[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 1213 Introduced in Senate (IS)]







110th CONGRESS
  1st Session
                                S. 1213

 To give States the flexibility to reduce bureaucracy by streamlining 
   enrollment processes for the medicaid and State children's health 
  insurance programs through better linkages with programs providing 
        nutrition and related assistance to low-income families.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 25, 2007

Mr. Lugar (for himself, Mr. Bingaman, and Mrs. Lincoln) introduced the 
 following bill; which was read twice and referred to the Committee on 
                                Finance

_______________________________________________________________________

                                 A BILL


 
 To give States the flexibility to reduce bureaucracy by streamlining 
   enrollment processes for the medicaid and State children's health 
  insurance programs through better linkages with programs providing 
        nutrition and related assistance to low-income families.

    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 ``Children's Express Lane to Health 
Coverage Act of 2007''.

SEC. 2. FINDINGS; PURPOSE.

    (a) Findings.--Congress finds the following:
            (1) Despite gains made in recent years, 9,000,000 children 
        in the United States are uninsured. At least 70 percent of 
        those children are eligible for public health insurance 
        coverage.
            (2) Most low-income uninsured children are enrolled in 
        nutrition and related programs that operate under income 
        guidelines similar to those of the Medicaid program. In fact, 
        71 percent of low-income uninsured children are in families 
        that receive benefits through the food stamps program, the 
        National school lunch program, or the special supplemental 
        nutrition program for women, infants and children (commonly 
        referred to as ``WIC'').
            (3) The public would be well served if Federal means-tested 
        public programs were able to improve administrative efficiency 
        and coordination as well as reduce unnecessary bureaucracy.
            (4) Uninsured children would be well served if their 
        enrollment in a nutrition-based or other means-tested program 
        could serve as a gateway to health coverage.
            (5) Existing law already allows children to be found income 
        eligible for WIC based on their enrollment in the Medicaid 
        program. Current law does not, however, give States adequate 
        flexibility to make an income determination for eligibility for 
        the Medicaid program or the State Children's Health Insurance 
        Program based on an uninsured child's enrollment in WIC or 
        another public program.
    (b) Purpose.--The purpose of this Act is to give States the 
flexibility to find children income eligible for the Medicaid program 
or State Children's Health Insurance Program based on findings that 
have already been made by nutrition assistance or similar public 
programs with comparable income standards.

SEC. 3. STATE OPTION TO PROVIDE FOR SIMPLIFIED DETERMINATIONS OF A 
              CHILD'S FINANCIAL ELIGIBILITY FOR MEDICAL ASSISTANCE 
              UNDER MEDICAID OR CHILD HEALTH ASSISTANCE UNDER SCHIP.

    (a) Medicaid.--Section 1902(e) of the Social Security Act (42 
U.S.C. 1396a(e)) is amended by adding at the end the following:
            ``(13)(A) At the option of the State, the plan may provide 
        that financial or other eligibility requirements (including 
        such requirements applicable to redeterminations or renewals of 
        eligibility) for medical assistance are met for a child who is 
        under 19 years of age (or, at State option, 20 or 21 years of 
        age) by using a determination made within a reasonable period 
        (as determined by the State) before its use for this purpose, 
        of the child's family or household income, or if applicable for 
        purposes of determining eligibility under this title or title 
        XXI, assets, resources, or other factual determinations 
        (notwithstanding any other provision of law, including section 
        1903(x) and section 1137(d)), by a Federal or State agency, or 
        a public or private entity making such determination on behalf 
        of such agency, specified by the plan, including (but not 
        limited to) an agency administering the State program funded 
        under part A of title IV, the Food Stamp Act of 1977, the 
        Richard B. Russell National School Lunch Act, or the Child 
        Nutrition Act of 1966, notwithstanding any differences in 
        budget unit, disregard, deeming, or other methodology, but only 
        if--
                    ``(i) the agency has fiscal liabilities or 
                responsibilities affected or potentially affected by 
                such determination;
                    ``(ii) the agency or entity notifies the child's 
                family--
                            ``(I) of the information which shall be 
                        disclosed in accordance with this subparagraph; 
                        and
                            ``(II) that the information disclosed will 
                        be used solely for purposes of determining 
                        eligibility for medical assistance under this 
                        title or for child health assistance under 
                        title XXI;
                    ``(iii) interagency agreements limit the use of 
                such information to that purpose; and
                    ``(iv) the requirements of section 1939 are 
                satisfied.
            ``(B) Nothing in this paragraph shall be construed--
                    ``(i) to authorize the denial of medical assistance 
                under this title or of child health assistance under 
                title XXI to a child who, without the application of 
                this paragraph, would qualify for such assistance;
                    ``(ii) to relieve a State of the obligation under 
                subsection (a)(8) to furnish medical assistance with 
                reasonable promptness after the submission of an 
                initial application that is evaluated or for which 
                evaluation is requested pursuant to this paragraph, 
                including an application that is submitted through 
                failure to decline enrollment, as provided in 
                subparagraph (E);
                    ``(iii) to relieve a State of the obligation to 
                determine, on another basis, eligibility for medical 
                assistance under this title or for child health 
                assistance under title XXI if a child is determined 
                ineligible for such assistance on the basis of 
                information furnished pursuant to this paragraph; or
                    ``(iv) as rendering subparagraph (A) inapplicable 
                to redeterminations or renewals of eligibility.
            ``(C) If a State applies the eligibility process described 
        in subparagraph (A) to individuals eligible under this title 
        and to individuals eligible under title XXI, the State may, at 
        its option, implement its duties under subparagraphs (A) and 
        (B) of section 2102(b)(3) using either or both of the following 
        approaches:
            ``(i) The State may--
                    ``(I) establish a threshold percentage of the 
                Federal poverty level (that shall exceed the income 
                eligibility level applicable for a population of 
                individuals under this title by 30 percentage points 
                (as a fraction of the Federal poverty level) or such 
                other higher number of percentage points as the State 
                determines reflects the typical application of income 
                methodologies by the non-health program and the State 
                plan under this title);
                    ``(II) provide that, with respect to any individual 
                within such population whom a non-health agency 
                determines has income that does not exceed such 
                threshold percentage for such population, such 
                individual meets all income requirements for 
                eligibility for medical assistance under this title 
                (regardless of whether such individual would otherwise 
                be determined to be eligible to receive such 
                assistance); and
                    ``(III) provide that, with respect to any 
                individual within such population whom a non-health 
                agency determines has income that exceeds such 
                threshold percentage for such population, such 
                individual has a family income that exceeds the 
                Medicaid applicable income level under section 
                2110(b)(4), regardless of whether the individual would 
                otherwise be determined to have such a family income.
        In exercising the approaches under this clause, a State shall 
        inform families whose children are enrolled in a State child 
        health plan under title XXI based on having family income above 
        the threshold described in subclause (I) that they may qualify 
        for medical assistance under this title and, at their option, 
        can seek a regular eligibility determination for such 
        assistance for their child.
            ``(ii) Regardless of whether a State otherwise provides for 
        presumptive eligibility under section 1920A, a State may 
        provide presumptive eligibility under this title, consistent 
        with subsection (e) of section 1920A, to a child who, based on 
        a determination by a non-health agency, would qualify for child 
        health assistance under a State child health plan under title 
        XXI. During such presumptive eligibility period, the State may 
        determine the child's eligibility for medical assistance under 
        this title, pursuant to subparagraph (A) of section 2102(b)(3), 
        based on telephone contact with family members, access to data 
        available in electronic or paper form, and other means of 
        gathering information that are less burdensome to the family 
        than completing an application form on behalf of the child. The 
        procedures described in the previous sentence may be used 
        regardless of whether the State uses similar procedures under 
        other circumstances for purposes of determining eligibility for 
        medical assistance under this title.
            ``(D) At the option of a State, the eligibility process 
        described in subparagraph (A) may apply to an individual who is 
        not a child.
            ``(E)(i) At the option of a State, an individual determined 
        to be eligible for medical assistance or child health 
        assistance pursuant to subparagraph (A) or (C) or other 
        procedures through which eligibility is determined based on 
        data obtained from sources other than the individual may 
        receive medical assistance under this title if such individual 
        (or, in the case of an individual under age 19 (or if the State 
        elects the option under subparagraph (A), age 20 or 21) who is 
        not authorized to consent to medical care, the individual's 
        parent, guardian, or other caretaker relative) fails to decline 
        enrollment after receiving notice of eligibility and a 
        reasonable opportunity to decline enrollment, in which case the 
        State (at its option) may waive any otherwise applicable 
        requirements for signatures by or on behalf of the individual.
            ``(ii)(I) If the application of clause (i) results in the 
        enrollment of individuals in managed care organizations that 
        receive capitated payments to cover some or all of the cost of 
        providing medical assistance or child health assistance, the 
        State shall establish mechanisms (including full or partial 
        withholding of capitated payments until the managed care 
        organization documents the provision of services to that 
        individual and awarding of default enrollment shares based in 
        significant part on such organization's documentation of prior 
        services furnished to default enrollees) to ensure that 
        individuals enrolled pursuant to this subparagraph do not 
        receive fewer preventive services (including well-child and 
        well-baby visits) than do individuals enrolled in such managed 
        care organizations who are eligible for medical assistance on 
        the basis of the same general eligibility category but who are 
        not determined to be so eligible pursuant to subparagraph (A) 
        or (C).
            ``(II) For purposes of subclause (I), the term `general 
        eligibility category' shall be construed as including the 
        following categories: low-income children who are eligible for 
        medical assistance based on factors other than disability, 
        adults eligible for such assistance because they are parents or 
        other caretaker relatives of dependent children, and women 
        eligible for such assistance because of pregnancy.
            ``(iii) In the case of an individual enrolled pursuant to 
        clause (i), the State shall inform the individual (or, in the 
        case of an individual under age 18, the individual's parent, 
        guardian, or other caretaker relative) about the significance 
        of such enrollment, including appropriate methods to access 
        covered services.
            ``(iv) In the case of an individual enrolled pursuant to 
        clause (i) who is charged premiums and who does not use any 
        health care services during the first 90 days following 
        enrollment, enrollment shall be considered declined if such 
        individual fails to pay premiums during that 90 day period, in 
        which case no financial liability or penalty may apply to such 
        individual. Such an individual shall be sent a notice 
        explaining the disenrollment and offering an opportunity to 
        reenroll.
            ``(F) For purposes of this paragraph--
                    ``(i) the term `non-health agency' means an agency 
                or entity described in subparagraph (A); and
                    ``(ii) the term `non-health benefits' means the 
                benefits or assistance provided by a non-health 
                agency.''.
    (b) SCHIP.--Section 2107(e)(1) of the Social Security Act (42 
U.S.C. 1397gg(e)(1)) is amended by adding at the end the following:
                    ``(E) Section 1902(e)(13) (relating to the State 
                option to base a determination of a child's eligibility 
                for assistance on determinations made by a non-health 
                agency administering a program providing nutrition or 
                other public assistance (except that the State option 
                under subparagraph (D) of such section shall apply 
                under this title only if an individual is 
                pregnant)).''.
    (c) Presumptive Eligibility.--
            (1) In general.--Section 1920A of the Social Security Act 
        (42 U.S.C. 1396r-1a) is amended--
                    (A) in subsection (b)(3)(A)(i)(II) is amended--
                            (i) by striking ``or'' before ``eligibility 
                        of a child for child health assistance''; and
                            (ii) by inserting ``or is an agency or 
                        entity described in section 1902(e)(13)(A),'' 
                        before ``(III)'';
                    (B) by adding at the end the following:
    ``(e) In the case of a State with a child health plan under title 
XXI that provides for presumptive eligibility under such plan and under 
this title, the State shall place each presumptively eligible child in 
the program under this title or title XXI for which the child appears 
most likely to qualify. During the child's period of presumptive 
eligibility, the State shall receive Federal matching funds under 
section 1903 or section 2105, depending on the program in which the 
child has been placed. If at the conclusion of such period, the child 
is found to qualify for, and is enrolled in, the program established 
under this title or title XXI when the child was enrolled in the 
program under the other such title during such period, the State's 
receipt of Federal matching funds shall be adjusted both retroactively 
and prospectively so that Federal matching funds are provided, both 
during and following such period of presumptive eligibility, based on 
the program in which the child is enrolled following the conclusion of 
the presumptive eligibility period.''.
            (2) Payment for presumptive eligibility for children from 
        the medicaid or schip program in which the child is enrolled.--
                    (A) In general.--Section 2105(a)(1)of such Act (42 
                U.S.C. 1397ee(a)(1)) is amended--
                            (i) by striking subparagraph (B) and 
                        inserting the following:
                    ``(B) at State option, for the provision of medical 
                assistance to a child described in section 
                1902(a)(10)(A)(ii)(XIV) during a period of presumptive 
                eligibility under section 1920A;''; and
                            (ii) in subparagraph (C), by inserting ``, 
                        including child health assistance provided 
                        during a period of presumptive eligibility in 
                        accordance with section 2107(e)(1)(D)'' after 
                        ``2103''.
                    (B) Rule of construction.--Section 2105(a)(1)(B) of 
                such Act (42 U.S.C. 1397ee(a)(1)(B)), as amended by 
                subparagraph (A)(i), shall not be construed as 
                affecting in any way the application of section 
                1920A(d) of such Act (42 U.S.C. 1396r-1a(d)) for 
                purposes of making payments to States under section 
                1903 of such Act (42 U.S.C. 1396b) for medical 
                assistance provided during a period of presumptive 
                eligibility in accordance with section 1920A of such 
                Act (42 U.S.C. 1396r-1a).
    (d) Signature Requirements.--Section 1902(a) of such Act (42 U.S.C. 
1396a(a)) is amended by adding at the end the following: 
``Notwithstanding any other provision of law, a signature under penalty 
of perjury shall not be required on an application form for medical 
assistance as to any element of eligibility for which eligibility is 
based on information received from a source other than applicant, 
rather than on representations from the applicant. Notwithstanding any 
other provision of law, any signature requirement for an application 
for medical assistance may be satisfied through an electronic 
signature, as defined in section 1710(1) of the Government Paperwork 
Elimination Act (44 U.S.C. 3504 note).''.

SEC. 4. INVESTMENTS TO PROMOTE ADMINISTRATIVE EFFICIENCY.

    (a) Management Information Systems.--
            (1) In general.--Section 1903(a)(3)(A)(i) of the Social 
        Security Act (42 U.S.C. 1396b(a)(3)(A)(i)) is amended by 
        inserting ``(including technology that enables inter-program 
        connections, as defined in section 1905(y), and other 
        technology that reduces the number of individuals who are 
        inaccurately granted eligibility, that increases the number of 
        individuals who are accurately granted eligibility, or that 
        improves the efficiency of eligibility determinations, under 
        this title or title XXI)'' after ``mechanized claims processing 
        and information retrieval systems''.
            (2) Inter-program connections defined.--Section 1905 of 
        such Act (42 U.S.C. 1396d) is amended by adding at the end the 
        following:
    ``(y)(1) For purposes of section 1903(a)(3)(A)(i), the term 
`technology that enables inter-program connections' means information 
technology (including software and hardware) that connects systems for 
determining eligibility or storing eligibility-related data pursuant to 
this title or title XXI to other sources of data potentially pertinent 
to eligibility determinations under this title or title XXI, 
including--
            ``(A) eligibility files maintained by programs described in 
        section 1902(e)(13)(A);
            ``(B) information described in paragraph (2) or (3) of 
        section 1137(a);
            ``(C) vital records information about births in any State; 
        and
            ``(D) information described in sections 453(i) and 
        1902(a)(25)(I)(i).
    ``(2) The technology described in paragraph (1) includes systems 
and activities involved in preparing, transmitting, processing, 
matching, analyzing, inputting, and storing information from the other 
sources of data described in that paragraph.''.
    (b) Authorization of Information Disclosure.--
            (1) In general.--Title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.) is amended--
                    (A) by redesignating section 1939 as section 1940; 
                and
                    (B) by inserting after section 1938 the following:

``SEC. 1939. AUTHORIZATION TO RECEIVE PERTINENT INFORMATION.

    ``(a) In General.--Notwithstanding any other provision of law, a 
Federal, State, or local agency or private entity in possession of the 
other sources of data described in section 1905(y) or the information 
described in section 453(i) or 1902(a)(25)(I)(i) is authorized to 
convey such data or information to a person directly connected with the 
administration or enforcement of a State plan under this title or title 
XXI, consistent with the succeeding provisions of this section.
    ``(b) Requirements for Conveyance.--Data or information may be 
conveyed pursuant to this section only if the following requirements 
are met:
            ``(1) The individual whose circumstances are described in 
        the data or information (or such individual's parent, guardian, 
        caretaker relative, or authorized representative) has either 
        provided advance consent to disclosure or has not objected to 
        disclosure after receiving advance notice of disclosure and a 
        reasonable opportunity to object.
            ``(2) Such data or information are used solely for the 
        purposes of--
                    ``(A) identifying individuals who are eligible or 
                potentially eligible for assistance under this title or 
                title XXI and enrolling such individuals in the State 
                plans established under such titles; and
                    ``(B) verifying the eligibility of individuals for 
                assistance under the State plans established under this 
                title or title XXI.
            ``(3) An interagency or other agreement, consistent with 
        standards developed by the Secretary--
                    ``(A) prevents the unauthorized use, disclosure, or 
                modification of such data and otherwise meets 
                applicable Federal requirements safeguarding privacy 
                and data security; and
                    ``(B) requires the State agencies administering the 
                State plans established under this title and title XXI 
                to use the data and information obtained under this 
                section to seek to enroll individuals in such plans.
    ``(c) Criminal Penalty.--A person described in the subsection (a) 
who publishes, divulges, discloses, or makes known in any manner, or to 
any extent not authorized by Federal law, any information obtained 
under this section shall be fined not more than $1,000 or imprisoned 
not more than 1 year, or both.
    ``(d) Rule of Construction.--The limitations and requirements that 
apply to disclosure pursuant to this section shall not be construed to 
prohibit the conveyance or disclosure of data or information otherwise 
permitted under Federal law (without regard to this section).''.
            (2) Conforming amendment to assure access to national new 
        hires database.--Section 453(i)(1) of such Act (42 U.S.C. 
        653(i)(1)) is amended--
                    (A) by striking ``and programs'' and inserting ``, 
                programs''; and
                    (B) by inserting ``and State plans approved under 
                title XIX or XXI'' after ``part A,''.
            (3) Conforming amendment to provide schip programs with 
        access to national income data.--Section 6103(l)(7)(D)(ii) of 
        the Internal Revenue Code of 1986 is amended by inserting ``or 
        title XXI'' after ``title XIX''.
            (4) Conforming amendment to provide access to data about 
        enrollment in private insurance.--Section 1902(a)(25)(I)(i) of 
        the Social Security Act (42 U.S.C. 1396a(a)(25)(I)(i)) is 
        amended--
                    (A) by inserting ``(and, at State option, 
                individuals who are potentially eligible or who 
                apply)'' after ``with respect to individuals who are 
                eligible''; and
                    (B) by inserting ``under this title (and, at State 
                option, child health assistance under title XXI)'' 
                after ``the State plan''.

SEC. 5. EFFECTIVE DATE.

    The amendments made by this Act take effect on October 1, 2007.
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