[Congressional Record Volume 145, Number 48 (Thursday, March 25, 1999)]
[Extensions of Remarks]
[Page E587]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


         THE MEDICAID CHILD ELIGIBILITY IMPROVEMENT ACT OF 1999

                                 ______
                                 

                            HON. KEN BENTSEN

                                of texas

                    in the house of representatives

                        Thursday, March 25, 1999

  Mr. BENTSEN. Mr. Speaker, I rise today to introduce legislation, the 
Medicaid Child Eligibility Improvement Act of 1999, to help more 
children obtain the health care they need through Medicaid. According 
to the U.S. Census Bureau, there are currently 4.4 million children in 
our nation who are eligible for Medicaid but are not receiving the care 
they need because they are not enrolled in the program.
  In Texas, according to the Texas Department of Health and Human 
Services Commission, there are currently 800,000 Medicaid-eligible 
children who are not enrolled in their critical health insurance 
program. Without this coverage, children do not receive the preventive 
health services they need and deserve. Clearly, we need to do more 
outreach to these children and their families and encourage them to 
sign up for Medicaid.
  This legislation would allow public schools, child care resource and 
referral centers, Childrens' Health Insurance Program (CHIP) workers, 
homeless eligibility agencies, and child support agencies to make the 
preliminary decision that a child is eligible to enroll in Medicaid so 
that they can receive coverage while waiting for full Medicaid 
eligibility determination. Schools and these other agencies are on the 
front lines of caring for children and can help to educate their 
families and enroll them in Medicaid.
  Under the Balanced Budget Act enacted in 1997, States received a new 
option under Medicaid to grant ``presumptive eligibility'' to certain 
children on a temporary basis as their Medicaid eligibility is 
determined. My legislation would expand this presumptive eligibility 
option to make it more flexible and attractive to the States. The 
presumptive eligibility period is normally sixty days and gives States 
sufficient time to complete the Medicaid eligibility determination 
process. If a state ultimately determines that the child is not 
eligible for Medicaid, none of these entities would be penalized or 
lose funding due to a negative determination. Under this legislation, 
we would be enrolling children on an expedited basis and could reach 
some of those 4.4 million children who are eligible but not enrolled.
  While some would argue that there will be a cost associated with 
increasing participation in the Medicaid program, it is important to 
remember that when Congress enacted Medicaid, it assumed that these 
children would be covered. I would argue that adding these children is 
not only morally right, but also cost-effective in comparison to 
letting these children receive health care on an ad hoc basis. Many of 
these children will simply go to hospital emergency rooms for treatment 
and will not be able to pay for these services. In the end, we will pay 
the cost. With Medicaid coverage, our public institutions will be 
reimbursed and these children will receive better care through primary 
care providers instead of high-cost, emergency-care based services.
  This legislation is also fiscally responsible in that it would 
require a state to deduct from their state allotment any funding used 
for this program. I believe that the small cost associated with this 
outreach effort will not adversely impact States' ability to provide 
health care for low-income children and in fact could reduce the 
States' disproportionate share expenditures.
  We know that these children are not being properly served now and we 
must find innovative ways to ensure that all eligible children are 
enrolled in Medicaid. My legislation would simply accelerate the 
application process while maintaining sufficient safeguards to prevent 
fraud and abuse. My legislation would give states greater flexibility 
to determine which entities can make these determinations, and States 
are authorized to apply certain limitations in order to prevent fraud 
and abuse. My legislation would also permit the Secretary of the Health 
and Human Services to review States' decisions and ensure that the 
appropriate entities are allowed to enroll these children. None of 
these entities could immediately offer these services until their state 
and the federal government has deemed them to be eligible to undertake 
preliminary determinations.
  I believe this is an important public policy matter which we need to 
address. My legislation would enroll more children in Medicaid while 
ensuring that appropriate entities are reviewing these applications. I 
believe it is more cost-effective to enroll these children and ensure 
that they are receiving the primary care services they need, rather 
than sending these children to emergency rooms where children will be 
sicker and taxpayers will end up paying more. I also believe that we 
need to improve our current Medicaid presumptive eligibility law by 
including these new entities which were not included in the Balanced 
Budget Act. I strongly urge my colleagues to support this critical 
legislation and would appreciate your support for this effort.

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