[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3176 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 3176

To amend title XXI of the Social Security Act to reauthorize and reform 
         the State Children's Health Insurance Program (SCHIP).


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 25, 2007

Mr. Barton of Texas (for himself, Mr. Deal of Georgia, Mr. Hastert, Mr. 
Buyer, Mrs. Blackburn, Mr. Terry, Mr. Shimkus, Mr. Pitts, Mr. Stearns, 
    Mr. Burgess, Mr. Hall of Texas, Mr. Pickering, and Mrs. Myrick) 
 introduced the following bill; which was referred to the Committee on 
                          Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To amend title XXI of the Social Security Act to reauthorize and reform 
         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.

    (a) Short Title.--This Act may be cited as the ``SCHIP 
Reauthorization and Reform Act of 2007''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Requiring outreach and coverage before expansion of 
                            eligibility.
Sec. 3. Application of citizenship documentation requirements; 
                            increased Federal matching rate for 
                            citizenship documentation enforcement under 
                            Medicaid and SCHIP.
Sec. 4. Limitations on eligibility based on substantial net assets.
Sec. 5. Clarification of State authorities.
Sec. 6. Easing administrative barriers to State cooperation with 
                            employer-sponsored insurance coverage.
Sec. 7. Improving beneficiary choice in SCHIP.
Sec. 8. Allotment distribution formula.
Sec. 9. Five-year reauthorization.
Sec. 10. Enhancing the programmatic focus on children and pregnant 
                            women.

SEC. 2. REQUIRING OUTREACH AND COVERAGE BEFORE EXPANSION OF 
              ELIGIBILITY.

    (a) State Plan Required To Specify How It Will Achieve Coverage for 
90 Percent of Targeted Low-Income Children.--
            (1) In general.--Section 2102(a) of the Social Security Act 
        (42 U.S.C. 1397bb(a)) is amended--
                    (A) in paragraph (6), by striking ``and'' at the 
                end;
                    (B) in paragraph (7), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(8) how the eligibility and benefits provided for under 
        the plan for each fiscal year (beginning with fiscal year 2009) 
        will allow for the State's annual funding allotment to cover at 
        least 90 percent of the eligible targeted low-income children 
        in the State.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to State child health plans for fiscal years 
        beginning with fiscal year 2009.
    (b) Limitation on Program Expansions Until Lowest Income Eligible 
Individuals Enrolled.--Section 2105(c) of such Act (42 U.S.C. 
1397dd(c)) is amended by adding at the end the following new paragraph:
            ``(8) Limitation on increased coverage of higher income 
        children.--For child health assistance furnished in a fiscal 
        year beginning with fiscal year 2008:
                    ``(A) No payment for children with family income 
                above 250 percent of poverty line.--Payment shall not 
                be made under this section for child health assistance 
                for a targeted low-income child in a family the income 
                of which exceeds 250 percent of the poverty line 
                applicable to a family of the size involved.
                    ``(B) Special rules for payment for children with 
                family income above 200 percent of poverty line.--In 
                the case of child health assistance for a targeted low-
                income child in a family the income of which exceeds 
                200 percent (but does not exceed 250 percent) of the 
                poverty line applicable to a family of the size 
                involved no payment shall be made under this section 
                for such assistance unless the State demonstrates to 
                the satisfaction of the Secretary that--
                            ``(i) the State has met the 90 percent 
                        retrospective coverage test specified in 
                        subparagraph (C)(i) for the previous fiscal 
                        year; and
                            ``(ii) the State will meet the 90 percent 
                        prospective coverage test specified in 
                        subparagraph (C)(ii) for the fiscal year.
                    ``(C) 90 percent coverage tests.--
                            ``(i) Retrospective test.--The 90 percent 
                        retrospective coverage test specified in this 
                        clause is, for a State for a fiscal year, that 
                        on average during the fiscal year, the State 
                        has enrolled under this title or title XIX at 
                        least 90 percent of the individuals residing in 
                        the State who--
                                    ``(I) are children under 19 years 
                                of age (or are pregnant women) and are 
                                eligible for medical assistance under 
                                title XIX; or
                                    ``(II) are targeted low-income 
                                children whose family income does not 
                                exceed 200 percent of the poverty line 
                                and who are eligible for child health 
                                assistance under this title.
                            ``(ii) Prospective test.--The 90 percent 
                        prospective test specified in this clause is, 
                        for a State for a fiscal year, that on average 
                        during the fiscal year, the State will enroll 
                        under this title or title XIX at least 90 
                        percent of the individuals residing in the 
                        State who--
                                    ``(I) are children under 19 years 
                                of age (or are pregnant women) and are 
                                eligible for medical assistance under 
                                title XIX; or
                                    ``(II) are targeted low-income 
                                children whose family income does not 
                                exceed such percent of the poverty line 
                                (in excess of 200 percent) as the State 
                                elects consistent with this paragraph 
                                and who are eligible for child health 
                                assistance under this title.
                    ``(D) Grandfather.--Subparagraphs (A) and (B) shall 
                not apply to the provision of child health assistance--
                            ``(i) to a targeted low-income child who is 
                        enrolled for child health assistance under this 
                        title as of September 30, 2007;
                            ``(ii) to a pregnant woman who is enrolled 
                        for assistance under this title as of September 
                        30, 2007, through the completion of the post-
                        partum period following completion of her 
                        pregnancy; and
                            ``(iii) for items and services furnished 
                        before October 1, 2008, to an individual who is 
                        not a targeted low-income child and who is 
                        enrolled for assistance under this title as of 
                        September 30, 2007.
                    ``(E) Treatment of pregnant women.--In this 
                paragraph and sections 2102(a)(8) and 2104(a)(2), the 
                term `targeted low-income child' includes an individual 
                under age 19, including the period from conception to 
                birth, who is eligible for child health assistance 
                under this title by virtue of the definition of the 
                term `child' under section 457.10 of title 42, Code of 
                Federal Regulations.''.
    (c) Standardization of Income Determinations.--
            (1) In general.--Section 2110(d) of such Act (42 U.S.C. 
        1397jj) is amended by adding at the end the following new 
        subsection:
    ``(d) Standardization of Income Determinations.--
            ``(1) In general.--In determining family income under this 
        title (including in the case of a State child health plan that 
        provides health benefits coverage in the manner described in 
        section 2101(a)(2)), a State shall base such determination on 
        gross income (including amounts that would be included in gross 
        income if they were not exempt from income taxation) and may 
        only take into consideration such income disregards as the 
        Secretary shall develop and specify on a uniform national 
        basis.
            ``(2) Construction.--Nothing in paragraph (1) shall be 
        construed as preventing the Secretary from approving, under 
        section 1115 as applied to this title under section 
        2107(e)(2)(A), a waiver that provides for the application of 
        alternative income disregards on an experimental or 
        demonstration basis.''.
            (2) Effective date.--(A) Subject to subparagraph (B), the 
        amendment made by paragraph (1) shall apply to determinations 
        (and redeterminations) of income made on or after April 1, 
        2008.
            (B) In the case of a State child health plan under title 
        XXI of the Social Security Act which the Secretary of Health 
        and Human Services determines requires State legislation (other 
        than legislation appropriating funds) in order for the plan to 
        meet the additional requirement imposed by the amendment made 
        by paragraph (1), the State child health plan shall not be 
        regarded as failing to comply with the requirements of such 
        title solely on the basis of its failure to meet this 
        additional requirement before the first day of the first 
        calendar quarter beginning after the close of the first regular 
        session of the State legislature that begins after the date of 
        the enactment of this Act. For purposes of the previous 
        sentence, in the case of a State that has a 2-year legislative 
        session, each year of such session shall be deemed to be a 
        separate regular session of the State legislature.

SEC. 3. APPLICATION OF CITIZENSHIP DOCUMENTATION REQUIREMENTS; 
              INCREASED FEDERAL MATCHING RATE FOR CITIZENSHIP 
              DOCUMENTATION ENFORCEMENT UNDER MEDICAID AND SCHIP.

    (a) Application of Requirements.--
            (1) In general.--Section 2105(c) of the Social Security Act 
        (42 U.S.C. 1397dd(c)), as amended by sections 2(b) and 3(c), is 
        amended by adding at the end the following new paragraph:
            ``(10) Application of citizenship documentation 
        requirements.--
                    ``(A) In general.--Subject to subparagraph (B), no 
                payment may be made under this section to a State with 
                respect to amounts expended for child health assistance 
                for an individual who declares under section 
                1137(d)(1)(A) to be a citizen or national of the United 
                States for purposes of establishing eligibility for 
                benefits under this title, unless the requirement of 
                section 1903(x) is met.
                    ``(B) Treatment of pregnant women.--For purposes of 
                applying subparagraph (A) in the case of a pregnant 
                woman who qualifies for child health assistance by 
                virtue of the application of section 457.10 of title 
                42, Code of Federal Regulations, the requirement of 
                such section shall be deemed to be satisfied by the 
                presentation of documentation of personal identity 
                described in section 274A(b)(1)(D) of the Immigration 
                and Nationality Act or any other documentation of 
                personal identity of such other type as the Secretary 
                finds, by regulation, provides a reliable means of 
                identification.''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply to eligibility determinations and redeterminations 
        made on or after April 1, 2008.
    (b) Temporary Increase in Federal Matching Rate for Administrative 
Costs Under Medicaid and SCHIP.----
            (1) Medicaid.--
                    (A) In general.--With respect to administrative 
                costs incurred on or after July 1, 2006, and before 
                October 1, 2008, in implementing the amendments made by 
                section 6036 of the Deficit Reduction Act of 2005 
                (Public Law 109-171), 75 percent shall be substituted 
                for 50 per centum in section 1903(a)(7) of the Social 
                Security Act (42 U.S.C. 1396b(a)(7)).
                    (B) Retroactive adjustment.--The Secretary of 
                Health and Human Services shall take such steps as may 
                be necessary to provide for the adjustment of payments 
                under section 1903(a) of the Social Security Act (42 
                U.S.C. 1396b(a)) to take into account the application 
                of subparagraph (A) for periods before the date of the 
                enactment of this Act.
            (2) SCHIP.--With respect to administrative costs incurred 
        on or after April 1, 2008, and before October 1, 2008 in 
        implementing the amendment made by subsection (a)(1), the 
        enhanced FMAP applied under section 2105(a)(1)(D)(iv) of the 
        Social Security Act (42 U.S.C. 1397d(a)(1)(D)(iv)) shall not be 
        less than 75 percent.

SEC. 4. LIMITATIONS ON ELIGIBILITY BASED ON SUBSTANTIAL NET ASSETS.

    (a) In General.--Section 2110(b) of the Social Security Act (42 
U.S.C. 1397jj(b)) is amended--
            (1) in paragraph (1), by striking ``paragraph (2)'' and 
        inserting ``paragraphs (2) and (5)''; and
            (2) by adding at the end the following new paragraph:
            ``(5) Disqualification for individuals in families with 
        substantial net assets.--An individual in a family is not 
        eligible for child health assistance under this title if the 
        individual's family has net assets (including the equity 
        interest in any home) that exceeds $500,000 or unless there is 
        provided a document (in such a form and manner as the Secretary 
        shall specify) signed under penalty of perjury by an applicant 
        for child health assistance on behalf of the individual that 
        the net assets of the individual's family (including the equity 
        interest in the any home) does not exceed $500,000. The 
        Secretary may increase the dollar amount specified in the 
        previous sentence from year to year beginning with 2013 based 
        on the percentage increase in the consumer price index for all 
        urban consumers (all items; United States city average), 
        rounded to the nearest $1,000.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to eligibility determinations and redeterminations made on or 
after April 1, 2008.

SEC. 5. CLARIFICATION OF STATE AUTHORITIES.

    Section 2102 of the Social Security Act (42 U.S.C. 1397bb) is 
amended by adding at the end the following new subsection:
    ``(d) Clarification of State Authorities.--Nothing in this title 
shall be construed as preventing a State, under its child health plan, 
from doing any of the following:
            ``(1) Use of waiting periods to prevent crowd out.--From 
        using waiting periods and other tools to prevent crowding out 
        private-sector insurance coverage.
            ``(2) Use of private providers and plans.--From cooperating 
        or contracting with private sector providers and plans in order 
        to provide care to targeted low-income children.
            ``(3) Use of state funds for ineligible individuals.--From 
        providing medical benefits for individuals who are not targeted 
        low-income children with State funds.''.

SEC. 6. EASING ADMINISTRATIVE BARRIERS TO STATE COOPERATION WITH 
              EMPLOYER-SPONSORED INSURANCE COVERAGE.

    (a) Requiring Some Coverage for Employer-Sponsored Insurance.--
            (1) In general.--Section 2102(a) of the Social Security Act 
        (42 U.S.C. 1397b(a)), as amended by section 2(a), is amended--
                    (A) in paragraph (7), by striking ``and'' at the 
                end;
                    (B) in paragraph (8), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(9) effective for plan years beginning on or after 
        October 1, 2008, how the plan will provide for child health 
        assistance with respect to targeted low-income children covered 
        under a group health plan.''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply beginning with fiscal year 2009.
    (b) Federal Financial Participation for Employer-Sponsored 
Insurance.--Section 2105 of such Act (42 U.S.C. 1397d) is amended--
            (1) in subsection (a)(1)(C), by inserting before the 
        semicolon at the end the following: ``and, subject to paragraph 
        (3)(C), in the form of payment of the premiums for coverage 
        under a group health plan that includes coverage of targeted 
        low-income children and benefits supplemental to such 
        coverage''; and
            (2) paragraph (3) of subsection (c) is amended to read as 
        follows:
            ``(3) Purchase of employer-sponsored insurance.--
                    ``(A) In general.--Payment may be made to a State 
                under subsection (a)(1)(C), subject to the provisions 
                of this paragraph, for the purchase of family coverage 
                under a group health plan that includes coverage of 
                targeted low-income children unless such coverage would 
                otherwise substitute for coverage that would be 
                provided to such children but for the purchase of 
                family coverage.
                    ``(B) Waiver of certain provisions.--With respect 
                to coverage described in subparagraph (A)--
                            ``(i) notwithstanding section 2102, no 
                        minimum benefits requirement (other than those 
                        otherwise applicable with respect to services 
                        referred to in section 2102(a)(7)) under this 
                        title shall apply; and
                            ``(ii) no limitation on beneficiary cost-
                        sharing otherwise applicable under this title 
                        or title XIX shall apply.
                    ``(C) Required provision of supplemental 
                benefits.--If the coverage described in subparagraph 
                (A) does not provide coverage for the services referred 
                to in section 2102(a)(7), the State child health plan 
                shall provide coverage of such services as supplemental 
                benefits.
                    ``(D) Limitation on ffp.--The amount of the payment 
                under paragraph (1)(C) for coverage described in 
                subparagraph (A) (and supplemental benefits under 
                subparagraph (C) for individuals so covered) during a 
                fiscal year may not exceed the product of--
                            ``(i) the national per capita expenditure 
                        under this title (taking into account both 
                        Federal and State expenditures) for the 
                        previous fiscal year (as determined by the 
                        Secretary using the best available data);
                            ``(ii) the enhanced FMAP for the State and 
                        fiscal year involved; and
                            ``(iii) the number of targeted low-income 
                        children for whom such coverage is provided.
                    ``(E) Voluntary enrollment.--A State child health 
                plan--
                            ``(i) may not require a targeted low-income 
                        child to enroll in coverage described in 
                        subparagraph (A) in order to obtain child 
                        health assistance under this title;
                            ``(ii) before providing such child health 
                        assistance for such coverage of a child, shall 
                        make available (which may be through an 
                        Internet website or other means) to the parent 
                        or guardian of the child information on the 
                        coverage available under this title, including 
                        benefits and cost-sharing; and
                            ``(iii) shall provide at least one 
                        opportunity per fiscal year for beneficiaries 
                        to switch coverage under this title from 
                        coverage described in subparagraph (A) to the 
                        coverage that is otherwise made available under 
                        this title.
                    ``(F) Information on coverage options.--A State 
                child health plan shall--
                            ``(i) describe how the State will notify 
                        potential beneficiaries of coverage described 
                        in subparagraph (A);
                            ``(ii) provide such notification in writing 
                        at least during the initial application for 
                        enrollment under this title and during 
                        redeterminations of eligibility if the 
                        individual was enrolled before October 1, 2008; 
                        and
                            ``(iii) post a description of these 
                        coverage options on any official website that 
                        may be established by the State in connection 
                        with the plan.
                    ``(G) Semiannual verification of coverage.--If 
                coverage described in subparagraph (A) is provided 
                under a group health plan with respect to a targeted 
                low-income child, the State child health plan shall 
                provide for the collection, at least once every six 
                months, of proof from the plan that the child is 
                enrolled in such coverage.
                    ``(H) Rule of construction.--Nothing in this 
                section is to be construed to prohibit a State from--
                            ``(i) offering wrap around benefits in 
                        order for a group health plan to meet any 
                        State-established minimum benefit requirements;
                            ``(ii) establishing a cost-effectiveness 
                        test to qualify for coverage under such a plan;
                            ``(iii) establishing limits on beneficiary 
                        cost-sharing under such a plan;
                            ``(iv) paying all or part of a 
                        beneficiary's cost-sharing requirements under 
                        such a plan;
                            ``(v) paying less than the full cost of the 
                        employee's share of the premium under such a 
                        plan, including prorating the cost of the 
                        premium to pay for only what the State 
                        determines is the portion of the premium that 
                        covers targeted low-income children;
                            ``(vi) using State funds to pay for 
                        benefits above the Federal upper limit 
                        established under subparagraph (C);
                            ``(vii) allowing beneficiaries enrolled in 
                        group health plans from changing plans to 
                        another coverage option available under this 
                        title at any time; or
                            ``(viii) providing any guidance or 
                        information it deems appropriate in order to 
                        help beneficiaries make an informed decision 
                        regarding the option to enroll in coverage 
                        described in subparagraph (A).
                    ``(I) Group health plan defined.--In this 
                paragraph, the term `group health plan' has the meaning 
                given such term in section 2791(a)(1) of the Public 
                Health Service Act (42 U.S.C. 300gg-91(a)(1)).''.

SEC. 7. IMPROVING BENEFICIARY CHOICE IN SCHIP.

    (a) Requiring Offering of Alternative Coverage Options.--Section 
2102 of the Social Security Act (42 U.S.C. 1397b), as amended by 
sections 2(a) and 6(a), is amended--
            (1) in subsection (a)--
                    (A) in paragraph (8), by striking ``and'' at the 
                end;
                    (B) in paragraph (9), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(10) effective for plan years beginning on or after 
        October 1, 2008, how the plan will provide for child health 
        assistance with respect to targeted low-income children through 
        alternative coverage options in accordance with subsection 
        (d).''; and
            (2) by adding at the end the following new subsection:
    ``(d) Alternative Coverage Options.--
            ``(1) In general.--Effective October 1, 2008, a State child 
        health plan shall provide for the offering of any qualified 
        alternative coverage that a qualified entity seeks to offer to 
        targeted low-income children through the plan in the State.
            ``(2) Application of uniform financial limitation for all 
        alternative coverage options.--With respect to all qualified 
        alternative coverage offered in a State, the State child health 
        plan shall establish a uniform dollar limitation on the per 
        capita monthly amount that will be paid by the State to the 
        qualified entity with respect to such coverage provided to a 
        targeted low-income child. Such limitation may not be less than 
        90 percent of the per capita monthly payment made for coverage 
        offered under the State child health plan that is not in the 
        form of an alternative coverage option. Nothing in this 
        paragraph shall be construed--
                    ``(A) as requiring a State to provide for the full 
                payment of premiums for qualified alternative coverage;
                    ``(B) as preventing a State from charging 
                additional premiums to cover the difference between the 
                cost of qualified alternative coverage and the amount 
                of such payment limitation;
                    ``(C) as preventing a State from using its own 
                funds to provide a dollar limitation that exceeds the 
                Federal financial participation as limited under 
                section 2105(c)(8).
            ``(3) Qualified alternative coverage defined.--In this 
        section, the term `qualified alternative coverage' means health 
        insurance coverage that--
                    ``(A) meets the coverage requirements of section 
                2103 (other than cost-sharing requirements of such 
                section); and
                    ``(B) is offered by a qualified insurer, and not 
                directly by the State.
            ``(4) Qualified insurer defined.--In this section, the term 
        `qualified insurer' means, with respect to a State, an entity 
        that is licensed to offer health insurance coverage in the 
        State.''.
    (b) Federal Financial Participation for Qualified Alternative 
Coverage.--Section 2105 of such Act (42 U.S.C. 1397d) is amended--
            (1) in subsection (a)(1)(C), as amended by section 6(b), by 
        inserting before the semicolon at the end the following: ``and, 
        subject to paragraph (8)(C), in the form of payment of the 
        premiums for coverage for qualified alternative coverage''; and
            (2) by adding at the end of subsection (c) the following 
        new paragraph:
            ``(8) Purchase of qualified alternative coverage.--
                    ``(A) In general.--Payment may be made to a State 
                under subsection (a)(1)(C), subject to the provisions 
                of this paragraph, for the purchase of qualified 
                alternative coverage.
                    ``(B) Waiver of certain provisions.--With respect 
                to coverage described in subparagraph (A), no 
                limitation on beneficiary cost-sharing otherwise 
                applicable under this title or title XIX shall apply.
                    ``(C) Limitation on ffp.--The amount of the payment 
                under paragraph (1)(C) for coverage described in 
                subparagraph (A) during a fiscal year in the aggregate 
                for all such coverage in the State may not exceed the 
                product of--
                            ``(i) the national per capita expenditure 
                        under this title (taking into account both 
                        Federal and State expenditures) for the 
                        previous fiscal year (as determined by the 
                        Secretary using the best available data);
                            ``(ii) the enhanced FMAP for the State and 
                        fiscal year involved; and
                            ``(iii) the number of targeted low-income 
                        children for whom such coverage is provided.
                    ``(D) Voluntary enrollment.--A State child health 
                plan--
                            ``(i) may not require a targeted low-income 
                        child to enroll in coverage described in 
                        subparagraph (A) in order to obtain child 
                        health assistance under this title;
                            ``(ii) before providing such child health 
                        assistance for such coverage of a child, shall 
                        make available (which may be through an 
                        Internet website or other means) to the parent 
                        or guardian of the child information on the 
                        coverage available under this title, including 
                        benefits and cost-sharing; and
                            ``(iii) shall provide at least one 
                        opportunity per fiscal year for beneficiaries 
                        to switch coverage under this title from 
                        coverage described in subparagraph (A) to the 
                        coverage that is otherwise made available under 
                        this title.
                    ``(E) Information on coverage options.--A State 
                child health plan shall--
                            ``(i) describe how the State will notify 
                        potential beneficiaries of coverage described 
                        in subparagraph (A);
                            ``(ii) provide such notification in writing 
                        at least during the initial application for 
                        enrollment under this title and during 
                        redeterminations of eligibility if the 
                        individual was enrolled before October 1, 2008; 
                        and
                            ``(iii) post a description of these 
                        coverage options on any official website that 
                        may be established by the State in connection 
                        with the plan.
                    ``(F) Rule of construction.--Nothing in this 
                section is to be construed to prohibit a State from--
                            ``(i) establishing limits on beneficiary 
                        cost-sharing under such alternative coverage;
                            ``(ii) paying all or part of a 
                        beneficiary's cost-sharing requirements under 
                        such coverage;
                            ``(iii) paying less than the full cost of a 
                        child's share of the premium under such 
                        coverage, insofar as the premium for such 
                        coverage exceeds the limitation established by 
                        the State under subparagraph (C);
                            ``(iv) using State funds to pay for 
                        benefits above the Federal upper limit 
                        established under subparagraph (C); or
                            ``(v) providing any guidance or information 
                        it deems appropriate in order to help 
                        beneficiaries make an informed decision 
                        regarding the option to enroll in coverage 
                        described in subparagraph (A).''.

SEC. 8. ALLOTMENT DISTRIBUTION FORMULA.

    (a) Allotments to 50 States and the District of Columbia.--
            (1) In general.--Section 2104(b) of the Social Security Act 
        (42 U.S.C. 1397dd(b)) is amended--
                    (A) in paragraph (1), by striking ``the same 
                proportion'' and all that follows and inserting ``the 
                product of the number of SCHIP targeted children, as 
                determined under paragraph (2) for the second preceding 
                fiscal year, the State and Federal per capita SCHIP 
                expenditures for the second preceding fiscal year, as 
                determined under such paragraph, and the enhanced FMAP 
                for the State for the second preceding fiscal year.'';
                    (B) by amending paragraph (2) to read as follows:
            ``(2) Number of schip targeted children and pregnant women 
        and national per capita schip expenditures.--
                    ``(A) In general.--By not later than September 30 
                of each year (beginning with 2007), the Secretary (in 
                consultation with the Director of the Bureau of the 
                Census and using the best available data for the fiscal 
                year ending in the previous year) shall determine and 
                publish in the Federal Register--
                            ``(i) the average number of low-income 
                        targeted children (described in subparagraph 
                        (B)) for any month during such preceding fiscal 
                        year; and
                            ``(ii) the combined State and Federal per 
                        capita SCHIP expenditures (described in 
                        subparagraph (C)) for such preceding fiscal 
                        year.
                    ``(B) Low-income schip targeted children.--Low-
                income targeted children described in this subparagraph 
                with respect to a subsection (b) State are children 
                (including pregnant women described in section 
                2105(c)(8)(E)) residing in the State who are not 
                covered under a group health plan or health insurance 
                coverage (as defined for purposes of section 
                2110(b)(1)(C)) and whose family income--
                            ``(i) exceeds the lesser of--
                                    ``(I) the Medicaid applicable 
                                income level (as defined in section 
                                2110(b)(4)); or
                                    ``(II) 150 percent of the poverty 
                                line; but
                            ``(ii) does not 200 percent of the poverty 
                        line.
                    ``(C) State and federal per capita schip 
                expenditures.--The State and Federal per capita SCHIP 
                expenditures for a fiscal year is equal to--
                            ``(i) the aggregate Federal and State 
                        expenditures made that are attributable to 
                        allotments under this title for subsection (b) 
                        States for the fiscal year; divided by
                            ``(ii) the average total number of targeted 
                        low-income children (including pregnant women 
                        described in section 2105(c)(8)(E)) for whom 
                        health assistance was made available from such 
                        allotments for such fiscal year.''; and
                    (C) by striking paragraphs (3) and (4) and 
                inserting the following:
            ``(3) Subsection (b) state defined.--In this subsection, 
        the term `subsection (b) State' means one of the 50 States or 
        the District of Columbia.
            ``(4) Proportional reduction if total allotments exceed 
        amount available.--If the Secretary estimates that the total of 
        the allotments under this subsection for a fiscal year (in 
        combination with allotments made under subsection (c)) will 
        exceed the aggregate amount available for allotments for such 
        fiscal year under subsection (a), the Secretary shall reduce 
        the amount of each allotment under this subsection in a pro-
        rata manner so that such total does not exceed the aggregate 
        amount available for allotments.''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply to allotments for fiscal years beginning with 
        fiscal year 2008.
    (b) No Redistribution of Unused Allotments.--
            (1) In general.--Section 2104(f) of such Act (42 U.S.C. 
        1397dd) is amended to read as follows:
    ``(f) No Redistribution of Unused Allotments.--There shall be no 
redistribution of allotments from States that are not expended within 
the period of availability under subsection (e).''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply to allotments for fiscal years beginning with 
        fiscal year 2005.

SEC. 9. FIVE-YEAR REAUTHORIZATION.

    Section 2104(a) of the Social Security Act (42 U.S.C. 1397dd(a)) is 
amended--
            (1) by striking ``and'' at the end of paragraph (9);
            (2) by striking the period at the end of paragraph (10) and 
        inserting a semicolon; and
            (3) by adding at the end the following new paragraphs:
            ``(11) for fiscal year 2008, $7,000,000,000;
            ``(12) for fiscal year 2009, $7,000,000,000;
            ``(13) for fiscal year 2010, $7,000,000,000;
            ``(14) for fiscal year 2011, $7,500,000,000; and
            ``(15) for fiscal year 2012, $8,000,000,000.''.

SEC. 10. ENHANCING THE PROGRAMMATIC FOCUS ON CHILDREN AND PREGNANT 
              WOMEN.

    (a) In General.--Section 2107(f) of the Social Security Act (42 
U.S.C. 1397gg(f)) is amended by striking ``childless''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of the enactment of this Act but shall not 
apply to projects, including extensions, amendments, or renewals to 
such projects, that are in effect or have been approved on the date of 
the enactment of this Act.
                                 <all>