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.

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.

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.

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.

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.

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.

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.