[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 82 Introduced in Senate (IS)]
111th CONGRESS
1st Session
S. 82
To amend title XXI of the Social Security Act to reauthorize the State
Children's Health Insurance Program, to limit income eligibility
expansions under that program until the lowest income eligible
individuals are enrolled, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
January 6, 2009
Mr. Vitter 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, to limit income eligibility
expansions under that program until the lowest income eligible
individuals are enrolled, and for other purposes.
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 ``Enhancing Health
Care Coverage for Children Act''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Reauthorization through Fiscal Year 2014.
Sec. 3. Requiring outreach and coverage before expansion of
eligibility.
Sec. 4. Application of DRA Medicaid citizenship documentation
requirements to SCHIP.
Sec. 5. Phase-out of coverage for nonpregnant adults under SCHIP.
Sec. 6. Requirement that individuals who are eligible for SCHIP and
employer-sponsored coverage use the
employer-sponsored coverage instead of
SCHIP.
SEC. 2. REAUTHORIZATION THROUGH FISCAL YEAR 2014.
(a) In General.--Section 2104 of the Social Security Act (42 U.S.C.
1397dd(a)), as amended by section 201(a)(1) of the Medicare, Medicaid,
and SCHIP Extension Act of 2007 (Public Law 110-173) is amended--
(1) in subsection (a)--
(A) by striking ``and'' at the end of paragraph
(10);
(B) in paragraph (11)--
(i) by striking ``each of fiscal years 2008
and 2009'' and inserting ``fiscal year 2008'';
and
(ii) by striking the period at the end and
inserting a semicolon; and
(C) by adding at the end the following new
paragraphs:
``(12) for fiscal year 2009, $7,000,000,000;
``(13) for fiscal year 2010, $8,000,000,000; and
``(14) for each of fiscal years 2011 through 2014,
$9,000,000,000.''; and
(2) in subsection (c)(4)(B), by striking ``2009'' and
inserting ``2014''.
(b) Repeal of Limitation on Availability of Funding for Fiscal
Years 2008 and 2009.--Section 201 of the Medicare, Medicaid, and SCHIP
Extension Act of 2007 (Public Law 110-173) is amended--
(1) in subsection (a), by striking paragraph (2) and
redesignating paragraphs (3) and (4), as paragraphs (2) and (3)
respectively; and
(2) in subsection (b), by striking paragraph (2) and
redesignating paragraph (3) as paragraph (2).
SEC. 3. REQUIRING OUTREACH AND COVERAGE BEFORE EXPANSION OF
ELIGIBILITY.
(a) State Plan Required To Specify How It Will Achieve Coverage for
85 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 2010)
will allow for the State's annual funding allotment to cover at
least 85 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 2010.
(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 any fiscal
year beginning with fiscal year 2010:
``(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 85 percent
retrospective coverage test specified in
subparagraph (C)(i) for the previous fiscal
year; and
``(ii) the State will meet the 85 percent
prospective coverage test specified in
subparagraph (C)(ii) for the fiscal year.
``(C) 85 percent coverage tests.--
``(i) Retrospective test.--The 85 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 85 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 85 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 85
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) 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.--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) 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 October 1,
2009.
(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. 4. APPLICATION OF DRA MEDICAID CITIZENSHIP DOCUMENTATION
REQUIREMENTS TO SCHIP.
(a) In General.--Section 2105(c) of the Social Security Act (42
U.S.C. 1397dd(c)), as amended by section 3(b), is amended by adding at
the end the following new paragraph:
``(9) 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
section 1903(x) 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.''.
(b) Effective Date.--The amendment made by paragraph (1) shall
apply to eligibility determinations and redeterminations made after the
date of enactment of this Act.
SEC. 5. PHASE-OUT OF COVERAGE FOR NONPREGNANT ADULTS UNDER SCHIP.
(a) In General.--Title XXI of the Social Security Act (42 U.S.C.
1397aa et seq.) is amended by adding at the end the following new
section:
``SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT ADULTS.
``(a) Termination of Coverage for Nonpregnant Adults.--
``(1) No new schip waivers; automatic extensions at state
option through december 2009.--Notwithstanding section 1115 or
any other provision of this title, except as provided in this
subsection--
``(A) the Secretary shall not on or after the date
of the enactment of the Enhancing Health Care Coverage
for Children Act, approve or renew a waiver,
experimental, pilot, or demonstration project that
would allow funds made available under this title to be
used to provide child health assistance or other health
benefits coverage to a nonpregnant adult; and
``(B) notwithstanding the terms and conditions of
an applicable existing waiver, the provisions of
paragraph (2) shall apply for purposes of any period
beginning on or after January 1, 2010, in determining
the period to which the waiver applies, the individuals
eligible to be covered by the waiver, and the amount of
the Federal payment under this title.
``(2) Termination of schip coverage under applicable
existing waivers at the end of 2009.--
``(A) In general.--No funds shall be available
under this title for child health assistance or other
health benefits coverage that is provided to a
nonpregnant adult under an applicable existing waiver
after December 31, 2009.
``(B) Extension upon state request.--If an
applicable existing waiver described in subparagraph
(A) would otherwise expire before January 1, 2010, and
the State requests an extension of such waiver, the
Secretary shall grant such an extension, but only
through December 31, 2009.
``(C) Application of enhanced fmap.--The enhanced
FMAP determined under section 2105(b) shall apply to
expenditures under an applicable existing waiver for
the provision of child health assistance or other
health benefits coverage to a nonpregnant childless
adult during the period beginning on the date of the
enactment of this subsection and ending on December 31,
2009.
``(b) Applicable Existing Waiver.--For purposes of this section--
``(1) In general.--The term `applicable existing waiver'
means a waiver, experimental, pilot, or demonstration project
under section 1115, grandfathered under section 6102(c)(3) of
the Deficit Reduction Act of 2005, or otherwise conducted under
authority that--
``(A) would allow funds made available under this
title to be used to provide child health assistance or
other health benefits coverage to--
``(i) a parent of a targeted low-income
child;
``(ii) a nonpregnant childless adult; or
``(iii) individuals described in both
clauses (i) and (ii); and
``(B) was in effect on October 1, 2008.
``(2) Definitions.--The term `nonpregnant adult' means any
individual who is not a targeted low-income pregnant woman (as
defined in section 2112(d)(2)) or a targeted low-income
child.''.
(b) Conforming Amendments.--
(1) Section 2107(f) of such Act (42 U.S.C. 1397gg(f)) is
amended--
(A) by striking ``, the Secretary'' and inserting
``:
``(1) The Secretary'';
(B) in the first sentence, by striking
``childless'';
(C) by striking the second sentence; and
(D) by adding at the end the following new
paragraph:
``(2) The Secretary may not approve, extend, renew, or
amend a waiver, experimental, pilot, or demonstration project
with respect to a State after the date of enactment of the
Enhancing Health Care Coverage for Children Act that would
waive or modify the requirements of section 2111.''.
(2) Section 6102(c) of the Deficit Reduction Act of 2005
(Public Law 109-171; 120 Stat. 131) is amended by striking
``Nothing'' and inserting ``Subject to section 2111 of the
Social Security Act, as added by section 5 of the Enhancing
Health Care Coverage for Children Act, nothing''.
SEC. 6. REQUIREMENT THAT INDIVIDUALS WHO ARE ELIGIBLE FOR SCHIP AND
EMPLOYER-SPONSORED COVERAGE USE THE EMPLOYER-SPONSORED
COVERAGE INSTEAD OF SCHIP.
(a) In General.--Section 2105(c) of the Social Security Act (42
U.S.C. 1397ee(c)), as amended by sections 3(b) and 4(a), is amended by
adding at the end the following new paragraph:
``(10) Requirement regarding employer-sponsored coverage.--
``(A) In general.--Subject to subparagraph (B), no
payment may be made under this title with respect to an
individual who is eligible for coverage under a group
health plan or health insurance coverage offered
through an employer, either as an individual or as part
of family coverage.
``(B) State option to offer premium assistance for
high-cost plans.--
``(i) In general.--In the case of an
individual who is otherwise eligible for
coverage under this title but for the
application of subparagraph (A) and who is
eligible for high-cost heath insurance
coverage, a State may elect to offer a premium
assistance subsidy for such coverage.
``(ii) Amount.--The amount of a premium
assistance subsidy under this paragraph shall
be determined by the State but in no case shall
exceed the lesser of--
``(I) an amount equal to the value
of the coverage under this title that
would otherwise apply with respect to
the individual but for the application
of subparagraph (A); or
``(II) an amount equal to the
difference between--
``(aa) the amount of the
employee's share of the premium
costs for the high-cost health
insurance coverage (for the
family or the individual, as
the case may be); and
``(bb) an amount equal to
20 percent of the total premium
costs for such coverage,
including both the employer and
employee share, (for the family
or the individual, as the case
may be).
``(C) High-cost health insurance coverage.--For
purposes of this paragraph, the term `high-cost health
insurance coverage' means a group health plan or health
insurance coverage offered through an employer in which
the employee is required to pay more than 20 percent of
the premium costs.
``(D) Treatment as child health assistance.--
Expenditures for the provision of premium assistance
subsidies under this paragraph shall be considered
child health assistance described in paragraph (1)(C)
of subsection (a) for purposes of making payments under
that subsection.''.
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