II 110th CONGRESS 1st Session S. 1224 IN THE SENATE OF THE UNITED STATES April 25, 2007 Mr. Rockefeller (for himself, Ms. Snowe, and Mr. Kennedy) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XXI of the Social Security Act to reauthorize the State Children's Health Insurance Program, and for other purposes.

1.

Short title; amendments to Social Security Act; table of contents

(a)

Short title

This Act may be cited as the Children’s Health Insurance Program (CHIP) Reauthorization Act of 2007 . (b)

Amendments to social security act

Except as otherwise specifically provided, whenever in this Act an amendment is expressed in terms of an amendment to or repeal of a section or other provision, the reference shall be considered to be made to that section or other provision of the Social Security Act. (c)

Medicaid; CHIP; Secretary

In this Act: (1)

CHIP

The term CHIP means the State Children's Health Insurance Program established under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.). (2)

Medicaid

The term Medicaid means the program for medical assistance established under title XIX of the Social Security Act (42 U.S.C. 1396 et seq,). (3)

Secretary

The term Secretary means the Secretary of Health and Human Services. (d)

Table of contents

The table of contents for this Act is as follows: Sec. 1. Short title; amendments to Social Security Act; table of contents. Sec. 2. Findings. TITLE I—Making Children's Health Coverage a National Priority Sec. 101. Providing necessary funding for CHIP. TITLE II—Improving CHIP Financing Sec. 201. State CHIP allotments that are responsive to health care costs, population growth, and the needs of low-income uninsured children. Sec. 202. 2-year initial availability of CHIP allotments for all States and territories. Sec. 203. Establishment of timely and responsive redistribution process. Sec. 204. Improving funding for the territories under CHIP and Medicaid. Sec. 205. Extension of authority for qualifying States to use CHIP allotments for certain Medicaid expenditures. Sec. 206. State option to expand coverage of children under CHIP up to 300 percent of the poverty line. Sec. 207. Requiring responsible CHIP enrollment growth. TITLE III—Enrolling Uninsured Children Eligible for CHIP and Medicaid Sec. 301. Express Lane option for States to determine components of a child’s eligibility for Medicaid or CHIP. Sec. 302. Information technology connections to simplify health coverage determinations. Sec. 303. Enhanced administrative funding for translation or interpretation services. Sec. 304. Enhanced assistance with coverage costs for States with increasing or high coverage rates among children. Sec. 305. Elimination of counting Medicaid child presumptive eligibility costs against title XXI allotment. Sec. 306. State option to require certain individuals to present satisfactory documentary evidence of proof of citizenship or nationality for purposes of eligibility for Medicaid. TITLE IV—Start Healthy, Stay Healthy Sec. 401. State option to expand or add coverage of certain pregnant women under Medicaid and CHIP. Sec. 402. Coordination with the maternal and child health program. Sec. 403. Optional coverage of legal immigrants under Medicaid and CHIP. Sec. 404. Improving benchmark coverage options. Sec. 405. Requiring coverage of dental and mental health services. Sec. 406. Clarification of requirement to provide EPSDT services for all children in benchmark benefit packages under Medicaid. Sec. 407. Childhood obesity demonstration project. TITLE V—Improving Access to Health Care for Children Sec. 501. Promoting children's access to covered health services. Sec. 502. Institute of Medicine study and report on children's access to health care. TITLE VI—Strengthening Quality of Care and Health Outcomes of Children Sec. 601. Strengthening child health quality improvement activities. Sec. 602. Application of certain managed care quality safeguards to CHIP. TITLE VII—Other Improvements Sec. 701. Strengthening premium assistance programs. Sec. 702. Permitting coverage of children of State employees. Sec. 703. Improving data collection. Sec. 704. Moratorium on application of PERM requirements related to eligibility reviews during period of independent study and report. Sec. 705. Elimination of confusing program references. TITLE VIII—Effective Date Sec. 801. Effective date.

2.

Findings

Congress makes the following findings: (1)

The State Children's Health Insurance Program (CHIP) and Medicaid have greatly improved children’s coverage rates and access to needed health care services

(A)CHIP and Medicaid serve as the critical health care safety net for 34,000,000 children over the course of a year, with 28,000,000 children enrolled in Medicaid and more than 6,000,000 children enrolled in CHIP. (B)CHIP and Medicaid have accounted for a 1/3 decline in the rate of uninsured low-income children since 1997. (C)During the recent economic downturn, and as the number of uninsured people has climbed to the highest number ever recorded in the United States, CHIP and Medicaid offset losses in employer-sponsored coverage that affected children and parents alike. (D)While the number of children living in low-income families increased between 2000 and 2005, the number of uninsured children fell due to Medicaid and CHIP. (E)Children enrolled in CHIP or Medicaid are much more likely to have a usual source of care than uninsured children, and are much more likely than uninsured children to receive well-child care, see a doctor during the year, and get dental care. Studies have found that children enrolled in public insurance programs experienced significant improvement in measures of school performance. (F)Since CHIP was created, coverage rates have increased significantly among children of all ethnic and racial groups. (G)According to one Federal evaluation of CHIP, uninsured children who gained coverage through the program received more preventive care, and their parents reported better access to providers and improved communications with their children’s doctors. (2)

Even with the success of CHIP and Medicaid, more needs to be done to improve the health status of our Nation’s children

(A)There are currently 9,000,000 uninsured children under age 19, accounting for nearly 20 percent of our Nation’s uninsured. (B)Approximately 7 out of every 10 uninsured children are eligible for CHIP or Medicaid. (C)The cost of unmet health needs among children extends beyond measurable health system costs. For example, problems that could be prevented, managed, or treated with regular access to care can become more serious, resulting in lower school attendance and increased health care costs. (D)Reducing the number of uninsured children in our country is an essential first step to improve health status. CHIP reauthorization presents an opportunity to secure health care coverage for more children who are eligible for CHIP or Medicaid but not yet enrolled. (3)

We must maintain coverage for the children currently enrolled in CHIP

(A)When CHIP was created in 1997, Congress allocated $40,000,000,000 for the 10-year authorization. (B)At current funding levels, nearly 2,000,000 children are at risk of losing their CHIP coverage over the next 5 years because the current CHIP financing structure is inadequate and States are facing CHIP funding shortfalls. (C)We must eliminate Federal funding shortfalls by providing States with significant new Federal resources for children’s health coverage. (D)CHIP reauthorization offers an opportunity to increase CHIP funding and to provide stable, predictable Federal funding so that States not only have the ability to maintain their current caseloads but also to expand coverage to currently unenrolled children. (4)

We must reach the uninsured children who are already eligible for CHIP or Medicaid but unenrolled

(A)More than 6,000,000 uninsured children are eligible for CHIP or Medicaid at any point during the year. (B)In some States, it is estimated that up to 50 percent of children covered through CHIP do not remain in the program due to reenrollment barriers. (C)Difficult renewal policies and reenrollment barriers make seamless coverage in CHIP unattainable. Studies indicate that as many as 67 percent of children who were eligible but not enrolled in CHIP or Medicaid had applied for coverage but were denied eligibility due to procedural issues. (D)States have tools at their disposal to streamline enrollment procedures, but further Federal changes would help States reach more children. (E)Insuring parents is an effective way to increase children’s participation in public programs and to increase children’s access to health care services. (F)To reduce the number of uninsured children, improve our children's health, and continue our progress in reducing health disparities, the reauthorization of CHIP should provide States with the tools and resources necessary to identify, enroll, and maintain coverage for children who are eligible for CHIP or Medicaid. (5)

We must support and encourage States that are leading the way with initiatives to cover more children

(A)States in every region of the country are seeking to move forward in covering more children, either by reaching already eligible children or further expanding eligibility. (B)The Federal government should serve as a partner in these efforts by providing sufficient funding to solidify and strengthen this momentum. (6)

We must promote high-quality health care that promotes children's healthy development

(A)Children and adolescents deserve better quality care than what they currently receive. (B)Most States report using some kind of measure to evaluate and improve the quality of care children receive through their CHIP and Medicaid programs. However, State efforts are often hampered by budget constraints, limitations on information technology systems, and a need for improved measurement tools and performance measurement standards. (C)As we improve access to health coverage as part of CHIP reauthorization, Congress also has an opportunity to enhance quality by improving and standardizing data collection efforts. (7)

We must support policies that strengthen and expand health insurance coverage

(A)There are more than 46,000,000 uninsured Americans today. (B)No one who is currently covered should lose coverage because of changes to CHIP or Medicaid as part of the reauthorization of CHIP. (C)Coverage of parents through family coverage waivers furthers the objectives of CHIP in that it promotes children’s enrollment, positively impacts children’s utilization of services, and improves family well-being. (D)Coverage of parents through family coverage waivers is also consistent with long-standing CHIP policy—the explicit authorization in the CHIP statute for the Secretary to grant waivers that are consistent with the objectives of CHIP, the parent waiver guidelines for CHIP issued by the Secretary, and the flexibility broadly accorded states through CHIP. (E)Parent coverage waivers have been granted to States that have made a commitment to cover children first and then to use funding to cover low-income parents. (F)Research indicates that having an uninsured parent not only decreases the likelihood that a child will have a well-child visit, it also decreases the likelihood that a child will see any medical provider at all. (G)We strongly support maintaining the current flexibility under CHIP that permits family coverage through waivers to cover parents, while assuring that children remain the primary focus of CHIP.