year); 
                                        reduced by
                                    ``(II) the amount of any allotment 
                                redistributed to the State under this 
                                section for such subsequent fiscal 
                                year.
                            ``(ii) Target number of enrollees.--In this 
                        subsection, the target number of enrollees for 
                        a State for a fiscal year is equal to the 
                        average number of enrollees enrolled in the 
                        State child health plan under this title during 
                        fiscal year 2007 increased (for each subsequent 
                        fiscal year through the fiscal year involved) 
                        by the population growth for children in that 
                        State for the year ending on June 30 before the 
                        beginning of the fiscal year (as estimated by 
                        the Bureau of the Census).
                            ``(iii) Projected per capita federal 
                        expenditures.--For purposes of subparagraph 
                        (A)(i)(II), the projected per capita Federal 
                        expenditures under a State child health plan 
                        for a fiscal year is equal to the average per 
                        capita Federal expenditures under such plan for 
                        fiscal year 2007, increased (for each 
                        subsequent fiscal year up to and including the 
                        fiscal year involved) by the annual percentage 
                        increase in per capita amount of National 
                        Health Expenditures (as estimated by the 
                        Secretary) for the respective subsequent fiscal 
                        year.
                            ``(iv) Availability.--Notwithstanding 
                        subsection (e), an increase in allotment under 
                        this paragraph shall only be available for 
                        expenditure during the fiscal year in which it 
                        is provided.
                            ``(v) Interaction with other provisions.--
                                    ``(I) Coverage expansion states.--
                                In the case of a State that has an 
                                increased allotment under section 
                                2105(i)--
                                            ``(aa) there shall be no 
                                        increased allotment under 
                                        paragraph (2); and
                                            ``(bb) the allotment under 
                                        this subsection shall not be 
                                        subject to reallotment or 
                                        redistribution to other States.
                                    ``(II) No reallotment of outreach 
                                adjustment.--In no case shall any 
                                increase in allotment under paragraph 
                                (2) for a State be subject to 
                                reallotment or redistribution to other 
                                States.''.

SEC. 6. 2-YEAR INITIAL AVAILABILITY OF SCHIP ALLOTMENTS.

    Section 2104(e) of the Social Security Act (42 U.S.C. 1397dd(e)) is 
amended to read as follows:
    ``(e) Availability of Amounts Allotted.--
            ``(1) In general.--Except as provided in paragraph (2), 
        amounts allotted to a State pursuant to this section--
                    ``(A) for each of fiscal years 1998 through 2007, 
                shall remain available for expenditure by the State 
                through the end of the second succeeding fiscal year; 
                and
                    ``(B) for fiscal year 2008 and each fiscal year 
                thereafter, shall remain available for expenditure by 
                the State through the end of the succeeding fiscal 
                year.
            ``(2) Availability of amounts reallotted.--Amounts 
        reallotted to a State under subsection (f) shall be available 
        for expenditure by the State through the end of the fiscal year 
        in which they are reallotted.''.

SEC. 7. SCHIP PREMIUM GRACE PERIOD.

    (a) In General.--Section 2103(e)(3) of the Social Security Act (42 
U.S.C. 1397bb(e)(3)) is amended by adding at the end the following new 
subparagraph:
                    ``(C) Premium grace period.--
                            ``(i) In general.--The State child health 
                        plan shall provide a grace period of at least 
                        30 days from the beginning of a new coverage 
                        period to make premium payments before coverage 
                        under this title may be terminated. For 
                        purposes of this clause, the term `new coverage 
                        period' means the month following the last 
                        month for which the premium has been paid.
                            ``(ii) Notice.--The State child health plan 
                        shall provide, not later than 7 days after the 
                        first day of a grace period described in clause 
                        (i), individual notice informing the enrollee 
                        involved--
                                    ``(I) that failure to make a 
                                premium payment within the grace period 
                                will result in termination from the 
                                State child health plan; and
                                    ``(II) of the enrollee's right to 
                                challenge the proposed termination 
                                pursuant to the applicable Federal 
                                regulations, in effect as of January 1, 
                                2007.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to new coverage periods beginning on and after such date, not 
later than October 1, 2007, as the Secretary of Health and Human 
Services shall specify.
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