1.Short
title; table of contents
(a)This Act may be cited
as the Enhancing Health Care Coverage
for Children Act
.
(b)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.
2.Reauthorization
through Fiscal Year 2014
(a)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
2009Section 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).
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)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)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
enrolledSection 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 childrenFor 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 linePayment 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
lineIn 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)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)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 womenIn 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)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 determinationsIn 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)(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.
4.Application of
DRA Medicaid citizenship documentation requirements to SCHIP
(a)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)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 womenFor 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)The amendment made by paragraph (1) shall apply to
eligibility determinations and redeterminations made after the date of
enactment of this Act.
5.Phase-out of coverage
for nonpregnant adults under SCHIP
(a)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:
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
2009Notwithstanding 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)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 requestIf 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 fmapThe 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 WaiverFor purposes of this section—
(1)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)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)
(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
.
6.Requirement that
individuals who are eligible for SCHIP and employer-sponsored coverage use the
employer-sponsored coverage instead of SCHIP
(a)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)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 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)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 coverageFor 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 assistanceExpenditures 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.
.