[Congressional Record Volume 147, Number 149 (Thursday, November 1, 2001)]
[Senate]
[Pages S11378-S11380]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. Jeffords, Mr. Leahy, and Mrs. 
        Murray):
  S. 1625. A bill to require the Secretary of Health and Human Services 
to approve up to 4 State waivers to allow a State to use its allotment 
under the State children's health insurance program under title XXI of 
the Social Security Act to increase the enrollment of children eligible 
for medical assistance under the Medicaid Program under title XIX of 
such Act; to the Committee on Finance.
  Mr. BINGAMAN. Mr. President, the legislation I am introducing today 
with Senators Jeffords, Leahy, and Murray entitled the ``Children's 
Health Equity Act of 2001'' addresses an inequity that was created 
during the establishment of the State Children's Health Insurance 
Program, CHIP, that unfairly penalized certain States that had done the 
right thing and had expanded Medicaid coverage to children prior to the 
enactment of the bill.
  While the Congress recognized this fact for some States and 
``grandfathered'' in their expansions so those States could use the new 
CHIP funding for the children of their respective states, the 
legislation failed to do so for others, including New Mexico. This had 
the effect of penalizing a certain group of states for having done the 
right thing.
  As a result, the ``Children's Health Equity Act of 2001'' addresses 
this inequity by allowing four States, including New Mexico, Vermont, 
Washington, and Rhode Island, to be allowed to also utilize their CHIP 
allotments for coverage of children covered by Medicaid above their 
1996 levels, putting them on a more level field with all other States 
in the country.
  Mr. President, as you know, in 1997 Congress and President Clinton 
agreed to establish the State Children's Health Insurance Program, 
CHIP, and provide $48 billion over 10 years as an incentive to States 
to provide health care coverage to uninsured, low-income children up 
200 percent of poverty or beyond.
  During the negotiations of the Balanced Budget Act, BBA, of 1997, 
Congress and the Administration properly recognized that certain states 
were already undertaking Medicaid or separate state-run expansions of 
coverage to children up to 185 percent of poverty or above and that 
they would be allowed to use the new CHIP funding for those purposes. 
The final bill specifically allowed the States of Florida, New York, 
and Pennsylvania to convert their separate state-run programs into CHIP 
expansions and States that had expanded coverage to children through 
Medicaid after March 31, 1997, were also allowed to use CHIP funding 
for their expansions.
  Unfortunately, New Mexico and other States that had enacted similar 
expansions prior to March 1997 were denied the use of CHIP funding for 
their expansions. This created an inequity among the states where some 
were allowed to have their prior programs ``grandfathered'' into CHIP 
and others were denied. Again, our bill addresses this inequity.
  New Mexico has a strong record of attempting to expand coverage to 
children through the Medicaid program. In 1995, prior to the enactment 
of CHIP, New Mexico expanded coverage to for all children through age 
18 through the Medicaid program up to 185 percent of poverty. After 
CHIP was passed, New Mexico further expanded its coverage up to 235 
percent of poverty, above the level of the vast majority of states 
across the country.

[[Page S11379]]

  Due to the inequity caused by CHIP, New Mexico has been allocated 
$182 million from CHIP between fiscal years 1998 and 2000, and yet, has 
only been able to spend slightly over $5 million as of the end of last 
fiscal year. In other words, New Mexico has been allowed to spend only 
3 percent of its Federal CHIP allocations.
  New Mexico is unable to spend its funding because it had enacted its 
expansion of coverage to children up to 185 percent of poverty prior to 
the enactment of CHIP and our State was not ``grandfathered'' into CHIP 
as other comparable States were.
  The consequences for the children of New Mexico are enormous. 
According to the Census Bureau, New Mexico has an estimated 129,000 
uninsured children. In other words, almost 22 percent of all the 
children in New Mexico are uninsured, despite the fact the State has 
expanded coverage up to 235 percent of poverty. This is the fourth 
highest rate of uninsured children in the country.
  This is a result of the fact that an estimated 103,000 of the 129,000 
uninsured children in New Mexico are below 200 percent of poverty. 
These children are, consequently, eligible for Medicaid but currently 
unenrolled. With the exception of those few children between 185 and 
200 percent of poverty who are eligible for CHIP funding, all of the 
remaining uninsured children below 185 percent of poverty in New Mexico 
are denied CHIP funding despite their need.
  Exacerbating this inequity is the fact that many states are accessing 
their CHIP allotments to cover kids at poverty levels far below New 
Mexico's current or past eligibility levels. The children in those 
states are certainly no more worthy of health insurance coverage than 
the children of New Mexico.
  As the most recent policy statement by the National Governors' 
Association reads, ``The Governors believe that it is critical that 
innovative States not be penalized for having expanded coverage to 
children before the enactment of S-CHIP, which provides enhanced 
funding to meet these goals. To this end, the Governors support 
providing additional funding flexibility to states that had already 
significantly expanded coverage to the majority of uninsured children 
in their States.''
  Consequently, the bill I am introducing today corrects this inequity. 
The bill reflects a carefully-crated response to the unintended 
consequences of CHIP and brings much needed assistance to children 
currently uninsured in my State and other similarly situated States, 
including Washington, Vermont, and Rhode Island.
  Rather than simply changing the effective date included in the BBA 
that helped a smaller subset of States, this initiative includes strong 
maintenance of effort language as well as incentives for our State to 
conduct outreach and enrollment efforts and program simplification to 
find and enroll uninsured kids because we feel strongly that they 
receive the health coverage for which they are eligible.
  The bill does not take money from other States' CHIP allotments. It 
simply allows our States to spend our States' specific CHIP allotments 
from the Federal Government on our uninsured children, just as other 
States across the country are doing.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1625

       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 ``Children's Health Equity Act 
     of 2001''.

     SEC. 2. APPROVAL OF UP TO 4 STATE WAIVERS TO ALLOW TITLE XXI 
                   ALLOTMENTS TO BE USED FOR INCREASING THE 
                   ENROLLMENT OF MEDICAID CHILDREN.

       (a) Definitions.--In this section:
       (1) Child.--With respect to a State, the term ``child'' has 
     the meaning given such term for purposes of the State 
     medicaid program under title XIX of the Social Security Act.
       (2) Child health assistance.--The term ``child health 
     assistance'' has the meaning given that term in section 
     2110(a) of the Social Security Act (42 U.S.C. 1397jj(a)).
       (3) Enhanced fmap.--The term ``enhanced FMAP'' has the 
     meaning given that term in section 2105(b) of such Act (42 
     U.S.C. 1397ee(b)).
       (4) Federal medical assistance percentage.--The term 
     ``Federal medical assistance percentage'' has the meaning 
     given that term in section 1905(b) of such Act (42 U.S.C. 
     1396d(b)).
       (5) Poverty line.--The term ``poverty line'' has the 
     meaning given that term in section 2110(c)(5) of such Act (42 
     U.S.C. 1397jj(c)(5)).
       (6) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (7) State child health plan.--The term ``State child health 
     plan'' has the meaning given that term under section 
     2110(c)(7) of such Act (42 U.S.C. 1397jj(c)(7)).
       (b) Approval of Certain Waivers.--The Secretary shall 
     approve not more than 4 waiver applications under which the 
     Secretary shall pay to a State that the Secretary determines 
     satisfies the requirements described in subsection (c) the 
     payment authorized under subsection (d).
       (c) Requirements.--The requirements described in this 
     subsection are the following:
       (1) SCHIP income eligibility.--The State has a State child 
     health plan that (whether implemented under title XIX or XXI 
     of the Social Security Act)--
       (A) has the highest income eligibility standard permitted 
     under title XXI of such Act as of January 1, 2001;
       (B) subject to paragraph (2), does not limit the acceptance 
     of applications for children; and
       (C) provides benefits to all children in the State who 
     apply for and meet eligibility standards on a statewide 
     basis.
       (2) No waiting list imposed.--With respect to children 
     whose family income is at or below 200 percent of the poverty 
     line, the State does not impose any numerical limitation, 
     waiting list, or similar limitation on the eligibility of 
     such children for child health assistance under such State 
     plan.
       (3) Additional requirements.--The State has implemented at 
     least 4 of the following policies and procedures (relating to 
     coverage of children under titles XIX and title XXI of the 
     Social Security Act):
       (A) Uniform, simplified application form.--With respect to 
     children who are eligible for medical assistance under 
     section 1902(a)(10)(A) of that Act (42 U.S.C. 
     1396a(a)(10)(A)), the State uses the same uniform, simplified 
     application form (including, if applicable, permitting 
     application other than in person) for purposes of 
     establishing eligibility for benefits under titles XIX and 
     XXI of that Act.
       (B) Elimination of asset test.--The State does not apply 
     any asset test for eligibility under section 1902(l) or title 
     XXI of the Social Security Act (42 U.S.C. 1396a(l), 1397aa et 
     seq.) with respect to children.
       (C) Adoption of 12-month continuous enrollment.--The State 
     provides that eligibility shall not be regularly redetermined 
     more often than once every year under title XXI of such Act 
     or for children described in section 1902(a)(10)(A) of such 
     Act (42 U.S.C. 1396a(a)(10)(A)).
       (D) Same verification and redetermination policies; 
     automatic reassessment of eligibility.--With respect to 
     children who are eligible for medical assistance under 
     section 1902(a)(10)(A) of such Act (42 U.S.C. 
     1396a(a)(10)(A)), the State provides for initial eligibility 
     determinations and redeterminations of eligibility using the 
     same verification policies (including with respect to face-
     to-face interviews), forms, and frequency as the State uses 
     for such purposes under title XXI of that Act, and, as part 
     of such redeterminations, provides for the automatic 
     reassessment of the eligibility of such children for 
     assistance under titles XIX and XXI.
       (E) Outstationing enrollment staff.--The State provides for 
     the receipt and initial processing of applications for 
     benefits under title XXI of such Act and for children under 
     title XIX of that Act at facilities defined as 
     disproportionate share hospitals under section 1923(a)(1)(A) 
     of such Act (42 U.S.C. 1396r-4(a)(1)(A)) and Federally-
     qualified health centers described in section 1905(l)(2)(B) 
     of that Act (42 U.S.C. 1396d(l)(2)(B)) consistent with 
     section 1902(a)(55) of that Act (42 U.S.C. 1396a(a)(55)).
       (d) Payment Authorized.--
       (1) In general.--Notwithstanding any provision of title XIX 
     or XXI of the Social Security Act, or any other provision of 
     law, with respect to a State with a waiver approved under 
     this section that satisfies the requirements of subsection 
     (c) (and that otherwise has a State child health plan 
     approved under title XXI of the Social Security Act), the 
     Secretary shall pay to the State from its allotment under 
     section 2104 of the Social Security Act (42 U.S.C. 1397dd) an 
     amount for each fiscal year (beginning with fiscal year 2002) 
     determined under subparagraph (D) as follows:
       (A) Base expenditure amount.--The Secretary shall determine 
     the total amount of expenditures for medical assistance under 
     title XIX of the Social Security Act in the State for 
     children described in paragraph (2) for fiscal year 1995.
       (B) Current expenditure amount.--The Secretary shall 
     determine the total amount of expenditures for medical 
     assistance under title XIX of such Act in the State for 
     children described in paragraph (2) for the fiscal year 
     involved.
       (C) Increased expenditures.--The Secretary shall determine 
     the number (if any) by which the total amount determined 
     under subparagraph (B) exceeds the total amount determined 
     under subparagraph (A).

[[Page S11380]]

       (D) Bonus amount.--The amount determined under this 
     subparagraph for a fiscal year is equal to the product of the 
     following:
       (i) The total amount determined under subparagraph (C).
       (ii) The difference between the enhanced FMAP and the 
     Federal medical assistance percentage for that State for the 
     fiscal year involved.
       (2) Children described.--For purposes of paragraph (1)(A), 
     the children described in this paragraph are--
       (A) children who are eligible and enrolled for medical 
     assistance under title XIX of the Social Security Act; and
       (B) children who--
       (i) would be described in subparagraph (A) but for having 
     family income that exceeds the highest income eligibility 
     level applicable to such individuals under the State plan; 
     and
       (ii) would be considered disabled under section 
     1614(a)(3)(C) of the Social Security Act (42 U.S.C. 
     1382c(a)(3)(C)) (determined without regard to the reference 
     to age in that section but for having earnings or deemed 
     income or resources, as determined under title XVI of such 
     Act for children) that exceed the requirements for receipt of 
     supplemental security income benefits.
       (3) Order of title xxi payments.--With respect to a State 
     with a waiver approved under this section, payments to the 
     State under section 2105(a) of the Social Security Act (42 
     U.S.C. 1397ee(a)) for a fiscal year shall, notwithstanding 
     paragraph (2) of such section, be made in the following 
     order:
       (A) First, for expenditures for items described in 
     paragraph (1)(A) of section 2105(a) of such Act.
       (B) Second, for expenditures for items described in 
     paragraph (1)(B) of such section.
       (C) Third, for the payment authorized under subsection 
     (d)(1) of this section.
       (D) Fourth, for expenditures for items described in 
     paragraph (1)(C) of section 2105(a) of the Social Security 
     Act.
       (E) Fifth, for expenditures for items described in 
     paragraph (1)(D) of such section.
                                 ______