[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.''.
                                 <all>