[Congressional Record Volume 151, Number 65 (Tuesday, May 17, 2005)]
[Senate]
[Pages S5302-S5305]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. FRIST (for himself, Mr. Bingaman, Mr. Lugar, Ms. Cantwell, 
        Mr. Santorum, Ms. Collins, Mr. Cochran, Mrs. Murray, and Mrs. 
        Feinstein):
  S. 1049. A bill to amend title XXI of the Social Security Act to 
provide grants to promote innovative outreach and enrollment under the 
medicaid and State children's health insurance programs, and for other 
purposes; to the Committee on Finance.
  Mr. FRIST. Mr. President, today, Senator Bingaman and I introduced 
the ``Covering Kids Act of 2005.'' This legislation provides $100 
million in funding to a host of entities including the States, local 
communities, schools, faith-based organizations, Indian tribes, safety 
net providers. The goal is to increase enrollment of eligible children 
in Medicaid and the State Children's Health Insurance Program (SCHIP).
  I believe that all Americans should have the security of lifelong, 
affordable access to health care, especially America's children. 
Programs like SCHIP help provide a critical safety net.
  But, unfortunately, there are still too many families who are not 
aware of the coverage available to them, or face barriers to 
enrollment. In fact, over 5.6 million kids are eligible for Medicaid 
and SCHIP, but are not enrolled. The Covering Kids Act will help close 
that gap.
  The legislation will fund innovative outreach and enrollment efforts 
to expand coverage among minority and underserved children, and to 
those living in rural areas. It will also give states additional 
flexibility to streamline enrollment in these programs, reducing 
administrative costs for the government and eliminating paperwork and 
hassles for families.
  Covering children is the right thing to do. And by ensuring that 
children have access to preventive care, it is also one of the best 
ways of reducing long-term strain on America's health care system.
  Since arriving in the Senate in 1995, I have advanced worked hard to 
expand

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coverage to uninsured Americans and improve health care for those in 
need. I have sponsored numerous pieces of bipartisan legislation 
including: the ``Closing the Health Care Gap Act of 2004,'' the 
``Pediatric Research Equity Act of 2003,'' the ``Birth Defects and 
Developmental Disabilities Prevention Act of 2003,'' and the 
``Children's Health Act of 2000.'' Last Congress, we took a critical 
step forward in expanding affordable health coverage to millions more 
Americans by authorizing tax-free, portable Health Savings Accounts as 
part of the Medicare Modernization Act of 2003.
  Today, we build on that record of progress.
  I first proposed expanding outreach efforts to help lower income 
children in July of last year. Today, I join with Senator Jeff Bingaman 
and other cosponsors in taking a critical step toward fulfilling that 
goal.
  I also want to applaud the President for his leadership on this 
issue. President Bush has made the expansion of Medicaid and SCHIP 
coverage a cornerstone of his agenda. I am confident that with his 
leadership, and the efforts of my colleagues on the other side of the 
aisle, we can help millions of kids who need coverage by passing this 
common sense legislation. All of our children should have access to the 
affordable quality health care.
  I'm proud to introduce this bipartisan legislation with Senators 
Bingaman, Lugar, Cantwell, Santorum, Collins, Cochran, and Murray. I 
look forward to working with them, and with all of my colleagues, to 
strengthen our Nation's health care system and expand affordable health 
coverage. 
  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. 1049

       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 ``Covering Kids Act of 2005''.

     SEC. 2. GRANTS TO PROMOTE INNOVATIVE OUTREACH AND ENROLLMENT 
                   UNDER MEDICAID AND SCHIP.

       (a) Grants for Expanded Outreach Activities.--Title XXI of 
     the Social Security Act (42 U.S.C. 1397aa et seq.) is amended 
     by adding at the end the following:

     ``SEC. 2111. EXPANDED OUTREACH ACTIVITIES.

       ``(a) Grants To Conduct Innovative Outreach and Enrollment 
     Efforts.--
       ``(1) In general.--The Secretary shall award grants to 
     eligible entities to--
       ``(A) conduct innovative outreach and enrollment efforts 
     that are designed to increase the enrollment and 
     participation of eligible children under this title and title 
     XIX; and
       ``(B) promote understanding of the importance of health 
     insurance coverage for prenatal care and children.
       ``(2) Performance bonuses.--The Secretary may reserve a 
     portion of the funds appropriated under subsection (g) for a 
     fiscal year for the purpose of awarding performance bonuses 
     during the succeeding fiscal year to eligible entities that 
     meet enrollment goals or other criteria established by the 
     Secretary.
       ``(b) Priority for Award of Grants.--
       ``(1) In general.--In making grants under subsection 
     (a)(1), the Secretary shall give priority to--
       ``(A) eligible entities that propose to target geographic 
     areas with high rates of--
       ``(i) eligible but unenrolled children, including such 
     children who reside in rural areas; or
       ``(ii) racial and ethnic minorities and health disparity 
     populations, including those proposals that address cultural 
     and linguistic barriers to enrollment; and
       ``(B) eligible entities that plan to engage in outreach 
     efforts with respect to individuals described in subparagraph 
     (A) and that are--
       ``(i) Federal health safety net organizations; or
       ``(ii) faith-based organizations or consortia.
       ``(2) 10 percent set aside for outreach to indian 
     children.--An amount equal to 10 percent of the funds 
     appropriated under subsection (g) for a fiscal year shall be 
     used by the Secretary to award grants to Indian Health 
     Service providers and urban Indian organizations receiving 
     funds under title V of the Indian Health Care Improvement Act 
     (25 U.S.C. 1651 et seq.) for outreach to, and enrollment of, 
     children who are Indians.
       ``(c) Application.--An eligible entity that desires to 
     receive a grant under subsection (a)(1) shall submit an 
     application to the Secretary in such form and manner, and 
     containing such information, as the Secretary may decide. 
     Such application shall include--
       ``(1) quality and outcomes performance measures to evaluate 
     the effectiveness of activities funded by a grant awarded 
     under this section to ensure that the activities are meeting 
     their goals; and
       ``(2) an assurance that the entity shall--
       ``(A) conduct an assessment of the effectiveness of such 
     activities against such performance measures; and
       ``(B) cooperate with the collection and reporting of 
     enrollment data and other information determined as a result 
     of conducting such assessments to the Secretary, in such form 
     and manner as the Secretary shall require.
       ``(d) Dissemination of Enrollment Data and Information 
     Determined From Effectiveness Assessments; Annual Report.--
     The Secretary shall--
       ``(1) disseminate to eligible entities and make publicly 
     available the enrollment data and information collected and 
     reported in accordance with subsection (c)(2)(B); and
       ``(2) submit an annual report to Congress on the outreach 
     activities funded by grants awarded under this section.
       ``(e) Supplement, Not Supplant.--Federal funds awarded 
     under this section shall be used to supplement, not supplant, 
     non-Federal funds that are otherwise available for activities 
     funded under this section.
       ``(f) Definitions.--In this section:
       ``(1) Eligible entity.--The term `eligible entity' means 
     any of the following:
       ``(A) A State or local government.
       ``(B) A Federal health safety net organization.
       ``(C) A national, local, or community-based public or 
     nonprofit private organization.
       ``(D) A faith-based organization or consortia, to the 
     extent that a grant awarded to such an entity is consistent 
     with the requirements of section 1955 of the Public Health 
     Service Act (42 U.S.C. 300x-65) relating to a grant award to 
     non-governmental entities.
       ``(E) An elementary or secondary school.
       ``(2) Federal health safety net organization.--The term 
     `Federal health safety net organization' means--
       ``(A) an Indian tribe, tribal organization, or an urban 
     Indian organization receiving funds under title V of the 
     Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.), 
     or an Indian Health Service provider;
       ``(B) a Federally-qualified health center (as defined in 
     section 1905(l)(2)(B));
       ``(C) a hospital defined as a disproportionate share 
     hospital for purposes of section 1923;
       ``(D) a covered entity described in section 340B(a)(4) of 
     the Public Health Service Act (42 U.S.C. 256b(a)(4)); and
       ``(E) any other entity or a consortium that serves children 
     under a federally-funded program, including the special 
     supplemental nutrition program for women, infants, and 
     children (WIC) established under section 17 of the Child 
     Nutrition Act of 1966 (42 U.S.C. 1786), the head start and 
     early head start programs under the Head Start Act (42 U.S.C. 
     9801 et seq.), the school lunch program established under the 
     Richard B. Russell National School Lunch Act, and an 
     elementary or secondary school.
       ``(3) Indians; indian tribe; tribal organization; urban 
     indian organization.--The terms `Indian', `Indian tribe', 
     `tribal organization', and `urban Indian organization' have 
     the meanings given such terms in section 4 of the Indian 
     Health Care Improvement Act (25 U.S.C. 1603).
       ``(g) Appropriation.--There is appropriated, out of any 
     money in the Treasury not otherwise appropriated, $50,000,000 
     for each of fiscal years 2006 and 2007 for the purpose of 
     awarding grants under this section. Amounts appropriated and 
     paid under the authority of this section shall be in addition 
     to amounts appropriated under section 2104 and paid to States 
     in accordance with section 2105, including with respect to 
     expenditures for outreach activities in accordance with 
     subsection (a)(1)(D)(iii) of that section.''.
       (b) Extending Use of Outstationed Workers To Accept Title 
     XXI Applications.--Section 1902(a)(55) of the Social Security 
     Act (42 U.S.C. 1396a(a)(55)) is amended by striking ``or 
     (a)(10)(A)(ii)(IX)'' and inserting ``(a)(10)(A)(ii)(IX), or 
     (a)(10)(A)(ii)(XIV), and applications for child health 
     assistance under title XXI''.

     SEC. 3. STATE OPTION TO PROVIDE FOR SIMPLIFIED DETERMINATIONS 
                   OF A CHILD'S FINANCIAL ELIGIBILITY FOR MEDICAL 
                   ASSISTANCE UNDER MEDICAID OR CHILD HEALTH 
                   ASSISTANCE UNDER SCHIP.

       (a) Medicaid.--Section 1902(e) of the Social Security Act 
     (42 U.S.C. 1396a(e)) is amended by adding at the end the 
     following:
       ``(13)(A) At the option of the State, the plan may provide 
     that financial eligibility requirements for medical 
     assistance are met for a child who is under an age specified 
     by the State (not to exceed 21 years of age) by using a 
     determination made within a reasonable period (as determined 
     by the State) before its use for this purpose, of the child's 
     family or household income, or if applicable for purposes of 
     determining eligibility under this title or title XXI, assets 
     or resources, by a Federal or State agency, or a public or 
     private entity making such determination on behalf of such 
     agency, specified by the plan, including (but not limited to) 
     an agency administering the State program funded under part A 
     of title IV, the Food Stamp Act of 1977, the Richard B. 
     Russell National School Lunch Act, or the Child Nutrition Act 
     of 1966, notwithstanding any differences in budget unit, 
     disregard, deeming, or other methodology, but only if--

[[Page S5304]]

       ``(i) the agency has fiscal liabilities or responsibilities 
     affected or potentially affected by such determination; and
       ``(ii) any information furnished by the agency pursuant to 
     this subparagraph is used solely for purposes of determining 
     financial eligibility for medical assistance under this title 
     or for child health assistance under title XXI.
       ``(B) Nothing in subparagraph (A) shall be construed--
       ``(i) to authorize the denial of medical assistance under 
     this title or of child health assistance under title XXI to a 
     child who, without the application of this paragraph, would 
     qualify for such assistance;
       ``(ii) to relieve a State of the obligation under 
     subsection (a)(8) to furnish medical assistance with 
     reasonable promptness after the submission of an initial 
     application that is evaluated or for which evaluation is 
     requested pursuant to this paragraph;
       ``(iii) to relieve a State of the obligation to determine 
     eligibility for medical assistance under this title or for 
     child health assistance under title XXI on a basis other than 
     family or household income (or, if applicable, assets or 
     resources) if a child is determined ineligible for such 
     assistance on the basis of information furnished pursuant to 
     this paragraph; or
       ``(iv) as affecting the applicability of any non-financial 
     requirements for eligibility for medical assistance under 
     this title or child health assistance under title XXI.''.
       (b) SCHIP.--Section 2107(e)(1) of the Social Security Act 
     (42 U.S.C. 1397gg(e)(1)) is amended by adding at the end the 
     following:
       ``(E) Section 1902(e)(13) (relating to the State option to 
     base a determination of child's financial eligibility for 
     assistance on financial determinations made by a program 
     providing nutrition or other public assistance).''.
       (c) Effective Date.--The amendments made by this section 
     take effect on October 1, 2005.

  There are nearly 10 million children in the United States without 
health insurance coverage. Over half of these children live in families 
with incomes below 200 percent of the Federal poverty level and are 
eligible for coverage under either the State Children's Health 
Insurance Program (S-CHIP) or Medicaid, but are not enrolled in those 
safety net programs. Studies have shown that the families of many 
eligible children are not familiar with the availability of safety net 
coverage or face other barriers that prevent enrollment.
  One Tuesday, May 17, Senate Majority Leader Bill Frist and Senator 
Jeff Bingaman will introduce bipartisan legislation to help close this 
coverage gap. The ``Covering Kids Act of 2005'' seeks to increase 
health coverage among uninsured, low-income children by providing 
grants to States, faith-based organizations, safety net providers, 
schools, and other community and non-profit organizations to conduct 
innovative Medicaid and SCHIP outreach and enrollment efforts. Grants 
may also be used to promote the understanding of the important role 
that health insurance coverage plays in ensuring quality health care 
for pregnant women and children.
  The legislation appropriates $50 million dollars in fiscal year 2006 
and an additional $50 million in fiscal year 2007 in addition to 
already appropriated SCHIP funds for these additional outreach and 
enrollment efforts. Ten percent of grant funding would be set aside for 
grants to the Indian Health Service, tribal organizations, and urban 
Indian programs for outreach and enrollment to Native American 
children. Outreach funds may be carried over into subsequent fiscal 
years until the entire $100 million is awarded to grantees.
  In making grants, the Secretary of Health and Human Services, HHS, 
must give priority to grantees that propose to target geographic areas 
with high numbers of children who are eligible but not enrolled in 
Medicaid and SCHIP, including those who live in rural areas and those 
areas with large numbers of racial and ethnic minorities and other 
health disparity populations.
  The Secretary is required to disseminate to eligible grantees as well 
as to the public enrollment data and other measurements of the 
effectiveness of these outreach programs. The Secretary also is 
required to submit an annual report to Congress describing the impact 
of these efforts on expanding access to uninsured children.
  Further, the legislation also allows States additional flexibility to 
streamline Medicaid and SCHIP enrollment processes. Because two-thirds 
of uninsured children live in families that receive benefits through 
other federal programs, the legislation gives states the option of 
using income and resource eligibility determinations made under other 
government programs to fast-track enrollment under Medicaid and SCHIP. 
This reform would simplify state administrative processes, reduce 
paperwork burdens for families and the government, help increase 
insurance coverage, and potentially reduce costs across a number of 
federal programs.
  Mr. BINGAMAN. Mr. President, I am pleased to be introducing 
bipartisan legislation today with Senators Frist, Cantwell, Lugar, 
Santorum, Collins, Cochran, Murray, and Feinstein named the ``Covering 
Kids Act of 2005.'' This legislation is intended to improve outreach 
and enrollment efforts targeted toward children and pregnant women and 
is very similar to language included in legislation I introduced in the 
107th Congress entitled the ``Children's Health Coverage Improvement 
Act'' and earlier this year with Senator Lugar entitled ``Children's 
Express Lane to Health Coverage Act.''
  The legislation provides $100 million in grants over the next two 
years to community and faith-based organizations, safety net 
organizations such as community health centers, disproportionate share 
hospitals, tribal providers or organizations, schools, or State or 
local governments for the purposes of conducting innovative outreach 
and enrollment efforts.
  The bill includes language from legislation introduced by Senator 
Lugar and me that would promote what is called ``Express Lane 
Eligibility.'' This approach uses two strategies to find and enroll 
eligible but uninsured children by: 1. targeting large numbers of 
eligible children in other public benefit programs like school lunch 
and food stamps; 2. expediting their enrollment in health coverage by 
using income-eligibility information already submitted by parents when 
they enrolled their children in these other public programs.
  In combination, these two common-sense ideas could have a dramatic 
impact on reducing the uninsured rate among our Nation's children, 
which we must do.
  According to the American College of Physicians, uninsured children, 
when compared to insured children, are: up to 6 times more likely to 
have gone without needed medical, dental, or other health care; 2 times 
more likely to have gone without a physician visit during the previous 
year; up to 4 times more likely to have delayed seeking medical care; 
up to 10 times less likely to have a regular source of medical care; 
1.7 times less likely to receive medical treatment for asthma; and, up 
to 30 percent less likely to receive medical attention for any injury.
  Another study estimated that the 15 percent rise in the number of 
children eligible for Medicaid between 1984 and 1992 decreased child 
mortality by 5 percent. I would add that the expansion period occurred 
during the Reagan and George H.W. Bush administrations with strong 
Democratic congressional support, so this is clearly a bipartisan issue 
that deserves further bipartisan action once again.
  In fact, during the last presidential campaign, President Bush made 
very few promises when it came to reducing the number of uninsured in 
this country. However, he did make the promise to reduce the number of 
uninsured by conducting additional efforts in outreach and enrollment. 
As he said in a speech in Pennsylvania on October 21, 2004, ``We'll 
keep our commitment to America's children by helping them get a healthy 
start in life. I'll work with governors and community leaders and 
religious leaders to make sure every eligible child is enrolled in our 
government's low-income health insurance program. We will not allow a 
lack of attention, or information, to stand between millions of 
children and the health care they need.''
  I agree and hope that with the support of the Administration and the 
Majority Leader in his introduction of this bipartisan legislation 
today that we can secure passage of it this year.
  Despite the passage of the State Children's Health Insurance Program, 
or SCHIP, which has, in combination with Medicaid, caused a reduction 
in the rate of uninsured children in recent years, it is estimated that 
5-6 million of the remaining 9.2 million uninsured children are 
eligible for but unenrolled in either Medicaid or SCHIP. In New Mexico, 
there are an estimated 80,000,

[[Page S5305]]

or 15.2 percent, of the children in my State without health insurance 
despite the fact that Medicaid and SCHIP cover children all the way up 
to 235 percent of the poverty level.
  Thus, ineligibility for coverage is no longer a barrier for the vast 
majority of uninsured children. As the Urban Institute has said, ``A 
major challenge today is how to reach and enroll the millions of 
children who are eligible but who remain uninsured.''
  The biggest problems are knowledge gaps, confusion about program 
rules, and problems created by bureaucratic barriers to coverage. The 
State of California has taken some important strides to eliminate some 
of these barriers through what they call their Express Lane 
Eligibility, or ELE, initiative, which allowed the sharing of income-
eligibility information across public programs. Unfortunately, Down 
Horner, Beth Marrow, and Wendy Lazarus of the Children's Partnership in 
California found in their report entitled ``Building an On-Ramp to 
Children's Health Coverage: A Report on California's Express Lane 
Eligibility Program": ``A clear lesson from California's experience is 
that there is only so far a state can go in putting an ELE system in 
place. In the end, existing Federal rules tend to thwart efforts to 
create a truly efficient process. In California, instead of allowing 
Medi-Cal to use a school lunch program's income determination, both 
school lunch and Medi-Cal have to recount a family's income based on 
their own rules.''
  If we can engage in innovative enrollment and outreach activities and 
promote ELE types of activities in the states, it clearly could have a 
profound impact on reducing the uninsured rate among our nation's 
children.
  I would like to express my thanks to the Majority Leader and his 
staff for working through a number of issues with me prior to the 
introduction of this legislation. I think the bill is stronger, as a 
result, and look forward to working with him on trying to get the bill 
enacted in this Congress.
                                 ______