SCHIP and Medicaid gross income eligibility ceiling

(a)

Application of SCHIP eligibility ceiling

(1)

In general

Section 2110 of the Social Security Act (42 U.S.C. 1397jj) is amended— (A)in subsection (b)(1)— (i)by striking and at the end of subparagraph (B); (ii)by striking the period at the end of subparagraph (C) and inserting ; and; and (iii)by adding at the end the following new subparagraph:

(D)whose gross family income (as defined in subsection (c)(9)) does not exceed 250 percent of the poverty line.

; and

(B)in subsection (c), by adding at the end the following new paragraph:

(9)

Gross family income

(A)

In general

Subject to subparagraph (B), the term gross family income means, with respect to an individual, gross income (as defined by the Secretary in regulations) for the members of the individual’s family. For purposes of the previous sentence, in defining gross income the Secretary shall, to the maximum extent practicable, include income from whatever source, other than amounts deducted under section 62(a)(1) of the Internal Revenue Code of 1986. (B)

Income disregards authorized

A State may provide, through a State plan amendment and with the approval of the Secretary, for the disregard from gross family income of one or more amounts so long as the total amount of such disregards for a family does not exceed $250 per month, or $3,000 per year.

(2)

Denial of federal matching payments for state SCHIP expenditures for individuals with gross family income above 250 percent of the poverty line

Section 2105(c) of the Social Security Act (42 U.S.C. 1397ee(c)) is amended by adding at the end the following new paragraph:

(8)

Denial of payments for expenditures for child health assistance for individuals whose gross family income exceeds 250 percent of the poverty line

No payment may be made under this section, for any expenditures for providing child health assistance or health benefits coverage under a State child health plan under this title, including under a waiver under section 1115, with respect to an individual whose gross family income (as defined in section 2110(c)(9)) exceeds 250 percent of the poverty line.

(3)

Conforming amendment to maintenance of effort

Section 2105(d)(1) of such Act (42 U.S.C. 1397ee(d)(1)) is amended by inserting before the period at the end the following: , unless such income standards were adopted in order to comply with the requirements of section 1939. (b)

Medicaid gross income eligibility ceiling

(1)

In general

Title XIX of the Social Security Act is amended by redesignating section 1939 as section 1940 and by inserting after section 1940 the following new section:

1939.

Income eligibility limitation

Notwithstanding any other provision of this title, no individual with gross family income (as defined in section 2110(c)(9)) that exceeds 250 percent of the poverty line shall be eligible to receive medical assistance under a State plan under this title, including under a waiver under section 1915 or 1115.

(2)

Denial of federal matching payments for state expenditures for medical assistance for individuals whose gross family income exceeds 250 percent of the federal poverty line

Section 1903(i) of such Act (42 U.S.C. 1396b(i)) is amended— (A)in paragraph (22) by striking or at the end; (B)in paragraph (23) by striking the period at the end and inserting ; or; and (C)by inserting after paragraph (23) the following new paragraph:

(24)if a State fails to comply with the provisions of section 1939, with respect to amounts expended by a State for medical assistance for individuals to whom the income eligibility limitation under such section applies.

(3)

Medicaid state plan requirements

Section 1902(a) of such Act (42 U.S.C. 1396a(a)) is amended— (A)in paragraph (69) by striking and at the end; (B)in paragraph (70) by striking the period at the end and inserting ; and; and (C)by inserting after paragraph (70) the following new paragraph:

(71)provide that the State complies with the requirements of section 1939.

(4)

Conforming amendment relating to income eligibility

Section 1903(f)(1)(A) of such Act (42 U.S.C. 1396b(f)(1)(A)) is amended by inserting before the period at the end the following: , if such payments are not otherwise prohibited under subsection (i)(24),. (c)

Effective date; transition

(1)

In general

Subject to paragraph (2), the amendments made by this section shall apply to payments made for items and services furnished on or after the first day of the first calendar quarter beginning more than 90 days after the date of the enactment of this Act. (2)

Transition

The amendments made by— (A)(i)subsection (a)(1) shall not apply to an individual who was receiving, or was determined eligible to receive, child health assistance or health benefits coverage under a State child health plan under title XXI of the Social Security Act, including under a waiver under section 1115 of such Act, as of the day before the date of the enactment of this Act, until such date as the individual is determined ineligible using income standards or methodologies in place as of the day before the date of the enactment of this Act; and (ii)subsection (a)(2) shall not apply to payment for items and services furnished to an individual described in clause (i); (B)(i)subsection (b)(1) shall not apply to an individual who was receiving, or was determined eligible to receive, medical assistance or health benefits coverage under a State plan under title XIX of the Social Security Act, including under a waiver under section 1115 of such Act, as of the day before the date of the enactment of this Act, until such date as the individual is determined ineligible using income standards or methodologies in place as of the day before the date of the enactment of this Act; and (ii)subsection (b)(2) shall not apply to payment for items and services furnished to an individual described in clause (i).