[Congressional Record Volume 144, Number 144 (Monday, October 12, 1998)]
[Senate]
[Pages S12402-S12403]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. TORRICELLI:
  S. 2626. A bill to amend title XIX of the Social Security Act to 
provide a children's enrollment performance bonus; to the Committee on 
Finance.


           the health care for america's children act of 1998

 Mr. TORRICELLI. Mr. President, during last year's passage of 
the balanced budget agreement, Congress achieved a great victory. We 
created a new $24 billion program to fund children's health--the State 
Children's Health Insurance Program.
  Even with that historic effort, our work is far from finished. There 
are 10 million children in this country without health insurance. But 
even more troubling is that nearly half of these children are eligible 
for Medicaid health coverage yet remain unenrolled.
  This is the great tragedy of Medicaid. Barriers to enrollment like 
complicated application forms, inaccessible sign-up procedures, and 
demeaning eligibility processes are preventing families from enrolling 
their kids. A recent report by the Agency for Health Care Policy and 
Research (AHCPR) stressed the need for states to engage in outreach 
activities to increase enrollment of Medicaid-eligible children. 
Likewise, President Clinton recently identified Medicaid outreach as a 
high priority of his administration.
  The bill I am introducing today would go a long way toward getting 
these children enrolled. This bill, the Health Care for America's 
Children Act of 1998, would create an incentive program to reward 
states who engage in outreach activities to enroll the 4.7 million 
uninsured children who are eligible for Medicaid. States who employ 
effective outreach activities like shortened and simplified 
applications, presumptive and continuous eligibility, and outstationing 
of eligibility workers in schools and day care centers, would be 
eligible for a performance bonus.
  State adoption of these outreach activities is critical to removing 
the barriers to enrollment and ensuring that all eligible children get 
the Medicaid health insurance to which they are already entitled. 
According to the Congressional Budget Office (CBO), adoption of these 
outreach measures would increase the number of children enrolled in 
Medicaid by 700,000 each year after the year 2000. That means that by 
the year 2007, we could have all eligible children covered.
  Lack of health insurance can be devastating to the health status of 
children. Children without health insurance are four times more likely 
to go without needed medical or surgical care. And children without 
health care are less likely to grow up to be healthy productive adults, 
less likely to receive timely preventive care, and less likely to 
receive treatment even for serious illnesses.
  Unmet health care needs also translate into higher costs over the 
long run. Uninsured children are more likely to need emergency room 
care at twice the cost of office-based care. Each dollar invested in 
immunization saves $7.40 in future medical costs.
  Ensuring that children have access to health care is an investment in 
our future. Over 10 million uninsured children in this country is a 
crisis. But it is a travesty that we have the means to cover almost 
half of these children and are failing to do so. In the words of Albert 
Camus (CAM-OO), ``perhaps we cannot prevent this from being our world 
which children suffer, but we can lessen the number of suffering 
children.''
  Mr. President, I ask that the Health Care for America's Children Act 
of 1998 be included in its entirety in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2626

       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 ``Health Care for America's 
     Children Act of 1998''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Over 10,000,000 children in the United States, 1 in 7, 
     lack health insurance coverage.
       (2) Nearly half of those children (4,700,000) are eligible 
     for health benefits coverage through the medicaid program but 
     are not enrolled in that program.
       (3) Children without health insurance coverage are 4 times 
     more likely to go without needed medical or surgical care.
       (4) One out of 5 children who are uninsured for a year or 
     longer are missing all of their current immunizations.
       (5) Children without health insurance are less likely to 
     have a family doctor, less likely to receive timely 
     preventive care, and less likely to receive treatment, even 
     for serious illnesses.

[[Page S12403]]

       (6) Uninsured children are more likely to need emergency 
     room care at twice the cost of office-based care.
       (7) A recent report by the Agency for Health Care Policy 
     and Research (AHCPR) stressed the need for States to engage 
     in outreach activities to increase the enrollment of 
     medicaid-eligible children.
       (8) Outreach activities like shortened and simplified 
     applications, presumptive and continuous eligibility, and 
     outstationing of eligibility workers in schools and day care 
     centers have been found to be effective in getting medicaid-
     eligible children enrolled in the medicaid program.

     SEC. 3. MEDICAID CHILDREN'S ENROLLMENT PERFORMANCE BONUS.

       Section 1903 of the Social Security Act (42 U.S.C. 1396b) 
     is amended by adding at the end the following:
       ``(x)(1) In general.--Beginning with fiscal year 1999 and 
     each fiscal year thereafter, in addition to any other payment 
     under this title, the Secretary shall pay to each State that 
     satisfies the requirements of paragraphs (2) and (3) a 
     children's enrollment performance bonus under this subsection 
     for such fiscal year in such amount as the Secretary shall 
     determine.
       ``(2) Demonstration of implementation of outreach 
     strategies.--A State shall demonstrate to the satisfaction of 
     the Secretary that the State has a commitment to reach and 
     enroll children who are eligible for medical assistance 
     under, but not enrolled in, the State plan under this title 
     through effective implementation of each of the following 
     outreach activities:
       ``(A) Streamlined eligibility procedures.--
       ``(i) In general.--The State uses streamlined procedures 
     described in clause (ii) for determining the eligibility for 
     medical assistance under, and enrollment in, the State plan 
     under this title of--
       ``(I) children in families with incomes that do not exceed 
     the effective income level (expressed as a percent of the 
     poverty line) that has been specified under such State plan 
     (including under a waiver authorized by the Secretary or 
     under section 1902(r)(2) for the child to be eligible for 
     medical assistance under section 1902(l)(2) or 1905(n)(2) (as 
     selected by a State) for the age of such child; and
       ``(II) children determined eligible for such assistance, 
     and enrolled in the State plan under this title in accordance 
     with the requirements of paragraphs (1) and (2) of section 
     1931(b).
       ``(ii) Procedures described.--The streamlined procedures 
     described in this clause include--
       ``(I) using shortened and simplified applications for the 
     children described in clause (i);
       ``(II) eliminating the assets test for determining the 
     eligibility of such children; and
       ``(III) allowing applications for such children to be 
     submitted by mail or telephone.
       ``(B) Continuous eligibility for children.--The State 
     provides (or demonstrates to the satisfaction of the 
     Secretary that, not later than fiscal year 2001, the State 
     shall provide) for 12-months of continuous eligibility for 
     children in accordance with section 1902(e)(12).
       ``(C) Presumptive eligibility for children.--The State 
     provides (or demonstrates to the satisfaction of the 
     Secretary that, not later than fiscal year 2001, the State 
     shall provide) for making medical assistance available to 
     children during a presumptive eligibility period in 
     accordance with section 1920A.
       ``(D) Outstationing and alternative applications.--The 
     State complies with the requirements of section 1902(a)(55) 
     (relating to outstationing of eligibility workers for the 
     receipt and initial processing of applications for medical 
     assistance and the use of alternative application forms).
       ``(E) Simplified verification of eligibility 
     requirements.--The State demonstrates to the satisfaction of 
     the Secretary that the State uses only the minimum level of 
     verification requirements as are necessary for the State to 
     ensure accurate eligibility determinations under the State 
     plan under this title.
       ``(3) Report on number of enrollments resulting from 
     outreach.--A State shall annually report to the Secretary on 
     the number of full year equivalent children that are 
     determined to be eligible for medical assistance under the 
     State plan under this title and are enrolled under the plan 
     as a result of--
       ``(A) having been provided presumptive eligibility in 
     accordance with section 1920A;
       ``(B) having submitted an application for such assistance 
     through an outstationed eligibility worker; and
       ``(C) having submitted an application for such assistance 
     by mail or telephone.
       ``(4) No substitution of spending.--Amounts paid to a State 
     under this subsection shall be used to supplement and not 
     supplant other Federal, State, or local funds provided to the 
     State under this title or title XXI. Amounts provided to the 
     State under any other provisions of this title shall not be 
     reduced solely as a result of the State's eligibility for a 
     performance bonus under this subsection.''.
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