[Congressional Record Volume 153, Number 163 (Thursday, October 25, 2007)]
[House]
[Pages H12042-H12090]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CHILDREN'S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT OF 2007
Mr. DINGELL. Madam Speaker, pursuant to House Resolution 774, I call
up the bill (H.R. 3963) to amend title XXI of the Social Security Act
to extend and improve the Children's Health Insurance Program, and for
other purposes, and ask for its immediate consideration.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 3963
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT;
REFERENCES; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as ``Children's
Health Insurance Program Reauthorization Act of 2007''.
(b) Amendments to Social Security Act.--Except as otherwise
specifically provided, whenever in this Act an amendment is
expressed in terms of an amendment to or repeal of a section
or other provision, the reference shall be considered to be
made to that section or other provision of the Social
Security Act.
(c) References to CHIP; Medicaid; Secretary.--In this Act:
(1) CHIP.--The term ``CHIP'' means the State Children's
Health Insurance Program established under title XXI of the
Social Security Act (42 U.S.C. 1397aa et seq.).
(2) Medicaid.--The term ``Medicaid'' means the program for
medical assistance established under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(3) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(d) Table of Contents.--The table of contents of this Act
is as follows:
Sec. 1. Short title; amendments to Social Security Act; references;
table of contents.
Sec. 2. Purpose.
Sec. 3. General effective date; exception for State legislation;
contingent effective date; reliance on law.
TITLE I--FINANCING
Subtitle A--Funding
Sec. 101. Extension of CHIP.
Sec. 102. Allotments for States and territories for fiscal years 2008
through 2012.
Sec. 103. Child Enrollment Contingency Fund.
Sec. 104. CHIP performance bonus payment to offset additional
enrollment costs resulting from enrollment and retention
efforts.
Sec. 105. 2-year initial availability of CHIP allotments.
Sec. 106. Making permanent redistribution of unused fiscal year 2005
allotments to address State funding shortfalls;
conforming extension of qualifying State authority;
redistribution of unused allotments for subsequent fiscal
years.
Sec. 107. Option for qualifying States to receive the enhanced portion
of the CHIP matching rate for Medicaid coverage of
certain children.
Sec. 108. One-time appropriation.
Sec. 109. Improving funding for the territories under CHIP and
Medicaid.
Subtitle B--Focus on Low-Income Children and Pregnant Women
Sec. 111. State option to cover low-income pregnant women under CHIP
through a State plan amendment.
Sec. 112. Phase-out of coverage for nonpregnant childless adults under
CHIP; conditions for coverage of parents.
Sec. 113. Elimination of counting Medicaid child presumptive
eligibility costs against title XXI allotment.
Sec. 114. Denial of payments for coverage of children with effective
family income that exceeds 300 percent of the poverty
line.
Sec. 115. State authority under Medicaid.
Sec. 116. Preventing substitution of CHIP coverage for private
coverage.
TITLE II--OUTREACH AND ENROLLMENT
Subtitle A--Outreach and Enrollment Activities
Sec. 201. Grants and enhanced administrative funding for outreach and
enrollment.
Sec. 202. Increased outreach and enrollment of Indians.
Sec. 203. State option to rely on findings from an Express Lane agency
to conduct simplified eligibility determinations.
Subtitle B--Reducing Barriers to Enrollment
Sec. 211. Verification of declaration of citizenship or nationality for
purposes of eligibility for Medicaid and CHIP.
Sec. 212. Reducing administrative barriers to enrollment.
Sec. 213. Model of Interstate coordinated enrollment and coverage
process.
TITLE III--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE
Subtitle A--Additional State Option for Providing Premium Assistance
Sec. 301. Additional State option for providing premium assistance.
Sec. 302. Outreach, education, and enrollment assistance.
Subtitle B--Coordinating Premium Assistance With Private Coverage
Sec. 311. Special enrollment period under group health plans in case of
termination of Medicaid or CHIP coverage or eligibility
for assistance in purchase of employment-based coverage;
coordination of coverage.
TITLE IV--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES
Sec. 401. Child health quality improvement activities for children
enrolled in Medicaid or CHIP.
Sec. 402. Improved availability of public information regarding
enrollment of children in CHIP and Medicaid.
Sec. 403. Application of certain managed care quality safeguards to
CHIP.
TITLE V--IMPROVING ACCESS TO BENEFITS
Sec. 501. Dental benefits.
Sec. 502. Mental health parity in CHIP plans.
Sec. 503. Application of prospective payment system for services
provided by Federally-qualified health centers and rural
health clinics.
Sec. 504. Premium grace period.
Sec. 505. Demonstration projects relating to diabetes prevention.
Sec. 506. Clarification of coverage of services provided through
school-based health centers.
[[Page H12043]]
TITLE VI--PROGRAM INTEGRITY AND OTHER MISCELLANEOUS PROVISIONS
Subtitle A--Program Integrity and Data Collection
Sec. 601. Payment error rate measurement (``PERM'').
Sec. 602. Improving data collection.
Sec. 603. Updated Federal evaluation of CHIP.
Sec. 604. Access to records for IG and GAO audits and evaluations.
Sec. 605. No Federal funding for illegal aliens; disallowance for
unauthorized expenditures.
Subtitle B--Miscellaneous Health Provisions
Sec. 611. Deficit Reduction Act technical corrections.
Sec. 612. References to title XXI.
Sec. 613. Prohibiting initiation of new health opportunity account
demonstration programs.
Sec. 614. County Medicaid health insuring organizations; GAO report on
Medicaid managed care payment rates.
Sec. 615. Adjustment in computation of Medicaid FMAP to disregard an
extraordinary employer pension contribution.
Sec. 616. Moratorium on certain payment restrictions.
Sec. 617. Medicaid DSH allotments for Tennessee and Hawaii.
Sec. 618. Clarification treatment of regional medical center.
Sec. 619. Extension of SSI web-based asset demonstration project to the
Medicaid program.
Subtitle C--Other Provisions
Sec. 621. Support for injured servicemembers.
Sec. 622. Outreach regarding health insurance options available to
children.
Sec. 623. Sense of Senate regarding access to affordable and meaningful
health insurance coverage.
TITLE VII--REVENUE PROVISIONS
Sec. 701. Increase in excise tax rate on tobacco products.
Sec. 702. Administrative improvements.
Sec. 703. Time for payment of corporate estimated taxes.
SEC. 2. PURPOSE.
It is the purpose of this Act to provide dependable and
stable funding for children's health insurance under titles
XXI and XIX of the Social Security Act in order to enroll all
six million uninsured children who are eligible, but not
enrolled, for coverage today through such titles.
SEC. 3. GENERAL EFFECTIVE DATE; EXCEPTION FOR STATE
LEGISLATION; CONTINGENT EFFECTIVE DATE;
RELIANCE ON LAW.
(a) General Effective Date.--Unless otherwise provided in
this Act, subject to subsections (b) through (d), this Act
(and the amendments made by this Act) shall take effect on
October 1, 2007, and shall apply to child health assistance
and medical assistance provided on or after that date.
(b) Exception for State Legislation.--In the case of a
State plan under title XIX or State child health plan under
XXI of the Social Security Act, which the Secretary of Health
and Human Services determines requires State legislation in
order for the respective plan to meet one or more additional
requirements imposed by amendments made by this Act, the
respective plan shall not be regarded as failing to comply
with the requirements of such title solely on the basis of
its failure to meet such an 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 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 the
session shall be considered to be a separate regular session
of the State legislature.
(c) Contingent Effective Date for CHIP Funding for Fiscal
Year 2008.--Notwithstanding any other provision of law, if
funds are appropriated under any law (other than this Act) to
provide allotments to States under CHIP for all (or any
portion) of fiscal year 2008--
(1) any amounts that are so appropriated that are not so
allotted and obligated before the date of the enactment of
this Act are rescinded; and
(2) any amount provided for CHIP allotments to a State
under this Act (and the amendments made by this Act) for such
fiscal year shall be reduced by the amount of such
appropriations so allotted and obligated before such date.
(d) Reliance on Law.--With respect to amendments made by
this Act (other than title VII) that become effective as of a
date--
(1) such amendments are effective as of such date whether
or not regulations implementing such amendments have been
issued; and
(2) Federal financial participation for medical assistance
or child health assistance furnished under title XIX or XXI,
respectively, of the Social Security Act on or after such
date by a State in good faith reliance on such amendments
before the date of promulgation of final regulations, if any,
to carry out such amendments (or before the date of guidance,
if any, regarding the implementation of such amendments)
shall not be denied on the basis of the State's failure to
comply with such regulations or guidance.
TITLE I--FINANCING
Subtitle A--Funding
SEC. 101. EXTENSION OF CHIP.
Section 2104(a) (42 U.S.C. 1397dd(a)) is amended--
(1) in paragraph (9), by striking ``and'' at the end;
(2) in paragraph (10), by striking the period at the end
and inserting a semicolon; and
(3) by adding at the end the following new paragraphs:
``(11) for fiscal year 2008, $9,125,000,000;
``(12) for fiscal year 2009, $10,675,000,000;
``(13) for fiscal year 2010, $11,850,000,000;
``(14) for fiscal year 2011, $13,750,000,000; and
``(15) for fiscal year 2012, for purposes of making 2 semi-
annual allotments--
``(A) $1,150,000,000 for the period beginning on October 1,
2011, and ending on March 31, 2012, and
``(B) $1,150,000,000 for the period beginning on April 1,
2012, and ending on September 30, 2012.''.
SEC. 102. ALLOTMENTS FOR STATES AND TERRITORIES FOR FISCAL
YEARS 2008 THROUGH 2012.
Section 2104 (42 U.S.C. 1397dd) is amended--
(1) in subsection (b)(1), by striking ``subsection (d)''
and inserting ``subsections (d) and (i)'';
(2) in subsection (c)(1), by striking ``subsection (d)''
and inserting ``subsections (d) and (i)(4)''; and
(3) by adding at the end the following new subsection:
``(i) Allotments for Fiscal Years 2008 Through 2012.--
``(1) For fiscal year 2008.--
``(A) For the 50 states and the district of columbia.--
Subject to the succeeding provisions of this paragraph and
paragraph (4), the Secretary shall allot for fiscal year 2008
from the amount made available under subsection (a)(11), to
each of the 50 States and the District of Columbia 110
percent of the highest of the following amounts for such
State or District:
``(i) The total Federal payments to the State under this
title for fiscal year 2007, multiplied by the allotment
increase factor determined under paragraph (5) for fiscal
year 2008.
``(ii) The Federal share of the amount allotted to the
State for fiscal year 2007 under subsection (b), multiplied
by the allotment increase factor determined under paragraph
(5) for fiscal year 2008.
``(iii) Only in the case of--
``(I) a State that received a payment, redistribution, or
allotment under paragraph (1), (2), or (4) of subsection (h),
the amount of the projected total Federal payments to the
State under this title for fiscal year 2007, as determined on
the basis of the November 2006 estimates certified by the
State to the Secretary;
``(II) a State whose projected total Federal payments to
the State under this title for fiscal year 2007, as
determined on the basis of the May 2006 estimates certified
by the State to the Secretary, were at least $95,000,000 but
not more than $96,000,000 higher than the projected total
Federal payments to the State under this title for fiscal
year 2007 on the basis of the November 2006 estimates, the
amount of the projected total Federal payments to the State
under this title for fiscal year 2007 on the basis of the May
2006 estimates; or
``(III) a State whose projected total Federal payments
under this title for fiscal year 2007, as determined on the
basis of the November 2006 estimates certified by the State
to the Secretary, exceeded all amounts available to the State
for expenditure for fiscal year 2007 (including any amounts
paid, allotted, or redistributed to the State in prior fiscal
years), the amount of the projected total Federal payments to
the State under this title for fiscal year 2007, as
determined on the basis of the November 2006 estimates
certified by the State to the Secretary,
multiplied by the allotment increase factor determined
under paragraph (5) for fiscal year 2008.
``(iv) The projected total Federal payments to the State
under this title for fiscal year 2008, as determined on the
basis of the August 2007 projections certified by the State
to the Secretary by not later than September 30, 2007.
``(B) For the commonwealths and territories.--Subject to
the succeeding provisions of this paragraph and paragraph
(4), the Secretary shall allot for fiscal year 2008 from the
amount made available under subsection (a)(11) to each of the
commonwealths and territories described in subsection (c)(3)
an amount equal to the highest amount of Federal payments to
the commonwealth or territory under this title for any fiscal
year occurring during the period of fiscal years 1998 through
2007, multiplied by the allotment increase factor determined
under paragraph (5) for fiscal year 2008, except that
subparagraph (B) thereof shall be applied by substituting
`the United States' for `the State'.
``(C) Deadline and data for determining fiscal year 2008
allotments.--In computing the amounts under subparagraphs (A)
and (B) that determine the allotments to States for fiscal
year 2008, the Secretary shall use the most recent data
available to the Secretary before the start of that fiscal
year. The Secretary may adjust such amounts and allotments,
as necessary, on the basis of the expenditure data for the
prior year reported by States on CMS Form 64 or CMS Form 21
not later than November 30, 2007, but in no
[[Page H12044]]
case shall the Secretary adjust the allotments provided under
subparagraph (A) or (B) for fiscal year 2008 after December
31, 2007.
``(D) Adjustment for qualifying states.--In the case of a
qualifying State described in paragraph (2) of section
2105(g), the Secretary shall permit the State to submit
revised projection described in subparagraph (A)(iv) in order
to take into account changes in such projections attributable
to the application of paragraph (4) of such section.
``(2) For fiscal years 2009 through 2011.--
``(A) In general.--Subject to paragraphs (4) and (6), from
the amount made available under paragraphs (12) through (14)
of subsection (a) for each of fiscal years 2009 through 2011,
respectively, the Secretary shall compute a State allotment
for each State (including the District of Columbia and each
commonwealth and territory) for each such fiscal year as
follows:
``(i) Growth factor update for fiscal year 2009.--For
fiscal year 2009, the allotment of the State is equal to the
sum of--
``(I) the amount of the State allotment under paragraph (1)
for fiscal year 2008; and
``(II) the amount of any payments made to the State under
subsection (j) for fiscal year 2008,
multiplied by the allotment increase factor under paragraph
(5) for fiscal year 2009.
``(ii) Rebasing in fiscal year 2010.--For fiscal year 2010,
the allotment of the State is equal to the Federal payments
to the State that are attributable to (and countable towards)
the total amount of allotments available under this section
to the State in fiscal year 2009 (including payments made to
the State under subsection (j) for fiscal year 2009 as well
as amounts redistributed to the State in fiscal year 2009),
multiplied by the allotment increase factor under paragraph
(5) for fiscal year 2010.
``(iii) Growth factor update for fiscal year 2011.--For
fiscal year 2011, the allotment of the State is equal to the
sum of--
``(I) the amount of the State allotment under clause (ii)
for fiscal year 2010; and
``(II) the amount of any payments made to the State under
subsection (j) for fiscal year 2010,
multiplied by the allotment increase factor under paragraph
(5) for fiscal year 2011.
``(3) For fiscal year 2012.--
``(A) First half.--Subject to paragraphs (4) and (6), from
the amount made available under subparagraph (A) of paragraph
(15) of subsection (a) for the semi-annual period described
in such paragraph, increased by the amount of the
appropriation for such period under section 108 of the
Children's Health Insurance Program Reauthorization Act of
2007, the Secretary shall compute a State allotment for each
State (including the District of Columbia and each
commonwealth and territory) for such semi-annual period in an
amount equal to the first half ratio (described in
subparagraph (D)) of the amount described in subparagraph
(C).
``(B) Second half.--Subject to paragraphs (4) and (6), from
the amount made available under subparagraph (B) of paragraph
(15) of subsection (a) for the semi-annual period described
in such paragraph, the Secretary shall compute a State
allotment for each State (including the District of Columbia
and each commonwealth and territory) for such semi-annual
period in an amount equal to the amount made available under
such subparagraph, multiplied by the ratio of--
``(i) the amount of the allotment to such State under
subparagraph (A); to
``(ii) the total of the amount of all of the allotments
made available under such subparagraph.
``(C) Full year amount based on rebased amount.--The amount
described in this subparagraph for a State is equal to the
Federal payments to the State that are attributable to (and
countable towards) the total amount of allotments available
under this section to the State in fiscal year 2011
(including payments made to the State under subsection (j)
for fiscal year 2011 as well as amounts redistributed to the
State in fiscal year 2011), multiplied by the allotment
increase factor under paragraph (5) for fiscal year 2012.
``(D) First half ratio.--The first half ratio described in
this subparagraph is the ratio of--
``(i) the sum of--
``(I) the amount made available under subsection
(a)(15)(A); and
``(II) the amount of the appropriation for such period
under section 108 of the Children's Health Insurance Program
Reauthorization Act of 2007; to
``(ii) the sum of the--
``(I) amount described in clause (i); and
``(II) the amount made available under subsection
(a)(15)(B).
``(4) Proration rule.--If, after the application of this
subsection without regard to this paragraph, the sum of the
allotments determined under paragraph (1), (2), or (3) for a
fiscal year (or, in the case of fiscal year 2012, for a semi-
annual period in such fiscal year) exceeds the amount
available under subsection (a) for such fiscal year or
period, the Secretary shall reduce each allotment for any
State under such paragraph for such fiscal year or period on
a proportional basis.
``(5) Allotment increase factor.--The allotment increase
factor under this paragraph for a fiscal year is equal to the
product of the following:
``(A) Per capita health care growth factor.--1 plus the
percentage increase in the projected per capita amount of
National Health Expenditures from the calendar year in which
the previous fiscal year ends to the calendar year in which
the fiscal year involved ends, as most recently published by
the Secretary before the beginning of the fiscal year.
``(B) Child population growth factor.--1 plus the
percentage increase (if any) in the population of children in
the State from July 1 in the previous fiscal year to July 1
in the fiscal year involved, as determined by the Secretary
based on the most recent published estimates of the Bureau of
the Census before the beginning of the fiscal year involved,
plus 1 percentage point.
``(6) Increase in allotment to account for approved program
expansions.--In the case of one of the 50 States or the
District of Columbia that--
``(A) has submitted to the Secretary, and has approved by
the Secretary, a State plan amendment or waiver request
relating to an expansion of eligibility for children or
benefits under this title that becomes effective for a fiscal
year (beginning with fiscal year 2009 and ending with fiscal
year 2012); and
``(B) has submitted to the Secretary, before the August 31
preceding the beginning of the fiscal year, a request for an
expansion allotment adjustment under this paragraph for such
fiscal year that specifies--
``(i) the additional expenditures that are attributable to
the eligibility or benefit expansion provided under the
amendment or waiver described in subparagraph (A), as
certified by the State and submitted to the Secretary by not
later than August 31 preceding the beginning of the fiscal
year; and
``(ii) the extent to which such additional expenditures are
projected to exceed the allotment of the State or District
for the year, subject to paragraph (4), the amount of the
allotment of the State or District under this subsection for
such fiscal year shall be increased by the excess amount
described in subparagraph (B)(i). A State or District may
only obtain an increase under this paragraph for an allotment
for fiscal year 2009 or fiscal year 2011.
``(7) Availability of amounts for semi-annual periods in
fiscal year 2012.--Each semi-annual allotment made under
paragraph (3) for a period in fiscal year 2012 shall remain
available for expenditure under this title for periods after
the end of such fiscal year in the same manner as if the
allotment had been made available for the entire fiscal
year.''.
SEC. 103. CHILD ENROLLMENT CONTINGENCY FUND.
Section 2104 (42 U.S.C. 1397dd), as amended by section 102,
is amended by adding at the end the following new subsection:
``(j) Child Enrollment Contingency Fund.--
``(1) Establishment.--There is hereby established in the
Treasury of the United States a fund which shall be known as
the `Child Enrollment Contingency Fund' (in this subsection
referred to as the `Fund'). Amounts in the Fund shall be
available without further appropriations for payments under
this subsection.
``(2) Deposits into fund.--
``(A) Initial and subsequent appropriations.--Subject to
subparagraphs (B) and (D), out of any money in the Treasury
of the United States not otherwise appropriated, there are
appropriated to the Fund--
``(i) for fiscal year 2008, an amount equal to 20 percent
of the amount made available under paragraph (11) of
subsection (a) for the fiscal year; and
``(ii) for each of fiscal years 2009 through 2011 (and for
each of the semi-annual allotment periods for fiscal year
2012), such sums as are necessary for making payments to
eligible States for such fiscal year or period, but not in
excess of the aggregate cap described in subparagraph (B).
``(B) Aggregate cap.--The total amount available for
payment from the Fund for each of fiscal years 2009 through
2011 (and for each of the semi-annual allotment periods for
fiscal year 2012), taking into account deposits made under
subparagraph (C), shall not exceed 20 percent of the amount
made available under subsection (a) for the fiscal year or
period.
``(C) Investment of fund.--The Secretary of the Treasury
shall invest, in interest bearing securities of the United
States, such currently available portions of the Fund as are
not immediately required for payments from the Fund. The
income derived from these investments constitutes a part of
the Fund.
``(D) Availability of excess funds for performance
bonuses.--Any amounts in excess of the aggregate cap
described in subparagraph (B) for a fiscal year or period
shall be made available for purposes of carrying out section
2105(a)(3) for any succeeding fiscal year and the Secretary
of the Treasury shall reduce the amount in the Fund by the
amount so made available.
``(3) Child enrollment contingency fund payments.--
``(A) In general.--If a State's expenditures under this
title in fiscal year 2008, fiscal year 2009, fiscal year
2010, fiscal year 2011, or a semi-annual allotment period for
fiscal year 2012, exceed the total amount of allotments
available under this section to the State in the fiscal year
or period (determined without regard to any redistribution it
receives under subsection (f) that is available for
expenditure during such fiscal year or period, but including
any carryover from a previous fiscal year) and if the average
monthly unduplicated number of children enrolled under the
State plan under this title (including children receiving
health care coverage
[[Page H12045]]
through funds under this title pursuant to a waiver under
section 1115) during such fiscal year or period exceeds its
target average number of such enrollees (as determined under
subparagraph (B)) for that fiscal year or period, subject to
subparagraph (D), the Secretary shall pay to the State from
the Fund an amount equal to the product of--
``(i) the amount by which such average monthly caseload
exceeds such target number of enrollees; and
``(ii) the projected per capita expenditures under the
State child health plan (as determined under subparagraph (C)
for the fiscal year), multiplied by the enhanced FMAP (as
defined in section 2105(b)) for the State and fiscal year
involved (or in which the period occurs).
``(B) Target average number of child enrollees.--In this
paragraph, the target average number of child enrollees for a
State--
``(i) for fiscal year 2008 is equal to the monthly average
unduplicated number of children enrolled in the State child
health plan under this title (including such children
receiving health care coverage through funds under this title
pursuant to a waiver under section 1115) during fiscal year
2007 increased by the population growth for children in that
State for the year ending on June 30, 2006 (as estimated by
the Bureau of the Census) plus 1 percentage point; or
``(ii) for a subsequent fiscal year (or semi-annual period
occurring in a fiscal year) is equal to the target average
number of child enrollees for the State for the previous
fiscal year increased by the child population growth factor
described in subsection (i)(5)(B) for the State for the prior
fiscal year.
``(C) Projected per capita expenditures.--For purposes of
subparagraph (A)(ii), the projected per capita expenditures
under a State child health plan--
``(i) for fiscal year 2008 is equal to the average per
capita expenditures (including both State and Federal
financial participation) under such plan for the targeted
low-income children counted in the average monthly caseload
for purposes of this paragraph during fiscal year 2007,
increased by the annual percentage increase in the projected
per capita amount of National Health Expenditures (as
estimated by the Secretary) for 2008; or
``(ii) for a subsequent fiscal year (or semi-annual period
occurring in a fiscal year) is equal to the projected per
capita expenditures under such plan for the previous fiscal
year (as determined under clause (i) or this clause)
increased by the annual percentage increase in the projected
per capita amount of National Health Expenditures (as
estimated by the Secretary) for the year in which such
subsequent fiscal year ends.
``(D) Proration rule.--If the amounts available for payment
from the Fund for a fiscal year or period are less than the
total amount of payments determined under subparagraph (A)
for the fiscal year or period, the amount to be paid under
such subparagraph to each eligible State shall be reduced
proportionally.
``(E) Timely payment; reconciliation.--Payment under this
paragraph for a fiscal year or period shall be made before
the end of the fiscal year or period based upon the most
recent data for expenditures and enrollment and the
provisions of subsection (e) of section 2105 shall apply to
payments under this subsection in the same manner as they
apply to payments under such section.
``(F) Continued reporting.--For purposes of this paragraph
and subsection (f), the State shall submit to the Secretary
the State's projected Federal expenditures, even if the
amount of such expenditures exceeds the total amount of
allotments available to the State in such fiscal year or
period.
``(G) Application to commonwealths and territories.--No
payment shall be made under this paragraph to a commonwealth
or territory described in subsection (c)(3) until such time
as the Secretary determines that there are in effect methods,
satisfactory to the Secretary, for the collection and
reporting of reliable data regarding the enrollment of
children described in subparagraphs (A) and (B) in order to
accurately determine the commonwealth's or territory's
eligibility for, and amount of payment, under this
paragraph.''.
SEC. 104. CHIP PERFORMANCE BONUS PAYMENT TO OFFSET ADDITIONAL
ENROLLMENT COSTS RESULTING FROM ENROLLMENT AND
RETENTION EFFORTS.
Section 2105(a) (42 U.S.C. 1397ee(a)) is amended by adding
at the end the following new paragraphs:
``(3) Performance bonus payment to offset additional
medicaid and chip child enrollment costs resulting from
enrollment and retention efforts.--
``(A) In general.--In addition to the payments made under
paragraph (1), for each fiscal year (beginning with fiscal
year 2008 and ending with fiscal year 2012), the Secretary
shall pay from amounts made available under subparagraph (E),
to each State that meets the condition under paragraph (4)
for the fiscal year, an amount equal to the amount described
in subparagraph (B) for the State and fiscal year. The
payment under this paragraph shall be made, to a State for a
fiscal year, as a single payment not later than the last day
of the first calendar quarter of the following fiscal year.
Payments made under this paragraph may only be used to reduce
the number of low-income children who do not have health
insurance coverage in the State.
``(B) Amount for above baseline medicaid child enrollment
costs.--Subject to subparagraph (E), the amount described in
this subparagraph for a State for a fiscal year is equal to
the sum of the following amounts:
``(i) First tier above baseline medicaid enrollees.--An
amount equal to the number of first tier above baseline child
enrollees (as determined under subparagraph (C)(i)) under
title XIX for the State and fiscal year, multiplied by 15
percent of the projected per capita State Medicaid
expenditures (as determined under subparagraph (D)) for the
State and fiscal year under title XIX.
``(ii) Second tier above baseline medicaid enrollees.--An
amount equal to the number of second tier above baseline
child enrollees (as determined under subparagraph (C)(ii))
under title XIX for the State and fiscal year, multiplied by
62.5 percent of the projected per capita State Medicaid
expenditures (as determined under subparagraph (D)) for the
State and fiscal year under title XIX.
``(C) Number of first and second tier above baseline child
enrollees; baseline number of child enrollees.--For purposes
of this paragraph:
``(i) First tier above baseline child enrollees.--The
number of first tier above baseline child enrollees for a
State for a fiscal year under title XIX is equal to the
number (if any, as determined by the Secretary) by which--
``(I) the monthly average unduplicated number of qualifying
children (as defined in subparagraph (F)) enrolled during the
fiscal year under the State plan under title XIX; exceeds
``(II) the baseline number of enrollees described in clause
(iii) for the State and fiscal year under title XIX;
but not to exceed 3 percent of the baseline number of
enrollees described in subclause (II).
``(ii) Second tier above baseline child enrollees.--The
number of second tier above baseline child enrollees for a
State for a fiscal year under title XIX is equal to the
number (if any, as determined by the Secretary) by which--
``(I) the monthly average unduplicated number of qualifying
children (as defined in subparagraph (F)) enrolled during the
fiscal year under title XIX as described in clause (i)(I);
exceeds
``(II) the sum of the baseline number of child enrollees
described in clause (iii) for the State and fiscal year title
XIX, as described in clause (i)(II), and the maximum number
of first tier above baseline child enrollees for the State
and fiscal year under title XIX, as determined under clause
(i).
``(iii) Baseline number of child enrollees.--Subject to
subparagraph (H), the baseline number of child enrollees for
a State under title XIX--
``(I) for fiscal year 2008 is equal to the monthly average
unduplicated number of qualifying children enrolled in the
State plan under title XIX during fiscal year 2007 increased
by the population growth for children in that State for the
year ending on June 30, 2006 (as estimated by the Bureau of
the Census) plus 1 percentage point; or
``(II) for a subsequent fiscal year is equal to the
baseline number of child enrollees for the State for the
previous fiscal year under title XIX, increased by the
population growth for children in that State for the year
ending on June 30 before the beginning of the fiscal year (as
estimated by the Bureau of the Census) plus 1 percentage
point.
``(D) Projected per capita state medicaid expenditures.--
For purposes of subparagraph (B), the projected per capita
State Medicaid expenditures for a State and fiscal year under
title XIX is equal to the average per capita expenditures
(including both State and Federal financial participation)
for children under the State plan under such title,
including under waivers but not including such children
eligible for assistance by virtue of the receipt of
benefits under title XVI, for the most recent fiscal year
for which actual data are available (as determined by the
Secretary), increased (for each subsequent fiscal year up
to and including the fiscal year involved) by the annual
percentage increase in per capita amount of National
Health Expenditures (as estimated by the Secretary) for
the calendar year in which the respective subsequent
fiscal year ends and multiplied by a State matching
percentage equal to 100 percent minus the Federal medical
assistance percentage (as defined in section 1905(b)) for
the fiscal year involved.
``(E) Amounts available for payments.--
``(i) Initial appropriation.--Out of any money in the
Treasury not otherwise appropriated, there are appropriated
$3,000,000,000 for fiscal year 2008 for making payments under
this paragraph, to be available until expended.
``(ii) Transfers.--Notwithstanding any other provision of
this title, the following amounts shall also be available,
without fiscal year limitation, for making payments under
this paragraph:
``(I) Unobligated national allotment.--
``(aa) Fiscal years 2008 through 2011.--As of December 31
of fiscal year 2008, and as of December 31 of each succeeding
fiscal year through fiscal year 2011, the portion, if any, of
the amount appropriated under subsection (a) for such fiscal
year that is unobligated for allotment to a State under
subsection (i) for such fiscal year or set aside under
subsection (a)(3) or (b)(2) of section 2111 for such fiscal
year.
[[Page H12046]]
``(bb) First half of fiscal year 2012.--As of December 31
of fiscal year 2012, the portion, if any, of the sum of the
amounts appropriated under subsection (a)(15)(A) and under
section 108 of the Children's Health Insurance
Reauthorization Act of 2007 for the period beginning on
October 1, 2011, and ending on March 31, 2012, that is
unobligated for allotment to a State under subsection (i) for
such fiscal year or set aside under subsection (b)(2) of
section 2111 for such fiscal year.
``(cc) Second half of fiscal year 2012.--As of June 30 of
fiscal year 2012, the portion, if any, of the amount
appropriated under subsection (a)(15)(B) for the period
beginning on April 1, 2012, and ending on September 30, 2012,
that is unobligated for allotment to a State under subsection
(i) for such fiscal year or set aside under subsection (b)(2)
of section 2111 for such fiscal year.
``(II) Unexpended allotments not used for redistribution.--
As of November 15 of each of fiscal years 2009 through 2012,
the total amount of allotments made to States under section
2104 for the second preceding fiscal year (third preceding
fiscal year in the case of the fiscal year 2006 and 2007
allotments) that is not expended or redistributed under
section 2104(f) during the period in which such allotments
are available for obligation.
``(III) Excess child enrollment contingency funds.--As of
October 1 of each of fiscal years 2009 through 2012, any
amount in excess of the aggregate cap applicable to the Child
Enrollment Contingency Fund for the fiscal year under section
2104(j).
``(iii) Proportional reduction.--If the sum of the amounts
otherwise payable under this paragraph for a fiscal year
exceeds the amount available for the fiscal year under this
subparagraph, the amount to be paid under this paragraph to
each State shall be reduced proportionally.
``(F) Qualifying children defined.--For purposes of this
subsection, the term `qualifying children' means children who
meet the eligibility criteria (including income, categorical
eligibility, age, and immigration status criteria) in effect
as of July 1, 2007, for enrollment under title XIX, taking
into account criteria applied as of such date under title XIX
pursuant to a waiver under section 1115.
``(G) Application to commonwealths and territories.--The
provisions of subparagraph (G) of section 2104(j)(3) shall
apply with respect to payment under this paragraph in the
same manner as such provisions apply to payment under such
section.
``(H) Application to states that implement a medicaid
expansion for children after fiscal year 2007.--In the case
of a State that provides coverage under paragraph (1) or (2)
of section 115(b) of the Children's Health Insurance Program
Reauthorization Act of 2007 for any fiscal year after fiscal
year 2007--
``(i) any child enrolled in the State plan under title XIX
through the application of such an election shall be
disregarded from the determination for the State of the
monthly average unduplicated number of qualifying children
enrolled in such plan during the first 3 fiscal years in
which such an election is in effect; and
``(ii) in determining the baseline number of child
enrollees for the State for any fiscal year subsequent to
such first 3 fiscal years, the baseline number of child
enrollees for the State under title XIX for the third of such
fiscal years shall be the monthly average unduplicated number
of qualifying children enrolled in the State plan under title
XIX for such third fiscal year.
``(4) Enrollment and retention provisions for children.--
For purposes of paragraph (3)(A), a State meets the condition
of this paragraph for a fiscal year if it is implementing at
least 5 of the following enrollment and retention provisions
(treating each subparagraph as a separate enrollment and
retention provision) throughout the entire fiscal year:
``(A) Continuous eligibility.--The State has elected the
option of continuous eligibility for a full 12 months for all
children described in section 1902(e)(12) under title XIX
under 19 years of age, as well as applying such policy under
its State child health plan under this title.
``(B) Liberalization of asset requirements.--The State
meets the requirement specified in either of the following
clauses:
``(i) Elimination of asset test.--The State does not apply
any asset or resource test for eligibility for children under
title XIX or this title.
``(ii) Administrative verification of assets.--The State--
``(I) permits a parent or caretaker relative who is
applying on behalf of a child for medical assistance under
title XIX or child health assistance under this title to
declare and certify by signature under penalty of perjury
information relating to family assets for purposes of
determining and redetermining financial eligibility; and
``(II) takes steps to verify assets through means other
than by requiring documentation from parents and applicants
except in individual cases of discrepancies or where
otherwise justified.
``(C) Elimination of in-person interview requirement.--The
State does not require an application of a child for medical
assistance under title XIX (or for child health assistance
under this title), including an application for renewal of
such assistance, to be made in person nor does the State
require a face-to-face interview, unless there are
discrepancies or individual circumstances justifying an in-
person application or face-to-face interview.
``(D) Use of joint application for medicaid and chip.--The
application form and supplemental forms (if any) and
information verification process is the same for purposes of
establishing and renewing eligibility for children for
medical assistance under title XIX and child health
assistance under this title.
``(E) Automatic renewal (use of administrative renewal).--
``(i) In general.--The State provides, in the case of
renewal of a child's eligibility for medical assistance under
title XIX or child health assistance under this title, a pre-
printed form completed by the State based on the information
available to the State and notice to the parent or caretaker
relative of the child that eligibility of the child will be
renewed and continued based on such information unless the
State is provided other information. Nothing in this clause
shall be construed as preventing a State from verifying,
through electronic and other means, the information so
provided.
``(ii) Satisfaction through demonstrated use of ex parte
process.--A State shall be treated as satisfying the
requirement of clause (i) if renewal of eligibility of
children under title XIX or this title is determined without
any requirement for an in-person interview, unless sufficient
information is not in the State's possession and cannot be
acquired from other sources (including other State agencies)
without the participation of the applicant or the applicant's
parent or caretaker relative.
``(F) Presumptive eligibility for children.--The State is
implementing section 1920A under title XIX as well as,
pursuant to section 2107(e)(1), under this title.
``(G) Express lane.--The State is implementing the option
described in section 1902(e)(13) under title XIX as well as,
pursuant to section 2107(e)(1), under this title.
``(H) Premium assistance subsidies.--The State is
implementing the option of providing premium assistance
subsidies under section 2105(c)(11) or section 1906A.''.
SEC. 105. 2-YEAR INITIAL AVAILABILITY OF CHIP ALLOTMENTS.
Section 2104(e) (42 U.S.C. 1397dd(e)) is amended to read as
follows:
``(e) Availability of Amounts Allotted.--
``(1) In general.--Except as provided in paragraph (2),
amounts allotted to a State pursuant to this section--
``(A) for each of fiscal years 1998 through 2007, shall
remain available for expenditure by the State through the end
of the second succeeding fiscal year; and
``(B) for fiscal year 2008 and each fiscal year thereafter,
shall remain available for expenditure by the State through
the end of the succeeding fiscal year.
``(2) Availability of amounts redistributed.--Amounts
redistributed to a State under subsection (f) shall be
available for expenditure by the State through the end of the
fiscal year in which they are redistributed.''.
SEC. 106. MAKING PERMANENT REDISTRIBUTION OF UNUSED FISCAL
YEAR 2005 ALLOTMENTS TO ADDRESS STATE FUNDING
SHORTFALLS; CONFORMING EXTENSION OF QUALIFYING
STATE AUTHORITY; REDISTRIBUTION OF UNUSED
ALLOTMENTS FOR SUBSEQUENT FISCAL YEARS.
(a) Redistribution of Unused Fiscal Year 2005 Allotments;
Extension of Qualifying State Authority.--Section 136(e) of
Public Law 110-92 is amended to read as follows:
``(e) Applicability.--
``(1) Redistribution of unused fiscal year 2005
allotments.--The amendment made by subsection (c) shall apply
without regard to any limitation under section 106.
``(2) Extension of qualifying state authority.--The
amendment made by subsection (d) shall be in effect through
the date of the enactment of the Children's Health Insurance
Program Reauthorization Act of 2007.''.
(b) Redistributions of Unused Allotments for Fiscal Years
After Fiscal Year 2005.--Section 2104(f) (42 U.S.C.
1397dd(f)) is amended--
(1) by striking ``The Secretary'' and inserting the
following:
``(1) In general.--The Secretary'';
(2) by striking ``States that have fully expended the
amount of their allotments under this section.'' and
inserting ``States that the Secretary determines with respect
to the fiscal year for which unused allotments are available
for redistribution under this subsection, are shortfall
States described in paragraph (2) for such fiscal year, but
not to exceed the amount of the shortfall described in
paragraph (2)(A) for each such State (as may be adjusted
under paragraph (2)(C)).''; and
(3) by adding at the end the following new paragraph:
``(2) Shortfall states described.--
``(A) In general.--For purposes of paragraph (1), with
respect to a fiscal year, a shortfall State described in this
subparagraph is a State with a State child health plan
approved under this title for which the Secretary estimates
on the basis of the most recent data available to the
Secretary, that the projected expenditures under such plan
for the State for the fiscal year will exceed the sum of--
``(i) the amount of the State's allotments for any
preceding fiscal years that remains available for expenditure
and that will not
[[Page H12047]]
be expended by the end of the immediately preceding fiscal
year;
``(ii) the amount (if any) of the child enrollment
contingency fund payment under subsection (j); and
``(iii) the amount of the State's allotment for the fiscal
year.
``(B) Proration rule.--If the amounts available for
redistribution under paragraph (1) for a fiscal year are less
than the total amounts of the estimated shortfalls determined
for the year under subparagraph (A), the amount to be
redistributed under such paragraph for each shortfall State
shall be reduced proportionally.
``(C) Retrospective adjustment.--The Secretary may adjust
the estimates and determinations made under paragraph (1) and
this paragraph with respect to a fiscal year as necessary on
the basis of the amounts reported by States not later than
November 30 of the succeeding fiscal year, as approved by the
Secretary.''.
SEC. 107. OPTION FOR QUALIFYING STATES TO RECEIVE THE
ENHANCED PORTION OF THE CHIP MATCHING RATE FOR
MEDICAID COVERAGE OF CERTAIN CHILDREN.
Section 2105(g) (42 U.S.C. 1397ee(g)) is amended--
(1) in paragraph (1)(A), as amended by section 136(d) of
Public Law 110-92--
(A) by inserting ``subject to paragraph (4),'' after
``Notwithstanding any other provision of law,''; and
(B) by striking ``2007, or 2008'' and inserting ``or
2007''; and
(2) by adding at the end the following new paragraph:
``(4) Option for allotments for fiscal years 2008 through
2012.--
``(A) Payment of enhanced portion of matching rate for
certain expenditures.--In the case of expenditures described
in subparagraph (B), a qualifying State (as defined in
paragraph (2)) may elect to be paid from the State's
allotment made under section 2104 for any of fiscal years
2008 through 2012 (insofar as the allotment is available to
the State under subsections (e) and (i) of such section) an
amount each quarter equal to the additional amount that would
have been paid to the State under title XIX with respect to
such expenditures if the enhanced FMAP (as determined under
subsection (b)) had been substituted for the Federal medical
assistance percentage (as defined in section 1905(b)).
``(B) Expenditures described.--For purposes of subparagraph
(A), the expenditures described in this subparagraph are
expenditures made after the date of the enactment of this
paragraph and during the period in which funds are available
to the qualifying State for use under subparagraph (A), for
the provision of medical assistance to individuals residing
in the State who are eligible for medical assistance under
the State plan under title XIX or under a waiver of such plan
and who have not attained age 19 (or, if a State has so
elected under the State plan under title XIX, age 20 or 21),
and whose family income equals or exceeds 133 percent of the
poverty line but does not exceed the Medicaid applicable
income level.''.
SEC. 108. ONE-TIME APPROPRIATION.
There is appropriated to the Secretary, out of any money in
the Treasury not otherwise appropriated, $13,700,000,000 to
accompany the allotment made for the period beginning on
October 1, 2011, and ending on March 31, 2012, under section
2104(a)(15)(A) of the Social Security Act (42 U.S.C.
1397dd(a)(15)(A)) (as added by section 101), to remain
available until expended. Such amount shall be used to
provide allotments to States under paragraph (3) of section
2104(i) of the Social Security Act (42 U.S.C. 1397dd(i)), as
added by section 102, for the first 6 months of fiscal year
2012 in the same manner as allotments are provided under
subsection (a)(15)(A) of such section 2104 and subject to the
same terms and conditions as apply to the allotments provided
from such subsection (a)(15)(A).
SEC. 109. IMPROVING FUNDING FOR THE TERRITORIES UNDER CHIP
AND MEDICAID.
(a) Removal of Federal Matching Payments for Data Reporting
Systems From the Overall Limit on Payments to Territories
Under Title XIX.--Section 1108(g) (42 U.S.C. 1308(g)) is
amended by adding at the end the following new paragraph:
``(4) Exclusion of certain expenditures from payment
limits.--With respect to fiscal years beginning with fiscal
year 2008, if Puerto Rico, the Virgin Islands, Guam, the
Northern Mariana Islands, or American Samoa qualify for a
payment under subparagraph (A)(i), (B), or (F) of section
1903(a)(3) for a calendar quarter of such fiscal year, the
payment shall not be taken into account in applying
subsection (f) (as increased in accordance with paragraphs
(1), (2), and (3) of this subsection) to such commonwealth or
territory for such fiscal year.''.
(b) GAO Study and Report.--Not later than September 30,
2009, the Comptroller General of the United States shall
submit a report to the Committee on Finance of the Senate and
the Committee on Energy and Commerce of the House of
Representatives regarding Federal funding under Medicaid and
CHIP for Puerto Rico, the United States Virgin Islands, Guam,
American Samoa, and the Northern Mariana Islands. The report
shall include the following:
(1) An analysis of all relevant factors with respect to--
(A) eligible Medicaid and CHIP populations in such
commonwealths and territories;
(B) historical and projected spending needs of such
commonwealths and territories and the ability of capped
funding streams to respond to those spending needs;
(C) the extent to which Federal poverty guidelines are used
by such commonwealths and territories to determine Medicaid
and CHIP eligibility; and
(D) the extent to which such commonwealths and territories
participate in data collection and reporting related to
Medicaid and CHIP, including an analysis of territory
participation in the Current Population Survey versus the
American Community Survey.
(2) Recommendations regarding methods for the collection
and reporting of reliable data regarding the enrollment under
Medicaid and CHIP of children in such commonwealths and
territories.
(3) Recommendations for improving Federal funding under
Medicaid and CHIP for such commonwealths and territories.
Subtitle B--Focus on Low-Income Children and Pregnant Women
SEC. 111. STATE OPTION TO COVER LOW-INCOME PREGNANT WOMEN
UNDER CHIP THROUGH A STATE PLAN AMENDMENT.
(a) In General.--Title XXI (42 U.S.C. 1397aa et seq.), as
amended by section 112(a), is amended by adding at the end
the following new section:
``SEC. 2112. OPTIONAL COVERAGE OF TARGETED LOW-INCOME
PREGNANT WOMEN THROUGH A STATE PLAN AMENDMENT.
``(a) In General.--Subject to the succeeding provisions of
this section, a State may elect through an amendment to its
State child health plan under section 2102 to provide
pregnancy-related assistance under such plan for targeted
low-income pregnant women.
``(b) Conditions.--A State may only elect the option under
subsection (a) if the following conditions are satisfied:
``(1) Minimum income eligibility levels for pregnant women
and children.--The State has established an income
eligibility level--
``(A) for pregnant women under subsection
(a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) of
section 1902 that is at least 185 percent (or such higher
percent as the State has in effect with regard to pregnant
women under this title) of the poverty line applicable to a
family of the size involved, but in no case lower than the
percent in effect under any such subsection as of July 1,
2007; and
``(B) for children under 19 years of age under this title
(or title XIX) that is at least 200 percent of the poverty
line applicable to a family of the size involved.
``(2) No chip income eligibility level for pregnant women
lower than the state's medicaid level.--The State does not
apply an effective income level for pregnant women under the
State plan amendment that is lower than the effective income
level (expressed as a percent of the poverty line and
considering applicable income disregards) specified under
subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or
(l)(1)(A) of section 1902, on the date of enactment of this
paragraph to be eligible for medical assistance as a pregnant
woman.
``(3) No coverage for higher income pregnant women without
covering lower income pregnant women.--The State does not
provide coverage for pregnant women with higher family income
without covering pregnant women with a lower family income.
``(4) Application of requirements for coverage of targeted
low-income children.--The State provides pregnancy-related
assistance for targeted low-income pregnant women in the same
manner, and subject to the same requirements, as the State
provides child health assistance for targeted low-income
children under the State child health plan, and in addition
to providing child health assistance for such women.
``(5) No preexisting condition exclusion or waiting
period.--The State does not apply any exclusion of benefits
for pregnancy-related assistance based on any preexisting
condition or any waiting period (including any waiting period
imposed to carry out section 2102(b)(3)(C)) for receipt of
such assistance.
``(6) Application of cost-sharing protection.--The State
provides pregnancy-related assistance to a targeted low-
income woman consistent with the cost-sharing protections
under section 2103(e) and applies the limitation on total
annual aggregate cost sharing imposed under paragraph (3)(B)
of such section to the family of such a woman.
``(7) No waiting list for children.--The State does not
impose, with respect to the enrollment under the State child
health plan of targeted low-income children during the
quarter, any enrollment cap or other numerical limitation on
enrollment, any waiting list, any procedures designed to
delay the consideration of applications for enrollment, or
similar limitation with respect to enrollment.
``(c) Option To Provide Presumptive Eligibility.--A State
that elects the option under subsection (a) and satisfies the
conditions described in subsection (b) may elect to apply
section 1920 (relating to presumptive eligibility for
pregnant women) to the State child health plan in the same
manner as such section applies to the State plan under title
XIX.
``(d) Definitions.--For purposes of this section:
``(1) Pregnancy-related assistance.--The term `pregnancy-
related assistance' has the
[[Page H12048]]
meaning given the term `child health assistance' in section
2110(a) with respect to an individual during the period
described in paragraph (2)(A).
``(2) Targeted low-income pregnant woman.--The term
`targeted low-income pregnant woman' means an individual--
``(A) during pregnancy and through the end of the month in
which the 60-day period (beginning on the last day of her
pregnancy) ends;
``(B) whose family income exceeds 185 percent (or, if
higher, the percent applied under subsection (b)(1)(A)) of
the poverty line applicable to a family of the size involved,
but does not exceed the income eligibility level established
under the State child health plan under this title for a
targeted low-income child; and
``(C) who satisfies the requirements of paragraphs (1)(A),
(1)(C), (2), and (3) of section 2110(b) in the same manner as
a child applying for child health assistance would have to
satisfy such requirements.
``(e) Automatic Enrollment for Children Born to Women
Receiving Pregnancy-Related Assistance.--If a child is born
to a targeted low-income pregnant woman who was receiving
pregnancy-related assistance under this section on the date
of the child's birth, the child shall be deemed to have
applied for child health assistance under the State child
health plan and to have been found eligible for such
assistance under such plan or to have applied for medical
assistance under title XIX and to have been found eligible
for such assistance under such title, as appropriate, on the
date of such birth and to remain eligible for such assistance
until the child attains 1 year of age. During the period in
which a child is deemed under the preceding sentence to be
eligible for child health or medical assistance, the child
health or medical assistance eligibility identification
number of the mother shall also serve as the identification
number of the child, and all claims shall be submitted and
paid under such number (unless the State issues a separate
identification number for the child before such period
expires).
``(f) States Providing Assistance Through Other Options.--
``(1) Continuation of other options for providing
assistance.--The option to provide assistance in accordance
with the preceding subsections of this section shall not
limit any other option for a State to provide--
``(A) child health assistance through the application of
sections 457.10, 457.350(b)(2), 457.622(c)(5), and
457.626(a)(3) of title 42, Code of Federal Regulations (as in
effect after the final rule adopted by the Secretary and set
forth at 67 Fed. Reg. 61956-61974 (October 2, 2002)), or
``(B) pregnancy-related services through the application of
any waiver authority (as in effect on June 1, 2007).
``(2) Clarification of authority to provide postpartum
services.--Any State that provides child health assistance
under any authority described in paragraph (1) may continue
to provide such assistance, as well as postpartum services,
through the end of the month in which the 60-day period
(beginning on the last day of the pregnancy) ends, in the
same manner as such assistance and postpartum services would
be provided if provided under the State plan under title XIX,
but only if the mother would otherwise satisfy the
eligibility requirements that apply under the State child
health plan (other than with respect to age) during such
period.
``(3) No inference.--Nothing in this subsection shall be
construed--
``(A) to infer congressional intent regarding the legality
or illegality of the content of the sections specified in
paragraph (1)(A); or
``(B) to modify the authority to provide pregnancy-related
services under a waiver specified in paragraph (1)(B).''.
(b) Additional Conforming Amendments.--
(1) No cost sharing for pregnancy-related benefits.--
Section 2103(e)(2) (42 U.S.C. 1397cc(e)(2)) is amended--
(A) in the heading, by inserting ``OR PREGNANCY-RELATED
ASSISTANCE'' after ``PREVENTIVE SERVICES''; and
(B) by inserting before the period at the end the
following: ``or for pregnancy-related assistance''.
(2) No waiting period.--Section 2102(b)(1)(B) (42 U.S.C.
1397bb(b)(1)(B)) is amended--
(A) in clause (i), by striking ``, and'' at the end and
inserting a semicolon;
(B) in clause (ii), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following new clause:
``(iii) may not apply a waiting period (including a waiting
period to carry out paragraph (3)(C)) in the case of a
targeted low-income pregnant woman provided pregnancy-related
assistance under section 2112.''.
SEC. 112. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS
ADULTS UNDER CHIP; CONDITIONS FOR COVERAGE OF
PARENTS.
(a) Phase-Out Rules.--
(1) In general.--Title XXI (42 U.S.C. 1397aa et seq.) is
amended by adding at the end the following new section:
``SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS
ADULTS; CONDITIONS FOR COVERAGE OF PARENTS.
``(a) Termination of Coverage for Nonpregnant Childless
Adults.--
``(1) No new chip waivers; automatic extensions at state
option through 2008.--Notwithstanding 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 Children's Health Insurance Program
Reauthorization Act of 2007, 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 childless 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, 2009, 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 chip coverage under applicable
existing waivers at the end of 2008.--
``(A) In general.--No funds shall be available under this
title for child health assistance or other health benefits
coverage that is provided to a nonpregnant childless adult
under an applicable existing waiver after December 31, 2008.
``(B) Extension upon state request.--If an applicable
existing waiver described in subparagraph (A) would otherwise
expire before January 1, 2009, and the State requests an
extension of such waiver, the Secretary shall grant such an
extension, but only through December 31, 2008.
``(C) Application of enhanced fmap.--The 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, 2008.
``(3) State option to apply for medicaid waiver to continue
coverage for nonpregnant childless adults.--
``(A) In general.--Each State for which coverage under an
applicable existing waiver is terminated under paragraph
(2)(A) may submit, not later than September 30, 2008, an
application to the Secretary for a waiver under section 1115
of the State plan under title XIX to provide medical
assistance to a nonpregnant childless adult whose coverage is
so terminated (in this subsection referred to as a `Medicaid
nonpregnant childless adults waiver').
``(B) Deadline for approval.--The Secretary shall make a
decision to approve or deny an application for a Medicaid
nonpregnant childless adults waiver submitted under
subparagraph (A) within 90 days of the date of the submission
of the application. If no decision has been made by the
Secretary as of December 31, 2008, on the application of a
State for a Medicaid nonpregnant childless adults waiver that
was submitted to the Secretary by September 30, 2008, the
application shall be deemed approved.
``(C) Standard for budget neutrality.--The budget
neutrality requirement applicable with respect to
expenditures for medical assistance under a Medicaid
nonpregnant childless adults waiver shall--
``(i) in the case of 2009, allow expenditures for medical
assistance under title XIX for all such adults to not exceed
the total amount of payments made to the State under
paragraph (3)(B) for 2008, increased by the percentage
increase (if any) in the projected nominal per capita amount
of National Health Expenditures for 2009 over 2008, as most
recently published by the Secretary; and
``(ii) in the case of any succeeding year, allow such
expenditures to not exceed the amount in effect under this
subparagraph for the preceding year, increased by the
percentage increase (if any) in the projected nominal per
capita amount of National Health Expenditures for the year
involved over the preceding year, as most recently published
by the Secretary.
``(b) Rules and Conditions for Coverage of Parents of
Targeted Low-Income Children.--
``(1) Two-year transition period; automatic extension at
state option through fiscal year 2009.--
``(A) No new chip waivers.--Notwithstanding section 1115 or
any other provision of this title, except as provided in this
subsection--
``(i) the Secretary shall not on or after the date of the
enactment of the Children's Health Insurance Program
Reauthorization Act of 2007 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 parent of a targeted low-income child; and
``(ii) notwithstanding the terms and conditions of an
applicable existing waiver, the provisions of paragraphs (2)
and (3) shall apply for purposes of any fiscal year beginning
on or after October 1, 2009, 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.
``(B) Extension upon state request.--If an applicable
existing waiver described in subparagraph (A) would otherwise
expire before October 1, 2009, and the State requests an
extension of such waiver, the Secretary
[[Page H12049]]
shall grant such an extension, but only, subject to paragraph
(2)(A), through September 30, 2009.
``(C) Application of enhanced fmap.--The 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 parent of a targeted low-income child during fiscal years
2008 and 2009.
``(2) Rules for fiscal years 2010 through 2012.--
``(A) Payments for coverage limited to block grant funded
from state allotment.--Any State that provides child health
assistance or health benefits coverage under an applicable
existing waiver for a parent of a targeted low-income child
may elect to continue to provide such assistance or coverage
through fiscal year 2010, 2011, or 2012, subject to the same
terms and conditions that applied under the applicable
existing waiver, unless otherwise modified in subparagraph
(B).
``(B) Terms and conditions.--
``(i) Block grant set aside from state allotment.--If the
State makes an election under subparagraph (A), the Secretary
shall set aside for the State for each such fiscal year an
amount equal to the Federal share of 110 percent of the
State's projected expenditures under the applicable existing
waiver for providing child health assistance or health
benefits coverage to all parents of targeted low-income
children enrolled under such waiver for the fiscal year (as
certified by the State and submitted to the Secretary by not
later than August 31 of the preceding fiscal year). In the
case of fiscal year 2012, the set aside for any State shall
be computed separately for each period described in
subparagraphs (A) and (B) of section 2104(a)(15) and any
reduction in the allotment for either such period under
section 2104(i)(4) shall be allocated on a pro rata basis to
such set aside.
``(ii) Payments from block grant.--The Secretary shall pay
the State from the amount set aside under clause (i) for the
fiscal year, an amount for each quarter of such fiscal year
equal to the applicable percentage determined under clause
(iii) or (iv) for expenditures in the quarter for providing
child health assistance or other health benefits coverage to
a parent of a targeted low-income child.
``(iii) Enhanced fmap only in fiscal year 2010 for states
with significant child outreach or that achieve child
coverage benchmarks; fmap for any other states.--For purposes
of clause (ii), the applicable percentage for any quarter of
fiscal year 2010 is equal to--
``(I) the enhanced FMAP determined under section 2105(b) in
the case of a State that meets the outreach or coverage
benchmarks described in any of subparagraph (A), (B), or (C)
of paragraph (3) for fiscal year 2009; or
``(II) the Federal medical assistance percentage (as
determined under section 1905(b) without regard to clause (4)
of such section) in the case of any other State.
``(iv) Amount of federal matching payment in 2011 or
2012.--For purposes of clause (ii), the applicable percentage
for any quarter of fiscal year 2011 or 2012 is equal to--
``(I) the REMAP percentage if--
``(aa) the applicable percentage for the State under clause
(iii) was the enhanced FMAP for fiscal year 2009; and
``(bb) the State met either of the coverage benchmarks
described in subparagraph (B) or (C) of paragraph (3) for the
preceding fiscal year; or
``(II) the Federal medical assistance percentage (as so
determined) in the case of any State to which subclause (I)
does not apply.
For purposes of subclause (I), the REMAP percentage is the
percentage which is the sum of such Federal medical
assistance percentage and a number of percentage points equal
to one-half of the difference between such Federal medical
assistance percentage and such enhanced FMAP.
``(v) No federal payments other than from block grant set
aside.--No payments shall be made to a State for expenditures
described in clause (ii) after the total amount set aside
under clause (i) for a fiscal year has been paid to the
State.
``(vi) No increase in income eligibility level for
parents.--No payments shall be made to a State from the
amount set aside under clause (i) for a fiscal year for
expenditures for providing child health assistance or health
benefits coverage to a parent of a targeted low-income child
whose family income exceeds the income eligibility level
applied under the applicable existing waiver to parents of
targeted low-income children on the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2007.
``(3) Outreach or coverage benchmarks.--For purposes of
paragraph (2), the outreach or coverage benchmarks described
in this paragraph are as follows:
``(A) Significant child outreach campaign.--The State--
``(i) was awarded a grant under section 2113 for fiscal
year 2009;
``(ii) implemented 1 or more of the enrollment and
retention provisions described in section 2105(a)(4) for such
fiscal year; or
``(iii) has submitted a specific plan for outreach for such
fiscal year.
``(B) High-performing state.--The State, on the basis of
the most timely and accurate published estimates of the
Bureau of the Census, ranks in the lowest \1/3\ of States in
terms of the State's percentage of low-income children
without health insurance.
``(C) State increasing enrollment of low-income children.--
The State qualified for a performance bonus payment under
section 2105(a)(3)(B) for the most recent fiscal year
applicable under such section.
``(4) Rules of construction.--Nothing in this subsection
shall be construed as prohibiting a State from submitting an
application to the Secretary for a waiver under section 1115
of the State plan under title XIX to provide medical
assistance to a parent of a targeted low-income child that
was provided child health assistance or health benefits
coverage under an applicable existing waiver.
``(c) Applicable Existing Waiver.--For purposes of this
section--
``(1) In general.--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, 2007.
``(2) Definitions.--
``(A) Parent.--The term `parent' includes a caretaker
relative (as such term is used in carrying out section 1931)
and a legal guardian.
``(B) Nonpregnant childless adult.--The term `nonpregnant
childless adult' has the meaning given such term by section
2107(f).''.
(2) Conforming amendments.--
(A) Section 2107(f) (42 U.S.C. 1397gg(f)) is amended--
(i) by striking ``, the Secretary'' and inserting ``:
``(1) The Secretary'';
(ii) in the first sentence, by inserting ``or a parent (as
defined in section 2111(c)(2)(A)), who is not pregnant, of a
targeted low-income child'' before the period;
(iii) by striking the second sentence; and
(iv) 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
Children's Health Insurance Program Reauthorization Act of
2007 that would waive or modify the requirements of section
2111.''.
(B) 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 112 of the
Children's Health Insurance Program Reauthorization Act of
2007, nothing''.
(b) GAO Study and Report.--
(1) In general.--The Comptroller General of the United
States shall conduct a study of whether--
(A) the coverage of a parent, a caretaker relative (as such
term is used in carrying out section 1931), or a legal
guardian of a targeted low-income child under a State health
plan under title XXI of the Social Security Act increases the
enrollment of, or the quality of care for, children, and
(B) such parents, relatives, and legal guardians who enroll
in such a plan are more likely to enroll their children in
such a plan or in a State plan under title XIX of such Act.
(2) Report.--Not later than 2 years after the date of the
enactment of this Act, the Comptroller General shall report
the results of the study to the Committee on Finance of the
Senate and the Committee on Energy and Commerce of the House
of Representatives, including recommendations (if any) for
changes in legislation.
SEC. 113. ELIMINATION OF COUNTING MEDICAID CHILD PRESUMPTIVE
ELIGIBILITY COSTS AGAINST TITLE XXI ALLOTMENT.
(a) In General.--Section 2105(a)(1) (42 U.S.C.
1397ee(a)(1)) is amended--
(1) in the matter preceding subparagraph (A), by striking
``(or, in the case of expenditures described in subparagraph
(B), the Federal medical assistance percentage (as defined in
the first sentence of section 1905(b)))''; and
(2) by striking subparagraph (B) and inserting the
following new subparagraph:
``(B) [reserved]''.
(b) Amendments to Medicaid.--
(1) Eligibility of a newborn.--Section 1902(e)(4) (42
U.S.C. 1396a(e)(4)) is amended in the first sentence by
striking ``so long as the child is a member of the woman's
household and the woman remains (or would remain if pregnant)
eligible for such assistance''.
(2) Application of qualified entities to presumptive
eligibility for pregnant women under medicaid.--Section
1920(b) (42 U.S.C. 1396r-1(b)) is amended by adding after
paragraph (2) the following flush sentence:
``The term `qualified provider' also includes a qualified
entity, as defined in section 1920A(b)(3).''.
SEC. 114. DENIAL OF PAYMENTS FOR COVERAGE OF CHILDREN WITH
EFFECTIVE FAMILY INCOME THAT EXCEEDS 300
PERCENT OF THE POVERTY LINE.
(a) In General.--Section 2105(c) (42 U.S.C. 1397ee(c)) is
amended by adding at the end the following new paragraph:
[[Page H12050]]
``(8) Denial of payments for expenditures for child health
assistance for children whose effective family income exceeds
300 percent of the poverty line.--
``(A) In general.--Except as provided in subparagraph (B),
for child health assistance furnished after the date of the
enactment of this paragraph, no payment shall be made under
this section for any expenditures for providing child health
assistance or health benefits coverage for a targeted low-
income child whose effective family income would exceed 300
percent of the poverty line but for the application of a
general exclusion of a block of income that is not determined
by type of expense or type of income.
``(B) Exception.--Subparagraph (A) shall not apply to any
State that, on the date of enactment of the Children's Health
Insurance Program Reauthorization Act of 2007, has an
approved State plan amendment or waiver to provide
expenditures described in such subparagraph under the State
child health plan.''.
(b) Rule of Construction.--Nothing in the amendments made
by this section shall be construed as--
(1) changing any income eligibility level for children
under title XXI of the Social Security Act; or
(2) changing the flexibility provided States under such
title to establish the income eligibility level for targeted
low-income children under a State child health plan and the
methodologies used by the State to determine income or assets
under such plan.
SEC. 115. STATE AUTHORITY UNDER MEDICAID.
(a) State Authority To Expand Income or Resource
Eligibility Levels for Children.--Nothing in this Act, the
amendments made by this Act, or title XIX of the Social
Security Act, including paragraph (2)(B) of section 1905(u)
of such Act, shall be construed as limiting the flexibility
afforded States under such title to increase the income or
resource eligibility levels for children under a State plan
or waiver under such title.
(b) State Authority To Receive Payments Under Medicaid for
Providing Medical Assistance to Children Eligible as a Result
of an Income or Resource Eligibility Level Expansion.--A
State may, notwithstanding the fourth sentence of subsection
(b) of section 1905 of the Social Security Act (42 U.S.C.
1396d) or subsection (u) of such section--
(1) cover individuals described in section
1902(a)(10)(A)(ii)(IX) of the Social Security Act and thereby
receive Federal financial participation for medical
assistance for such individuals under title XIX of the Social
Security Act; or
(2) receive Federal financial participation for
expenditures for medical assistance under Medicaid for
children described in paragraph (2)(B) or (3) of section
1905(u) of such Act based on the Federal medical assistance
percentage, as otherwise determined based on the first and
third sentences of subsection (b) of section 1905 of the
Social Security Act, rather than on the basis of an enhanced
FMAP (as defined in section 2105(b) of such Act).
SEC. 116. PREVENTING SUBSTITUTION OF CHIP COVERAGE FOR
PRIVATE COVERAGE.
(a) Findings.--
(1) Congress agrees with the President that low-income
children should be the first priority of all States in
providing child health assistance under CHIP.
(2) Congress agrees with the President and the
Congressional Budget Office that the substitution of CHIP
coverage for private coverage occurs more frequently for
children in families at higher income levels.
(3) Congress agrees with the President that it is
appropriate that States that expand CHIP eligibility to
children at higher income levels should have achieved a high
level of health benefits coverage for low-income children and
should implement strategies to address such substitution.
(4) Congress concludes that the policies specified in this
section (and the amendments made by this section) are the
appropriate policies to address these issues.
(b) Analyses of Best Practices and Methodology in
Addressing Crowd-Out.--
(1) GAO report.--Not later than 18 months after the date of
the enactment of this Act, the Comptroller General of the
United States shall submit to the Committee on Finance of the
Senate and the Committee on Energy and Commerce of the House
of Representatives and the Secretary a report describing the
best practices by States in addressing the issue of CHIP
crowd-out. Such report shall include analyses of--
(A) the impact of different geographic areas, including
urban and rural areas, on CHIP crowd-out;
(B) the impact of different State labor markets on CHIP
crowd-out;
(C) the impact of different strategies for addressing CHIP
crowd-out;
(D) the incidence of crowd-out for children with different
levels of family income; and
(E) the relationship (if any) between changes in the
availability and affordability of dependent coverage under
employer-sponsored health insurance and CHIP crowd-out.
(2) IOM report on methodology.--The Secretary shall enter
into an arrangement with the Institute of Medicine under
which the Institute submits to the Committee on Finance of
the Senate and the Committee on Energy and Commerce of the
House of Representatives and the Secretary, not later than 18
months after the date of the enactment of this Act, a report
on--
(A) the most accurate, reliable, and timely way to
measure--
(i) on a State-by-State basis, the rate of public and
private health benefits coverage among low-income children
with family income that does not exceed 200 percent of the
poverty line; and
(ii) CHIP crowd-out, including in the case of children with
family income that exceeds 200 percent of the poverty line;
and
(B) the least burdensome way to gather the necessary data
to conduct the measurements described in subparagraph (A).
Out of any money in the Treasury not otherwise appropriated,
there are hereby appropriated $2,000,000 to carry out this
paragraph for the period ending September 30, 2009.
(3) Incorporation of definitions.--In this section, the
terms ``CHIP crowd-out'', ``children'', ``poverty line'', and
``State'' have the meanings given such terms for purposes of
CHIP.
(4) Definition of chip crowd-out.--Section 2110(c) (42
U.S.C. 1397jj(c)) is amended by adding at the end the
following:
``(9) CHIP crowd-out.--The term `CHIP crowd-out' means the
substitution of--
``(A) health benefits coverage for a child under this
title, for
``(B) health benefits coverage for the child other than
under this title or title XIX.''.
(c) Development of Best Practice Recommendations.--Section
2107 (42 U.S.C. 1397gg) is amended by adding at the end the
following:
``(g) Development of Best Practice Recommendations.--Within
6 months after the date of receipt of the reports under
subsections (a) and (b) of section 116 of the Children's
Health Insurance Program Reauthorization Act of 2007, the
Secretary, in consultation with States, including Medicaid
and CHIP directors in States, shall publish in the Federal
Register, and post on the public website for the Department
of Health and Human Services--
``(1) recommendations regarding best practices for States
to use to address CHIP crowd-out; and
``(2) uniform standards for data collection by States to
measure and report--
``(A) health benefits coverage for children with family
income below 200 percent of the poverty line; and
``(B) on CHIP crowd-out, including for children with family
income that exceeds 200 percent of the poverty line.
The Secretary, in consultation with States, including
Medicaid and CHIP directors in States, may from time to time
update the best practice recommendations and uniform
standards set published under paragraphs (1) and (2) and
shall provide for publication and posting of such updated
recommendations and standards.''.
(d) Requirement To Address CHIP Crowd-Out; Secretarial
Review.--Section 2106 (42 U.S.C. 1397ff) is amended by adding
at the end the following:
``(f) Requirement To Address CHIP Crowd-Out; Secretarial
Review.--
``(1) In general.--Not later than 6 months after the best
practice application date described in paragraph (2), each
State that has a State child health plan shall submit to the
Secretary a State plan amendment describing how the State--
``(A) will address CHIP crowd-out; and
``(B) will incorporate recommended best practices referred
to in such paragraph.
``(2) Best practice application date.--The best practice
application date described in this paragraph is the date that
is 6 months after the date of publication of recommendations
regarding best practices under section 2107(g)(1).
``(3) Secretarial review.--The Secretary shall--
``(A) review each State plan amendment submitted under
paragraph (1);
``(B) determine whether the amendment incorporates
recommended best practices referred to in paragraph (2);
``(C) in the case of a higher income eligibility State (as
defined in section 2105(c)(9)(B)), determine whether the
State meets the enrollment targets required under reference
section 2105(c)(9)(C); and
``(D) notify the State of such determinations.''.
(e) Limitation on Payments for States Covering Higher
Income Children.--
(1) In general.--Section 2105(c) (42 U.S.C. 1397ee(c)), as
amended by section 114(a), is amended by adding at the end
the following new subsection:
``(9) Limitation on payments for states covering higher
income children.--
``(A) Determinations.--
``(i) In general.--The Secretary shall determine, for each
State that is a higher income eligibility State as of April 1
of 2010 and each subsequent year, whether the State meets the
target rate of coverage of low-income children required under
subparagraph (C) and shall notify the State in that month of
such determination.
``(ii) Determination of failure.--If the Secretary
determines in such month that a higher income eligibility
State does not meet such target rate of coverage, subject to
subparagraph (E), no payment shall be made as of October 1 of
such year on or after October 1, 2010, under this section for
child health assistance provided for higher-income children
(as defined in subparagraph (D)) under the State child health
plan unless and until the State establishes it is in
compliance with such requirement.
[[Page H12051]]
``(B) Higher income eligibility state.--A higher income
eligibility State described in this clause is a State that--
``(i) applies under its State child health plan an
eligibility income standard for targeted low-income children
that exceeds 300 percent of the poverty line; or
``(ii) because of the application of a general exclusion of
a block of income that is not determined by type of expense
or type of income, applies an effective income standard under
the State child health plan for such children that exceeds
300 percent of the poverty line.
``(C) Requirement for target rate of coverage of low-income
children.--
``(i) In general.--The requirement of this subparagraph for
a State is that the rate of health benefits coverage (both
private and public) for low-income children in the State is
not statistically significantly (at a p=0.05 level) less than
the target rate of coverage specified in clause (ii).
``(ii) Target rate.--The target rate of coverage specified
in this clause is the average rate (determined by the
Secretary) of health benefits coverage (both private and
public) as of January 1, 2010, among the 10 of the 50 States
and the District of Columbia with the highest percentage of
health benefits coverage (both private and public) for low-
income children.
``(iii) Standards for data.--In applying this subparagraph,
rates of health benefits coverage for States shall be
determined using the uniform standards identified by the
Secretary under section 2107(g)(2).
``(D) Higher-income child.--For purposes of this paragraph,
the term `higher income child' means, with respect to a State
child health plan, a targeted low-income child whose family
income--
``(i) exceeds 300 percent of the poverty line; or
``(ii) would exceed 300 percent of the poverty line if
there were not taken into account any general exclusion
described in subparagraph (B)(ii).
``(E) Notice and opportunity to comply with target rate.--
If the Secretary makes a determination described in
subparagraph (A)(ii) in April of a year, the Secretary--
``(i) shall provide the State with the opportunity to
submit and implement a corrective action plan for the State
to come into compliance with the requirement of subparagraph
(C) before October 1 of such year;
``(ii) shall not effect a denial of payment under
subparagraph (A) on the basis of such determination before
October 1 of such year; and
``(iii) shall not effect such a denial if the Secretary
determines that there is a reasonable likelihood that the
implementation of such a correction action plan will bring
the State into compliance with the requirement of
subparagraph (C).''.
(2) Construction.--Nothing in the amendment made by
paragraph (1) or this section this shall be construed as
authorizing the Secretary of Health and Human Services to
limit payments under title XXI of the Social Security Act in
the case of a State that is not a higher income eligibility
State (as defined in section 2105(c)(9)(B) of such Act, as
added by paragraph (1)).
(f) Treatment of Medical Support Orders.--Section 2102(b)
(42 U.S.C. 1397bb(c)) is amended by adding at the end the
following:
``(5) Treatment of medical support orders.--
``(A) In general.--Nothing in this title shall be construed
to allow the Secretary to require that a State deny
eligibility for child health assistance to a child who is
otherwise eligible on the basis of the existence of a valid
medical support order being in effect.
``(B) State election.--A State may elect to limit
eligibility for child health assistance to a targeted low-
income child on the basis of the existence of a valid medical
support order on the child's behalf, but only if the State
does not deny such eligibility for a child on such basis if
the child asserts that the order is not being complied with
for any of the reasons described in subparagraph (C) unless
the State demonstrates that none of such reasons applies in
the case involved.
``(C) Reasons for noncompliance.--The reasons described in
this subparagraph for noncompliance with a medical support
order with respect to a child are that the child is not being
provided health benefits coverage pursuant to such order
because--
``(i) of failure of the noncustodial parent to comply with
the order;
``(ii) of the failure of an employer, group health plan or
health insurance issuer to comply with such order; or
``(iii) the child resides in a geographic area in which
benefits under the health benefits coverage are generally
unavailable.''.
(g) Effective Date of Amendments; Consistency of
Policies.--The amendments made by this section shall take
effect as if enacted on August 16, 2007. The Secretary may
not impose (or continue in effect) any requirement, prevent
the implementation of any provision, or condition the
approval of any provision under any State child health plan,
State plan amendment, or waiver request on the basis of any
policy or interpretation relating to CHIP crowd-out,
coordination with other sources of coverage, target rate of
coverage, or medical support order other than under the
amendments made by this section. In the case of a State plan
amendment which was denied on or after August 16, 2007, on
the basis of any such policy or interpretation in effect
before the date of the enactment of this Act, if the State
submits a modification of such State plan amendment that
complies with title XXI of the Social Security Act as amended
by this Act, such submitted State plan amendment, as so
modified, shall be considered as if it had been submitted (as
so modified) as of the date of its original submission, but
such State plan amendment shall not be effective before the
date of the enactment of this Act and the exception described
in subparagraph (B) of section 2105(c)(8) of the Social
Security Act, as added by section 114(a), shall not apply to
such State plan amendment.
TITLE II--OUTREACH AND ENROLLMENT
Subtitle A--Outreach and Enrollment Activities
SEC. 201. GRANTS AND ENHANCED ADMINISTRATIVE FUNDING FOR
OUTREACH AND ENROLLMENT.
(a) Grants.--Title XXI (42 U.S.C. 1397aa et seq.), as
amended by section 111, is amended by adding at the end the
following:
``SEC. 2113. GRANTS TO IMPROVE OUTREACH AND ENROLLMENT.
``(a) Outreach and Enrollment Grants; National Campaign.--
``(1) In general.--From the amounts appropriated under
subsection (g), subject to paragraph (2), the Secretary shall
award grants to eligible entities during the period of fiscal
years 2008 through 2012 to conduct outreach and enrollment
efforts that are designed to increase the enrollment and
participation of eligible children under this title and title
XIX.
``(2) Ten percent set aside for national enrollment
campaign.--An amount equal to 10 percent of such amounts
shall be used by the Secretary for expenditures during such
period to carry out a national enrollment campaign in
accordance with subsection (h).
``(b) Priority for Award of Grants.--
``(1) In general.--In awarding grants under subsection (a),
the Secretary shall give priority to eligible entities that--
``(A) 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) submit the most demonstrable evidence required under
paragraphs (1) and (2) of subsection (c).
``(2) Ten percent set aside for outreach to indian
children.--An amount equal to 10 percent of the funds
appropriated under subsection (g) 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) 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) evidence demonstrating that the entity includes
members who have access to, and credibility with, ethnic or
low-income populations in the communities in which activities
funded under the grant are to be conducted;
``(2) evidence demonstrating that the entity has the
ability to address barriers to enrollment, such as lack of
awareness of eligibility, stigma concerns and punitive fears
associated with receipt of benefits, and other cultural
barriers to applying for and receiving child health
assistance or medical assistance;
``(3) specific quality or outcomes performance measures to
evaluate the effectiveness of activities funded by a grant
awarded under this section; and
``(4) an assurance that the eligible entity shall--
``(A) conduct an assessment of the effectiveness of such
activities against the performance measures;
``(B) cooperate with the collection and reporting of
enrollment data and other information in order for the
Secretary to conduct such assessments; and
``(C) in the case of an eligible entity that is not the
State, provide the State with enrollment data and other
information as necessary for the State to make necessary
projections of eligible children and pregnant women.
``(d) Dissemination of Enrollment Data and Information
Determined From Effectiveness Assessments; Annual Report.--
The Secretary shall--
``(1) make publicly available the enrollment data and
information collected and reported in accordance with
subsection (c)(4)(B); and
``(2) submit an annual report to Congress on the outreach
and enrollment activities conducted with funds appropriated
under this section.
``(e) Maintenance of Effort for States Awarded Grants; No
State Match Required.--In the case of a State that is awarded
a grant under this section--
``(1) the State share of funds expended for outreach and
enrollment activities under the State child health plan shall
not be less than the State share of such funds expended in
the fiscal year preceding the first fiscal year for which the
grant is awarded; and
[[Page H12052]]
``(2) no State matching funds shall be required for the
State to receive a grant under this section.
``(f) Definitions.--In this section:
``(1) Eligible entity.--The term `eligible entity' means
any of the following:
``(A) A State with an approved child health plan under this
title.
``(B) A local government.
``(C) An Indian tribe or tribal consortium, a tribal
organization, 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.
``(D) A Federal health safety net organization.
``(E) A national, State, local, or community-based public
or nonprofit private organization, including organizations
that use community health workers or community-based doula
programs.
``(F) 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
nongovernmental entities.
``(G) An elementary or secondary school.
``(2) Federal health safety net organization.--The term
`Federal health safety net organization' means--
``(A) a Federally-qualified health center (as defined in
section 1905(l)(2)(B));
``(B) a hospital defined as a disproportionate share
hospital for purposes of section 1923;
``(C) a covered entity described in section 340B(a)(4) of
the Public Health Service Act (42 U.S.C. 256b(a)(4)); and
``(D) any other entity or 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).
``(4) Community health worker.--The term `community health
worker' means an individual who promotes health or nutrition
within the community in which the individual resides--
``(A) by serving as a liaison between communities and
health care agencies;
``(B) by providing guidance and social assistance to
community residents;
``(C) by enhancing community residents' ability to
effectively communicate with health care providers;
``(D) by providing culturally and linguistically
appropriate health or nutrition education;
``(E) by advocating for individual and community health or
nutrition needs; and
``(F) by providing referral and followup services.
``(g) Appropriation.--There is appropriated, out of any
money in the Treasury not otherwise appropriated,
$100,000,000 for the period of fiscal years 2008 through
2012, 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 subsections (a)(1)(D)(iii) and
(c)(2)(C) of that section.
``(h) National Enrollment Campaign.--From the amounts made
available under subsection (a)(2), the Secretary shall
develop and implement a national enrollment campaign to
improve the enrollment of underserved child populations in
the programs established under this title and title XIX. Such
campaign may include--
``(1) the establishment of partnerships with the Secretary
of Education and the Secretary of Agriculture to develop
national campaigns to link the eligibility and enrollment
systems for the assistance programs each Secretary
administers that often serve the same children;
``(2) the integration of information about the programs
established under this title and title XIX in public health
awareness campaigns administered by the Secretary;
``(3) increased financial and technical support for
enrollment hotlines maintained by the Secretary to ensure
that all States participate in such hotlines;
``(4) the establishment of joint public awareness outreach
initiatives with the Secretary of Education and the Secretary
of Labor regarding the importance of health insurance to
building strong communities and the economy;
``(5) the development of special outreach materials for
Native Americans or for individuals with limited English
proficiency; and
``(6) such other outreach initiatives as the Secretary
determines would increase public awareness of the programs
under this title and title XIX.''.
(b) Enhanced Administrative Funding for Translation or
Interpretation Services Under CHIP and Medicaid.--
(1) CHIP.--Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)), as
amended by section 113, is amended--
(A) in the matter preceding subparagraph (A), by inserting
``(or, in the case of expenditures described in subparagraph
(D)(iv), the higher of 75 percent or the sum of the enhanced
FMAP plus 5 percentage points)'' after ``enhanced FMAP''; and
(B) in subparagraph (D)--
(i) in clause (iii), by striking ``and'' at the end;
(ii) by redesignating clause (iv) as clause (v); and
(iii) by inserting after clause (iii) the following new
clause:
``(iv) for translation or interpretation services in
connection with the enrollment of, retention of, and use of
services under this title by, individuals for whom English is
not their primary language (as found necessary by the
Secretary for the proper and efficient administration of the
State plan); and''.
(2) Medicaid.--
(A) Use of medicaid funds.--Section 1903(a)(2) (42 U.S.C.
1396b(a)(2)) is amended by adding at the end the following
new subparagraph:
``(E) an amount equal to 75 percent of so much of the sums
expended during such quarter (as found necessary by the
Secretary for the proper and efficient administration of the
State plan) as are attributable to translation or
interpretation services in connection with the enrollment of,
retention of, and use of services under this title by,
children of families for whom English is not the primary
language; plus''.
(B) Use of community health workers for outreach
activities.--
(i) In general.--Section 2102(c)(1) of such Act (42 U.S.C.
1397bb(c)(1)) is amended by inserting ``(through community
health workers and others)'' after ``Outreach''.
(ii) In federal evaluation.--Section 2108(c)(3)(B) of such
Act (42 U.S.C. 1397hh(c)(3)(B)) is amended by inserting
``(such as through community health workers and others)''
after ``including practices''.
SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF INDIANS.
(a) In General.--Section 1139 (42 U.S.C. 1320b-9) is
amended to read as follows:
``SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE
FOR INDIANS UNDER TITLES XIX AND XXI.
``(a) Agreements With States for Medicaid and CHIP Outreach
On or Near Reservations To Increase the Enrollment of Indians
in Those Programs.--
``(1) In general.--In order to improve the access of
Indians residing on or near a reservation to obtain benefits
under the Medicaid and State children's health insurance
programs established under titles XIX and XXI, the Secretary
shall encourage the State to take steps to provide for
enrollment on or near the reservation. Such steps may include
outreach efforts such as the outstationing of eligibility
workers, entering into agreements with the Indian Health
Service, Indian Tribes, Tribal Organizations, and Urban
Indian Organizations to provide outreach, education regarding
eligibility and benefits, enrollment, and translation
services when such services are appropriate.
``(2) Construction.--Nothing in paragraph (1) shall be
construed as affecting arrangements entered into between
States and the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations for such
Service, Tribes, or Organizations to conduct administrative
activities under such titles.
``(b) Requirement To Facilitate Cooperation.--The
Secretary, acting through the Centers for Medicare & Medicaid
Services, shall take such steps as are necessary to
facilitate cooperation with, and agreements between, States
and the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations with respect to
the provision of health care items and services to Indians
under the programs established under title XIX or XXI.
``(c) Definition of Indian; Indian Tribe; Indian Health
Program; Tribal Organization; Urban Indian Organization.--In
this section, the terms `Indian', `Indian Tribe', `Indian
Health Program', `Tribal Organization', and `Urban Indian
Organization' have the meanings given those terms in section
4 of the Indian Health Care Improvement Act.''.
(b) Nonapplication of 10 Percent Limit on Outreach and
Certain Other Expenditures.--Section 2105(c)(2) (42 U.S.C.
1397ee(c)(2)) is amended by adding at the end the following:
``(C) Nonapplication to certain expenditures.--The
limitation under subparagraph (A) shall not apply with
respect to the following expenditures:
``(i) Expenditures to increase outreach to, and the
enrollment of, indian children under this title and title
xix.--Expenditures for outreach activities to families of
Indian children likely to be eligible for child health
assistance under the plan or medical assistance under the
State plan under title XIX (or under a waiver of such plan),
to inform such families of the availability of, and to assist
them in enrolling their children in, such plans, including
such activities conducted under grants, contracts, or
agreements entered into under section 1139(a).''.
SEC. 203. STATE OPTION TO RELY ON FINDINGS FROM AN EXPRESS
LANE AGENCY TO CONDUCT SIMPLIFIED ELIGIBILITY
DETERMINATIONS.
(a) Application Under Medicaid and CHIP Programs.--
(1) Medicaid.--Section 1902(e) (42 U.S.C. 1396a(e)) is
amended by adding at the end the following:
[[Page H12053]]
``(13) Express Lane Option.--
``(A) In general.--
``(i) Option to use a finding from an express lane
agency.--At the option of the State, the State plan may
provide that in determining eligibility under this title for
a child (as defined in subparagraph (G)), the State may rely
on a finding made within a reasonable period (as determined
by the State) from an Express Lane agency (as defined in
subparagraph (F)) when it determines whether a child
satisfies one or more components of eligibility for medical
assistance under this title. The State may rely on a finding
from an Express Lane agency notwithstanding sections
1902(a)(46)(B) and 1137(d) and any differences in budget
unit, disregard, deeming or other methodology, if the
following requirements are met:
``(I) Prohibition on determining children ineligible for
coverage.--If a finding from an Express Lane agency would
result in a determination that a child does not satisfy an
eligibility requirement for medical assistance under this
title and for child health assistance under title XXI, the
State shall determine eligibility for assistance using its
regular procedures.
``(II) Notice requirement.--For any child who is found
eligible for medical assistance under the State plan under
this title or child health assistance under title XXI and who
is subject to premiums based on an Express Lane agency's
finding of such child's income level, the State shall provide
notice that the child may qualify for lower premium payments
if evaluated by the State using its regular policies and of
the procedures for requesting such an evaluation.
``(III) Compliance with screen and enroll requirement.--The
State shall satisfy the requirements under subparagraphs (A)
and (B) of section 2102(b)(3) (relating to screen and enroll)
before enrolling a child in child health assistance under
title XXI. At its option, the State may fulfill such
requirements in accordance with either option provided under
subparagraph (C) of this paragraph.
``(IV) Verification of citizenship or nationality status.--
The State shall satisfy the requirements of section
1902(a)(46)(B) or 2105(c)(10), as applicable for
verifications of citizenship or nationality status.
``(V) Coding.--The State meets the requirements of
subparagraph (E).
``(ii) Option to apply to renewals and redeterminations.--
The State may apply the provisions of this paragraph when
conducting initial determinations of eligibility,
redeterminations of eligibility, or both, as described in the
State plan.
``(B) Rules of construction.--Nothing in this paragraph
shall be construed--
``(i) to limit or prohibit a State from taking any actions
otherwise permitted under this title or title XXI in
determining eligibility for or enrolling children into
medical assistance under this title or child health
assistance under title XXI; or
``(ii) to modify the limitations in section 1902(a)(5)
concerning the agencies that may make a determination of
eligibility for medical assistance under this title.
``(C) Options for satisfying the screen and enroll
requirement.--
``(i) In general.--With respect to a child whose
eligibility for medical assistance under this title or for
child health assistance under title XXI has been evaluated by
a State agency using an income finding from an Express Lane
agency, a State may carry out its duties under subparagraphs
(A) and (B) of section 2102(b)(3) (relating to screen and
enroll) in accordance with either clause (ii) or clause
(iii).
``(ii) Establishing a screening threshold.--
``(I) In general.--Under this clause, the State establishes
a screening threshold set as a percentage of the Federal
poverty level that exceeds the highest income threshold
applicable under this title to the child by a minimum of 30
percentage points or, at State option, a higher number of
percentage points that reflects the value (as determined by
the State and described in the State plan) of any differences
between income methodologies used by the program administered
by the Express Lane agency and the methodologies used by the
State in determining eligibility for medical assistance under
this title.
``(II) Children with income not above threshold.--If the
income of a child does not exceed the screening threshold,
the child is deemed to satisfy the income eligibility
criteria for medical assistance under this title regardless
of whether such child would otherwise satisfy such criteria.
``(III) Children with income above threshold.--If the
income of a child exceeds the screening threshold, the child
shall be considered to have an income above the Medicaid
applicable income level described in section 2110(b)(4) and
to satisfy the requirement under section 2110(b)(1)(C)
(relating to the requirement that CHIP matching funds be used
only for children not eligible for Medicaid). If such a child
is enrolled in child health assistance under title XXI, the
State shall provide the parent, guardian, or custodial
relative with the following:
``(aa) Notice that the child may be eligible to receive
medical assistance under the State plan under this title if
evaluated for such assistance under the State's regular
procedures and notice of the process through which a parent,
guardian, or custodial relative can request that the State
evaluate the child's eligibility for medical assistance under
this title using such regular procedures.
``(bb) A description of differences between the medical
assistance provided under this title and child health
assistance under title XXI, including differences in cost-
sharing requirements and covered benefits.
``(iii) Temporary enrollment in chip pending screen and
enroll.--
``(I) In general.--Under this clause, a State enrolls a
child in child health assistance under title XXI for a
temporary period if the child appears eligible for such
assistance based on an income finding by an Express Lane
agency.
``(II) Determination of eligibility.--During such temporary
enrollment period, the State shall determine the child's
eligibility for child health assistance under title XXI or
for medical assistance under this title in accordance with
this clause.
``(III) Prompt follow up.--In making such a determination,
the State shall take prompt action to determine whether the
child should be enrolled in medical assistance under this
title or child health assistance under title XXI pursuant to
subparagraphs (A) and (B) of section 2102(b)(3) (relating to
screen and enroll).
``(IV) Requirement for simplified determination.--In making
such a determination, the State shall use procedures that, to
the maximum feasible extent, reduce the burden imposed on the
individual of such determination. Such procedures may not
require the child's parent, guardian, or custodial relative
to provide or verify information that already has been
provided to the State agency by an Express Lane agency or
another source of information unless the State agency has
reason to believe the information is erroneous.
``(V) Availability of chip matching funds during temporary
enrollment period.--Medical assistance for items and services
that are provided to a child enrolled in title XXI during a
temporary enrollment period under this clause shall be
treated as child health assistance under such title.
``(D) Option for automatic enrollment.--
``(i) In general.--The State may initiate and determine
eligibility for medical assistance under the State Medicaid
plan or for child health assistance under the State CHIP plan
without a program application from, or on behalf of, the
child based on data obtained from sources other than the
child (or the child's family), but a child can only be
automatically enrolled in the State Medicaid plan or the
State CHIP plan if the child or the family affirmatively
consents to being enrolled through affirmation and signature
on an Express Lane agency application, if the requirement of
clause (ii) is met.
``(ii) Information requirement.--The requirement of this
clause is that the State informs the parent, guardian, or
custodial relative of the child of the services that will be
covered, appropriate methods for using such services, premium
or other cost sharing charges (if any) that apply, medical
support obligations (under section 1912(a)) created by
enrollment (if applicable), and the actions the parent,
guardian, or relative must take to maintain enrollment and
renew coverage.
``(E) Coding; application to enrollment error rates.--
``(i) In general.--For purposes of subparagraph (A)(iv),
the requirement of this subparagraph for a State is that the
State agrees to--
``(I) assign such codes as the Secretary shall require to
the children who are enrolled in the State Medicaid plan or
the State CHIP plan through reliance on a finding made by an
Express Lane agency for the duration of the State's election
under this paragraph;
``(II) annually provide the Secretary with a statistically
valid sample (that is approved by Secretary) of the children
enrolled in such plans through reliance on such a finding by
conducting a full Medicaid eligibility review of the children
identified for such sample for purposes of determining an
eligibility error rate (as described in clause (iv)) with
respect to the enrollment of such children (and shall not
include such children in any data or samples used for
purposes of complying with a Medicaid Eligibility Quality
Control (MEQC) review or a payment error rate measurement
(PERM) requirement);
``(III) submit the error rate determined under subclause
(II) to the Secretary;
``(IV) if such error rate exceeds 3 percent for either of
the first 2 fiscal years in which the State elects to apply
this paragraph, demonstrate to the satisfaction of the
Secretary the specific corrective actions implemented by the
State to improve upon such error rate; and
``(V) if such error rate exceeds 3 percent for any fiscal
year in which the State elects to apply this paragraph, a
reduction in the amount otherwise payable to the State under
section 1903(a) for quarters for that fiscal year, equal to
the total amount of erroneous excess payments determined for
the fiscal year only with respect to the children included in
the sample for the fiscal year that are in excess of a 3
percent error rate with respect to such children.
``(ii) No punitive action based on error rate.--The
Secretary shall not apply the error rate derived from the
sample under clause (i) to the entire population of children
enrolled in the State Medicaid plan or the State CHIP plan
through reliance on a finding made by an Express Lane agency,
or to the population of children enrolled in such plans on
the basis of the State's regular procedures for determining
eligibility, or penalize the State on the basis of such error
rate
[[Page H12054]]
in any manner other than the reduction of payments provided
for under clause (i)(V).
``(iii) Rule of construction.--Nothing in this paragraph
shall be construed as relieving a State that elects to apply
this paragraph from being subject to a penalty under section
1903(u), for payments made under the State Medicaid plan with
respect to ineligible individuals and families that are
determined to exceed the error rate permitted under that
section (as determined without regard to the error rate
determined under clause (i)(II)).
``(iv) Error rate defined.--In this subparagraph, the term
`error rate' means the rate of erroneous excess payments for
medical assistance (as defined in section 1903(u)(1)(D)) for
the period involved, except that such payments shall be
limited to individuals for which eligibility determinations
are made under this paragraph and except that in applying
this paragraph under title XXI, there shall be substituted
for references to provisions of this title corresponding
provisions within title XXI.
``(F) Express lane agency.--
``(i) In general.--In this paragraph, the term `Express
Lane agency' means a public agency that--
``(I) is determined by the State Medicaid agency or the
State CHIP agency (as applicable) to be capable of making the
determinations of one or more eligibility requirements
described in subparagraph (A)(i);
``(II) is identified in the State Medicaid plan or the
State CHIP plan; and
``(III) notifies the child's family--
``(aa) of the information which shall be disclosed in
accordance with this paragraph;
``(bb) that the information disclosed will be used solely
for purposes of determining eligibility for medical
assistance under the State Medicaid plan or for child health
assistance under the State CHIP plan; and
``(cc) that the family may elect to not have the
information disclosed for such purposes; and
``(IV) enters into, or is subject to, an interagency
agreement to limit the disclosure and use of the information
disclosed.
``(ii) Inclusion of specific public agencies.--Such term
includes the following:
``(I) A public agency that determines eligibility for
assistance under any of the following:
``(aa) The temporary assistance for needy families program
funded under part A of title IV.
``(bb) A State program funded under part D of title IV.
``(cc) The State Medicaid plan.
``(dd) The State CHIP plan.
``(ee) The Food Stamp Act of 1977 (7 U.S.C. 2011 et seq.).
``(ff) The Head Start Act (42 U.S.C. 9801 et seq.).
``(gg) The Richard B. Russell National School Lunch Act (42
U.S.C. 1751 et seq.).
``(hh) The Child Nutrition Act of 1966 (42 U.S.C. 1771 et
seq.).
``(ii) The Child Care and Development Block Grant Act of
1990 (42 U.S.C. 9858 et seq.).
``(jj) The Stewart B. McKinney Homeless Assistance Act (42
U.S.C. 11301 et seq.).
``(kk) The United States Housing Act of 1937 (42 U.S.C.
1437 et seq.).
``(ll) The Native American Housing Assistance and Self-
Determination Act of 1996 (25 U.S.C. 4101 et seq.).
``(II) A State-specified governmental agency that has
fiscal liability or legal responsibility for the accuracy of
the eligibility determination findings relied on by the
State.
``(III) A public agency that is subject to an interagency
agreement limiting the disclosure and use of the information
disclosed for purposes of determining eligibility under the
State Medicaid plan or the State CHIP plan.
``(iii) Exclusions.--Such term does not include an agency
that determines eligibility for a program established under
the Social Services Block Grant established under title XX or
a private, for-profit organization.
``(iv) Rules of construction.--Nothing in this paragraph
shall be construed as--
``(I) exempting a State Medicaid agency from complying with
the requirements of section 1902(a)(4) relating to merit-
based personnel standards for employees of the State Medicaid
agency and safeguards against conflicts of interest); or
``(II) authorizing a State Medicaid agency that elects to
use Express Lane agencies under this subparagraph to use the
Express Lane option to avoid complying with such requirements
for purposes of making eligibility determinations under the
State Medicaid plan.
``(v) Additional definitions.--In this paragraph:
``(I) State.--The term `State' means 1 of the 50 States or
the District of Columbia.
``(II) State chip agency.--The term `State CHIP agency'
means the State agency responsible for administering the
State CHIP plan.
``(III) State chip plan.--The term `State CHIP plan' means
the State child health plan established under title XXI and
includes any waiver of such plan.
``(IV) State medicaid agency.--The term `State Medicaid
agency' means the State agency responsible for administering
the State Medicaid plan.
``(V) State medicaid plan.--The term `State Medicaid plan'
means the State plan established under title XIX and includes
any waiver of such plan.
``(G) Child defined.--For purposes of this paragraph, the
term `child' means an individual under 19 years of age, or,
at the option of a State, such higher age, not to exceed 21
years of age, as the State may elect.
``(H) Application.--This paragraph shall not apply to with
respect to eligibility determinations made after September
30, 2012.''.
(2) CHIP.--Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is
amended by redesignating subparagraphs (B), (C), and (D) as
subparagraphs (C), (D), and (E), respectively, and by
inserting after subparagraph (A) the following new
subparagraph:
``(B) Section 1902(e)(13) (relating to the State option to
rely on findings from an Express Lane agency to help evaluate
a child's eligibility for medical assistance).''.
(b) Evaluation and Report.--
(1) Evaluation.--The Secretary shall conduct, by grant,
contract, or interagency agreement, a comprehensive,
independent evaluation of the option provided under the
amendments made by subsection (a). Such evaluation shall
include an analysis of the effectiveness of the option, and
shall include--
(A) obtaining a statistically valid sample of the children
who were enrolled in the State Medicaid plan or the State
CHIP plan through reliance on a finding made by an Express
Lane agency and determining the percentage of children who
were erroneously enrolled in such plans;
(B) determining whether enrolling children in such plans
through reliance on a finding made by an Express Lane agency
improves the ability of a State to identify and enroll low-
income, uninsured children who are eligible but not enrolled
in such plans;
(C) evaluating the administrative costs or savings related
to identifying and enrolling children in such plans through
reliance on such findings, and the extent to which such costs
differ from the costs that the State otherwise would have
incurred to identify and enroll low-income, uninsured
children who are eligible but not enrolled in such plans; and
(D) any recommendations for legislative or administrative
changes that would improve the effectiveness of enrolling
children in such plans through reliance on such findings.
(2) Report to congress.--Not later than September 30, 2011,
the Secretary shall submit a report to Congress on the
results of the evaluation under paragraph (1).
(3) Funding.--
(A) In general.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated to the
Secretary to carry out the evaluation under this subsection
$5,000,000 for the period of fiscal years 2008 through 2011.
(B) Budget authority.--Subparagraph (A) constitutes budget
authority in advance of appropriations Act and represents the
obligation of the Federal Government to provide for the
payment of such amount to conduct the evaluation under this
subsection.
(c) Electronic Transmission of Information.--Section 1902
(42 U.S.C. 1396a) is amended by adding at the end the
following new subsection:
``(dd) Electronic Transmission of Information.--If the
State agency determining eligibility for medical assistance
under this title or child health assistance under title XXI
verifies an element of eligibility based on information from
an Express Lane Agency (as defined in subsection (e)(13)(F)),
or from another public agency, then the applicant's signature
under penalty of perjury shall not be required as to such
element. Any signature requirement for an application for
medical assistance may be satisfied through an electronic
signature, as defined in section 1710(1) of the Government
Paperwork Elimination Act (44 U.S.C. 3504 note). The
requirements of subparagraphs (A) and (B) of section
1137(d)(2) may be met through evidence in digital or
electronic form.''.
(d) Authorization of Information Disclosure.--
(1) In general.--Title XIX is amended--
(A) by redesignating section 1939 as section 1940; and
(B) by inserting after section 1938 the following new
section:
``SEC. 1939. AUTHORIZATION TO RECEIVE RELEVANT INFORMATION.
``(a) In General.--Notwithstanding any other provision of
law, a Federal or State agency or private entity in
possession of the sources of data directly relevant to
eligibility determinations under this title (including
eligibility files maintained by Express Lane agencies
described in section 1902(e)(13)(F), information described in
paragraph (2) or (3) of section 1137(a), vital records
information about births in any State, and information
described in sections 453(i) and 1902(a)(25)(I)) is
authorized to convey such data or information to the State
agency administering the State plan under this title, to the
extent such conveyance meets the requirements of subsection
(b).
``(b) Requirements for Conveyance.--Data or information may
be conveyed pursuant to subsection (a) only if the following
requirements are met:
``(1) The individual whose circumstances are described in
the data or information (or such individual's parent,
guardian, caretaker relative, or authorized representative)
has either provided advance consent to disclosure or has not
objected to disclosure after receiving advance notice of
disclosure and a reasonable opportunity to object.
``(2) Such data or information are used solely for the
purposes of--
[[Page H12055]]
``(A) identifying individuals who are eligible or
potentially eligible for medical assistance under this title
and enrolling or attempting to enroll such individuals in the
State plan; and
``(B) verifying the eligibility of individuals for medical
assistance under the State plan.
``(3) An interagency or other agreement, consistent with
standards developed by the Secretary--
``(A) prevents the unauthorized use, disclosure, or
modification of such data and otherwise meets applicable
Federal requirements safeguarding privacy and data security;
and
``(B) requires the State agency administering the State
plan to use the data and information obtained under this
section to seek to enroll individuals in the plan.
``(c) Penalties for Improper Disclosure.--
``(1) Civil money penalty.--A private entity described in
the subsection (a) that publishes, discloses, or makes known
in any manner, or to any extent not authorized by Federal
law, any information obtained under this section is subject
to a civil money penalty in an amount equal to $10,000 for
each such unauthorized publication or disclosure. The
provisions of section 1128A (other than subsections (a) and
(b) and the second sentence of subsection (f)) shall apply to
a civil money penalty under this paragraph in the same manner
as such provisions apply to a penalty or proceeding under
section 1128A(a).
``(2) Criminal penalty.--A private entity described in the
subsection (a) that willfully publishes, discloses, or makes
known in any manner, or to any extent not authorized by
Federal law, any information obtained under this section
shall be fined not more than $10,000 or imprisoned not more
than 1 year, or both, for each such unauthorized publication
or disclosure.
``(d) Rule of Construction.--The limitations and
requirements that apply to disclosure pursuant to this
section shall not be construed to prohibit the conveyance or
disclosure of data or information otherwise permitted under
Federal law (without regard to this section).''.
(2) Conforming amendment to title xxi.--Section 2107(e)(1)
(42 U.S.C. 1397gg(e)(1)), as amended by subsection (a)(2), is
amended by adding at the end the following new subparagraph:
``(F) Section 1939 (relating to authorization to receive
data directly relevant to eligibility determinations).''.
(3) Conforming amendment to provide access to data about
enrollment in insurance for purposes of evaluating
applications and for chip.--Section 1902(a)(25)(I)(i) (42
U.S.C. 1396a(a)(25)(I)(i)) is amended--
(A) by inserting ``(and, at State option, individuals who
apply or whose eligibility for medical assistance is being
evaluated in accordance with section 1902(e)(13)(D))'' after
``with respect to individuals who are eligible''; and
(B) by inserting ``under this title (and, at State option,
child health assistance under title XXI)'' after ``the State
plan''.
(e) Authorization for States Electing Express Lane Option
To Receive Certain Data Directly Relevant To Determining
Eligibility and Correct Amount of Assistance.--The Secretary
shall enter into such agreements as are necessary to permit a
State that elects the Express Lane option under section
1902(e)(13) of the Social Security Act to receive data
directly relevant to eligibility determinations and
determining the correct amount of benefits under a State
child health plan under CHIP or a State plan under Medicaid
from the following:
(1) The National Directory of New Hires established under
section 453(i) of the Social Security Act (42 U.S.C. 653(i)).
(2) Data regarding enrollment in insurance that may help to
facilitate outreach and enrollment under the State Medicaid
plan, the State CHIP plan, and such other programs as the
Secretary may specify.
(f) Effective Date.--The amendments made by this section
are effective on January 1, 2008.
Subtitle B--Reducing Barriers to Enrollment
SEC. 211. VERIFICATION OF DECLARATION OF CITIZENSHIP OR
NATIONALITY FOR PURPOSES OF ELIGIBILITY FOR
MEDICAID AND CHIP.
(a) Alternative State Process for Verification of
Declaration of Citizenship or Nationality for Purposes of
Eligibility for Medicaid.--
(1) Alternative to documentation requirement.--
(A) In general.--Section 1902 (42 U.S.C. 1396a), as amended
by section 203(c), is amended--
(i) in subsection (a)(46)--
(I) by inserting ``(A)'' after ``(46)'';
(II) by adding ``and'' after the semicolon; and
(III) by adding at the end the following new subparagraph:
``(B) provide, with respect to an individual declaring to
be a citizen or national of the United States for purposes of
establishing eligibility under this title, that the State
shall satisfy the requirements of--
``(i) section 1903(x); or
``(ii) subsection (ee);''; and
(ii) by adding at the end the following new subsection:
``(ee)(1) For purposes of subsection (a)(46)(B)(ii), the
requirements of this subsection with respect to an individual
declaring to be a citizen or national of the United States
for purposes of establishing eligibility under this title,
are, in lieu of requiring the individual to present
satisfactory documentary evidence of citizenship or
nationality under section 1903(x) (if the individual is not
described in paragraph (2) of that section), as follows:
``(A) The State submits the name and social security number
of the individual to the Commissioner of Social Security as
part of the program established under paragraph (2).
``(B) If the State receives notice from the Commissioner of
Social Security that the name or social security number, or
the declaration of citizenship or nationality, of the
individual is inconsistent with information in the records
maintained by the Commissioner--
``(i) the State makes a reasonable effort to identify and
address the causes of such inconsistency, including through
typographical or other clerical errors, by contacting the
individual to confirm the accuracy of the name or social
security number submitted or declaration of citizenship or
nationality and by taking such additional actions as the
Secretary, through regulation or other guidance, or the State
may identify, and continues to provide the individual with
medical assistance while making such effort; and
``(ii) in the case such inconsistency is not resolved under
clause (i), the State--
``(I) notifies the individual of such fact;
``(II) provides the individual with a period of 90 days
from the date on which the notice required under subclause
(I) is received by the individual to either present
satisfactory documentary evidence of citizenship or
nationality (as defined in section 1903(x)(3)) or resolve the
inconsistency with the Commissioner of Social Security (and
continues to provide the individual with medical assistance
during such 90-day period); and
``(III) disenrolls the individual from the State plan under
this title within 30 days after the end of such 90-day period
if no such documentary evidence is presented or if such
inconsistency is not resolved.
``(2)(A) Each State electing to satisfy the requirements of
this subsection for purposes of section 1902(a)(46)(B) shall
establish a program under which the State submits at least
monthly to the Commissioner of Social Security for comparison
of the name and social security number, of each individual
newly enrolled in the State plan under this title that month
who is not described in section 1903(x)(2) and who declares
to be a United States citizen or national, with information
in records maintained by the Commissioner.
``(B) In establishing the State program under this
paragraph, the State may enter into an agreement with the
Commissioner of Social Security--
``(i) to provide, through an on-line system or otherwise,
for the electronic submission of, and response to, the
information submitted under subparagraph (A) for an
individual enrolled in the State plan under this title who
declares to be citizen or national on at least a monthly
basis; or
``(ii) to provide for a determination of the consistency of
the information submitted with the information maintainted in
the records of the Commissioner through such other method as
agreed to by the State and the Commissioner and approved by
the Secretary, provided that such method is no more
burdensome for individuals to comply with than any burdens
that may apply under a method described in clause (i).
``(C) The program established under this paragraph shall
provide that, in the case of any individual who is required
to submit a social security number to the State under
subparagraph (A) and who is unable to provide the State with
such number, shall be provided with at least the reasonable
opportunity to present satisfactory documentary evidence of
citizenship or nationality (as defined in section 1903(x)(3))
as is provided under clauses (i) and (ii) of section
1137(d)(4)(A) to an individual for the submittal to the State
of evidence indicating a satisfactory immigration status.
``(3)(A) The State agency implementing the plan approved
under this title shall, at such times and in such form as the
Secretary may specify, provide information on the percentage
each month that the inconsistent submissions bears to the
total submissions made for comparison for such month. For
purposes of this subparagraph, a name, social security
number, or declaration of citizenship or nationality of an
individual shall be treated as inconsistent and included in
the determination of such percentage only if--
``(i) the information submitted by the individual is not
consistent with information in records maintained by the
Commissioner of Social Security;
``(ii) the inconsistency is not resolved by the State;
``(iii) the individual was provided with a reasonable
period of time to resolve the inconsistency with the
Commissioner of Social Security or provide satisfactory
documentation of citizenship status and did not successfully
resolve such inconsistency; and
``(iv) payment has been made for an item or service
furnished to the individual under this title.
``(B) If, for any fiscal year, the average monthly
percentage determined under subparagraph (A) is greater than
3 percent--
``(i) the State shall develop and adopt a corrective plan
to review its procedures for verifying the identities of
individuals seeking to enroll in the State plan under this
title and to identify and implement changes in such
procedures to improve their accuracy; and
``(ii) pay to the Secretary an amount equal to the amount
which bears the same ratio to
[[Page H12056]]
the total payments under the State plan for the fiscal year
for providing medical assistance to individuals who provided
inconsistent information as the number of individuals with
inconsistent information in excess of 3 percent of such total
submitted bears to the total number of individuals with
inconsistent information.
``(C) The Secretary may waive, in certain limited cases,
all or part of the payment under subparagraph (B)(ii) if the
State is unable to reach the allowable error rate despite a
good faith effort by such State.
``(D) Subparagraph (A) and (B) shall not apply to a State
for a fiscal year if there is an agreement described in
paragraph (2)(B) in effect as of the close of the fiscal year
that provides for the submission on a real-time basis of the
information described in such paragraph.
``(4) Nothing in this subsection shall affect the rights of
any individual under this title to appeal any disenrollment
from a State plan.''.
(B) Costs of implementing and maintaining system.--Section
1903(a)(3) (42 U.S.C. 1396b(a)(3)) is amended--
(i) by striking ``plus'' at the end of subparagraph (E) and
inserting ``and'', and
(ii) by adding at the end the following new subparagraph:
``(F)(i) 90 percent of the sums expended during the quarter
as are attributable to the design, development, or
installation of such mechanized verification and information
retrieval systems as the Secretary determines are necessary
to implement section 1902(ee) (including a system described
in paragraph (2)(B) thereof), and
``(ii) 75 percent of the sums expended during the quarter
as are attributable to the operation of systems to which
clause (i) applies, plus''.
(2) Limitation on waiver authority.--Notwithstanding any
provision of section 1115 of the Social Security Act (42
U.S.C. 1315), or any other provision of law, the Secretary
may not waive the requirements of section 1902(a)(46)(B) of
such Act (42 U.S.C. 1396a(a)(46)(B)) with respect to a State.
(3) Conforming amendments.--Section 1903 (42 U.S.C. 1396b)
is amended--
(A) in subsection (i)(22), by striking ``subsection (x)''
and inserting ``section 1902(a)(46)(B)''; and
(B) in subsection (x)(1), by striking ``subsection
(i)(22)'' and inserting ``section 1902(a)(46)(B)(i)''.
(4) Appropriation.--Out of any money in the Treasury of the
United States not otherwise appropriated, there are
appropriated to the Commissioner of Social Security
$5,000,000 to remain available until expended to carry out
the Commissioner's responsibilities under section 1902(ee) of
the Social Security Act, as added by subsection (a).
(b) Clarification of Requirements Relating to Presentation
of Satisfactory Documentary Evidence of Citizenship or
Nationality.--
(1) Acceptance of documentary evidence issued by a
federally recognized indian tribe.--Section 1903(x)(3)(B) (42
U.S.C. 1396b(x)(3)(B)) is amended--
(A) by redesignating clause (v) as clause (vi); and
(B) by inserting after clause (iv), the following new
clause:
``(v)(I) Except as provided in subclause (II), a document
issued by a federally recognized Indian tribe evidencing
membership or enrollment in, or affiliation with, such tribe
(such as a tribal enrollment card or certificate of degree of
Indian blood).
``(II) With respect to those federally recognized Indian
tribes located within States having an international border
whose membership includes individuals who are not citizens of
the United States, the Secretary shall, after consulting with
such tribes, issue regulations authorizing the presentation
of such other forms of documentation (including tribal
documentation, if appropriate) that the Secretary determines
to be satisfactory documentary evidence of citizenship or
nationality for purposes of satisfying the requirement of
this subsection.''.
(2) Requirement to provide reasonable opportunity to
present satisfactory documentary evidence.--Section 1903(x)
(42 U.S.C. 1396b(x)) is amended by adding at the end the
following new paragraph:
``(4) In the case of an individual declaring to be a
citizen or national of the United States with respect to whom
a State requires the presentation of satisfactory documentary
evidence of citizenship or nationality under section
1902(a)(46)(B)(i), the individual shall be provided at least
the reasonable opportunity to present satisfactory
documentary evidence of citizenship or nationality under this
subsection as is provided under clauses (i) and (ii) of
section 1137(d)(4)(A) to an individual for the submittal to
the State of evidence indicating a satisfactory immigration
status.''.
(3) Children born in the united states to mothers eligible
for medicaid.--
(A) Clarification of rules.--Section 1903(x) (42 U.S.C.
1396b(x)), as amended by paragraph (2), is amended--
(i) in paragraph (2)--
(I) in subparagraph (C), by striking ``or'' at the end;
(II) by redesignating subparagraph (D) as subparagraph (E);
and
(III) by inserting after subparagraph (C) the following new
subparagraph:
``(D) pursuant to the application of section 1902(e)(4)
(and, in the case of an individual who is eligible for
medical assistance on such basis, the individual shall be
deemed to have provided satisfactory documentary evidence of
citizenship or nationality and shall not be required to
provide further documentary evidence on any date that occurs
during or after the period in which the individual is
eligible for medical assistance on such basis); or''; and
(ii) by adding at the end the following new paragraph:
``(5) Nothing in subparagraph (A) or (B) of section
1902(a)(46), the preceding paragraphs of this subsection, or
the Deficit Reduction Act of 2005, including section 6036 of
such Act, shall be construed as changing the requirement of
section 1902(e)(4) that a child born in the United States to
an alien mother for whom medical assistance for the delivery
of such child is available as treatment of an emergency
medical condition pursuant to subsection (v) shall be deemed
eligible for medical assistance during the first year of such
child's life.''.
(B) State requirement to issue separate identification
number.--Section 1902(e)(4) (42 U.S.C. 1396a(e)(4)) is
amended by adding at the end the following new sentence:
``Notwithstanding the preceding sentence, in the case of a
child who is born in the United States to an alien mother for
whom medical assistance for the delivery of the child is made
available pursuant to section 1903(v), the State immediately
shall issue a separate identification number for the child
upon notification by the facility at which such delivery
occurred of the child's birth.''.
(4) Technical amendments.--Section 1903(x)(2) (42 U.S.C.
1396b(x)) is amended--
(A) in subparagraph (B)--
(i) by realigning the left margin of the matter preceding
clause (i) 2 ems to the left; and
(ii) by realigning the left margins of clauses (i) and
(ii), respectively, 2 ems to the left; and
(B) in subparagraph (C)--
(i) by realigning the left margin of the matter preceding
clause (i) 2 ems to the left; and
(ii) by realigning the left margins of clauses (i) and
(ii), respectively, 2 ems to the left.
(c) Application of Documentation System to CHIP.--
(1) In general.--Section 2105(c) (42 U.S.C. 1397ee(c)), as
amended by sections 114(a) and 116(c), is amended by adding
at the end the following new paragraph:
``(10) Citizenship documentation requirements.--
``(A) In general.--No payment may be made under this
section with respect to an individual who has, or is,
declared to be a citizen or national of the United States for
purposes of establishing eligibility under this title unless
the State meets the requirements of section 1902(a)(46)(B)
with respect to the individual.
``(B) Enhanced payments.--Notwithstanding subsection (b),
the enhanced FMAP with respect to payments under subsection
(a) for expenditures described in clause (i) or (ii) of
section 1903(a)(3)(F) necessary to comply with subparagraph
(A) shall in no event be less than 90 percent and 75 percent,
respectively.''.
(2) Nonapplication of administrative expenditures cap.--
Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as amended
by section 202(b), is amended by adding at the end the
following:
``(ii) Expenditures to comply with citizenship or
nationality verification requirements.--Expenditures
necessary for the State to comply with paragraph (9)(A).''.
(d) Effective Date.--
(1) In general.--
(A) In general.--Except as provided in subparagraph (B),
the amendments made by this section shall take effect on
October 1, 2008.
(B) Technical amendments.--The amendments made by--
(i) paragraphs (1), (2), and (3) of subsection (b) shall
take effect as if included in the enactment of section 6036
of the Deficit Reduction Act of 2005 (Public Law 109-171; 120
Stat. 80); and
(ii) paragraph (4) of subsection (b) shall take effect as
if included in the enactment of section 405 of division B of
the Tax Relief and Health Care Act of 2006 (Public Law 109-
432; 120 Stat. 2996).
(2) Restoration of eligibility.--In the case of an
individual who, during the period that began on July 1, 2006,
and ends on October 1, 2008, was determined to be ineligible
for medical assistance under a State Medicaid plan, including
any waiver of such plan, solely as a result of the
application of subsections (i)(22) and (x) of section 1903 of
the Social Security Act (as in effect during such period),
but who would have been determined eligible for such
assistance if such subsections, as amended by subsection (b),
had applied to the individual, a State may deem the
individual to be eligible for such assistance as of the date
that the individual was determined to be ineligible for such
medical assistance on such basis.
(3) Special transition rule for indians.--During the period
that begins on July 1, 2006, and ends on the effective date
of final regulations issued under subclause (II) of section
1903(x)(3)(B)(v) of the Social Security Act (42 U.S.C.
1396b(x)(3)(B)(v)) (as added by subsection (b)(1)(B)), an
individual who is a member of a federally-recognized Indian
tribe described in subclause (II) of that section who
presents a document described in subclause (I) of such
section that is issued by such Indian tribe, shall be deemed
to have
[[Page H12057]]
presented satisfactory evidence of citizenship or nationality
for purposes of satisfying the requirement of subsection (x)
of section 1903 of such Act.
SEC. 212. REDUCING ADMINISTRATIVE BARRIERS TO ENROLLMENT.
Section 2102(b) (42 U.S.C. 1397bb(b)) is amended--
(1) by redesignating paragraph (4) as paragraph (5); and
(2) by inserting after paragraph (3) the following new
paragraph:
``(4) Reduction of administrative barriers to enrollment.--
``(A) In general.--Subject to subparagraph (B), the plan
shall include a description of the procedures used to reduce
administrative barriers to the enrollment of children and
pregnant women who are eligible for medical assistance under
title XIX or for child health assistance or health benefits
coverage under this title. Such procedures shall be
established and revised as often as the State determines
appropriate to take into account the most recent information
available to the State identifying such barriers.
``(B) Deemed compliance if joint application and renewal
process that permits application other than in person.--A
State shall be deemed to comply with subparagraph (A) if the
State's application and renewal forms and supplemental forms
(if any) and information verification process is the same for
purposes of establishing and renewing eligibility for
children and pregnant women for medical assistance under
title XIX and child health assistance under this title, and
such process does not require an application to be made in
person or a face-to-face interview.''.
SEC. 213. MODEL OF INTERSTATE COORDINATED ENROLLMENT AND
COVERAGE PROCESS.
(a) In General.--In order to assure continuity of coverage
of low-income children under the Medicaid program and the
State Children's Health Insurance Program (CHIP), not later
than 18 months after the date of the enactment of this Act,
the Secretary of Health and Human Services, in consultation
with State Medicaid and CHIP directors and organizations
representing program beneficiaries, shall develop a model
process for the coordination of the enrollment, retention,
and coverage under such programs of children who, because of
migration of families, emergency evacuations, natural or
other disasters, public health emergencies, educational
needs, or otherwise, frequently change their State of
residency or otherwise are temporarily located outside of the
State of their residency.
(b) Report to Congress.--After development of such model
process, the Secretary of Health and Human Services shall
submit to Congress a report describing additional steps or
authority needed to make further improvements to coordinate
the enrollment, retention, and coverage under CHIP and
Medicaid of children described in subsection (a).
TITLE III--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE
Subtitle A--Additional State Option for Providing Premium Assistance
SEC. 301. ADDITIONAL STATE OPTION FOR PROVIDING PREMIUM
ASSISTANCE.
(a) CHIP.--
(1) In general.--Section 2105(c) (42 U.S.C. 1397ee(c)), as
amended by sections 114(a), 116(c), and 211(c), is amended by
adding at the end the following:
``(11) State option to offer premium assistance.--
``(A) In general.--A State may elect to offer a premium
assistance subsidy (as defined in subparagraph (C)) for
qualified employer-sponsored coverage (as defined in
subparagraph (B)) to all targeted low-income children who are
eligible for child health assistance under the plan and have
access to such coverage in accordance with the requirements
of this paragraph. No subsidy shall be provided to a targeted
low-income child under this paragraph unless the child (or
the child's parent) voluntarily elects to receive such a
subsidy. A State may not require such an election as a
condition of receipt of child health assistance.
``(B) Qualified employer-sponsored coverage.--
``(i) In general.--Subject to clause (ii), in this
paragraph, the term `qualified employer-sponsored coverage'
means a group health plan or health insurance coverage
offered through an employer--
``(I) that qualifies as creditable coverage as a group
health plan under section 2701(c)(1) of the Public Health
Service Act;
``(II) for which the employer contribution toward any
premium for such coverage is at least 40 percent; and
``(III) that is offered to all individuals in a manner that
would be considered a nondiscriminatory eligibility
classification for purposes of paragraph (3)(A)(ii) of
section 105(h) of the Internal Revenue Code of 1986 (but
determined without regard to clause (i) of subparagraph (B)
of such paragraph).
``(ii) Exception.--Such term does not include coverage
consisting of--
``(I) benefits provided under a health flexible spending
arrangement (as defined in section 106(c)(2) of the Internal
Revenue Code of 1986); or
``(II) a high deductible health plan (as defined in section
223(c)(2) of such Code), without regard to whether the plan
is purchased in conjunction with a health savings account (as
defined under section 223(d) of such Code).
``(C) Premium assistance subsidy.--
``(i) In general.--In this paragraph, the term `premium
assistance subsidy' means, with respect to a targeted low-
income child, the amount equal to the difference between the
employee contribution required for enrollment only of the
employee under qualified employer-sponsored coverage and the
employee contribution required for enrollment of the employee
and the child in such coverage, less any applicable premium
cost-sharing applied under the State child health plan
(subject to the limitations imposed under section 2103(e),
including the requirement to count the total amount of the
employee contribution required for enrollment of the employee
and the child in such coverage toward the annual aggregate
cost-sharing limit applied under paragraph (3)(B) of such
section).
``(ii) State payment option.--A State may provide a premium
assistance subsidy either as reimbursement to an employee for
out-of-pocket expenditures or, subject to clause (iii),
directly to the employee's employer.
``(iii) Employer opt-out.--An employer may notify a State
that it elects to opt-out of being directly paid a premium
assistance subsidy on behalf of an employee. In the event of
such a notification, an employer shall withhold the total
amount of the employee contribution required for enrollment
of the employee and the child in the qualified employer-
sponsored coverage and the State shall pay the premium
assistance subsidy directly to the employee.
``(iv) Treatment as child health assistance.--Expenditures
for the provision of premium assistance subsidies shall be
considered child health assistance described in paragraph
(1)(C) of subsection (a) for purposes of making payments
under that subsection.
``(D) Application of secondary payor rules.--The State
shall be a secondary payor for any items or services provided
under the qualified employer-sponsored coverage for which the
State provides child health assistance under the State child
health plan.
``(E) Requirement to provide supplemental coverage for
benefits and cost-sharing protection provided under the state
child health plan.--
``(i) In general.--Notwithstanding section 2110(b)(1)(C),
the State shall provide for each targeted low-income child
enrolled in qualified employer-sponsored coverage,
supplemental coverage consisting of--
``(I) items or services that are not covered, or are only
partially covered, under the qualified employer-sponsored
coverage; and
``(II) cost-sharing protection consistent with section
2103(e).
``(ii) Record keeping requirements.--For purposes of
carrying out clause (i), a State may elect to directly pay
out-of-pocket expenditures for cost-sharing imposed under the
qualified employer-sponsored coverage and collect or not
collect all or any portion of such expenditures from the
parent of the child.
``(F) Application of waiting period imposed under the
state.--Any waiting period imposed under the State child
health plan prior to the provision of child health assistance
to a targeted low-income child under the State plan shall
apply to the same extent to the provision of a premium
assistance subsidy for the child under this paragraph.
``(G) Opt-out permitted for any month.--A State shall
establish a process for permitting the parent of a targeted
low-income child receiving a premium assistance subsidy to
disenroll the child from the qualified employer-sponsored
coverage and enroll the child in, and receive child health
assistance under, the State child health plan, effective on
the first day of any month for which the child is eligible
for such assistance and in a manner that ensures continuity
of coverage for the child.
``(H) Application to parents.--If a State provides child
health assistance or health benefits coverage to parents of a
targeted low-income child in accordance with section 2111(b),
the State may elect to offer a premium assistance subsidy to
a parent of a targeted low-income child who is eligible for
such a subsidy under this paragraph in the same manner as the
State offers such a subsidy for the enrollment of the child
in qualified employer-sponsored coverage, except that--
``(i) the amount of the premium assistance subsidy shall be
increased to take into account the cost of the enrollment of
the parent in the qualified employer-sponsored coverage or,
at the option of the State if the State determines it cost-
effective, the cost of the enrollment of the child's family
in such coverage; and
``(ii) any reference in this paragraph to a child is deemed
to include a reference to the parent or, if applicable under
clause (i), the family of the child.
``(I) Additional state option for providing premium
assistance.--
``(i) In general.--A State may establish an employer-family
premium assistance purchasing pool for employers with less
than 250 employees who have at least 1 employee who is a
pregnant woman eligible for assistance under the State child
health plan (including through the application of an option
described in section 2112(f)) or a member of a family with at
least 1 targeted low-income child and to provide a premium
assistance subsidy under this paragraph for enrollment in
coverage made available through such pool.
``(ii) Access to choice of coverage.--A State that elects
the option under clause (i) shall identify and offer access
to not less
[[Page H12058]]
than 2 private health plans that are health benefits coverage
that is equivalent to the benefits coverage in a benchmark
benefit package described in section 2103(b) or benchmark-
equivalent coverage that meets the requirements of section
2103(a)(2) for employees described in clause (i).
``(iii) Clarification of payment for administrative
expenditures.--Nothing in this subparagraph shall be
construed as permitting payment under this section for
administrative expenditures attributable to the establishment
or operation of such pool, except to the extent that such
payment would otherwise be permitted under this title.
``(J) No effect on premium assistance waiver programs.--
Nothing in this paragraph shall be construed as limiting the
authority of a State to offer premium assistance under
section 1906 or 1906A, a waiver described in paragraph (2)(B)
or (3), a waiver approved under section 1115, or other
authority in effect prior to the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2007.
``(K) Notice of availability.--If a State elects to provide
premium assistance subsidies in accordance with this
paragraph, the State shall--
``(i) include on any application or enrollment form for
child health assistance a notice of the availability of
premium assistance subsidies for the enrollment of targeted
low-income children in qualified employer-sponsored coverage;
``(ii) provide, as part of the application and enrollment
process under the State child health plan, information
describing the availability of such subsidies and how to
elect to obtain such a subsidy; and
``(iii) establish such other procedures as the State
determines necessary to ensure that parents are fully
informed of the choices for receiving child health assistance
under the State child health plan or through the receipt of
premium assistance subsidies.
``(L) Application to qualified employer-sponsored benchmark
coverage.--If a group health plan or health insurance
coverage offered through an employer is certified by an
actuary as health benefits coverage that is equivalent to the
benefits coverage in a benchmark benefit package described in
section 2103(b) or benchmark-equivalent coverage that meets
the requirements of section 2103(a)(2), the State may provide
premium assistance subsidies for enrollment of targeted low-
income children in such group health plan or health insurance
coverage in the same manner as such subsidies are provided
under this paragraph for enrollment in qualified employer-
sponsored coverage, but without regard to the requirement to
provide supplemental coverage for benefits and cost-sharing
protection provided under the State child health plan under
subparagraph (E).
``(M) Satisfaction of cost-effectiveness test.--Premium
assistance subsidies for qualified employer-sponsored
coverage offered under this paragraph shall be deemed to meet
the requirement of subparagraph (A) of paragraph (3).
``(N) Coordination with medicaid.--In the case of a
targeted low-income child who receives child health
assistance through a State plan under title XIX and who
voluntarily elects to receive a premium assistance subsidy
under this section, the provisions of section 1906A shall
apply and shall supersede any other provisions of this
paragraph that are inconsistent with such section.''.
(2) Determination of cost-effectiveness for premium
assistance or purchase of family coverage.--
(A) In general.--Section 2105(c)(3)(A) (42 U.S.C.
1397ee(c)(3)(A)) is amended by striking ``relative to'' and
all that follows through the comma and inserting ``relative
to
``(i) the amount of expenditures under the State child
health plan, including administrative expenditures, that the
State would have made to provide comparable coverage of the
targeted low-income child involved or the family involved (as
applicable); or
``(ii) the aggregate amount of expenditures that the State
would have made under the State child health plan, including
administrative expenditures, for providing coverage under
such plan for all such children or families.''.
(B) Nonapplication to previously approved coverage.--The
amendment made by subparagraph (A) shall not apply to
coverage the purchase of which has been approved by the
Secretary under section 2105(c)(3) of the Social Security Act
prior to the date of enactment of this Act.
(b) Medicaid.--Title XIX is amended by inserting after
section 1906 the following new section:
``PREMIUM ASSISTANCE OPTION FOR CHILDREN
``Sec. 1906A. (a) In General.--A State may elect to offer
a premium assistance subsidy (as defined in subsection (c))
for qualified employer-sponsored coverage (as defined in
subsection (b)) to all individuals under age 19 who are
entitled to medical assistance under this title (and to the
parent of such an individual) who have access to such
coverage if the State meets the requirements of this section.
``(b) Qualified Employer-Sponsored Coverage.--
``(1) In general.--Subject to paragraph (2)), in this
paragraph, the term `qualified employer-sponsored coverage'
means a group health plan or health insurance coverage
offered through an employer--
``(A) that qualifies as creditable coverage as a group
health plan under section 2701(c)(1) of the Public Health
Service Act;
``(B) for which the employer contribution toward any
premium for such coverage is at least 40 percent; and
``(C) that is offered to all individuals in a manner that
would be considered a nondiscriminatory eligibility
classification for purposes of paragraph (3)(A)(ii) of
section 105(h) of the Internal Revenue Code of 1986 (but
determined without regard to clause (i) of subparagraph (B)
of such paragraph).
``(2) Exception.--Such term does not include coverage
consisting of--
``(A) benefits provided under a health flexible spending
arrangement (as defined in section 106(c)(2) of the Internal
Revenue Code of 1986); or
``(B) a high deductible health plan (as defined in section
223(c)(2) of such Code), without regard to whether the plan
is purchased in conjunction with a health savings account (as
defined under section 223(d) of such Code).
``(3) Treatment as third party liability.--The State shall
treat the coverage provided under qualified employer-
sponsored coverage as a third party liability under section
1902(a)(25).
``(c) Premium Assistance Subsidy.--In this section, the
term `premium assistance subsidy' means the amount of the
employee contribution for enrollment in the qualified
employer-sponsored coverage by the individual under age 19 or
by the individual's family. Premium assistance subsidies
under this section shall be considered, for purposes of
section 1903(a), to be a payment for medical assistance.
``(d) Voluntary Participation.--
``(1) Employers.--Participation by an employer in a premium
assistance subsidy offered by a State under this section
shall be voluntary. An employer may notify a State that it
elects to opt-out of being directly paid a premium assistance
subsidy on behalf of an employee.
``(2) Beneficiaries.--No subsidy shall be provided to an
individual under age 19 under this section unless the
individual (or the individual's parent) voluntarily elects to
receive such a subsidy. A State may not require such an
election as a condition of receipt of medical assistance.
State may not require, as a condition of an individual under
age 19 (or the individual's parent) being or remaining
eligible for medical assistance under this title, apply for
enrollment in qualified employer-sponsored coverage under
this section.
``(3) Opt-out permitted for any month.--A State shall
establish a process for permitting the parent of an
individual under age 19 receiving a premium assistance
subsidy to disenroll the individual from the qualified
employer-sponsored coverage.
``(e) Requirement To Pay Premiums and Cost-Sharing and
Provide Supplemental Coverage.--In the case of the
participation of an individual under age 19 (or the
individual's parent) in a premium assistance subsidy under
this section for qualified employer-sponsored coverage, the
State shall provide for payment of all enrollee premiums for
enrollment in such coverage and all deductibles, coinsurance,
and other cost-sharing obligations for items and services
otherwise covered under the State plan under this title
(exceeding the amount otherwise permitted under section 1916
or, if applicable, section 1916A). The fact that an
individual under age 19 (or a parent) elects to enroll in
qualified employer-sponsored coverage under this section
shall not change the individual's (or parent's) eligibility
for medical assistance under the State plan, except insofar
as section 1902(a)(25) provides that payments for such
assistance shall first be made under such coverage.''.
(c) GAO Study and Report.--Not later than January 1, 2009,
the Comptroller General of the United States shall study cost
and coverage issues relating to any State premium assistance
programs for which Federal matching payments are made under
title XIX or XXI of the Social Security Act, including under
waiver authority, and shall submit a report to the Committee
on Finance of the Senate and the Committee on Energy and
Commerce of the House of Representatives on the results of
such study.
SEC. 302. OUTREACH, EDUCATION, AND ENROLLMENT ASSISTANCE.
(a) Requirement To Include Description of Outreach,
Education, and Enrollment Efforts Related to Premium
Assistance Subsidies in State Child Health Plan.--Section
2102(c) (42 U.S.C. 1397bb(c)) is amended by adding at the end
the following new paragraph:
``(3) Premium assistance subsidies.--In the case of a State
that provides for premium assistance subsidies under the
State child health plan in accordance with paragraph (2)(B),
(3), or (10) of section 2105(c), or a waiver approved under
section 1115, outreach, education, and enrollment assistance
for families of children likely to be eligible for such
subsidies, to inform such families of the availability of,
and to assist them in enrolling their children in, such
subsidies, and for employers likely to provide coverage that
is eligible for such subsidies, including the specific,
significant resources the State intends to apply to educate
employers about the availability of premium assistance
subsidies under the State child health plan.''.
(b) Nonapplication of 10 Percent Limit on Outreach and
Certain Other Expenditures.--Section 2105(c)(2)(C) (42 U.S.C.
1397ee(c)(2)(C)), as amended by section 301(c)(2), is amended
by adding at the end the following new clause:
[[Page H12059]]
``(iv) Expenditures for outreach to increase the enrollment
of children under this title and title xix through premium
assistance subsidies.--Expenditures for outreach activities
to families of children likely to be eligible for premium
assistance subsidies in accordance with paragraph (2)(B),
(3), or (10), or a waiver approved under section 1115, to
inform such families of the availability of, and to assist
them in enrolling their children in, such subsidies, and to
employers likely to provide qualified employer-sponsored
coverage (as defined in subparagraph (B) of such paragraph),
but not to exceed an amount equal to 1.25 percent of the
maximum amount permitted to be expended under subparagraph
(A) for items described in subsection (a)(1)(D).''.
Subtitle B--Coordinating Premium Assistance With Private Coverage
SEC. 311. SPECIAL ENROLLMENT PERIOD UNDER GROUP HEALTH PLANS
IN CASE OF TERMINATION OF MEDICAID OR CHIP
COVERAGE OR ELIGIBILITY FOR ASSISTANCE IN
PURCHASE OF EMPLOYMENT-BASED COVERAGE;
COORDINATION OF COVERAGE.
(a) Amendments to Internal Revenue Code of 1986.--Section
9801(f) of the Internal Revenue Code of 1986 (relating to
special enrollment periods) is amended by adding at the end
the following new paragraph:
``(3) Special rules relating to medicaid and chip.--
``(A) In general.--A group health plan shall permit an
employee who is eligible, but not enrolled, for coverage
under the terms of the plan (or a dependent of such an
employee if the dependent is eligible, but not enrolled, for
coverage under such terms) to enroll for coverage under the
terms of the plan if either of the following conditions is
met:
``(i) Termination of medicaid or chip coverage.--The
employee or dependent is covered under a Medicaid plan under
title XIX of the Social Security Act or under a State child
health plan under title XXI of such Act and coverage of the
employee or dependent under such a plan is terminated as a
result of loss of eligibility for such coverage and the
employee requests coverage under the group health plan not
later than 60 days after the date of termination of such
coverage.
``(ii) Eligibility for employment assistance under medicaid
or chip.--The employee or dependent becomes eligible for
assistance, with respect to coverage under the group health
plan under such Medicaid plan or State child health plan
(including under any waiver or demonstration project
conducted under or in relation to such a plan), if the
employee requests coverage under the group health plan not
later than 60 days after the date the employee or dependent
is determined to be eligible for such assistance.
``(B) Employee outreach and disclosure.--
``(i) Outreach to employees regarding availability of
medicaid and chip coverage.--
``(I) In general.--Each employer that maintains a group
health plan in a State that provides medical assistance under
a State Medicaid plan under title XIX of the Social Security
Act, or child health assistance under a State child health
plan under title XXI of such Act, in the form of premium
assistance for the purchase of coverage under a group health
plan, shall provide to each employee a written notice
informing the employee of potential opportunities then
currently available in the State in which the employee
resides for premium assistance under such plans for health
coverage of the employee or the employee's dependents. For
purposes of compliance with this clause, the employer may use
any State-specific model notice developed in accordance with
section 701(f)(3)(B)(i)(II) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1181(f)(3)(B)(i)(II)).
``(II) Option to provide concurrent with provision of plan
materials to employee.--An employer may provide the model
notice applicable to the State in which an employee resides
concurrent with the furnishing of materials notifying the
employee of health plan eligibility, concurrent with
materials provided to the employee in connection with an open
season or election process conducted under the plan, or
concurrent with the furnishing of the summary plan
description as provided in section 104(b) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1024).
``(ii) Disclosure about group health plan benefits to
states for medicaid and chip eligible individuals.--In the
case of a participant or beneficiary of a group health plan
who is covered under a Medicaid plan of a State under title
XIX of the Social Security Act or under a State child health
plan under title XXI of such Act, the plan administrator of
the group health plan shall disclose to the State, upon
request, information about the benefits available under the
group health plan in sufficient specificity, as determined
under regulations of the Secretary of Health and Human
Services in consultation with the Secretary that require use
of the model coverage coordination disclosure form developed
under section 311(b)(1)(C) of the Children's Health Insurance
Program Reauthorization Act of 2007, so as to permit the
State to make a determination (under paragraph (2)(B), (3),
or (10) of section 2105(c) of the Social Security Act or
otherwise) concerning the cost-effectiveness of the State
providing medical or child health assistance through premium
assistance for the purchase of coverage under such group
health plan and in order for the State to provide
supplemental benefits required under paragraph (10)(E) of
such section or other authority.''.
(b) Conforming Amendments.--
(1) Amendments to employee retirement income security
act.--
(A) In general.--Section 701(f) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1181(f)) is amended by
adding at the end the following new paragraph:
``(3) Special rules for application in case of medicaid and
chip.--
``(A) In general.--A group health plan, and a health
insurance issuer offering group health insurance coverage in
connection with a group health plan, shall permit an employee
who is eligible, but not enrolled, for coverage under the
terms of the plan (or a dependent of such an employee if the
dependent is eligible, but not enrolled, for coverage under
such terms) to enroll for coverage under the terms of the
plan if either of the following conditions is met:
``(i) Termination of medicaid or chip coverage.--The
employee or dependent is covered under a Medicaid plan under
title XIX of the Social Security Act or under a State child
health plan under title XXI of such Act and coverage of the
employee or dependent under such a plan is terminated as a
result of loss of eligibility for such coverage and the
employee requests coverage under the group health plan (or
health insurance coverage) not later than 60 days after the
date of termination of such coverage.
``(ii) Eligibility for employment assistance under medicaid
or chip.--The employee or dependent becomes eligible for
assistance, with respect to coverage under the group health
plan or health insurance coverage, under such Medicaid plan
or State child health plan (including under any waiver or
demonstration project conducted under or in relation to such
a plan), if the employee requests coverage under the group
health plan or health insurance coverage not later than 60
days after the date the employee or dependent is determined
to be eligible for such assistance.
``(B) Coordination with medicaid and chip.--
``(i) Outreach to employees regarding availability of
medicaid and chip coverage.--
``(I) In general.--Each employer that maintains a group
health plan in a State that provides medical assistance under
a State Medicaid plan under title XIX of the Social Security
Act, or child health assistance under a State child health
plan under title XXI of such Act, in the form of premium
assistance for the purchase of coverage under a group health
plan, shall provide to each employee a written notice
informing the employee of potential opportunities then
currently available in the State in which the employee
resides for premium assistance under such plans for health
coverage of the employee or the employee's dependents.
``(II) Model notice.--Not later than 1 year after the date
of enactment of the Children's Health Insurance Program
Reauthorization Act of 2007, the Secretary and the Secretary
of Health and Human Services, in consultation with Directors
of State Medicaid agencies under title XIX of the Social
Security Act and Directors of State CHIP agencies under title
XXI of such Act, shall jointly develop national and State-
specific model notices for purposes of subparagraph (A). The
Secretary shall provide employers with such model notices so
as to enable employers to timely comply with the requirements
of subparagraph (A). Such model notices shall include
information regarding how an employee may contact the State
in which the employee resides for additional information
regarding potential opportunities for such premium
assistance, including how to apply for such assistance.
``(III) Option to provide concurrent with provision of
plan materials to employee.--An employer may provide the
model notice applicable to the State in which an employee
resides concurrent with the furnishing of materials
notifying the employee of health plan eligibility,
concurrent with materials provided to the employee in
connection with an open season or election process
conducted under the plan, or concurrent with the
furnishing of the summary plan description as provided in
section 104(b).
``(ii) Disclosure about group health plan benefits to
states for medicaid and chip eligible individuals.--In the
case of a participant or beneficiary of a group health plan
who is covered under a Medicaid plan of a State under title
XIX of the Social Security Act or under a State child health
plan under title XXI of such Act, the plan administrator of
the group health plan shall disclose to the State, upon
request, information about the benefits available under the
group health plan in sufficient specificity, as determined
under regulations of the Secretary of Health and Human
Services in consultation with the Secretary that require use
of the model coverage coordination disclosure form developed
under section 311(b)(1)(C) of the Children's Health Insurance
Program Reauthorization Act of 2007, so as to permit the
State to make a determination (under paragraph (2)(B), (3),
or (10) of section 2105(c) of the Social Security Act or
otherwise) concerning the cost-effectiveness of the State
providing medical or child health assistance through premium
assistance for the purchase of coverage under such group
health plan and in order for the State to provide
supplemental benefits required under paragraph (10)(E) of
such section or other authority.''.
[[Page H12060]]
(B) Conforming amendment.--Section 102(b) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1022(b)) is
amended--
(i) by striking ``and the remedies'' and inserting ``, the
remedies''; and
(ii) by inserting before the period the following: ``, and
if the employer so elects for purposes of complying with
section 701(f)(3)(B)(i), the model notice applicable to the
State in which the participants and beneficiaries reside''.
(C) Working group to develop model coverage coordination
disclosure form.--
(i) Medicaid, chip, and employer-sponsored coverage
coordination working group.--
(I) In general.--Not later than 60 days after the date of
enactment of this Act, the Secretary of Health and Human
Services and the Secretary of Labor shall jointly establish a
Medicaid, CHIP, and Employer-Sponsored Coverage Coordination
Working Group (in this subparagraph referred to as the
``Working Group''). The purpose of the Working Group shall be
to develop the model coverage coordination disclosure form
described in subclause (II) and to identify the impediments
to the effective coordination of coverage available to
families that include employees of employers that maintain
group health plans and members who are eligible for medical
assistance under title XIX of the Social Security Act or
child health assistance or other health benefits coverage
under title XXI of such Act.
(II) Model coverage coordination disclosure form
described.--The model form described in this subclause is a
form for plan administrators of group health plans to
complete for purposes of permitting a State to determine the
availability and cost-effectiveness of the coverage available
under such plans to employees who have family members who are
eligible for premium assistance offered under a State plan
under title XIX or XXI of such Act and to allow for
coordination of coverage for enrollees of such plans. Such
form shall provide the following information in addition to
such other information as the Working Group determines
appropriate:
(aa) A determination of whether the employee is eligible
for coverage under the group health plan.
(bb) The name and contract information of the plan
administrator of the group health plan.
(cc) The benefits offered under the plan.
(dd) The premiums and cost-sharing required under the plan.
(ee) Any other information relevant to coverage under the
plan.
(ii) Membership.--The Working Group shall consist of not
more than 30 members and shall be composed of representatives
of--
(I) the Department of Labor;
(II) the Department of Health and Human Services;
(III) State directors of the Medicaid program under title
XIX of the Social Security Act;
(IV) State directors of the State Children's Health
Insurance Program under title XXI of the Social Security Act;
(V) employers, including owners of small businesses and
their trade or industry representatives and certified human
resource and payroll professionals;
(VI) plan administrators and plan sponsors of group health
plans (as defined in section 607(1) of the Employee
Retirement Income Security Act of 1974);
(VII) health insurance issuers; and
(VIII) children and other beneficiaries of medical
assistance under title XIX of the Social Security Act or
child health assistance or other health benefits coverage
under title XXI of such Act.
(iii) Compensation.--The members of the Working Group shall
serve without compensation.
(iv) Administrative support.--The Department of Health and
Human Services and the Department of Labor shall jointly
provide appropriate administrative support to the Working
Group, including technical assistance. The Working Group may
use the services and facilities of either such Department,
with or without reimbursement, as jointly determined by such
Departments.
(v) Report.--
(I) Report by working group to the secretaries.--Not later
than 18 months after the date of the enactment of this Act,
the Working Group shall submit to the Secretary of Labor and
the Secretary of Health and Human Services the model form
described in clause (i)(II) along with a report containing
recommendations for appropriate measures to address the
impediments to the effective coordination of coverage between
group health plans and the State plans under titles XIX and
XXI of the Social Security Act.
(II) Report by secretaries to the congress.--Not later than
2 months after receipt of the report pursuant to subclause
(I), the Secretaries shall jointly submit a report to each
House of the Congress regarding the recommendations contained
in the report under such subclause.
(vi) Termination.--The Working Group shall terminate 30
days after the date of the issuance of its report under
clause (v).
(D) Effective dates.--The Secretary of Labor and the
Secretary of Health and Human Services shall develop the
initial model notices under section 701(f)(3)(B)(i)(II) of
the Employee Retirement Income Security Act of 1974, and the
Secretary of Labor shall provide such notices to employers,
not later than the date that is 1 year after the date of
enactment of this Act, and each employer shall provide the
initial annual notices to such employer's employees beginning
with the first plan year that begins after the date on which
such initial model notices are first issued. The model
coverage coordination disclosure form developed under
subparagraph (C) shall apply with respect to requests made by
States beginning with the first plan year that begins after
the date on which such model coverage coordination disclosure
form is first issued.
(E) Enforcement.--Section 502 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1132) is amended--
(i) in subsection (a)(6), by striking ``or (8)'' and
inserting ``(8), or (9)''; and
(ii) in subsection (c), by redesignating paragraph (9) as
paragraph (10), and by inserting after paragraph (8) the
following:
``(9)(A) The Secretary may assess a civil penalty against
any employer of up to $100 a day from the date of the
employer's failure to meet the notice requirement of section
701(f)(3)(B)(i)(I). For purposes of this subparagraph, each
violation with respect to any single employee shall be
treated as a separate violation.
``(B) The Secretary may assess a civil penalty against any
plan administrator of up to $100 a day from the date of the
plan administrator's failure to timely provide to any State
the information required to be disclosed under section
701(f)(3)(B)(ii). For purposes of this subparagraph, each
violation with respect to any single participant or
beneficiary shall be treated as a separate violation.''.
(2) Amendments to public health service act.--Section
2701(f) of the Public Health Service Act (42 U.S.C. 300gg(f))
is amended by adding at the end the following new paragraph:
``(3) Special rules for application in case of medicaid and
chip.--
``(A) In general.--A group health plan, and a health
insurance issuer offering group health insurance coverage in
connection with a group health plan, shall permit an employee
who is eligible, but not enrolled, for coverage under the
terms of the plan (or a dependent of such an employee if the
dependent is eligible, but not enrolled, for coverage under
such terms) to enroll for coverage under the terms of the
plan if either of the following conditions is met:
``(i) Termination of medicaid or chip coverage.--The
employee or dependent is covered under a Medicaid plan under
title XIX of the Social Security Act or under a State child
health plan under title XXI of such Act and coverage of the
employee or dependent under such a plan is terminated as a
result of loss of eligibility for such coverage and the
employee requests coverage under the group health plan (or
health insurance coverage) not later than 60 days after the
date of termination of such coverage.
``(ii) Eligibility for employment assistance under medicaid
or chip.--The employee or dependent becomes eligible for
assistance, with respect to coverage under the group health
plan or health insurance coverage, under such Medicaid plan
or State child health plan (including under any waiver or
demonstration project conducted under or in relation to such
a plan), if the employee requests coverage under the group
health plan or health insurance coverage not later than 60
days after the date the employee or dependent is determined
to be eligible for such assistance.
``(B) Coordination with medicaid and chip.--
``(i) Outreach to employees regarding availability of
medicaid and chip coverage.--
``(I) In general.--Each employer that maintains a group
health plan in a State that provides medical assistance under
a State Medicaid plan under title XIX of the Social Security
Act, or child health assistance under a State child health
plan under title XXI of such Act, in the form of premium
assistance for the purchase of coverage under a group health
plan, shall provide to each employee a written notice
informing the employee of potential opportunities then
currently available in the State in which the employee
resides for premium assistance under such plans for health
coverage of the employee or the employee's dependents. For
purposes of compliance with this subclause, the employer may
use any State-specific model notice developed in accordance
with section 701(f)(3)(B)(i)(II) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1181(f)(3)(B)(i)(II)).
``(II) Option to provide concurrent with provision of plan
materials to employee.--An employer may provide the model
notice applicable to the State in which an employee resides
concurrent with the furnishing of materials notifying the
employee of health plan eligibility, concurrent with
materials provided to the employee in connection with an open
season or election process conducted under the plan, or
concurrent with the furnishing of the summary plan
description as provided in section 104(b) of the Employee
Retirement Income Security Act of 1974.
``(ii) Disclosure about group health plan benefits to
states for medicaid and chip eligible individuals.--In the
case of an enrollee in a group health plan who is covered
under a Medicaid plan of a State under title XIX of the
Social Security Act or under a State child health plan under
title XXI of
[[Page H12061]]
such Act, the plan administrator of the group health plan
shall disclose to the State, upon request, information about
the benefits available under the group health plan in
sufficient specificity, as determined under regulations of
the Secretary of Health and Human Services in consultation
with the Secretary that require use of the model coverage
coordination disclosure form developed under section
311(b)(1)(C) of the Children's Health Insurance
Reauthorization Act of 2007, so as to permit the State to
make a determination (under paragraph (2)(B), (3), or (10) of
section 2105(c) of the Social Security Act or otherwise)
concerning the cost-effectiveness of the State providing
medical or child health assistance through premium assistance
for the purchase of coverage under such group health plan and
in order for the State to provide supplemental benefits
required under paragraph (10)(E) of such section or other
authority.''.
TITLE IV--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES
SEC. 401. CHILD HEALTH QUALITY IMPROVEMENT ACTIVITIES FOR
CHILDREN ENROLLED IN MEDICAID OR CHIP.
(a) Development of Child Health Quality Measures for
Children Enrolled in Medicaid or Chip.--Title XI (42 U.S.C.
1301 et seq.) is amended by inserting after section 1139 the
following new section:
``SEC. 1139A. CHILD HEALTH QUALITY MEASURES.
``(a) Development of an Initial Core Set of Health Care
Quality Measures for Children Enrolled in Medicaid or CHIP.--
``(1) In general.--Not later than January 1, 2009, the
Secretary shall identify and publish for general comment an
initial, recommended core set of child health quality
measures for use by State programs administered under titles
XIX and XXI, health insurance issuers and managed care
entities that enter into contracts with such programs, and
providers of items and services under such programs.
``(2) Identification of initial core measures.--In
consultation with the individuals and entities described in
subsection (b)(3), the Secretary shall identify existing
quality of care measures for children that are in use under
public and privately sponsored health care coverage
arrangements, or that are part of reporting systems that
measure both the presence and duration of health insurance
coverage over time.
``(3) Recommendations and dissemination.--Based on such
existing and identified measures, the Secretary shall publish
an initial core set of child health quality measures that
includes (but is not limited to) the following:
``(A) The duration of children's health insurance coverage
over a 12-month time period.
``(B) The availability and effectiveness of a full range
of--
``(i) preventive services, treatments, and services for
acute conditions, including services to promote healthy
birth, prevent and treat premature birth, and detect the
presence or risk of physical or mental conditions that could
adversely affect growth and development; and
``(ii) treatments to correct or ameliorate the effects of
physical and mental conditions, including chronic conditions,
in infants, young children, school-age children, and
adolescents.
``(C) The availability of care in a range of ambulatory and
inpatient health care settings in which such care is
furnished.
``(D) The types of measures that, taken together, can be
used to estimate the overall national quality of health care
for children, including children with special needs, and to
perform comparative analyses of pediatric health care quality
and racial, ethnic, and socioeconomic disparities in child
health and health care for children.
``(4) Encourage voluntary and standardized reporting.--Not
later than 2 years after the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2007, the Secretary, in consultation with States, shall
develop a standardized format for reporting information and
procedures and approaches that encourage States to use the
initial core measurement set to voluntarily report
information regarding the quality of pediatric health care
under titles XIX and XXI.
``(5) Adoption of best practices in implementing quality
programs.--The Secretary shall disseminate information to
States regarding best practices among States with respect to
measuring and reporting on the quality of health care for
children, and shall facilitate the adoption of such best
practices. In developing best practices approaches, the
Secretary shall give particular attention to State
measurement techniques that ensure the timeliness and
accuracy of provider reporting, encourage provider reporting
compliance, encourage successful quality improvement
strategies, and improve efficiency in data collection using
health information technology.
``(6) Reports to congress.--Not later than January 1, 2010,
and every 3 years thereafter, the Secretary shall report to
Congress on--
``(A) the status of the Secretary's efforts to improve--
``(i) quality related to the duration and stability of
health insurance coverage for children under titles XIX and
XXI;
``(ii) the quality of children's health care under such
titles, including preventive health services, health care for
acute conditions, chronic health care, and health services to
ameliorate the effects of physical and mental conditions and
to aid in growth and development of infants, young children,
school-age children, and adolescents with special health care
needs; and
``(iii) the quality of children's health care under such
titles across the domains of quality, including clinical
quality, health care safety, family experience with health
care, health care in the most integrated setting, and
elimination of racial, ethnic, and socioeconomic disparities
in health and health care;
``(B) the status of voluntary reporting by States under
titles XIX and XXI, utilizing the initial core quality
measurement set; and
``(C) any recommendations for legislative changes needed to
improve the quality of care provided to children under titles
XIX and XXI, including recommendations for quality reporting
by States.
``(7) Technical assistance.--The Secretary shall provide
technical assistance to States to assist them in adopting and
utilizing core child health quality measures in administering
the State plans under titles XIX and XXI.
``(8) Definition of core set.--In this section, the term
`core set' means a group of valid, reliable, and evidence-
based quality measures that, taken together--
``(A) provide information regarding the quality of health
coverage and health care for children;
``(B) address the needs of children throughout the
developmental age span; and
``(C) allow purchasers, families, and health care providers
to understand the quality of care in relation to the
preventive needs of children, treatments aimed at managing
and resolving acute conditions, and diagnostic and treatment
services whose purpose is to correct or ameliorate physical,
mental, or developmental conditions that could, if untreated
or poorly treated, become chronic.
``(b) Advancing and Improving Pediatric Quality Measures.--
``(1) Establishment of pediatric quality measures
program.--Not later than January 1, 2010, the Secretary shall
establish a pediatric quality measures program to--
``(A) improve and strengthen the initial core child health
care quality measures established by the Secretary under
subsection (a);
``(B) expand on existing pediatric quality measures used by
public and private health care purchasers and advance the
development of such new and emerging quality measures; and
``(C) increase the portfolio of evidence-based, consensus
pediatric quality measures available to public and private
purchasers of children's health care services, providers, and
consumers.
``(2) Evidence-based measures.--The measures developed
under the pediatric quality measures program shall, at a
minimum, be--
``(A) evidence-based and, where appropriate, risk adjusted;
``(B) designed to identify and eliminate racial and ethnic
disparities in child health and the provision of health care;
``(C) designed to ensure that the data required for such
measures is collected and reported in a standard format that
permits comparison of quality and data at a State, plan, and
provider level;
``(D) periodically updated; and
``(E) responsive to the child health needs, services, and
domains of health care quality described in clauses (i),
(ii), and (iii) of subsection (a)(6)(A).
``(3) Process for pediatric quality measures program.--In
identifying gaps in existing pediatric quality measures and
establishing priorities for development and advancement of
such measures, the Secretary shall consult with--
``(A) States;
``(B) pediatricians, children's hospitals, and other
primary and specialized pediatric health care professionals
(including members of the allied health professions) who
specialize in the care and treatment of children,
particularly children with special physical, mental, and
developmental health care needs;
``(C) dental professionals, including pediatric dental
professionals;
``(D) health care providers that furnish primary health
care to children and families who live in urban and rural
medically underserved communities or who are members of
distinct population sub-groups at heightened risk for poor
health outcomes;
``(E) national organizations representing children,
including children with disabilities and children with
chronic conditions;
``(F) national organizations representing consumers and
purchasers of children's health care;
``(G) national organizations and individuals with expertise
in pediatric health quality measurement; and
``(H) voluntary consensus standards setting organizations
and other organizations involved in the advancement of
evidence-based measures of health care.
``(4) Developing, validating, and testing a portfolio of
pediatric quality measures.--As part of the program to
advance pediatric quality measures, the Secretary shall--
``(A) award grants and contracts for the development,
testing, and validation of new, emerging, and innovative
evidence-based measures for children's health care services
across the domains of quality described in
[[Page H12062]]
clauses (i), (ii), and (iii) of subsection (a)(6)(A); and
``(B) award grants and contracts for--
``(i) the development of consensus on evidence-based
measures for children's health care services;
``(ii) the dissemination of such measures to public and
private purchasers of health care for children; and
``(iii) the updating of such measures as necessary.
``(5) Revising, strengthening, and improving initial core
measures.--Beginning no later than January 1, 2012, and
annually thereafter, the Secretary shall publish recommended
changes to the core measures described in subsection (a) that
shall reflect the testing, validation, and consensus process
for the development of pediatric quality measures described
in subsection paragraphs (1) through (4).
``(6) Definition of pediatric quality measure.--In this
subsection, the term `pediatric quality measure' means a
measurement of clinical care that is capable of being
examined through the collection and analysis of relevant
information, that is developed in order to assess 1 or more
aspects of pediatric health care quality in various
institutional and ambulatory health care settings, including
the structure of the clinical care system, the process of
care, the outcome of care, or patient experiences in care.
``(7) Construction.--Nothing in this section shall be
construed as supporting the restriction of coverage, under
title XIX or XXI or otherwise, to only those services that
are evidence-based.
``(c) Annual State Reports Regarding State-Specific Quality
of Care Measures Applied Under Medicaid or CHIP.--
``(1) Annual state reports.--Each State with a State plan
approved under title XIX or a State child health plan
approved under title XXI shall annually report to the
Secretary on the--
``(A) State-specific child health quality measures applied
by the States under such plans, including measures described
in subparagraphs (A) and (B) of subsection (a)(6); and
``(B) State-specific information on the quality of health
care furnished to children under such plans, including
information collected through external quality reviews of
managed care organizations under section 1932 of the Social
Security Act (42 U.S.C. 1396u-4) and benchmark plans under
sections 1937 and 2103 of such Act (42 U.S.C. 1396u-7,
1397cc).
``(2) Publication.--Not later than September 30, 2009, and
annually thereafter, the Secretary shall collect, analyze,
and make publicly available the information reported by
States under paragraph (1).
``(d) Demonstration Projects for Improving the Quality of
Children's Health Care and the Use of Health Information
Technology.--
``(1) In general.--During the period of fiscal years 2008
through 2012, the Secretary shall award not more than 10
grants to States and child health providers to conduct
demonstration projects to evaluate promising ideas for
improving the quality of children's health care provided
under title XIX or XXI, including projects to--
``(A) experiment with, and evaluate the use of, new
measures of the quality of children's health care under such
titles (including testing the validity and suitability for
reporting of such measures);
``(B) promote the use of health information technology in
care delivery for children under such titles;
``(C) evaluate provider-based models which improve the
delivery of children's health care services under such
titles, including care management for children with chronic
conditions and the use of evidence-based approaches to
improve the effectiveness, safety, and efficiency of health
care services for children; or
``(D) demonstrate the impact of the model electronic health
record format for children developed and disseminated under
subsection (f) on improving pediatric health, including the
effects of chronic childhood health conditions, and pediatric
health care quality as well as reducing health care costs.
``(2) Requirements.--In awarding grants under this
subsection, the Secretary shall ensure that--
``(A) only 1 demonstration project funded under a grant
awarded under this subsection shall be conducted in a State;
and
``(B) demonstration projects funded under grants awarded
under this subsection shall be conducted evenly between
States with large urban areas and States with large rural
areas.
``(3) Authority for multistate projects.--A demonstration
project conducted with a grant awarded under this subsection
may be conducted on a multistate basis, as needed.
``(4) Funding.--$20,000,000 of the amount appropriated
under subsection (i) for a fiscal year shall be used to carry
out this subsection.
``(e) Childhood Obesity Demonstration Project.--
``(1) Authority to conduct demonstration.--The Secretary,
in consultation with the Administrator of the Centers for
Medicare & Medicaid Services, shall conduct a demonstration
project to develop a comprehensive and systematic model for
reducing childhood obesity by awarding grants to eligible
entities to carry out such project. Such model shall--
``(A) identify, through self-assessment, behavioral risk
factors for obesity among children;
``(B) identify, through self-assessment, needed clinical
preventive and screening benefits among those children
identified as target individuals on the basis of such risk
factors;
``(C) provide ongoing support to such target individuals
and their families to reduce risk factors and promote the
appropriate use of preventive and screening benefits; and
``(D) be designed to improve health outcomes, satisfaction,
quality of life, and appropriate use of items and services
for which medical assistance is available under title XIX or
child health assistance is available under title XXI among
such target individuals.
``(2) Eligibility entities.--For purposes of this
subsection, an eligible entity is any of the following:
``(A) A city, county, or Indian tribe.
``(B) A local or tribal educational agency.
``(C) An accredited university, college, or community
college.
``(D) A Federally-qualified health center.
``(E) A local health department.
``(F) A health care provider.
``(G) A community-based organization.
``(H) Any other entity determined appropriate by the
Secretary, including a consortia or partnership of entities
described in any of subparagraphs (A) through (G).
``(3) Use of funds.--An eligible entity awarded a grant
under this subsection shall use the funds made available
under the grant to--
``(A) carry out community-based activities related to
reducing childhood obesity, including by--
``(i) forming partnerships with entities, including schools
and other facilities providing recreational services, to
establish programs for after school and weekend community
activities that are designed to reduce childhood obesity;
``(ii) forming partnerships with daycare facilities to
establish programs that promote healthy eating behaviors and
physical activity; and
``(iii) developing and evaluating community educational
activities targeting good nutrition and promoting healthy
eating behaviors;
``(B) carry out age-appropriate school-based activities
that are designed to reduce childhood obesity, including by--
``(i) developing and testing educational curricula and
intervention programs designed to promote healthy eating
behaviors and habits in youth, which may include--
``(I) after hours physical activity programs; and
``(II) science-based interventions with multiple components
to prevent eating disorders including nutritional content,
understanding and responding to hunger and satiety, positive
body image development, positive self-esteem development, and
learning life skills (such as stress management,
communication skills, problemsolving and decisionmaking
skills), as well as consideration of cultural and
developmental issues, and the role of family, school, and
community;
``(ii) providing education and training to educational
professionals regarding how to promote a healthy lifestyle
and a healthy school environment for children;
``(iii) planning and implementing a healthy lifestyle
curriculum or program with an emphasis on healthy eating
behaviors and physical activity; and
``(iv) planning and implementing healthy lifestyle classes
or programs for parents or guardians, with an emphasis on
healthy eating behaviors and physical activity for children;
``(C) carry out educational, counseling, promotional, and
training activities through the local health care delivery
systems including by--
``(i) promoting healthy eating behaviors and physical
activity services to treat or prevent eating disorders, being
overweight, and obesity;
``(ii) providing patient education and counseling to
increase physical activity and promote healthy eating
behaviors;
``(iii) training health professionals on how to identify
and treat obese and overweight individuals which may include
nutrition and physical activity counseling; and
``(iv) providing community education by a health
professional on good nutrition and physical activity to
develop a better understanding of the relationship between
diet, physical activity, and eating disorders, obesity, or
being overweight; and
``(D) provide, through qualified health professionals,
training and supervision for community health workers to--
``(i) educate families regarding the relationship between
nutrition, eating habits, physical activity, and obesity;
``(ii) educate families about effective strategies to
improve nutrition, establish healthy eating patterns, and
establish appropriate levels of physical activity; and
``(iii) educate and guide parents regarding the ability to
model and communicate positive health behaviors.
``(4) Priority.--In awarding grants under paragraph (1),
the Secretary shall give priority to awarding grants to
eligible entities--
``(A) that demonstrate that they have previously applied
successfully for funds to carry out activities that seek to
promote individual and community health and to prevent the
incidence of chronic disease and that can cite published and
peer-reviewed research demonstrating that the activities
[[Page H12063]]
that the entities propose to carry out with funds made
available under the grant are effective;
``(B) that will carry out programs or activities that seek
to accomplish a goal or goals set by the State in the Healthy
People 2010 plan of the State;
``(C) that provide non-Federal contributions, either in
cash or in-kind, to the costs of funding activities under the
grants;
``(D) that develop comprehensive plans that include a
strategy for extending program activities developed under
grants in the years following the fiscal years for which they
receive grants under this subsection;
``(E) located in communities that are medically
underserved, as determined by the Secretary;
``(F) located in areas in which the average poverty rate is
at least 150 percent or higher of the average poverty rate in
the State involved, as determined by the Secretary; and
``(G) that submit plans that exhibit multisectoral,
cooperative conduct that includes the involvement of a broad
range of stakeholders, including--
``(i) community-based organizations;
``(ii) local governments;
``(iii) local educational agencies;
``(iv) the private sector;
``(v) State or local departments of health;
``(vi) accredited colleges, universities, and community
colleges;
``(vii) health care providers;
``(viii) State and local departments of transportation and
city planning; and
``(ix) other entities determined appropriate by the
Secretary.
``(5) Program design.--
``(A) Initial design.--Not later than 1 year after the date
of enactment of the Children's Health Insurance Program
Reauthorization Act of 2007, the Secretary shall design the
demonstration project. The demonstration should draw upon
promising, innovative models and incentives to reduce
behavioral risk factors. The Administrator of the Centers for
Medicare & Medicaid Services shall consult with the Director
of the Centers for Disease Control and Prevention, the
Director of the Office of Minority Health, the heads of other
agencies in the Department of Health and Human Services, and
such professional organizations, as the Secretary determines
to be appropriate, on the design, conduct, and evaluation of
the demonstration.
``(B) Number and project areas.--Not later than 2 years
after the date of enactment of the Children's Health
Insurance Program Reauthorization Act of 2007, the Secretary
shall award 1 grant that is specifically designed to
determine whether programs similar to programs to be
conducted by other grantees under this subsection should be
implemented with respect to the general population of
children who are eligible for child health assistance under
State child health plans under title XXI in order to reduce
the incidence of childhood obesity among such population.
``(6) Report to congress.--Not later than 3 years after the
date the Secretary implements the demonstration project under
this subsection, the Secretary shall submit to Congress a
report that describes the project, evaluates the
effectiveness and cost effectiveness of the project,
evaluates the beneficiary satisfaction under the project, and
includes any such other information as the Secretary
determines to be appropriate.
``(7) Definitions.--In this subsection:
``(A) Federally-qualified health center.--The term
`Federally-qualified health center' has the meaning given
that term in section 1905(l)(2)(B).
``(B) Indian tribe.--The term `Indian tribe' has the
meaning given that term in section 4 of the Indian Health
Care Improvement Act (25 U.S.C. 1603).
``(C) Self-assessment.--The term `self-assessment' means a
form that--
``(i) includes questions regarding--
``(I) behavioral risk factors;
``(II) needed preventive and screening services; and
``(III) target individuals' preferences for receiving
follow-up information;
``(ii) is assessed using such computer generated assessment
programs; and
``(iii) allows for the provision of such ongoing support to
the individual as the Secretary determines appropriate.
``(D) Ongoing support.--The term `ongoing support' means--
``(i) to provide any target individual with information,
feedback, health coaching, and recommendations regarding--
``(I) the results of a self-assessment given to the
individual;
``(II) behavior modification based on the self-assessment;
and
``(III) any need for clinical preventive and screening
services or treatment including medical nutrition therapy;
``(ii) to provide any target individual with referrals to
community resources and programs available to assist the
target individual in reducing health risks; and
``(iii) to provide the information described in clause (i)
to a health care provider, if designated by the target
individual to receive such information.
``(8) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection, $25,000,000
for the period of fiscal years 2008 through 2012.
``(f) Development of Model Electronic Health Record Format
for Children Enrolled in Medicaid or CHIP.--
``(1) In general.--Not later than January 1, 2009, the
Secretary shall establish a program to encourage the
development and dissemination of a model electronic health
record format for children enrolled in the State plan under
title XIX or the State child health plan under title XXI that
is--
``(A) subject to State laws, accessible to parents,
caregivers, and other consumers for the sole purpose of
demonstrating compliance with school or leisure activity
requirements, such as appropriate immunizations or physicals;
``(B) designed to allow interoperable exchanges that
conform with Federal and State privacy and security
requirements;
``(C) structured in a manner that permits parents and
caregivers to view and understand the extent to which the
care their children receive is clinically appropriate and of
high quality; and
``(D) capable of being incorporated into, and otherwise
compatible with, other standards developed for electronic
health records.
``(2) Funding.--$5,000,000 of the amount appropriated under
subsection (i) for a fiscal year shall be used to carry out
this subsection.
``(g) Study of Pediatric Health and Health Care Quality
Measures.--
``(1) In general.--Not later than July 1, 2009, the
Institute of Medicine shall study and report to Congress on
the extent and quality of efforts to measure child health
status and the quality of health care for children across the
age span and in relation to preventive care, treatments for
acute conditions, and treatments aimed at ameliorating or
correcting physical, mental, and developmental conditions in
children. In conducting such study and preparing such report,
the Institute of Medicine shall--
``(A) consider all of the major national population-based
reporting systems sponsored by the Federal Government that
are currently in place, including reporting requirements
under Federal grant programs and national population surveys
and estimates conducted directly by the Federal Government;
``(B) identify the information regarding child health and
health care quality that each system is designed to capture
and generate, the study and reporting periods covered by each
system, and the extent to which the information so generated
is made widely available through publication;
``(C) identify gaps in knowledge related to children's
health status, health disparities among subgroups of
children, the effects of social conditions on children's
health status and use and effectiveness of health care, and
the relationship between child health status and family
income, family stability and preservation, and children's
school readiness and educational achievement and attainment;
and
``(D) make recommendations regarding improving and
strengthening the timeliness, quality, and public
transparency and accessibility of information about child
health and health care quality.
``(2) Funding.--Up to $1,000,000 of the amount appropriated
under subsection (i) for a fiscal year shall be used to carry
out this subsection.
``(h) Rule of Construction.--Notwithstanding any other
provision in this section, no evidence based quality measure
developed, published, or used as a basis of measurement or
reporting under this section may be used to establish an
irrebuttable presumption regarding either the medical
necessity of care or the maximum permissible coverage for any
individual child who is eligible for and receiving medical
assistance under title XIX or child health assistance under
title XXI.
``(i) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated for each of
fiscal years 2008 through 2012, $45,000,000 for the purpose
of carrying out this section (other than subsection (e)).
Funds appropriated under this subsection shall remain
available until expended.''.
(b) Increased Matching Rate for Collecting and Reporting on
Child Health Measures.--Section 1903(a)(3)(A) (42 U.S.C.
1396b(a)(3)(A)), is amended--
(1) by striking ``and'' at the end of clause (i); and
(2) by adding at the end the following new clause:
``(iii) an amount equal to the Federal medical assistance
percentage (as defined in section 1905(b)) of so much of the
sums expended during such quarter (as found necessary by the
Secretary for the proper and efficient administration of the
State plan) as are attributable to such developments or
modifications of systems of the type described in clause (i)
as are necessary for the efficient collection and reporting
on child health measures; and''.
SEC. 402. IMPROVED AVAILABILITY OF PUBLIC INFORMATION
REGARDING ENROLLMENT OF CHILDREN IN CHIP AND
MEDICAID.
(a) Inclusion of Process and Access Measures in Annual
State Reports.--Section 2108 (42 U.S.C. 1397hh) is amended--
(1) in subsection (a), in the matter preceding paragraph
(1), by striking ``The State'' and inserting ``Subject to
subsection (e), the State''; and
(2) by adding at the end the following new subsection:
``(e) Information Required for Inclusion in State Annual
Report.--The State shall include the following information in
the annual report required under subsection (a):
``(1) Eligibility criteria, enrollment, and retention data
(including data with respect to continuity of coverage or
duration of benefits).
[[Page H12064]]
``(2) Data regarding the extent to which the State uses
process measures with respect to determining the eligibility
of children under the State child health plan, including
measures such as 12-month continuous eligibility, self-
declaration of income for applications or renewals, or
presumptive eligibility.
``(3) Data regarding denials of eligibility and
redeterminations of eligibility.
``(4) Data regarding access to primary and specialty
services, access to networks of care, and care coordination
provided under the State child health plan, using quality
care and consumer satisfaction measures included in the
Consumer Assessment of Healthcare Providers and Systems
(CAHPS) survey.
``(5) If the State provides child health assistance in the
form of premium assistance for the purchase of coverage under
a group health plan, data regarding the provision of such
assistance, including the extent to which employer-sponsored
health insurance coverage is available for children eligible
for child health assistance under the State child health
plan, the range of the monthly amount of such assistance
provided on behalf of a child or family, the number of
children or families provided such assistance on a monthly
basis, the income of the children or families provided such
assistance, the benefits and cost-sharing protection provided
under the State child health plan to supplement the coverage
purchased with such premium assistance, the effective
strategies the State engages in to reduce any administrative
barriers to the provision of such assistance, and, the
effects, if any, of the provision of such assistance on
preventing the coverage provided under the State child health
plan from substituting for coverage provided under employer-
sponsored health insurance offered in the State.
``(6) To the extent applicable, a description of any State
activities that are designed to reduce the number of
uncovered children in the State, including through a State
health insurance connector program or support for innovative
private health coverage initiatives.''.
(b) Standardized Reporting Format.--
(1) In general.--Not later than 1 year after the date of
enactment of this Act, the Secretary shall specify a
standardized format for States to use for reporting the
information required under section 2108(e) of the Social
Security Act, as added by subsection (a)(2).
(2) Transition period for states.--Each State that is
required to submit a report under subsection (a) of section
2108 of the Social Security Act that includes the information
required under subsection (e) of such section may use up to 3
reporting periods to transition to the reporting of such
information in accordance with the standardized format
specified by the Secretary under paragraph (1).
(c) Additional Funding for the Secretary To Improve
Timeliness of Data Reporting and Analysis for Purposes of
Determining Enrollment Increases Under Medicaid and CHIP.--
(1) Appropriation.--There is appropriated, out of any money
in the Treasury not otherwise appropriated, $5,000,000 to the
Secretary for fiscal year 2008 for the purpose of improving
the timeliness of the data reported and analyzed from the
Medicaid Statistical Information System (MSIS) for purposes
of providing more timely data on enrollment and eligibility
of children under Medicaid and CHIP and to provide guidance
to States with respect to any new reporting requirements
related to such improvements. Amounts appropriated under this
paragraph shall remain available until expended.
(2) Requirements.--The improvements made by the Secretary
under paragraph (1) shall be designed and implemented
(including with respect to any necessary guidance for States
to report such information in a complete and expeditious
manner) so that, beginning no later than October 1, 2008,
data regarding the enrollment of low-income children (as
defined in section 2110(c)(4) of the Social Security Act (42
U.S.C. 1397jj(c)(4)) of a State enrolled in the State plan
under Medicaid or the State child health plan under CHIP with
respect to a fiscal year shall be collected and analyzed by
the Secretary within 6 months of submission.
(d) GAO Study and Report on Access to Primary and
Speciality Services.--
(1) In general.--The Comptroller General of the United
States shall conduct a study of children's access to primary
and specialty services under Medicaid and CHIP, including--
(A) the extent to which providers are willing to treat
children eligible for such programs;
(B) information on such children's access to networks of
care;
(C) geographic availability of primary and specialty
services under such programs;
(D) the extent to which care coordination is provided for
children's care under Medicaid and CHIP; and
(E) as appropriate, information on the degree of
availability of services for children under such programs.
(2) Report.--Not later than 2 years after the date of
enactment of this Act, the Comptroller General shall submit a
report to the Committee on Finance of the Senate and the
Committee on Energy and Commerce of the House of
Representatives on the study conducted under paragraph (1)
that includes recommendations for such Federal and State
legislative and administrative changes as the Comptroller
General determines are necessary to address any barriers to
access to children's care under Medicaid and CHIP that may
exist.
SEC. 403. APPLICATION OF CERTAIN MANAGED CARE QUALITY
SAFEGUARDS TO CHIP.
(a) In General.--Section 2103(f) of Social Security Act (42
U.S.C. 1397bb(f)) is amended by adding at the end the
following new paragraph:
``(3) Compliance with managed care requirements.--The State
child health plan shall provide for the application of
subsections (a)(4), (a)(5), (b), (c), (d), and (e) of section
1932 (relating to requirements for managed care) to coverage,
State agencies, enrollment brokers, managed care entities,
and managed care organizations under this title in the same
manner as such subsections apply to coverage and such
entities and organizations under title XIX.''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply to contract years for health plans beginning on
or after July 1, 2008.
TITLE V--IMPROVING ACCESS TO BENEFITS
SEC. 501. DENTAL BENEFITS.
(a) Coverage.--
(1) In general.--Section 2103 (42 U.S.C. 1397cc) is
amended--
(A) in subsection (a)--
(i) in the matter before paragraph (1), by striking
``subsection (c)(5)'' and inserting ``paragraphs (5) and (7)
of subsection (c)''; and
(ii) in paragraph (1), by inserting ``at least'' after
``that is''; and
(B) in subsection (c)--
(i) by redesignating paragraph (5) as paragraph (7); and
(ii) by inserting after paragraph (4), the following:
``(5) Dental benefits.--
``(A) In general.--The child health assistance provided to
a targeted low-income child shall include coverage of dental
services necessary to prevent disease and promote oral
health, restore oral structures to health and function, and
treat emergency conditions.
``(B) Permitting use of dental benchmark plans by certain
states.--A State may elect to meet the requirement of
subparagraph (A) through dental coverage that is equivalent
to a benchmark dental benefit package described in
subparagraph (C).
``(C) Benchmark dental benefit packages.--The benchmark
dental benefit packages are as follows:
``(i) FEHBP children's dental coverage.--A dental benefits
plan under chapter 89A of title 5, United States Code, that
has been selected most frequently by employees seeking
dependent coverage, among such plans that provide such
dependent coverage, in either of the previous 2 plan years.
``(ii) State employee dependent dental coverage.--A dental
benefits plan that is offered and generally available to
State employees in the State involved and that has been
selected most frequently by employees seeking dependent
coverage, among such plans that provide such dependent
coverage, in either of the previous 2 plan years.
``(iii) Coverage offered through commercial dental plan.--A
dental benefits plan that has the largest insured commercial,
non-medicaid enrollment of dependent covered lives of such
plans that is offered in the State involved.''.
(2) Assuring access to care.--Section 2102(a)(7)(B) (42
U.S.C. 1397bb(c)(2)) is amended by inserting ``and services
described in section 2103(c)(5)'' after ``emergency
services''.
(3) Effective date.--The amendments made by paragraph (1)
shall apply to coverage of items and services furnished on or
after October 1, 2008.
(b) Dental Education for Parents of Newborns.--The
Secretary shall develop and implement, through entities that
fund or provide perinatal care services to targeted low-
income children under a State child health plan under title
XXI of the Social Security Act, a program to deliver oral
health educational materials that inform new parents about
risks for, and prevention of, early childhood caries and the
need for a dental visit within their newborn's first year of
life.
(c) Provision of Dental Services Through FQHCs.--
(1) Medicaid.--Section 1902(a) (42 U.S.C. 1396a(a)) is
amended--
(A) by striking ``and'' at the end of paragraph (69);
(B) by striking the period at the end of paragraph (70) and
inserting ``; and''; and
(C) by inserting after paragraph (70) the following new
paragraph:
``(71) provide that the State will not prevent a Federally-
qualified health center from entering into contractual
relationships with private practice dental providers in the
provision of Federally-qualified health center services.''.
(2) CHIP.--Section 2107(e)(1) (42 U.S.C. 1397g(e)(1)), as
amended by subsections (a)(2) and (d)(2) of section 203, is
amended by inserting after subparagraph (B) the following new
subparagraph (and redesignating the succeeding subparagraphs
accordingly):
``(C) Section 1902(a)(71) (relating to limiting FQHC
contracting for provision of dental services).''.
(3) Effective date.--The amendments made by this subsection
shall take effect on January 1, 2008.
(d) Reporting Information on Dental Health.--
[[Page H12065]]
(1) Medicaid.--Section 1902(a)(43)(D)(iii) (42 U.S.C.
1396a(a)(43)(D)(iii)) is amended by inserting ``and other
information relating to the provision of dental services to
such children described in section 2108(e)'' after
``receiving dental services,''.
(2) CHIP.--Section 2108 (42 U.S.C. 1397hh) is amended by
adding at the end the following new subsection:
``(e) Information on Dental Care for Children.--
``(1) In general.--Each annual report under subsection (a)
shall include the following information with respect to care
and services described in section 1905(r)(3) provided to
targeted low-income children enrolled in the State child
health plan under this title at any time during the year
involved:
``(A) The number of enrolled children by age grouping used
for reporting purposes under section 1902(a)(43).
``(B) For children within each such age grouping,
information of the type contained in questions 12(a)-(c) of
CMS Form 416 (that consists of the number of enrolled
targeted low income children who receive any, preventive, or
restorative dental care under the State plan).
``(C) For the age grouping that includes children 8 years
of age, the number of such children who have received a
protective sealant on at least one permanent molar tooth.
``(2) Inclusion of information on enrollees in managed care
plans.--The information under paragraph (1) shall include
information on children who are enrolled in managed care
plans and other private health plans and contracts with such
plans under this title shall provide for the reporting of
such information by such plans to the State.''.
(3) Effective date.--The amendments made by this subsection
shall be effective for annual reports submitted for years
beginning after date of enactment.
(e) Improved Accessibility of Dental Provider Information
to Enrollees Under Medicaid and CHIP.--The Secretary shall--
(1) work with States, pediatric dentists, and other dental
providers (including providers that are, or are affiliated
with, a school of dentistry) to include, not later than 6
months after the date of the enactment of this Act, on the
Insure Kids Now website (http://www.insurekidsnow.gov/) and
hotline (1-877-KIDS-NOW) (or on any successor websites or
hotlines) a current and accurate list of all such dentists
and providers within each State that provide dental services
to children enrolled in the State plan (or waiver) under
Medicaid or the State child health plan (or waiver) under
CHIP, and shall ensure that such list is updated at least
quarterly; and
(2) work with States to include, not later than 6 months
after the date of the enactment of this Act, a description of
the dental services provided under each State plan (or
waiver) under Medicaid and each State child health plan (or
waiver) under CHIP on such Insure Kids Now website, and shall
ensure that such list is updated at least annually.
(f) Inclusion of Status of Efforts To Improve Dental Care
in Reports on the Quality of Children's Health Care Under
Medicaid and CHIP.--Section 1139A(a), as added by section
401(a), is amended--
(1) in paragraph (3)(B)(ii), by inserting ``and, with
respect to dental care, conditions requiring the restoration
of teeth, relief of pain and infection, and maintenance of
dental health'' after ``chronic conditions''; and
(2) in paragraph (6)(A)(ii), by inserting ``dental care,''
after ``preventive health services,''.
(g) GAO Study and Report.--
(1) Study.--The Comptroller General of the United States
shall provide for a study that examines--
(A) access to dental services by children in underserved
areas;
(B) children's access to oral health care, including
preventive and restorative services, under Medicaid and CHIP,
including--
(i) the extent to which dental providers are willing to
treat children eligible for such programs;
(ii) information on such children's access to networks of
care, including such networks that serve special needs
children; and
(iii) geographic availability of oral health care,
including preventive and restorative services, under such
programs; and
(C) the feasibility and appropriateness of using qualified
mid-level dental health providers, in coordination with
dentists, to improve access for children to oral health
services and public health overall.
(2) Report.--Not later than 18 months year after the date
of the enactment of this Act, the Comptroller General shall
submit to Congress a report on the study conducted under
paragraph (1). The report shall include recommendations for
such Federal and State legislative and administrative changes
as the Comptroller General determines are necessary to
address any barriers to access to oral health care, including
preventive and restorative services, under Medicaid and CHIP
that may exist.
SEC. 502. MENTAL HEALTH PARITY IN CHIP PLANS.
(a) Assurance of Parity.--Section 2103(c) (42 U.S.C.
1397cc(c)), as amended by section 501(a)(1)(B), is amended by
inserting after paragraph (5), the following:
``(6) Mental health services parity.--
``(A) In general.--In the case of a State child health plan
that provides both medical and surgical benefits and mental
health or substance abuse benefits, such plan shall ensure
that the financial requirements and treatment limitations
applicable to such mental health or substance abuse benefits
are no more restrictive than the financial requirements and
treatment limitations applied to substantially all medical
and surgical benefits covered by the plan.
``(B) Deemed compliance.--To the extent that a State child
health plan includes coverage with respect to an individual
described in section 1905(a)(4)(B) and covered under the
State plan under section 1902(a)(10)(A) of the services
described in section 1905(a)(4)(B) (relating to early and
periodic screening, diagnostic, and treatment services
defined in section 1905(r)) and provided in accordance with
section 1902(a)(43), such plan shall be deemed to satisfy the
requirements of subparagraph (A).''.
(b) Conforming Amendments.--Section 2103 (42 U.S.C. 1397cc)
is amended--
(1) in subsection (a), as amended by section
501(a)(1)(A)(i), in the matter preceding paragraph (1), by
inserting ``, (6),'' after ``(5)''; and
(2) in subsection (c)(2), by striking subparagraph (B) and
redesignating subparagraphs (C) and (D) as subparagraphs (B)
and (C), respectively.
SEC. 503. APPLICATION OF PROSPECTIVE PAYMENT SYSTEM FOR
SERVICES PROVIDED BY FEDERALLY-QUALIFIED HEALTH
CENTERS AND RURAL HEALTH CLINICS.
(a) Application of Prospective Payment System.--
(1) In general.--Section 2107(e)(1) (42 U.S.C.
1397gg(e)(1)), as amended by section 501(c)(2) is amended by
inserting after subparagraph (C) the following new
subparagraph (and redesignating the succeeding subparagraphs
accordingly):
``(D) Section 1902(bb) (relating to payment for services
provided by Federally-qualified health centers and rural
health clinics).''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to services provided on or after October 1, 2008.
(b) Transition Grants.--
(1) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated to the
Secretary for fiscal year 2008, $5,000,000, to remain
available until expended, for the purpose of awarding grants
to States with State child health plans under CHIP that are
operated separately from the State Medicaid plan under title
XIX of the Social Security Act (including any waiver of such
plan), or in combination with the State Medicaid plan, for
expenditures related to transitioning to compliance with the
requirement of section 2107(e)(1)(D) of the Social Security
Act (as added by subsection (a)) to apply the prospective
payment system established under section 1902(bb) of the such
Act (42 U.S.C. 1396a(bb)) to services provided by Federally-
qualified health centers and rural health clinics.
(2) Monitoring and report.--The Secretary shall monitor the
impact of the application of such prospective payment system
on the States described in paragraph (1) and, not later than
October 1, 2010, shall report to Congress on any effect on
access to benefits, provider payment rates, or scope of
benefits offered by such States as a result of the
application of such payment system.
SEC. 504. PREMIUM GRACE PERIOD.
(a) In General.--Section 2103(e)(3) (42 U.S.C.
1397cc(e)(3)) is amended by adding at the end the following
new subparagraph:
``(C) Premium grace period.--The State child health plan--
``(i) shall afford individuals enrolled under the plan a
grace period of at least 30 days from the beginning of a new
coverage period to make premium payments before the
individual's coverage under the plan may be terminated; and
``(ii) shall provide to such an individual, not later than
7 days after the first day of such grace period, notice--
``(I) that failure to make a premium payment within the
grace period will result in termination of coverage under the
State child health plan; and
``(II) of the individual's right to challenge the proposed
termination pursuant to the applicable Federal regulations.
For purposes of clause (i), the term `new coverage period'
means the month immediately following the last month for
which the premium has been paid.''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply to new coverage periods beginning on or after
January 1, 2009.
SEC. 505. DEMONSTRATION PROJECTS RELATING TO DIABETES
PREVENTION.
There is authorized to be appropriated $15,000,000 during
the period of fiscal years 2008 through 2012 to fund
demonstration projects in up to 10 States over 3 years for
voluntary incentive programs to promote children's receipt of
relevant screenings and improvements in healthy eating and
physical activity with the aim of reducing the incidence of
type 2 diabetes. Such programs may involve reductions in
cost-sharing or premiums when children receive regular
screening and reach certain benchmarks in healthy eating and
physical activity. Under such programs, a State may also
provide financial bonuses for partnerships with entities,
such as schools, which increase their education and efforts
with respect to reducing the incidence of type 2 diabetes and
may also devise incentives for providers serving children
covered under this title and title XIX to perform
[[Page H12066]]
relevant screening and counseling regarding healthy eating
and physical activity. Upon completion of these
demonstrations, the Secretary shall provide a report to
Congress on the results of the State demonstration projects
and the degree to which they helped improve health outcomes
related to type 2 diabetes in children in those States.
SEC. 506. CLARIFICATION OF COVERAGE OF SERVICES PROVIDED
THROUGH SCHOOL-BASED HEALTH CENTERS.
Section 2103(c) (42 U.S.C. 1397cc(c)), as amended by
section 501(a)(1)(B), is amended by adding at the end the
following new paragraph:
``(8) Availability of coverage for items and services
furnished through school-based health centers.--Nothing in
this title shall be construed as limiting a State's ability
to provide child health assistance for covered items and
services that are furnished through school-based health
centers.''.
TITLE VI--PROGRAM INTEGRITY AND OTHER MISCELLANEOUS PROVISIONS
Subtitle A--Program Integrity and Data Collection
SEC. 601. PAYMENT ERROR RATE MEASUREMENT (``PERM'').
(a) Expenditures Related to Compliance With Requirements.--
(1) Enhanced payments.--Section 2105(c) (42 U.S.C.
1397ee(c)), as amended by section 301(a), is amended by
adding at the end the following new paragraph:
``(12) Enhanced payments.--Notwithstanding subsection (b),
the enhanced FMAP with respect to payments under subsection
(a) for expenditures related to the administration of the
payment error rate measurement (PERM) requirements applicable
to the State child health plan in accordance with the
Improper Payments Information Act of 2002 and parts 431 and
457 of title 42, Code of Federal Regulations (or any related
or successor guidance or regulations) shall in no event be
less than 90 percent.''.
(2) Exclusion of from cap on administrative expenditures.--
Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)C)), as amended
by section 302(b)), is amended by adding at the end the
following:
``(iv) Payment error rate measurement (perm)
expenditures.--Expenditures related to the administration of
the payment error rate measurement (PERM) requirements
applicable to the State child health plan in accordance with
the Improper Payments Information Act of 2002 and parts 431
and 457 of title 42, Code of Federal Regulations (or any
related or successor guidance or regulations).''.
(b) Final Rule Required To Be in Effect for All States.--
Notwithstanding parts 431 and 457 of title 42, Code of
Federal Regulations (as in effect on the date of enactment of
this Act), the Secretary shall not calculate or publish any
national or State-specific error rate based on the
application of the payment error rate measurement (in this
section referred to as ``PERM'') requirements to CHIP until
after the date that is 6 months after the date on which a
final rule implementing such requirements in accordance with
the requirements of subsection (c) is in effect for all
States. Any calculation of a national error rate or a State
specific error rate after such final rule in effect for all
States may only be inclusive of errors, as defined in such
final rule or in guidance issued within a reasonable time
frame after the effective date for such final rule that
includes detailed guidance for the specific methodology for
error determinations.
(c) Requirements for Final Rule.--For purposes of
subsection (b), the requirements of this subsection are that
the final rule implementing the PERM requirements shall--
(1) include--
(A) clearly defined criteria for errors for both States and
providers;
(B) a clearly defined process for appealing error
determinations by--
(i) review contractors; or
(ii) the agency and personnel described in section
431.974(a)(2) of title 42, Code of Federal Regulations, as in
effect on September 1, 2007, responsible for the development,
direction, implementation, and evaluation of eligibility
reviews and associated activities; and
(C) clearly defined responsibilities and deadlines for
States in implementing any corrective action plans; and
(2) provide that the payment error rate determined for a
State shall not take into account payment errors resulting
from the State's verification of an applicant's self-
declaration or self-certification of eligibility for, and the
correct amount of, medical assistance or child health
assistance, if the State process for verifying an applicant's
self-declaration or self-certification satisfies the
requirements for such process applicable under regulations
promulgated by the Secretary or otherwise approved by the
Secretary.
(d) Option for Application of Data for States in First
Application Cycle Under the Interim Final Rule.--After the
final rule implementing the PERM requirements in accordance
with the requirements of subsection (c) is in effect for all
States, a State for which the PERM requirements were first in
effect under an interim final rule for fiscal year 2007 may
elect to accept any payment error rate determined in whole or
in part for the State on the basis of data for that fiscal
year or may elect to not have any payment error rate
determined on the basis of such data and, instead, shall be
treated as if fiscal year 2010 were the first fiscal year for
which the PERM requirements apply to the State.
(e) Harmonization of MEQC and PERM.--
(1) Reduction of redundancies.--The Secretary shall review
the Medicaid Eligibility Quality Control (in this subsection
referred to as the ``MEQC'') requirements with the PERM
requirements and coordinate consistent implementation of both
sets of requirements, while reducing redundancies.
(2) State option to apply perm data.--A State may elect,
for purposes of determining the erroneous excess payments for
medical assistance ratio applicable to the State for a fiscal
year under section 1903(u) of the Social Security Act (42
U.S.C. 1396b(u)) to substitute data resulting from the
application of the PERM requirements to the State after the
final rule implementing such requirements is in effect for
all States for data obtained from the application of the MEQC
requirements to the State with respect to a fiscal year.
(3) State option to apply meqc data.--For purposes of
satisfying the requirements of subpart Q of part 431 of title
42, Code of Federal Regulations, as in effect on September 1,
2007, relating to Medicaid eligibility reviews, a State may
elect to substitute data obtained through MEQC reviews
conducted in accordance with section 1903(u) of the Social
Security Act (42 U.S.C. 1396b(u)) for data required for
purposes of PERM requirements, but only if the State MEQC
reviews are based on a broad, representative sample of
Medicaid applicants or enrollees in the States.
(f) Identification of Improved State-Specific Sample
Sizes.--The Secretary shall establish State-specific sample
sizes for application of the PERM requirements with respect
to State child health plans for fiscal years beginning with
fiscal year 2009, on the basis of such information as the
Secretary determines appropriate. In establishing such sample
sizes, the Secretary shall, to the greatest extent
practicable--
(1) minimize the administrative cost burden on States under
Medicaid and CHIP; and
(2) maintain State flexibility to manage such programs.
SEC. 602. IMPROVING DATA COLLECTION.
(a) Increased Appropriation.--Section 2109(b)(2) (42 U.S.C.
1397ii(b)(2)) is amended by striking ``$10,000,000 for fiscal
year 2000'' and inserting ``$20,000,000 for fiscal year
2008''.
(b) Use of Additional Funds.--Section 2109(b) (42 U.S.C.
1397ii(b)), as amended by subsection (a), is amended--
(1) by redesignating paragraph (2) as paragraph (4); and
(2) by inserting after paragraph (1), the following new
paragraphs:
``(2) Additional requirements.--In addition to making the
adjustments required to produce the data described in
paragraph (1), with respect to data collection occurring for
fiscal years beginning with fiscal year 2008, in appropriate
consultation with the Secretary of Health and Human Services,
the Secretary of Commerce shall do the following:
``(A) Make appropriate adjustments to the Current
Population Survey to develop more accurate State-specific
estimates of the number of children enrolled in health
coverage under title XIX or this title.
``(B) Make appropriate adjustments to the Current
Population Survey to improve the survey estimates used to
determine the child population growth factor under section
2104(i)(5)(B) and any other data necessary for carrying out
this title.
``(C) Include health insurance survey information in the
American Community Survey related to children.
``(D) Assess whether American Community Survey estimates,
once such survey data are first available, produce more
reliable estimates than the Current Population Survey with
respect to the purposes described in subparagraph (B).
``(E) On the basis of the assessment required under
subparagraph (D), recommend to the Secretary of Health and
Human Services whether American Community Survey estimates
should be used in lieu of, or in some combination with,
Current Population Survey estimates for the purposes
described in subparagraph (B).
``(F) Continue making the adjustments described in the last
sentence of paragraph (1) with respect to expansion of the
sample size used in State sampling units, the number of
sampling units in a State, and using an appropriate
verification element.
``(3) Authority for the secretary of health and human
services to transition to the use of all, or some combination
of, acs estimates upon recommendation of the secretary of
commerce.--If, on the basis of the assessment required under
paragraph (2)(D), the Secretary of Commerce recommends to the
Secretary of Health and Human Services that American
Community Survey estimates should be used in lieu of, or in
some combination with, Current Population Survey estimates
for the purposes described in paragraph (2)(B), the Secretary
of Health and Human Services, in consultation with the
States, may provide for a period during which the Secretary
may transition from carrying out such purposes through the
use of Current Population Survey estimates to the use of
American Community Survey estimates (in lieu of, or in
combination with the Current Population Survey estimates, as
recommended), provided that any such transition is
implemented in a manner that is designed to avoid adverse
impacts upon States with approved State child health plans
under this title.''.
[[Page H12067]]
SEC. 603. UPDATED FEDERAL EVALUATION OF CHIP.
Section 2108(c) (42 U.S.C. 1397hh(c)) is amended by
striking paragraph (5) and inserting the following:
``(5) Subsequent evaluation using updated information.--
``(A) In general.--The Secretary, directly or through
contracts or interagency agreements, shall conduct an
independent subsequent evaluation of 10 States with approved
child health plans.
``(B) Selection of states and matters included.--Paragraphs
(2) and (3) shall apply to such subsequent evaluation in the
same manner as such provisions apply to the evaluation
conducted under paragraph (1).
``(C) Submission to congress.--Not later than December 31,
2010, the Secretary shall submit to Congress the results of
the evaluation conducted under this paragraph.
``(D) Funding.--Out of any money in the Treasury of the
United States not otherwise appropriated, there are
appropriated $10,000,000 for fiscal year 2009 for the purpose
of conducting the evaluation authorized under this paragraph.
Amounts appropriated under this subparagraph shall remain
available for expenditure through fiscal year 2011.''.
SEC. 604. ACCESS TO RECORDS FOR IG AND GAO AUDITS AND
EVALUATIONS.
Section 2108(d) (42 U.S.C. 1397hh(d)) is amended to read as
follows:
``(d) Access to Records for IG and GAO Audits and
Evaluations.--For the purpose of evaluating and auditing the
program established under this title, or title XIX, the
Secretary, the Office of Inspector General, and the
Comptroller General shall have access to any books, accounts,
records, correspondence, and other documents that are related
to the expenditure of Federal funds under this title and that
are in the possession, custody, or control of States
receiving Federal funds under this title or political
subdivisions thereof, or any grantee or contractor of such
States or political subdivisions.''.
SEC. 605. NO FEDERAL FUNDING FOR ILLEGAL ALIENS; DISALLOWANCE
FOR UNAUTHORIZED EXPENDITURES.
Nothing in this Act allows Federal payment for individuals
who are not legal residents. Titles XI, XIX, and XXI of the
Social Security Act provide for the disallowance of Federal
financial participation for erroneous expenditures under
Medicaid and under CHIP, respectively.
Subtitle B--Miscellaneous Health Provisions
SEC. 611. DEFICIT REDUCTION ACT TECHNICAL CORRECTIONS.
(a) Clarification of Requirement To Provide EPSDT Services
for All Children in Benchmark Benefit Packages Under
Medicaid.--Section 1937(a)(1) (42 U.S.C. 1396u-7(a)(1)), as
inserted by section 6044(a) of the Deficit Reduction Act of
2005 (Public Law 109-171, 120 Stat. 88), is amended--
(1) in subparagraph (A)--
(A) in the matter before clause (i)--
(i) by striking ``Notwithstanding any other provision of
this title'' and inserting ``Notwithstanding section
1902(a)(1) (relating to statewideness), section
1902(a)(10)(B) (relating to comparability) and any other
provision of this title which would be directly contrary to
the authority under this section and subject to subsection
(E)''; and
(ii) by striking ``enrollment in coverage that provides''
and inserting ``coverage that'';
(B) in clause (i), by inserting ``provides'' after ``(i)'';
and
(C) by striking clause (ii) and inserting the following:
``(ii) for any individual described in section
1905(a)(4)(B) who is eligible under the State plan in
accordance with paragraphs (10) and (17) of section 1902(a),
consists of the items and services described in section
1905(a)(4)(B) (relating to early and periodic screening,
diagnostic, and treatment services defined in section
1905(r)) and provided in accordance with the requirements of
section 1902(a)(43).'';
(2) in subparagraph (C)--
(A) in the heading, by striking ``WRAP-AROUND'' and
inserting ``ADDITIONAL''; and
(B) by striking ``wrap-around or''; and
(3) by adding at the end the following new subparagraph:
``(E) Rule of construction.--Nothing in this paragraph
shall be construed as--
``(i) requiring a State to offer all or any of the items
and services required by subparagraph (A)(ii) through an
issuer of benchmark coverage described in subsection (b)(1)
or benchmark equivalent coverage described in subsection
(b)(2);
``(ii) preventing a State from offering all or any of the
items and services required by subparagraph (A)(ii) through
an issuer of benchmark coverage described in subsection
(b)(1) or benchmark equivalent coverage described in
subsection (b)(2); or
``(iii) affecting a child's entitlement to care and
services described in subsections (a)(4)(B) and (r) of
section 1905 and provided in accordance with section
1902(a)(43) whether provided through benchmark coverage,
benchmark equivalent coverage, or otherwise.''.
(b) Correction of Reference to Children in Foster Care
Receiving Child Welfare Services.--Section
1937(a)(2)(B)(viii) (42 U.S.C. 1396u-7(a)(2)(B)(viii), as
inserted by section 6044(a) of the Deficit Reduction Act of
2005, is amended by striking ``aid or assistance is made
available under part B of title IV to children in foster care
and individuals'' and inserting ``child welfare services are
made available under part B of title IV on the basis of being
a child in foster care or''.
(c) Transparency.--Section 1937 (42 U.S.C. 1396u-7), as
inserted by section 6044(a) of the Deficit Reduction Act of
2005, is amended by adding at the end the following:
``(c) Publication of Provisions Affected.--With respect to
a State plan amendment to provide benchmark benefits in
accordance with subsections (a) and (b) that is approved by
the Secretary, the Secretary shall publish on the Internet
website of the Centers for Medicare & Medicaid Services, a
list of the provisions of this title that the Secretary has
determined do not apply in order to enable the State to carry
out the plan amendment and the reason for each such
determination on the date such approval is made, and shall
publish such list in the Federal Register and not later than
30 days after such date of approval.''.
(d) Effective Date.--The amendments made by subsections
(a), (b), and (c) of this section shall take effect as if
included in the amendment made by section 6044(a) of the
Deficit Reduction Act of 2005.
SEC. 612. REFERENCES TO TITLE XXI.
Section 704 of the Medicare, Medicaid, and SCHIP Balanced
Budget Refinement Act of 1999, as enacted into law by
division B of Public Law 106-113 (113 Stat. 1501A-402) is
repealed.
SEC. 613. PROHIBITING INITIATION OF NEW HEALTH OPPORTUNITY
ACCOUNT DEMONSTRATION PROGRAMS.
After the date of the enactment of this Act, the Secretary
of Health and Human Services may not approve any new
demonstration programs under section 1938 of the Social
Security Act (42 U.S.C. 1396u-8).
SEC. 614. COUNTY MEDICAID HEALTH INSURING ORGANIZATIONS; GAO
REPORT ON MEDICAID MANAGED CARE PAYMENT RATES.
(a) In General.--Section 9517(c)(3) of the Consolidated
Omnibus Budget Reconciliation Act of 1985 (42 U.S.C. 1396b
note), as added by section 4734 of the Omnibus Budget
Reconciliation Act of 1990 and as amended by section 704 of
the Medicare, Medicaid, and SCHIP Benefits Improvement and
Protection Act of 2000, is amended--
(1) in subparagraph (A), by inserting ``, in the case of
any health insuring organization described in such
subparagraph that is operated by a public entity established
by Ventura County, and in the case of any health insuring
organization described in such subparagraph that is operated
by a public entity established by Merced County'' after
``described in subparagraph (B)''; and
(2) in subparagraph (C), by striking ``14 percent'' and
inserting ``16 percent''.
(b) Effective Date.--The amendments made by subsection (a)
shall take effect on the date of the enactment of this Act.
(c) GAO Report on Actuarial Soundness of Medicaid Managed
Care Payment Rates.--Not later than 18 months after the date
of the enactment of this Act, the Comptroller General of the
United States shall submit a report to the Committee on
Finance of the Senate and the Committee on Energy and
Commerce of the House of Representatives analyzing the extent
to which State payment rates for medicaid managed care
organizations under title XIX of the Social Security Act are
actuarially sound.
SEC. 615. ADJUSTMENT IN COMPUTATION OF MEDICAID FMAP TO
DISREGARD AN EXTRAORDINARY EMPLOYER PENSION
CONTRIBUTION.
(a) In General.--Only for purposes of computing the FMAP
(as defined in subsection (e)) for a State for a fiscal year
(beginning with fiscal year 2006) and applying the FMAP under
title XIX of the Social Security Act, any significantly
disproportionate employer pension or insurance fund
contribution described in subsection (b) shall be disregarded
in computing the per capita income of such State, but shall
not be disregarded in computing the per capita income for the
continental United States (and Alaska) and Hawaii.
(b) Significantly Disproportionate Employer Pension and
Insurance Fund Contribution.--
(1) In general.--For purposes of this section, a
significantly disproportionate employer pension and insurance
fund contribution described in this subsection with respect
to a State is any identifiable employer contribution towards
pension or other employee insurance funds that is estimated
to accrue to residents of such State for a calendar year
(beginning with calendar year 2003) if the increase in the
amount so estimated exceeds 25 percent of the total increase
in personal income in that State for the year involved.
(2) Data to be used.--For estimating and adjustment a FMAP
already calculated as of the date of the enactment of this
Act for a State with a significantly disproportionate
employer pension and insurance fund contribution, the
Secretary shall use the personal income data set originally
used in calculating such FMAP.
(3) Special adjustment for negative growth.--If in any
calendar year the total personal income growth in a State is
negative, an employer pension and insurance fund contribution
for the purposes of calculating the State's FMAP for a
calendar year shall not exceed 125 percent of the amount of
such contribution for the previous calendar year for the
State.
[[Page H12068]]
(c) Hold Harmless.--No State shall have its FMAP for a
fiscal year reduced as a result of the application of this
section.
(d) Report.--Not later than May 15, 2008, the Secretary
shall submit to the Congress a report on the problems
presented by the current treatment of pension and insurance
fund contributions in the use of Bureau of Economic Affairs
calculations for the FMAP and for Medicaid and on possible
alternative methodologies to mitigate such problems.
(e) FMAP Defined.--For purposes of this section, the term
``FMAP'' means the Federal medical assistance percentage, as
defined in section 1905(b) of the Social Security Act (42
U.S.C. 1396(d)).
SEC. 616. MORATORIUM ON CERTAIN PAYMENT RESTRICTIONS.
Notwithstanding any other provision of law, the Secretary
of Health and Human Services shall not, prior to January 1,
2010, take any action (through promulgation of regulation,
issuance of regulatory guidance, use of federal payment audit
procedures, or other administrative action, policy, or
practice, including a Medical Assistance Manual transmittal
or letter to State Medicaid directors) to restrict coverage
or payment under title XIX of the Social Security Act for
rehabilitation services, or school-based administration,
transportation, or medical services if such restrictions are
more restrictive in any aspect than those applied to such
coverage or payment as of July 1, 2007.
SEC. 617. MEDICAID DSH ALLOTMENTS FOR TENNESSEE AND HAWAII.
(a) Tennessee.--The DSH allotments for Tennessee for each
fiscal year beginning with fiscal year 2008 under subsection
(f)(3) of section 1923 of the Social Security Act (42 U.S.C.
1396r-4) are deemed to be $30,000,000. The Secretary of
Health and Human Services may impose a limitation on the
total amount of payments made to hospitals under the TennCare
Section 1115 waiver only to the extent that such limitation
is necessary to ensure that a hospital does not receive
payment in excess of the amounts described in subsection (f)
of such section or as necessary to ensure that the waiver
remains budget neutral.
(b) Hawaii.--Section 1923(f)(6) (42 U.S.C. 1396r-4(f)(6))
is amended--
(1) in the paragraph heading, by striking ``for fiscal year
2007''; and
(2) in subparagraph (B)--
(A) in clause (i), by striking ``Only with respect to
fiscal year 2007'' and inserting ``With respect to each of
fiscal years 2007 and 2008'';
(B) by redesignating clause (ii) as clause (iv); and
(C) by inserting after clause (i), the following new
clauses:
``(ii) Treatment as a low-dsh state.--With respect to
fiscal year 2009 and each fiscal year thereafter,
notwithstanding the table set forth in paragraph (2), the DSH
allotment for Hawaii shall be increased in the same manner as
allotments for low DSH States are increased for such fiscal
year under clauses (ii) and (iii) of paragraph (5)(B).
``(iii) Certain hospital payments.--The Secretary may not
impose a limitation on the total amount of payments made to
hospitals under the QUEST section 1115 Demonstration Project
except to the extent that such limitation is necessary to
ensure that a hospital does not receive payments in excess of
the amounts described in subsection (g), or as necessary to
ensure that such payments under the waiver and such payments
pursuant to the allotment provided in this section do not, in
the aggregate in any year, exceed the amount that the
Secretary determines is equal to the Federal medical
assistance percentage component attributable to
disproportionate share hospital payment adjustments for such
year that is reflected in the budget neutrality provision of
the QUEST Demonstration Project.''.
SEC. 618. CLARIFICATION TREATMENT OF REGIONAL MEDICAL CENTER.
(a) In General.--Nothing in section 1903(w) of the Social
Security Act (42 U.S.C. 1396b(w)) shall be construed by the
Secretary of Health and Human Services as prohibiting a
State's use of funds as the non-Federal share of expenditures
under title XIX of such Act where such funds are transferred
from or certified by a publicly-owned regional medical center
located in another State and described in subsection (b), so
long as the Secretary determines that such use of funds is
proper and in the interest of the program under title XIX.
(b) Center Described.--A center described in this
subsection is a publicly-owned regional medical center that--
(1) provides level 1 trauma and burn care services;
(2) provides level 3 neonatal care services;
(3) is obligated to serve all patients, regardless of
ability to pay;
(4) is located within a Standard Metropolitan Statistical
Area (SMSA) that includes at least 3 States;
(5) provides services as a tertiary care provider for
patients residing within a 125-mile radius; and
(6) meets the criteria for a disproportionate share
hospital under section 1923 of such Act (42 U.S.C. 1396r-4)
in at least one State other than the State in which the
center is located.
SEC. 619. EXTENSION OF SSI WEB-BASED ASSET DEMONSTRATION
PROJECT TO THE MEDICAID PROGRAM.
(a) In General.--Beginning on October 1, 2012, the
Secretary of Health and Human Services shall provide for the
application to asset eligibility determinations under the
Medicaid program under title XIX of the Social Security Act
of the automated, secure, web-based asset verification
request and response process being applied for determining
eligibility for benefits under the Supplemental Security
Income (SSI) program under title XVI of such Act under a
demonstration project conducted under the authority of
section 1631(e)(1)(B)(ii) of such Act (42 U.S.C.
1383(e)(1)(B)(ii)).
(b) Limitation.--Such application shall only extend to
those States in which such demonstration project is operating
and only for the period in which such project is otherwise
provided.
(c) Rules of Application.--For purposes of carrying out
subsection (a), notwithstanding any other provision of law,
information obtained from a financial institution that is
used for purposes of eligibility determinations under such
demonstration project with respect to the Secretary of Health
and Human Services under the SSI program may also be shared
and used by States for purposes of eligibility determinations
under the Medicaid program. In applying section
1631(e)(1)(B)(ii) of the Social Security Act under this
subsection, references to the Commissioner of Social Security
and benefits under title XVI of such Act shall be treated as
including a reference to a State described in subsection (b)
and medical assistance under title XIX of such Act provided
by such a State.
Subtitle C--Other Provisions
SEC. 621. SUPPORT FOR INJURED SERVICEMEMBERS.
(a) Short Title.--This section may be cited as the
``Support for Injured Servicemembers Act''.
(b) Servicemember Family Leave.--
(1) Definitions.--Section 101 of the Family and Medical
Leave Act of 1993 (29 U.S.C. 2611) is amended by adding at
the end the following:
``(14) Active duty.--The term `active duty' means duty
under a call or order to active duty under a provision of law
referred to in section 101(a)(13)(B) of title 10, United
States Code.
``(15) Covered servicemember.--The term `covered
servicemember' means a member of the Armed Forces, including
a member of the National Guard or a Reserve, who is
undergoing medical treatment, recuperation, or therapy, is
otherwise in medical hold or medical holdover status, or is
otherwise on the temporary disability retired list, for a
serious injury or illness.
``(16) Medical hold or medical holdover status.--The term
`medical hold or medical holdover status' means--
``(A) the status of a member of the Armed Forces, including
a member of the National Guard or a Reserve, assigned or
attached to a military hospital for medical care; and
``(B) the status of a member of a reserve component of the
Armed Forces who is separated, whether pre-deployment or
post-deployment, from the member's unit while in need of
health care based on a medical condition identified while the
member is on active duty in the Armed Forces.
``(17) Next of kin.--The term `next of kin', used with
respect to an individual, means the nearest blood relative of
that individual.
``(18) Serious injury or illness.--The term `serious injury
or illness', in the case of a member of the Armed Forces,
means an injury or illness incurred by the member in line of
duty on active duty in the Armed Forces that may render the
member medically unfit to perform the duties of the member's
office, grade, rank, or rating.''.
(2) Entitlement to leave.--Section 102(a) of such Act (29
U.S.C. 2612(a)) is amended by adding at the end the
following:
``(3) Servicemember family leave.--Subject to section 103,
an eligible employee who is the spouse, son, daughter,
parent, or next of kin of a covered servicemember shall be
entitled to a total of 26 workweeks of leave during a 12-
month period to care for the servicemember. The leave
described in this paragraph shall only be available during a
single 12-month period.
``(4) Combined leave total.--During the single 12-month
period described in paragraph (3), an eligible employee shall
be entitled to a combined total of 26 workweeks of leave
under paragraphs (1) and (3). Nothing in this paragraph shall
be construed to limit the availability of leave under
paragraph (1) during any other 12-month period.''.
(3) Requirements relating to leave.--
(A) Schedule.--Section 102(b) of such Act (29 U.S.C.
2612(b)) is amended--
(i) in paragraph (1), in the second sentence--
(I) by striking ``section 103(b)(5)'' and inserting
``subsection (b)(5) or (f) (as appropriate) of section 103'';
and
(II) by inserting ``or under subsection (a)(3)'' after
``subsection (a)(1)''; and
(ii) in paragraph (2), by inserting ``or under subsection
(a)(3)'' after ``subsection (a)(1)''.
(B) Substitution of paid leave.--Section 102(d) of such Act
(29 U.S.C. 2612(d)) is amended--
(i) in paragraph (1)--
(I) by inserting ``(or 26 workweeks in the case of leave
provided under subsection (a)(3))'' after ``12 workweeks''
the first place it appears; and
(II) by inserting ``(or 26 workweeks, as appropriate)''
after ``12 workweeks'' the second place it appears; and
(ii) in paragraph (2)(B), by adding at the end the
following: ``An eligible employee may elect, or an employer
may require the employee, to substitute any of the accrued
[[Page H12069]]
paid vacation leave, personal leave, family leave, or medical
or sick leave of the employee for leave provided under
subsection (a)(3) for any part of the 26-week period of such
leave under such subsection.''.
(C) Notice.--Section 102(e)(2) of such Act (29 U.S.C.
2612(e)(2)) is amended by inserting ``or under subsection
(a)(3)'' after ``subsection (a)(1)''.
(D) Spouses employed by same employer.--Section 102(f) of
such Act (29 U.S.C. 2612(f)) is amended--
(i) by redesignating paragraphs (1) and (2) as
subparagraphs (A) and (B), and aligning the margins of the
subparagraphs with the margins of section 102(e)(2)(A);
(ii) by striking ``In any'' and inserting the following:
``(1) In general.--In any''; and
(iii) by adding at the end the following:
``(2) Servicemember family leave.--
``(A) In general.--The aggregate number of workweeks of
leave to which both that husband and wife may be entitled
under subsection (a) may be limited to 26 workweeks during
the single 12-month period described in subsection (a)(3) if
the leave is--
``(i) leave under subsection (a)(3); or
``(ii) a combination of leave under subsection (a)(3) and
leave described in paragraph (1).
``(B) Both limitations applicable.--If the leave taken by
the husband and wife includes leave described in paragraph
(1), the limitation in paragraph (1) shall apply to the leave
described in paragraph (1).''.
(E) Certification.--Section 103 of such Act (29 U.S.C.
2613) is amended by adding at the end the following:
``(f) Certification for Servicemember Family Leave.--An
employer may require that a request for leave under section
102(a)(3) be supported by a certification issued at such time
and in such manner as the Secretary may by regulation
prescribe.''.
(F) Failure to return.--Section 104(c) of such Act (29
U.S.C. 2614(c)) is amended--
(i) in paragraph (2)(B)(i), by inserting ``or under section
102(a)(3)'' before the semicolon; and
(ii) in paragraph (3)(A)--
(I) in clause (i), by striking ``or'' at the end;
(II) in clause (ii), by striking the period and inserting
``; or''; and
(III) by adding at the end the following:
``(iii) a certification issued by the health care provider
of the servicemember being cared for by the employee, in the
case of an employee unable to return to work because of a
condition specified in section 102(a)(3).''.
(G) Enforcement.--Section 107 of such Act (29 U.S.C. 2617)
is amended, in subsection (a)(1)(A)(i)(II), by inserting
``(or 26 weeks, in a case involving leave under section
102(a)(3))'' after ``12 weeks''.
(H) Instructional employees.--Section 108 of such Act (29
U.S.C. 2618) is amended, in subsections (c)(1), (d)(2), and
(d)(3), by inserting ``or under section 102(a)(3)'' after
``section 102(a)(1)''.
(c) Servicemember Family Leave for Civil Service
Employees.--
(1) Definitions.--Section 6381 of title 5, United States
Code, is amended--
(A) in paragraph (5), by striking ``and'' at the end;
(B) in paragraph (6), by striking the period and inserting
``; and''; and
(C) by adding at the end the following:
``(7) the term `active duty' means duty under a call or
order to active duty under a provision of law referred to in
section 101(a)(13)(B) of title 10, United States Code;
``(8) the term `covered servicemember' means a member of
the Armed Forces, including a member of the National Guard or
a Reserve, who is undergoing medical treatment, recuperation,
or therapy, is otherwise in medical hold or medical holdover
status, or is otherwise on the temporary disability retired
list, for a serious injury or illness;
``(9) the term `medical hold or medical holdover status'
means--
``(A) the status of a member of the Armed Forces, including
a member of the National Guard or a Reserve, assigned or
attached to a military hospital for medical care; and
``(B) the status of a member of a reserve component of the
Armed Forces who is separated, whether pre-deployment or
post-deployment, from the member's unit while in need of
health care based on a medical condition identified while the
member is on active duty in the Armed Forces;
``(10) the term `next of kin', used with respect to an
individual, means the nearest blood relative of that
individual; and
``(11) the term `serious injury or illness', in the case of
a member of the Armed Forces, means an injury or illness
incurred by the member in line of duty on active duty in the
Armed Forces that may render the member medically unfit to
perform the duties of the member's office, grade, rank, or
rating.''.
(2) Entitlement to leave.--Section 6382(a) of such title is
amended by adding at the end the following:
``(3) Subject to section 6383, an employee who is the
spouse, son, daughter, parent, or next of kin of a covered
servicemember shall be entitled to a total of 26
administrative workweeks of leave during a 12-month period to
care for the servicemember. The leave described in this
paragraph shall only be available during a single 12-month
period.
``(4) During the single 12-month period described in
paragraph (3), an employee shall be entitled to a combined
total of 26 administrative workweeks of leave under
paragraphs (1) and (3). Nothing in this paragraph shall be
construed to limit the availability of leave under paragraph
(1) during any other 12-month period.''.
(3) Requirements relating to leave.--
(A) Schedule.--Section 6382(b) of such title is amended--
(i) in paragraph (1), in the second sentence--
(I) by striking ``section 6383(b)(5)'' and inserting
``subsection (b)(5) or (f) (as appropriate) of section
6383''; and
(II) by inserting ``or under subsection (a)(3)'' after
``subsection (a)(1)''; and
(ii) in paragraph (2), by inserting ``or under subsection
(a)(3)'' after ``subsection (a)(1)''.
(B) Substitution of paid leave.--Section 6382(d) of such
title is amended by adding at the end the following: ``An
employee may elect to substitute for leave under subsection
(a)(3) any of the employee's accrued or accumulated annual or
sick leave under subchapter I for any part of the 26-week
period of leave under such subsection.''.
(C) Notice.--Section 6382(e) of such title is amended by
inserting ``or under subsection (a)(3)'' after ``subsection
(a)(1)''.
(D) Certification.--Section 6383 of such title is amended
by adding at the end the following:
``(f) An employing agency may require that a request for
leave under section 6382(a)(3) be supported by a
certification issued at such time and in such manner as the
Office of Personnel Management may by regulation
prescribe.''.
SEC. 622. OUTREACH REGARDING HEALTH INSURANCE OPTIONS
AVAILABLE TO CHILDREN.
(a) Definitions.--In this section--
(1) the terms ``Administration'' and ``Administrator''
means the Small Business Administration and the Administrator
thereof, respectively;
(2) the term ``certified development company'' means a
development company participating in the program under title
V of the Small Business Investment Act of 1958 (15 U.S.C. 695
et seq.);
(3) the term ``Medicaid program'' means the program
established under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.);
(4) the term ``Service Corps of Retired Executives'' means
the Service Corps of Retired Executives authorized by section
8(b)(1) of the Small Business Act (15 U.S.C. 637(b)(1));
(5) the term ``small business concern'' has the meaning
given that term in section 3 of the Small Business Act (15
U.S.C. 632);
(6) the term ``small business development center'' means a
small business development center described in section 21 of
the Small Business Act (15 U.S.C. 648);
(7) the term ``State'' has the meaning given that term for
purposes of title XXI of the Social Security Act (42 U.S.C.
1397aa et seq.);
(8) the term ``State Children's Health Insurance Program''
means the State Children's Health Insurance Program
established under title XXI of the Social Security Act (42
U.S.C. 1397aa et seq.);
(9) the term ``task force'' means the task force
established under subsection (b)(1); and
(10) the term ``women's business center'' means a women's
business center described in section 29 of the Small Business
Act (15 U.S.C. 656).
(b) Establishment of Task Force.--
(1) Establishment.--There is established a task force to
conduct a nationwide campaign of education and outreach for
small business concerns regarding the availability of
coverage for children through private insurance options, the
Medicaid program, and the State Children's Health Insurance
Program.
(2) Membership.--The task force shall consist of the
Administrator, the Secretary of Health and Human Services,
the Secretary of Labor, and the Secretary of the Treasury.
(3) Responsibilities.--The campaign conducted under this
subsection shall include--
(A) efforts to educate the owners of small business
concerns about the value of health coverage for children;
(B) information regarding options available to the owners
and employees of small business concerns to make insurance
more affordable, including Federal and State tax deductions
and credits for health care-related expenses and health
insurance expenses and Federal tax exclusion for health
insurance options available under employer-sponsored
cafeteria plans under section 125 of the Internal Revenue
Code of 1986;
(C) efforts to educate the owners of small business
concerns about assistance available through public programs;
and
(D) efforts to educate the owners and employees of small
business concerns regarding the availability of the hotline
operated as part of the Insure Kids Now program of the
Department of Health and Human Services.
(4) Implementation.--In carrying out this subsection, the
task force may--
(A) use any business partner of the Administration,
including--
(i) a small business development center;
(ii) a certified development company;
(iii) a women's business center; and
(iv) the Service Corps of Retired Executives;
(B) enter into--
(i) a memorandum of understanding with a chamber of
commerce; and
(ii) a partnership with any appropriate small business
concern or health advocacy group; and
(C) designate outreach programs at regional offices of the
Department of Health and Human Services to work with district
offices of the Administration.
[[Page H12070]]
(5) Website.--The Administrator shall ensure that links to
information on the eligibility and enrollment requirements
for the Medicaid program and State Children's Health
Insurance Program of each State are prominently displayed on
the website of the Administration.
(6) Report.--
(A) In general.--Not later than 2 years after the date of
enactment of this Act, and every 2 years thereafter, the
Administrator shall submit to the Committee on Small Business
and Entrepreneurship of the Senate and the Committee on Small
Business of the House of Representatives a report on the
status of the nationwide campaign conducted under paragraph
(1).
(B) Contents.--Each report submitted under subparagraph (A)
shall include a status update on all efforts made to educate
owners and employees of small business concerns on options
for providing health insurance for children through public
and private alternatives.
SEC. 623. SENSE OF SENATE REGARDING ACCESS TO AFFORDABLE AND
MEANINGFUL HEALTH INSURANCE COVERAGE.
(a) Findings.--The Senate finds the following:
(1) There are approximately 45 million Americans currently
without health insurance.
(2) More than half of uninsured workers are employed by
businesses with less than 25 employees or are self-employed.
(3) Health insurance premiums continue to rise at more than
twice the rate of inflation for all consumer goods.
(4) Individuals in the small group and individual health
insurance markets usually pay more for similar coverage than
those in the large group market.
(5) The rapid growth in health insurance costs over the
last few years has forced many employers, particularly small
employers, to increase deductibles and co-pays or to drop
coverage completely.
(b) Sense of the Senate.--The Senate--
(1) recognizes the necessity to improve affordability and
access to health insurance for all Americans;
(2) acknowledges the value of building upon the existing
private health insurance market; and
(3) affirms its intent to enact legislation this year that,
with appropriate protection for consumers, improves access to
affordable and meaningful health insurance coverage for
employees of small businesses and individuals by--
(A) facilitating pooling mechanisms, including pooling
across State lines, and
(B) providing assistance to small businesses and
individuals, including financial assistance and tax
incentives, for the purchase of private insurance coverage.
TITLE VII--REVENUE PROVISIONS
SEC. 701. INCREASE IN EXCISE TAX RATE ON TOBACCO PRODUCTS.
(a) Cigars.--Section 5701(a) of the Internal Revenue Code
of 1986 is amended--
(1) by striking ``$1.828 cents per thousand ($1.594 cents
per thousand on cigars removed during 2000 or 2001)'' in
paragraph (1) and inserting ``$50.00 per thousand'',
(2) by striking ``20.719 percent (18.063 percent on cigars
removed during 2000 or 2001)'' in paragraph (2) and inserting
``52.988 percent'', and
(3) by striking ``$48.75 per thousand ($42.50 per thousand
on cigars removed during 2000 or 2001)'' in paragraph (2) and
inserting ``$3.00 per cigar''.
(b) Cigarettes.--Section 5701(b) of such Code is amended--
(1) by striking ``$19.50 per thousand ($17 per thousand on
cigarettes removed during 2000 or 2001)'' in paragraph (1)
and inserting ``$50.00 per thousand'', and
(2) by striking ``$40.95 per thousand ($35.70 per thousand
on cigarettes removed during 2000 or 2001)'' in paragraph (2)
and inserting ``$105.00 per thousand''.
(c) Cigarette Papers.--Section 5701(c) of such Code is
amended by striking ``1.22 cents (1.06 cents on cigarette
papers removed during 2000 or 2001)'' and inserting ``3.13
cents''.
(d) Cigarette Tubes.--Section 5701(d) of such Code is
amended by striking ``2.44 cents (2.13 cents on cigarette
tubes removed during 2000 or 2001)'' and inserting ``6.26
cents''.
(e) Smokeless Tobacco.--Section 5701(e) of such Code is
amended--
(1) by striking ``58.5 cents (51 cents on snuff removed
during 2000 or 2001)'' in paragraph (1) and inserting
``$1.50'', and
(2) by striking ``19.5 cents (17 cents on chewing tobacco
removed during 2000 or 2001)'' in paragraph (2) and inserting
``50 cents''.
(f) Pipe Tobacco.--Section 5701(f) of such Code is amended
by striking ``$1.0969 cents (95.67 cents on pipe tobacco
removed during 2000 or 2001)'' and inserting ``$2.8126
cents''.
(g) Roll-Your-Own Tobacco.--Section 5701(g) of such Code is
amended by striking ``$1.0969 cents (95.67 cents on roll-
your-own tobacco removed during 2000 or 2001)'' and inserting
``$8.8889 cents''.
(h) Floor Stocks Taxes.--
(1) Imposition of tax.--On tobacco products (other than
cigars described in section 5701(a)(2) of the Internal
Revenue Code of 1986) and cigarette papers and tubes
manufactured in or imported into the United States which are
removed before January 1, 2008, and held on such date for
sale by any person, there is hereby imposed a tax in an
amount equal to the excess of--
(A) the tax which would be imposed under section 5701 of
such Code on the article if the article had been removed on
such date, over
(B) the prior tax (if any) imposed under section 5701 of
such Code on such article.
(2) Credit against tax.--Each person shall be allowed as a
credit against the taxes imposed by paragraph (1) an amount
equal to $500. Such credit shall not exceed the amount of
taxes imposed by paragraph (1) on January 1, 2008, for which
such person is liable.
(3) Liability for tax and method of payment.--
(A) Liability for tax.--A person holding tobacco products,
cigarette papers, or cigarette tubes on January 1, 2008, to
which any tax imposed by paragraph (1) applies shall be
liable for such tax.
(B) Method of payment.--The tax imposed by paragraph (1)
shall be paid in such manner as the Secretary shall prescribe
by regulations.
(C) Time for payment.--The tax imposed by paragraph (1)
shall be paid on or before April 1, 2008.
(4) Articles in foreign trade zones.--Notwithstanding the
Act of June 18, 1934 (commonly known as the Foreign Trade
Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.) or any other
provision of law, any article which is located in a foreign
trade zone on January 1, 2008, shall be subject to the tax
imposed by paragraph (1) if--
(A) internal revenue taxes have been determined, or customs
duties liquidated, with respect to such article before such
date pursuant to a request made under the 1st proviso of
section 3(a) of such Act, or
(B) such article is held on such date under the supervision
of an officer of the United States Customs and Border
Protection of the Department of Homeland Security pursuant to
the 2d proviso of such section 3(a).
(5) Definitions.--For purposes of this subsection--
(A) In general.--Any term used in this subsection which is
also used in section 5702 of the Internal Revenue Code of
1986 shall have the same meaning as such term has in such
section.
(B) Secretary.--The term ``Secretary'' means the Secretary
of the Treasury or the Secretary's delegate.
(6) Controlled groups.--Rules similar to the rules of
section 5061(e)(3) of such Code shall apply for purposes of
this subsection.
(7) Other laws applicable.--All provisions of law,
including penalties, applicable with respect to the taxes
imposed by section 5701 of such Code shall, insofar as
applicable and not inconsistent with the provisions of this
subsection, apply to the floor stocks taxes imposed by
paragraph (1), to the same extent as if such taxes were
imposed by such section 5701. The Secretary may treat any
person who bore the ultimate burden of the tax imposed by
paragraph (1) as the person to whom a credit or refund under
such provisions may be allowed or made.
(i) Effective Date.--The amendments made by this section
shall apply to articles removed (as defined in section
5702(j) of the Internal Revenue Code of 1986) after December
31, 2007.
SEC. 702. ADMINISTRATIVE IMPROVEMENTS.
(a) Permit, Report, and Record Requirements for
Manufacturers and Importers of Processed Tobacco.--
(1) Permits.--
(A) Application.--Section 5712 of the Internal Revenue Code
of 1986 is amended by inserting ``or processed tobacco''
after ``tobacco products''.
(B) Issuance.--Section 5713(a) of such Code is amended by
inserting ``or processed tobacco'' after ``tobacco
products''.
(2) Inventories and reports.--
(A) Inventories.--Section 5721 of such Code is amended by
inserting ``, processed tobacco,'' after ``tobacco
products''.
(B) Reports.--Section 5722 of such Code is amended by
inserting ``, processed tobacco,'' after ``tobacco
products''.
(3) Records.--Section 5741 of such Code is amended by
inserting ``, processed tobacco,'' after ``tobacco
products''.
(4) Manufacturer of processed tobacco.--Section 5702 of
such Code is amended by adding at the end the following new
subsection:
``(p) Manufacturer of Processed Tobacco.--
``(1) In general.--The term `manufacturer of processed
tobacco' means any person who processes any tobacco other
than tobacco products.
``(2) Processed tobacco.--The processing of tobacco shall
not include the farming or growing of tobacco or the handling
of tobacco solely for sale, shipment, or delivery to a
manufacturer of tobacco products or processed tobacco.''.
(5) Conforming amendment.--Section 5702(k) of such Code is
amended by inserting ``, or any processed tobacco,'' after
``nontaxpaid tobacco products or cigarette papers or tubes''.
(6) Effective date.--The amendments made by this subsection
shall take effect on January 1, 2008.
(b) Basis for Denial, Suspension, or Revocation of
Permits.--
(1) Denial.--Paragraph (3) of section 5712 of such Code is
amended to read as follows:
``(3) such person (including, in the case of a corporation,
any officer, director, or principal stockholder and, in the
case of a partnership, a partner)--
``(A) is, by reason of his business experience, financial
standing, or trade connections or by reason of previous or
current
[[Page H12071]]
legal proceedings involving a felony violation of any other
provision of Federal criminal law relating to tobacco
products, cigarette paper, or cigarette tubes, not likely to
maintain operations in compliance with this chapter,
``(B) has been convicted of a felony violation of any
provision of Federal or State criminal law relating to
tobacco products, cigarette paper, or cigarette tubes, or
``(C) has failed to disclose any material information
required or made any material false statement in the
application therefor.''.
(2) Suspension or revocation.--Subsection (b) of section
5713 of such Code is amended to read as follows:
``(b) Suspension or Revocation.--
``(1) Show cause hearing.--If the Secretary has reason to
believe that any person holding a permit--
``(A) has not in good faith complied with this chapter, or
with any other provision of this title involving intent to
defraud,
``(B) has violated the conditions of such permit,
``(C) has failed to disclose any material information
required or made any material false statement in the
application for such permit,
``(D) has failed to maintain his premises in such manner as
to protect the revenue,
``(E) is, by reason of previous or current legal
proceedings involving a felony violation of any other
provision of Federal criminal law relating to tobacco
products, cigarette paper, or cigarette tubes, not likely to
maintain operations in compliance with this chapter, or
``(F) has been convicted of a felony violation of any
provision of Federal or State criminal law relating to
tobacco products, cigarette paper, or cigarette tubes,
the Secretary shall issue an order, stating the facts
charged, citing such person to show cause why his permit
should not be suspended or revoked.
``(2) Action following hearing.--If, after hearing, the
Secretary finds that such person has not shown cause why his
permit should not be suspended or revoked, such permit shall
be suspended for such period as the Secretary deems proper or
shall be revoked.''.
(3) Effective date.--The amendments made by this subsection
shall take effect on the date of the enactment of this Act.
(c) Application of Internal Revenue Code Statute of
Limitations for Alcohol and Tobacco Excise Taxes.--
(1) In general.--Section 514(a) of the Tariff Act of 1930
(19 U.S.C. 1514(a)) is amended by striking ``and section 520
(relating to refunds)'' and inserting ``section 520 (relating
to refunds), and section 6501 of the Internal Revenue Code of
1986 (but only with respect to taxes imposed under chapters
51 and 52 of such Code)''.
(2) Effective date.--The amendment made by this subsection
shall apply to articles imported after the date of the
enactment of this Act.
(d) Expansion of Definition of Roll-Your-Own Tobacco.--
(1) In general.--Section 5702(o) of the Internal Revenue
Code of 1986 is amended by inserting ``or cigars, or for use
as wrappers thereof'' before the period at the end.
(2) Effective date.--The amendment made by this subsection
shall apply to articles removed (as defined in section
5702(j) of the Internal Revenue Code of 1986) after December
31, 2007.
(e) Time of Tax for Unlawfully Manufactured Tobacco
Products.--
(1) In general.--Section 5703(b)(2) of such Code is amended
by adding at the end the following new subparagraph:
``(F) Special rule for unlawfully manufactured tobacco
products.--In the case of any tobacco products, cigarette
paper, or cigarette tubes produced in the United States at
any place other than the premises of a manufacturer of
tobacco products, cigarette paper, or cigarette tubes that
has filed the bond and obtained the permit required under
this chapter, tax shall be due and payable immediately upon
manufacture.''.
(2) Effective date.--The amendment made by this subsection
shall take effect on the date of the enactment of this Act.
SEC. 703. TIME FOR PAYMENT OF CORPORATE ESTIMATED TAXES.
Subparagraph (B) of section 401(1) of the Tax Increase
Prevention and Reconciliation Act of 2005 is amended by
striking ``114.75 percent'' and inserting ``113.75 percent''.
The SPEAKER pro tempore. Pursuant to House Resolution 774, the
gentleman from Michigan (Mr. Dingell), the gentleman from Texas (Mr.
Barton), the gentleman from New York (Mr. Rangel) and the gentleman
from Louisiana (Mr. McCrery) each will control 15 minutes.
The Chair recognizes the gentleman from Michigan.
General Leave
Mr. DINGELL. Madam Speaker, I ask unanimous consent that all Members
may have 5 legislative days in which to revise and extend their remarks
and to include extraneous material on the bill under consideration.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Michigan?
There was no objection.
Mr. DINGELL. Madam Speaker, I yield myself 3 minutes.
Madam Speaker, I rise in support of H.R. 3963, the Children's Health
Insurance Program Reauthorization Act of 2007.
Madam Speaker, this is not a perfect bill, but it is an excellent
bipartisan compromise. I would observe that it meets the concerns
expressed both in the President's veto message and also in the comments
raised by our Republican colleagues as we debated the bill at earlier
times.
I will note that the bill protects health insurance coverage for some
6 million children who now depend on CHIP. I will observe that it
provides health coverage for 3.9 million children who are eligible, yet
remain uninsured. Together, this is a total of better than 10 million
young Americans who, without this legislation, would not have health
insurance, and it is to be noted that those same young people will be
losing their health insurance shortly if we do not act expeditiously on
this matter.
{time} 1430
As mentioned, the bill makes changes to accommodate the President's
stated concerns.
First, it terminates the coverage of childless adults in 1 year.
Second, it targets bonus payments only to States that increase
enrollments of the poorest uninsured children, and it prohibits States
from covering children in families with incomes above $51,000.
Third, it contains adequate enforcement to ensure that only U.S.
citizens are covered.
Fourth, it encourages States to help low-income families to secure
health insurance provided through their private employer.
The bill is focused on the private marketplace. The evidence of that
is the bill has strong support from the private health insurance
industry. It is supported by the medical community, AMA, children's
advocates, educators, advocates for people with disabilities, health
professionals, hospitals, the AARP and others.
It is solid, bipartisan legislation worked out in careful meetings
with Members from both parties, including Senator Hatch and others on
the Senate side who have done such important work on this matter in
times past, and that includes also our dear friend, Senator Grassley.
It is solid, bipartisan legislation that addresses the concerns
expressed by the President and by our colleagues in the House on the
Republican side. I urge an ``aye'' vote on H.R. 3963.
Madam Speaker, I reserve the balance of my time.
Mr. BARTON of Texas. Madam Speaker, I yield 2 minutes to the
distinguished gentleman from Georgia (Mr. Deal), ranking member of the
Subcommittee on Health, and I ask unanimous consent that he control the
minority time for the Committee on Energy and Commerce.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
There was no objection.
Mr. DEAL of Georgia. Madam Speaker, today we are dealing with a bill
that supposedly is a fix of the previous legislation that has been
vetoed. We are all entitled to our opinion, but we should rely on a
body that gives us the facts, and that is the Congressional Budget
Office. I would like to look at some of those facts.
First of all, there is supposed to have been a fix on the issue of
illegal immigration. CBO still estimates that there will be $3.7
billion of increased Federal spending and complementary State spending
that will total some $6.5 billion of additional spending because of
this change as it relates to the immigration issue over the next 10
years, and an additional 100,000 adults will gain eligibility because
of this section.
The questions that ought to be asked are the two questions that were
put to the staff of the Social Security Administration, because if we
are going to allow Social Security numbers to be used as
identification, these ought to be the questions. They were said to the
staff. And the question is: Would the name and Social Security number
verification system in this bill verify that the person submitting the
name and the Social Security number is who they say they are?
The answer: No.
Second question: Would the name and Social Security verification
system in this bill prevent an illegal alien
[[Page H12072]]
from fraudulently using another person's valid name and matching Social
Security number to obtain Medicaid and SCHIP benefits?
The answer: No.
The authors of this bill also claim there is a fix on the issue of
adults in SCHIP. The fact that CBO still projects that up to 10 percent
of the enrollees in SCHIP will be adults, not children, in the next 5
years, and money for poor children shouldn't, in my opinion, go to
cover adults.
The fix on the issue of crowd-out. The CBO still estimates there will
be some 2 million people who will lose their private health insurance
coverage and become enrolled in a government-run program.
Then the fix relating to the enrollment of higher income children.
CBO estimates there will only be some 800,000 who are currently
eligible for SCHIP who will be enrolled in the next 5 years, but an
additional 1.1 million people with incomes that are not currently
eligible for SCHIP will be enrolled in the program.
I urge a ``no'' vote.
Madam Speaker, I reserve the balance of my time.
Mr. RANGEL. Madam Speaker, I yield myself 3 minutes.
(Mr. RANGEL asked and was given permission to revise and extend his
remarks.)
Mr. RANGEL. Madam Speaker and my colleagues, now that the dust has
settled and the parliamentary games have been played and some of the
facts that have been distorted have been corrected, we reach the point
that at the end of the line the question is going to be: Did you vote
for health care for 10 million children and did you vote to support the
$35 billion that is necessary to do it?
I don't think that any of the families of the children or the
Governors or the agencies that are just waiting to see what is going to
happen are very interested in the distortions continuing. It is going
to be very, very simple. Which way do you vote, and if you did not vote
for the bill, why didn't you?
Now there may be some particular loyalty to the President, but you
have to remember that when these voters and people come to you, the
President's veto message will not be stapled to you and you will have
to, on your own, be able to explain why you thought what he said was
true. That's why we rely heavily on some of the President's strongest
supporters, Senator Orrin Hatch and Senator Chuck Grassley, because as
a Democrat, I am kind of used to Republicans beating up on me, but I am
not used to them beating up on the Republican leaders in the Senate
such as Orrin Hatch and Chuck Grassley. This is particularly so since
the Senate has assumed so much responsibility in putting together this
bill which neither you nor I like, but what the heck, we have to play
the hand that is dealt.
So remember that just by attacking personalities, it may be like
getting into a firing squad that is in a circle and we find everybody
shooting at each other. But really, the winners and losers are going to
be those children without health coverage and their families who are
struggling hard. And ultimately, these kids are really America. It
takes so much to take care of some of the illnesses that could be
detected.
And as sensitive as the President is to the poor that are smoking and
having the tobacco tax increase, tobacco smoking is dangerous for
America and for our health system. It is very expensive, and it is a
deterrent to children smoking.
So when all of this is done, I don't know how many people are going
to ask you why did you vote no. But please remember that many of the
reasons that are stated today, the truth will be caught up to the
allegations and you will have to have a better answer.
Madam Speaker, I reserve the balance of my time.
Mr. McCRERY. Madam Speaker, I yield myself 2 minutes.
First, I want to thank the distinguished gentleman from Michigan, the
chairman of the Energy and Commerce Committee, Mr. Dingell, for
requesting unanimous consent that every Member may have 5 days to
revise and extend his remarks. The reason I say that is we on the
minority side just got this bill at 8 p.m. last night, so it is going
to take a few days to understand the changes that have been made, and
so we may want to revise and extend our remarks when this debate is
over today.
This is the third time we have debated a measure like this along
these lines. I am probably going to repeat some of the things I have
said earlier because, in our cursory examination of the bill at least,
it doesn't appear to have changed very much.
The bill does nothing, for example, to address the cliff in the
funding of SCHIP, so a future Congress will still face a choice of
throwing off the SCHIP rolls 6.5 million kids or raising taxes by about
$40 billion.
It still relies on a declining revenue source, tobacco taxes, to fund
a growing program which is likely to exacerbate the funding cliff
issue. In short, the legislation remains fiscally irresponsible.
Further, despite some window dressing on this, it appears illegal
immigrants will be able to use fraudulent Social Security numbers and
still be able to get SCHIP and Medicaid benefits.
It still allows States to enroll higher income children at least
through 2010 and continues to allow States to use a system of so-called
income disregards to set just about any income limit they please.
I support SCHIP. I want SCHIP to be extended, but this so-called new
legislation seems to do absolutely nothing to address the serious flaws
in the previous proposals.
Madam Speaker, I reserve the balance of my time.
The SPEAKER pro tempore. Without objection, the gentleman from
Michigan yields his time to the gentleman from New Jersey.
There was no objection.
Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentleman from
New York (Mr. Engel).
Mr. ENGEL. Madam Speaker, I rise in strong support of the SCHIP
program. The bottom line, my friends, is do we want to fund children's
health care for poor children in this country or do we not?
The arguments against it from fiscal conservatives, and I always have
to question that a bit because our Republican friends have driven up
the deficit to the greatest in American history, and now they want to
tell us this program is too expensive.
One of the reasons the American people are so disenchanted with
Congress is because the Republicans are blocking a bill that is very,
very supportive of what American people want. We see here that 72
percent of the American public, two-thirds of the Senate, the majority
of the House, 43 State Governors and more than 300 organizations
support this legislation; and our friends on the other side of the
aisle are blocking the will of the American people.
Let's fund this bill. Let's help poor children. Stop with the
nonsense, stop with the nonsense about New York. We try to help as much
as we can. Congress ought to help our poor kids. That's the question.
Do you want to help poor kids, or don't you?
Mr. DEAL of Georgia. Madam Speaker, I yield 2 minutes to the
gentlewoman from Tennessee (Mrs. Blackburn).
Mrs. BLACKBURN. Madam Speaker, I don't think anyone opposes providing
health care for poor children and children of the working poor. That is
not what our argument is about today.
What we do oppose is having a bill before us that covers 400,000 less
kids in SCHIP than previously. We do oppose having a bill that has a
funding cliff in 2012 where you just plan to run out of money. Now the
question is: Why would you vote for a bill where you plan on having a
program fail?
Another thing we see in this bill before us, it is going to spend a
half billion dollars more than SCHIP version one, and it is going to
cover less kids. So there are plenty of reasons to oppose this bill.
In addition, you have the issue with illegal immigration. CBO, the
Congressional Budget Office, projects that section 211 of this bill
will result in spending $3.7 billion in increased spending on health
care for this population over the next 10 years.
And then you get to the issue of adults. Well, what you are talking
about is getting childless adults off the program, not all adults, just
childless adults.
[[Page H12073]]
Madam Speaker, I think we as parents expect our children to grow up
and expect them to take responsibility. This is not Never Never Land,
and all adults need to be removed from this program.
SCHIP, as it was put in place in 1997, is there for poor children,
children of the working poor. The list could go on and on. We also know
there is a massive redistribution of taxes within this bill. We have
all seen those figures.
On top of that, you look at what goes to the east coast and it is
harming those children in the middle of the country. I oppose the bill.
Mr. RANGEL. Madam Speaker, at this time I recognize the chairman of
the Health Subcommittee who has worked very hard on the Medicare part
and transferred that knowledge to help perfect the SCHIP bill, Chairman
Stark, for 2 minutes.
Mr. STARK. Madam Speaker, I thank the distinguished chairman for
yielding, and I rise in strong support of this third version of
legislation to improve and extend the Children's Health Insurance
Program, and I hope the third time will be a charm.
Eighty percent of Americans, 72 percent perhaps, a strong bipartisan
majority in the Senate, nearly every House Democrat, and at last count
45 House Republicans, all supported this version of SCHIP. President
Bush and many of my Republican colleagues, however, opposed the
previous version of this legislation. Supposedly you opposed it
because, one, it might have enabled the States to provide health care
to adults.
{time} 1445
Two, children in the middle-income families might get health care.
And, three, worst of all, undocumented immigrant children might have
gotten health care. Also, there was a concern by some that we'd run out
of money. I haven't heard that concern of where we're going to get $1.7
trillion for a war that we're fighting, but at least you're worried
about bringing that money to health care.
The bill before us today answers those criticisms. It should be more
acceptable to a few more of my Republican colleagues, perhaps even to
the President. The previous version concerns have been met, rectified,
and so those who vote against today's legislation can only be voting
against the government providing health care to poor children who have
no other means of obtaining medical care. That's the only reason left
to vote against this. No other way to account for a ``no'' vote.
But I'm most proud of what this bill does not do. It doesn't
compromise in covering children. It adds $35 billion in new funding to
the SCHIP program, and it provides coverage to 10 million additional
children.
I urge my colleagues to join with me, making the third time a charm,
not a strike out, for America's children. With even stronger bipartisan
support, we may convince President Bush to do right by America's
children. Let's provide him that opportunity and guide him down the
path to compassion and humane treatment for all our children.
Mr. McCRERY. Madam Speaker, at this time I yield 2 minutes to the
gentleman from Texas (Mr. Sam Johnson).
(Mr. SAM JOHNSON of Texas asked and was given permission to revise
and extend his remarks.)
Mr. SAM JOHNSON of Texas. Madam Speaker, I rise today to simply state
that facts are funny things. No matter what's said on the floor of this
House or how many times it's said, facts are facts.
And the real fact is, this compromise bill is nothing less than a
bunch of baloney. This bill covers fewer kids, costs more than last
week's bogus SCHIP bill, and you know, we have a saying in Texas, if
you put lipstick on a pig, it will still be a pig.
My biggest concern with this bill is it doesn't fix the illegal
immigration loophole. The Congressional Budget Office projects that the
Federal Government will spend almost $4 billion to pay for health
insurance benefits for illegal immigrants. That doesn't sound like much
of a solution to me.
And this bill diverts resources away from kids who need the resources
most. In fact, in 5 years, 10 percent of the enrollees in the
Children's Health Insurance Program will not be children but adults. If
we're going to reauthorize a Children's Health Insurance Program, we
ought to be sure American kids have access to health insurance, not
adults, not illegal immigrants.
I say support poor kids first. The American taxpayer wants, needs,
and deserves a bill that does just that.
The SPEAKER pro tempore. Without objection, the gentleman from
Michigan (Mr. Dingell) reclaims control of his time.
There was no objection.
Mr. DINGELL. Madam Speaker, at this time, it is a privilege for me to
yield 3 minutes to the distinguished chairman of the subcommittee, my
good friend from New Jersey (Mr. Pallone) who has been a great leader
in these matters.
Mr. PALLONE. Madam Speaker, I thank Chairman Dingell.
I'm really pained when I listen to the last speaker and some of the
comments that have been made on the other side, you know, calling this
sincere effort by the Democrats, on a bipartisan basis with the Senate,
to try to come up with something that we can get you on the other side
of the aisle to support. You know, I heard words like ``baloney'' and
``bogus,'' and almost I think actual laughter. And it's a sad day when
we laugh at this issue which is an issue of whether we're going to
cover kids so that they don't have to go to an emergency room and can
actually go to a doctor and get proper health care.
The Democrats, and this is again bipartisan where some Republicans
and the Senate Republicans have gone out of their way to try to address
the concerns that some of the Republicans have expressed, but the
bottom line is that we can't change the fact that we want to cover
additional kids, 10 million in total.
And when we know that the American people support this effort, what
they support is covering more kids, those that are already eligible and
not enrolled up to the tune of 10 million kids. Now, that's going to
take $35 billion over 5 years. You can't get away from it.
And the President is saying, well, I can't support any new tobacco
tax to pay for it; I'm going to pay for it out of the existing budget.
Well, that's simply not possible. If you look at the budget, he's
actually cutting Medicaid, and one of the things that this bill does is
to stop those cuts in Medicaid so we can cover the kids that we have.
Now, we have tried very hard to address each of the three issues that
the Republicans have raised, and the first one I'd like to talk about
today is the issue of illegal aliens. There was never anything in this
provision that allowed illegal aliens to be covered. We have made it
absolutely clear in this new bill that that is the case and that they
will not be covered. Anyone who suggests otherwise is just not being
honest about this.
The second thing that we did, we tried to address the issue of
adults. Single adults who are phased out after 2 years now under this
bill will be phased out after 1 year, and even the parents, yes,
they're also phased out I think over two or three years. So we're
addressing that issue.
And then the third issue that was raised was the issue with regard to
the income eligibility; and here, again, what we're saying is that if
you go over 300 percent, okay, other than those that are already
grandfathered into the program, you're no longer going to be able to
cover those kids at that $82,000 or the other levels that they
suggested.
Now, we've made an honest effort here to accomplish this, and all
we're asking is that a few more of you come over to our side and join
the Republicans in the Senate to vote for this legislation. This is an
honest way to try to achieve a compromise that will allow us to cover
these 10 million children.
Now, take this seriously. One of my colleagues said, well, this is
Never, Neverland. This isn't Never, Neverland. We've had discussions
with the Republicans. We've talked to you. Give us those votes so we
can cover the kids.
Mr. DEAL of Georgia. Madam Speaker, I understand why my colleague
from New Jersey might like the bill, because his State, that's at 350
percent of poverty, gets grandfathered in and gives special treatment
over the majority of States in this country.
Madam Speaker, I'm pleased to yield 1 minute to a member of the
Energy and Commerce Committee, Mr. Shadegg from Arizona.
[[Page H12074]]
Mr. SHADEGG. Madam Speaker, I thank the gentleman for yielding.
It really is a sad day here in the United States Congress. This is an
effort in pure politics. If this was an honest effort at compromise,
how come nobody ever sat down with the President? How come nobody ever
sat down with our leaders?
The gentleman just said that they tried to address the issues.
Everybody here on the floor knows they didn't address the issues.
Adults remain covered under this legislation, though Republicans said
adults shouldn't be covered in the child health care program.
And crowd-out, the issue of people losing their private health
insurance, causing the private health insurance to go up in cost, was
not addressed. The CBO, a nonpartisan body, says 2 million people will
lose their private coverage by crowd-out under this legislation.
The sad thing is, this is pure politics, and it was demonstrated the
day that the override attempt failed. Because, on that day, the
Republicans had an opportunity to celebrate, having sustained the
President's position. But we weren't proud of that moment or of that
day because we'd like to deal with the Nation's problems.
You know who applauded on that day? Democrats applauded when the
override failed. Why? For political gain, not because they care about
insurance or kids or kids' health, but because they want political
gain. That's sad; this is a sad day for this Congress.
Mr. RANGEL. Madam Speaker, it is my pleasure to yield 1 minute to Mr.
Lewis, an outstanding member of the committee, the conscience of the
House of Representatives from the sovereign State of Georgia.
Mr. LEWIS of Georgia. Madam Speaker, I want to thank my friend, my
colleague, my chairman for yielding.
Madam Speaker, I rise today in the spirit of bipartisanship to thank
all of our colleagues, both Democrats and Republicans, for working
together to bring forth this important piece of legislation.
Now is the time, not tomorrow or next week, now is the time to
reauthorize and expand SCHIP, because there's nothing, but nothing,
more important than the health of our little children. All of our
children, all of the poor children are in the same boat, whether black
or white, Hispanic, Asian American or Native American. They need health
care to grow strong and survive.
We, in Congress, have the best possible health care, and now is the
time to deliver that same promise of health to our Nation's children.
Suffer the little children. Suffer the little children, all of the
children.
The time is always right to do right. We must pass the bill today for
the children of America.
Mr. McCRERY. Madam Speaker, it is a pleasure to at this time yield 2
minutes to the gentleman from Texas (Mr. Brady), a member of the
committee.
Mr. BRADY of Texas. Madam Speaker, I voted to create the children's
health care program, and I believe in it. But let's be honest. These
changes are more cosmetic than Dr. 90210. This bill still isn't paid
for. It still doesn't cover poor kids first, and it still allows abuses
like subsidizing adults to continue.
And what's especially sad is that today, while the California tragedy
unfolds, most Americans see homes in flames, lives lost, and families
huddling in football stadiums as their life's possessions go up in
flames, the Washington Democrats see political opportunity.
While dedicated California lawmakers rush home to their communities,
Democrats rush their bill to the floor.
It seems like none of us in Congress, either party, ought to look
like vultures circling above the burned out homes of California
families gleefully eyeing a cynical chance to try to pass their
partisan legislation.
This proves what we said all along. This isn't about the children.
It's about defeating George Bush. Some hate him so badly they will
sacrifice whatever morals and integrity to win at all costs.
Democrats promised to change Washington, but it's business as usual
up here; and it's the children who lose.
As parents we teach our kids to sit down and work out their
differences, that fighting doesn't accomplish anything, that big boys
and girls find a way to work together. When this political trick fails,
and it will, why don't we apply the same lessons up here and work
together to find a reasonable, fiscally responsible way to help cover
our kids who need our help?
Mr. DINGELL. Madam Speaker, at this time, I yield 1 minute to the
distinguished gentleman from Texas (Mr. Gene Green).
Mr. GENE GREEN of Texas. Madam Speaker, I thank my Chair of the
Energy and Commerce Committee.
The legislation before us today is not about politics. It's about
providing children's health care coverage to 10 million low-income
American children.
This bill is paid for. It's paid for more than the $190 billion the
President's asking for a supplemental to support the war in Iraq and
Afghanistan. This is for the ten million children and parents who are
hardworking Americans but cannot afford private health insurance.
The bill is clear on undocumented children. No Federal funding will
be spent on undocumented immigrants.
The bill is clear on childless adults. For 1 year they get coverage,
and these adults actually got a waiver, these States got a waiver to
cover these adults. So they're going to have 1 year, and then they're
off of it.
The bill is clear on family income. Only the lowest-income children
are covered with a prohibition on coverage of children above 300
percent. You can't go above 300 percent. Most are at 200 percent, but
some are at 300.
Madam Speaker, 4 months of spending in Iraq is enough to provide
SCHIP to 10 million children for 5 years. More than 80 percent of the
American people support it, and I urge my colleagues to support it.
We've prioritized it to the low-income.
We've prioritized it to citizens.
We've prioritized children.
It's about priorities, not politics, and the Congress should be able
to put aside politics and unite behind these priorities for our
children.
Mr. DEAL of Georgia. Madam Speaker, I am pleased to yield 2\1/2\
minutes to another member of the Energy and Commerce Committee, Mr.
Burgess from Texas.
{time} 1500
Mr. BURGESS. I appreciate the gentleman yielding.
Madam Speaker, I wonder if I might ask if I could engage the highly
regarded chairman of the Energy and Commerce Committee for purposes of
a colloquy.
Mr. DINGELL. I would be happy to oblige my good friend.
Mr. BURGESS. I thank the chairman.
As the chairman knows we, of course, worked on this together last
night on the Rules Committee until late into the night, so I know the
chairman and I are both a little under the weather today.
Mr. Chairman, under the changes that have been made in regards to the
income disregards in the bill, could a State in its current practice
still allow a family to exclude from income $500 a year for child care
expenses?
Mr. DINGELL. The answer to the question is yes.
Mr. BURGESS. I thank the chairman.
Could a State allow a family to exclude from income $20,000 a year
for housing expenses?
Mr. DINGELL. That would be a matter to be determined by the State in
which the transaction and the events occurred.
Mr. BURGESS. I am not a lawyer, but if I were a lawyer and ask for a
``yes'' or ``no'' answer, I would assume that's a yes.
Mr. DINGELL. Well, it's a ``yes'' if the State so decides. It's a
``no'' if they decide not.
Mr. BURGESS. Further, then, if the Chair will indulge me, could a
State allow for a family to exclude from income $10,000 per year for
transportation expenses?
Mr. DINGELL. Again, the response is that that is up to the State, and
there is nothing in the legislation to preclude that.
Mr. BURGESS. So the answer would be a ``yes'' if to transportation
expenses.
If the chairman would, then, could a State allow a family to exclude
from
[[Page H12075]]
income $10,000 a year for clothing expenses?
Mr. DINGELL. Again, the answer is if that is so determined by the
States, the answer is yes.
Mr. BURGESS. So State income disregards, now, are up to $40,500, if I
am doing my math correctly? Or if I could then just ask one last
question, several people have alluded on this floor today that 6.6
million children will lose their health insurance if the House does not
act.
Mr. Chairman, you know and I know that this Congress, this Speaker,
is not so insensitive as to allow this health insurance to expire for
these children. We will do an extension. We will do what is required to
continue to allow coverage for the children until Congress passes the
bill; is that not correct?
Mr. DINGELL. Well, I would certainly hope so, but I can't guarantee.
Mr. BURGESS. Again, reclaiming my time, I cannot think that any
Speaker of the House would be so insensitive as to allow this program
to expire.
The SPEAKER pro tempore. Without objection, the gentleman from
Georgia (Mr. Lewis) will control the time for the gentleman from New
York (Mr. Rangel).
Mr. LEWIS of Georgia. Madam Speaker, I am pleased to yield 1 minute
to a member of the Ways and Means Committee, the gentlewoman from the
State of Ohio (Mrs. Jones).
(Mrs. JONES of Ohio asked and was given permission to revise and
extend her remarks.)
Mrs. JONES of Ohio. There is a piece of poetry that starts like this,
``I'd rather see a sermon than to hear one any day, I'd rather one
should walk with me than just to show the way.
``The eye is a better pupil and more willing than the ear; Advice may
be misleading, but examples are always clear. And the very best of
teachers are the ones who live their creeds.''
It goes on to talk about how you can deliver lectures, but I would
rather get a lesson by observing what you do.
I am saying to my colleagues, Democrat and Republican, the children
of America are listening to us gibe at one another about whether they
deserve health care. They deserve health care, and we could give it to
them today.
They deserve health care because many of them are spending so many
hours in an emergency room, costly, many of them are spending times at
home when they could be educated. Many parents are not at work because
they are staying home with their children. Health care should be a
right in America, and our children are saying they would rather see a
sermon than to hear one. They want us to walk and give them health care
and stop talking about it.
Mr. McCRERY. Madam Speaker, I yield 2 minutes to the gentleman from
Wisconsin (Mr. Ryan), a member of the Ways and Means Committee.
Mr. RYAN of Wisconsin. I thank the gentleman for yielding.
As we look at this bill, which we received this morning, it still has
the same policy, just a little different cosmetics. I don't think our
constituents want us to vote for a bill that makes it easier for
illegal immigrants to get tax-paid health care. This bill does that.
I don't think our constituents want us to vote for a bill where we
spend our constituents's tax dollars to pay for insurance that people
already have. This bill does that.
I don't think our constituents want us to vote to create a new
middle-class entitlement. This does that.
This bill also is only one-half paid for. That's right, they only pay
for half of this law, and they have an enormous budget gimmick that
when you add it all together doubles the cost of this bill.
So if the goal here is ultimately to get universal health care so
that everybody has insurance, which I think most of us all share, this
is not the pathway to do it.
If you take a look at what it costs to fund 3.9 million people who
are uninsured, that leaves us another 43 million people uninsured. At
the spend rate, at the cost of that, if we want to fund everybody, it's
another $400 billion. That would add $8 trillion to the debt we have
for our kids and our grandkids.
By doing it this way, by creating an enormous new entitlement, you
are making matters worse for the baby boomers. You are making this
enormous cliff we have of entitlement spending that much deeper.
Madam Speaker, there is a better way to getting universal access to
affordable health insurance. This is not the way. We believe in
patient-centered health care, not government-centered health care. We
don't think bureaucrats should be running health care, whether they are
an insurance bureaucrat or a government bureaucrat.
We think patients and their doctors should be running and making
health care decisions. Unfortunately, this bill does not do that. This
bill puts the government squarely in the middle and says if you want
health care, you got to get it from the government. That's not what we
believe in. That's not what we should be doing. That's why we should be
voting against this bill.
Mr. DINGELL. Madam Speaker, I submit for the Record the disregards
for children's coverage that have been submitted to us by the
Congressional Research Service.
The point here is that the money needs to continue to flow to working
families so that we can keep them working rather than staying on
welfare.
Within the Medicaid and SCHIP programs, states are
permitted to disregard or not count certain types of amounts
of family income as decided by the State in determining
eligibility for the program.
This bill maintains this long-standing flexibility to allow
States to disregard certain legitimate costs like child care
and child support costs, recognizing that this income is not
available for a family to spend on health coverage.
Allowing States to disregard these costs ensures that
working families have the money they need to pay for work-
related expenses to ensure that low-income families can keep
their jobs. This is important to keep families from having to
go on welfare to get health coverage for their children.
The following are the monthly disregards applied by States
in 2006.
The state of Alabama disregards $90 of earnings, $200 or
$175 of childcare expenses and $50 of child support received
for a family in its Medicaid program when determining
eligibility for an individual for Medicaid. It disregards $90
of earnings, $200 or $175 of childcare expenses and $50 of
child support received for a family in its SCHIP program when
determining eligibility for an individual in SCHIP.
The state of Alaska disregards $90 of earnings, $200 or
$175 of childcare expenses, $50 of child support received and
the full amount of child support paid for a family in its
Medicaid program when determining eligibility for an
individual for Medicaid. It does not disregard income when
determining eligibility for an individual in SCHIP.
The state of Arizona disregards $90 of earnings, $200 or
$175 of childcare expenses, and $50 of child support received
for a family in its Medicaid program when determining
eligibility for an individual for Medicaid. It does not
disregard income when determining eligibility for an
individual in SCHIP.
The state of Arkansas disregards $90 of earnings, $200 or
$175 of childcare expenses and $50 of child support received
for a family in its Medicaid program when determining
eligibility for an individual for Medicaid. It disregards $50
of child support received for a family in its ARKids B
Medicaid program when determining eligibility for an
individual for Medicaid. It does not disregard income when
determining eligibility for an individual in SCHIP.
The state of California disregards $90 of earnings, $200 or
$175 of childcare expenses, $50 of child support received and
the full amount of child support paid for a family in its
Medicaid program when determining eligibility for an
individual for Medicaid. It disregards $90 of earnings, $200
or $175 of childcare expenses, $50 of child support received
and the full amount of child support paid for a family in its
SCHIP program when determining eligibility for an individual
in SCHIP.
The state of Colorado disregards $90 of earnings, $200 or
$175 of childcare expenses and $50 of child support received
for a family in its Medicaid program when determining
eligibility for an individual for Medicaid. It disregards all
childcare and medical expenses, including health insurance
premiums paid in the last 90 days for a family in its SCHIP
program when determining eligibility for an individual in
SCHIP. Note: Child support received is not counted as income
in SCHIP.
The state of Connecticut disregards $90 of earnings, $200
or $175 of childcare expenses and $100 of child support
received for a family in its Medicaid program when
determining eligibility for an individual for Medicaid. It
disregards $90 of earnings, $200 or $175 of childcare
expenses and $50 of child support received for a family in
its SCHIP program when determining eligibility for an
individual in SCHIP.
The state of Delaware disregards $90 of earnings, $200 or
$175 of childcare expenses and $50 of child support received
for a family in its Medicaid program when determining
eligibility for an individual for Medicaid. It disregards $90
of earnings, $200 or $175 of childcare expenses and $50 of
child support
[[Page H12076]]
received for a family in its SCHIP program when determining
eligibility for an individual in SCHIP.
The District of Columbia disregards Under poverty-level,
the full amount of child care expenses may be disregarded for
families under the federal poverty level, and disregards $100
in earnings and the full amount of child care expenses for
those under the SCHIP-funded expansion when determining
eligibility for an individual for Medicaid. It does not
disregard income when determining eligibility for an
individual in SCHIP.
The state of Florida disregards $90 of earnings, $200 or
$175 of childcare expenses and $50 of child support received
for a family in its Medicaid program when determining
eligibility for an individual for Medicaid. It disregards
either Medicaid disregards or gross income (whichever is more
beneficial to the family) when determining eligibility for an
individual in SCHIP.
The state of Georgia disregards $90 of earnings, $200 or
$175 of childcare expenses and $50 of child support received
for a family in its Medicaid program when determining
eligibility for an individual for Medicaid. It disregards $90
of earnings, $200 or $175 of childcare expenses and $50 of
child support received for a family in its SCHIP program when
determining eligibility for an individual in SCHIP.
The state of Hawaii disregards $90 of earnings for a family
in its Medicaid program when determining eligibility for an
individual for Medicaid. It does not disregard income when
determining eligibility for an individual in SCHIP.
The state of Idaho does not disregard income for a family
in its Medicaid program when determining eligibility for an
individual for Medicaid. It does not disregard income when
determining eligibility for an individual in SCHIP.
The state of Illinois disregards $90 of earnings, $200 or
$175 of childcare expenses, $50 of child support received and
the full amount of child support paid for a family in its
Medicaid program when determining eligibility for an
individual for Medicaid. It disregards $90 of earnings, $200
or $175 of childcare expenses, $50 of child support received
and the full amount of child support paid for a family in its
SCHIP program when determining eligibility for an individual
in SCHIP.
The state of Indiana disregards $90 of earnings, $200 or
$175 of childcare expenses and $50 of child support received
for a family in its Medicaid program when determining
eligibility for an individual for Medicaid. It disregards $90
of earnings, $200 or $175 of childcare expenses and $50 of
child support received for a family in its SCHIP program when
determining eligibility for an individual in SCHIP.
The state of Iowa disregards 20 percent of earnings, $200
or $175 of childcare expenses, $50 of child support received
and the full amount of child support paid for a family in its
Medicaid program when determining eligibility for an
individual for Medicaid. It disregards 20 percent of earnings
and $50 of child support received for a family in its SCHIP
program when determining eligibility for an individual in
SCHIP.
The state of Kansas has a standard disregard of $200 per
worker in its Medicaid program when determining eligibility
for an individual for Medicaid. It has a standard disregard
of $200 per worker in its SCHIP program when determining
eligibility for an individual in SCHIP.
The state of Kentucky disregards $90 of earnings, $200 or
$175 of childcare expenses and $50 of child support received
for a family in its Medicaid program when determining
eligibility for an individual for Medicaid. It disregards $90
of earnings, $200 or $175 of childcare expenses and $50 of
child support received for a family in its SCHIP program when
determining eligibility for an individual in SCHIP.
The state of Louisiana disregards $90 of earnings, $200 or
$175 of childcare expenses, $50 of child support received and
the full amount of child support paid for a family in its
Medicaid program when determining eligibility for an
individual for Medicaid. It does not disregard income when
determining eligibility for an individual in SCHIP.
The state of Maine disregards $90 of earnings, $200 or $175
of childcare expenses and the full amount of child support
paid. There is an income exclusion of $50 of child support
received for a family in its Medicaid program when
determining eligibility for an individual for Medicaid. It
disregards $50 of child support received for a family in its
SCHIP program when determining eligibility for an individual
in SCHIP.
The state of Maryland disregards $90 of earnings, $200 or
$175 of childcare expenses, $50 of child support received and
the actual amount of child support paid for a family in its
Medicaid program when determining eligibility for an
individual for Medicaid. It disregards $90 of earnings, $200
or $175 of childcare expenses, $50 of child support received
and the actual amount of child support paid for a family
in its SCHIP program when determining eligibility for an
individual in SCHIP.
The state of Massachusetts does not disregard income when
determining eligibility for an individual for Medicaid. It
does not disregard income when determining eligibility for an
individual in SCHIP.
The state of Michigan disregards $90 of earnings, a
standard $200 of childcare expenses, $50 of child support
received, the full amount of child support paid and a $60
deduction for legal guardians (if a guardianship arrangement
is in place) for a family in its Medicaid program when
determining eligibility for an individual for Medicaid. It
disregards $90 of earnings, a standard $200 of childcare
expenses, $50 of child support received, the full amount of
child support paid and a $60 deduction for legal guardians
(if a guardianship arrangement is in place) for a family in
its SCHIP program when determining eligibility for an
individual in SCHIP.
The state of Minnesota disregards $90 of work expenses,
$200/$175 for childcare and child support paid for its
Medical Assistance for children ages 2-19. MinnesotaCare
(waiver coverage) is based on gross family income. A gross
income test is used for SCHIP-funded Medicaid for infants,
with some protections so that no child could be adversely
affected by the gross income test. It does not disregard
income when determining eligibility for an individual in
SCHIP.
The state of Mississippi disregards $90 of earnings, $200
or $175 of childcare expenses and $50 of child support
received for a family in its Medicaid program when
determining eligibility for an individual for Medicaid. It
disregards $90 of earnings, $200 or $175 of childcare
expenses and $50 of child support received for a family in
its SCHIP program when determining eligibility for an
individual in SCHIP.
The state of Missouri disregards $90 of earnings and $200
or $175 of childcare expenses for a family in its Medicaid
program when determining eligibility for an individual for
Medicaid. Its Medicaid expansion program is based on gross
income. It does not disregard when determining eligibility
for an individual in SCHIP.
The state of Montana disregards $120 of work expenses and
up to $200 of childcare expenses for a family in its Medicaid
program when determining eligibility for an individual for
Medicaid. It disregards $120 of work expenses and up to $200
of childcare expenses for a family in its SCHIP program when
determining eligibility for an individual in SCHIP.
The state of Nebraska disregards $100 of earnings plus all
childcare expenses for a family in its Medicaid program when
determining eligibility for an individual for Medicaid. It
does not disregard income when determining eligibility for an
individual in SCHIP.
The state of Nevada disregards 20 percent or $90 of
earnings (whichever is greater) and the full amount of
childcare expenses for a family in its Medicaid program when
determining eligibility for an individual for Medicaid. It
does not disregard income when determining eligibility for
an individual in SCHIP.
The state of New Hampshire disregards $90 of earnings, $200
or $175 of childcare expenses and the full amount of child
support paid for a family in its Medicaid program when
determining eligibility for an individual for Medicaid. It
disregards $90 of earnings, $200 or $175 of childcare
expenses and the full amount of child support paid for a
family in its SCHIP program when determining eligibility for
an individual in SCHIP.
The state of New Jersey disregards $90 of earnings, $200 or
$175 of childcare expenses, $50 of child support received and
the full amount of child support paid for a family in its
Medicaid program when determining eligibility for an
individual for Medicaid. It does not disregard income when
determining eligibility for an individual in SCHIP.
The state of New Mexico disregards income based on a
child's age for its Medicaid program when determining
eligibility for an individual for Medicaid: children age six
and older get $90 of earnings, $175 of childcare expenses and
$50 of child support received. Children under age six get
earnings disregard of $750 per assistance unit, $375 or
actual child care expenses and $50 of child support received.
It does not disregard income when determining eligibility for
an individual in SCHIP.
The state of New York disregards $90 of earnings, $200 or
$175 of childcare expenses and $50 of child support received
for a family in its Medicaid program when determining
eligibility for an individual for Medicaid. It does not
disregard income when determining eligibility for an
individual in SCHIP.
The state of North Carolina disregards $90 of earnings,
$200 or $175 of childcare expenses, $50 of child support
received and the full amount of child support paid for a
family in its Medicaid program when determining eligibility
for an individual for Medicaid. It disregards $90 of
earnings, $200 or $175 of childcare expenses, $50 of child
support received and the full amount of child support paid
for a family in its SCHIP program when determining
eligibility for an individual in SCHIP.
The state of North Dakota disregards $90 of actual work
expenses (in the form of payroll taxes) or $30 work training
expenses, all reasonable childcare expenses, $50 of child
support received and the full amount of child support paid,
and premiums paid for other health insurance for a family in
its Medicaid program when determining eligibility for an
individual for Medicaid. It disregards $90 of actual work
expenses (in the form of payroll taxes), all reasonable
childcare expenses, and the full amount child support paid
for a family in its SCHIP program when determining
eligibility for an individual in SCHIP.
The state of Ohio disregards $90 of earnings, $200 or $175
of childcare expenses, $50 of child support received and the
full amount of child support paid for a family in
its Medicaid program when determining eligibility
[[Page H12077]]
for an individual for Medicaid. It does not disregard
income when determining eligibility for an individual in
SCHIP.
The state of Oklahoma disregards $120 of earnings, $200 or
$175 of childcare expenses and $50 of child support received
for a family in its Medicaid program when determining
eligibility for an individual for Medicaid. It does not
disregard income when determining eligibility for an
individual in SCHIP.
The state of Oregon does not disregard income when
determining eligibility for an individual for Medicaid. It
does not disregard income when determining eligibility for an
individual in SCHIP.
The state of Pennsylvania disregards $120 of earnings, $200
or $175 of childcare expenses and $50 of child support
received for a family in its Medicaid program when
determining eligibility for an individual for Medicaid. It
disregards $120 of earnings and $200 or $175 of childcare
expenses for a family in its SCHIP program when determining
eligibility for an individual in SCHIP.
The state of Rhode Island disregards $90 of earnings, $200
or $175 of childcare expenses and $50 of child support
received for a family in its Medicaid program when
determining eligibility for an individual for Medicaid. It
does not disregard income when determining eligibility for an
individual in SCHIP.
The state of South Carolina disregards $100 of earnings, up
to $200 for actual childcare expenses and $50 of child
support received for a family in its Medicaid program when
determining eligibility for an individual for Medicaid. It
does not disregard income when determining eligibility for an
individual in SCHIP.
The state of South Dakota disregards 20 percent of
earnings, $200 or $175 of childcare expenses, $50 of child
support received and the full amount of child support paid
for a family in its Medicaid program when determining
eligibility for an individual for Medicaid. It disregards all
childcare expenses ($500 family maximum), $50 of child
support received and the full amount of child support paid
for a family in its SCHIP program when determining
eligibility for an individual in SCHIP.
The state of Tennessee disregards $50 of child support
received for a family in its ``regular'' Medicaid program
when determining eligibility for an individual for Medicaid.
It disregards $90 of earnings, $20 of unearned income, $200
or $175 of childcare expenses and $50 of child support
received for a family in its Medicaid expansion program when
determining eligibility for an individual for Medicaid. It
does not disregard income for a family in its SCHIP program
when determining eligibility for an individual in SCHIP.
The state of Texas disregards $120 of earnings, $200 or
$175 of childcare expenses, $50 of child support received and
the full amount of child support paid for a family in
its Medicaid program when determining eligibility for an
individual for Medicaid. It does not disregard income when
determining eligibility for an individual in SCHIP.
The state of Utah disregards $90 of earnings, $200 or $175
of childcare expenses and $50 of child support received for a
family in its Medicaid program when determining eligibility
for an individual for Medicaid. It does not disregard income
for a family in its SCHIP program when determining
eligibility for an individual in SCHIP. No income of a child
under the age of 19 is considered unless they are a head of
household.
The state of Vermont disregards $90 of earnings, $200 or
$175 of childcare expenses and $50 of child support received
for a family in its Medicaid program when determining
eligibility for an individual for Medicaid. The state also
disregards earned income of anyone under 18 and earned income
of anyone under 22 who is a full-time student when
determining eligibility for an individual for Medicaid. It
does not disregard income when determining eligibility for an
individual in SCHIP, except for earned income of anyone under
18 and earned income of anyone under 22 who is a full-time
student when determining eligibility for an individual for
SCHIP.
The state of Virginia disregards $90 of earnings, $200 or
$175 of childcare expenses and $50 of child support received
for a family in its Medicaid program when determining
eligibility for an individual for Medicaid. It does not
disregard income when determining eligibility for an
individual in SCHIP.
The state of Washington disregards $90 of earnings, all
reasonable work-related childcare expenses and the full
amount of child support paid for a family in its Medicaid
program when determining eligibility for an individual for
Medicaid. It disregards $90 of earnings and all reasonable
work-related childcare expenses for a family in its SCHIP
program when determining eligibility for an individual in
SCHIP.
The state of West Virginia disregards $90 of work expenses,
$200 or $175 of childcare expenses and $50 of child support
received for a family in its Medicaid program when
determining eligibility for an individual for Medicaid. It
disregards $90 of work expenses, $200 or $175 of childcare
expenses and $50 of child support received for a family in
its SCHIP program when determining eligibility for an
individual in SCHIP.
The state of Wisconsin disregards $90 of earnings, $200 or
$175 of childcare expenses, $50 of child support received and
the full amount of child support paid for a family in its
Medicaid program when determining eligibility for an
individual for Medicaid. It does not disregard income when
determining eligibility for an individual in SCHIP.
The state of Wyoming disregards income based on marital
status for a family in its Medicaid program when determining
eligibility for an individual for Medicaid. Married couples
automatically get a standard $400 deduction. If not married
and both parents are working they get the $400 deduction. If
unmarried with one parent working, there is $200 deduction.
There is also a $50 deduction for child support received. It
does not disregard income when determining eligibility for an
individual in SCHIP.
Madam Speaker, I yield to the distinguished gentlewoman from Oregon
(Ms. Hooley) for 1 minute.
Ms. HOOLEY. I thank my good friend from Michigan for yielding.
Madam Speaker, this vote today is about what kind of a country are
we. This vote today is about what our priorities are. This vote today
is about what our values are. Just the interest rate on funds to pay
for the Iraq war are $25 billion a year; yet our President believes
that spending $12 billion a year on children's health care is too much.
I strongly reject the argument that we are spending too much on our
children. Our children deserve better. Our children deserve a healthy
start.
I have heard over and over from my constituents about the vital
importance of the State Children's Health Insurance Program. Nearly
60,000 children in Oregon currently receive health care through SCHIP,
and the legislation before the House today will provide for an
additional 36,000 children. I know hardworking parents who can't afford
health insurance for their children. They don't know what to do. How am
I going to cover my kids?
Thankfully, today, we are taking strong action to ensure that
thousands of fewer working families in Oregon will have to endure the
agony of having a sick child for whom they cannot afford medical care.
I urge my colleagues to vote for this bill.
The SPEAKER pro tempore. Without objection, the gentleman from Texas
(Mr. Barton) reclaims control of the time.
There was no objection.
Mr. BARTON of Texas. Madam Speaker, could I ask the amount of time
remaining on all sides.
The SPEAKER pro tempore. The gentleman from Texas has 7\1/2\ minutes.
The gentleman from Michigan has 6 minutes. The gentleman from Georgia
has 8 minutes. The gentleman from Louisiana has 8 minutes.
Mr. BARTON of Texas. Madam Speaker, I reserve the balance of my time.
Mr. LEWIS of Georgia. Madam Speaker, I ask unanimous consent that
Mrs. Jones control the time until Mr. Rangel returns.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Georgia?
There was no objection.
Mrs. JONES of Ohio. Madam Speaker, I yield 1 minute to my colleague
and good friend from the Ways and Means Committee, Allyson Schwartz,
from the great State of Pennsylvania.
Ms. SCHWARTZ. Madam Speaker, the American people are clear, they want
this Congress and the President to ensure that America's children have
access to health coverage. American parents on behalf of the children
who get health care coverage under the CHIP program are clear: CHIP is
working. Health care under CHIP is affordable and is accessible.
We have compromised, but we are determined. We are determined to
continue and to extend CHIP for America's children, 10 million American
children of working families. This bill before us is reasonable, it is
smart, and it is responsible. A majority of Congress agrees; yet the
President and some in Congress are still unsure.
The choice is clear: Vote for health care for America's children or
stand in the way. The American people are watching, they are waiting,
and maybe, most importantly, they are hoping we will do the right thing
and 10 million American children will have access to health coverage.
Let's make it happen. It's time to make this vote work. Today is the
day for a majority of Republicans to join us.
Mr. McCRERY. Madam Speaker, I request unanimous consent to allow Mr.
Camp of Michigan, ranking member of the Health Subcommittee of the Ways
and Means Committee, to allocate the remainder of my time.
[[Page H12078]]
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Louisiana?
There was no objection.
Mr. CAMP of Michigan. Madam Speaker, I yield 1\1/2\ minutes to the
gentleman from Louisiana.
Mr. BOUSTANY. I thank my colleague for yielding time.
Madam Speaker, our Democratic friends claim that they won't consider
covering anything less than 10 million children, and yet the
Congressional Budget Office shows that their own bill falls short yet
again. It also fails to give real priority to poor children. It imposes
billions of dollars in new taxes on poor families, and we know that
this tax revenue stream won't even cover the expense of the bill in the
outyears, and it causes millions to lose private coverage.
Finally, despite warnings from GAO, it also ignores provider access,
something that's critical for our children in the SCHIP programs
throughout the country. I know in my State of Louisiana we have a
serious access problem, despite the fact that we have 106,000 children
in the State covered by SCHIP, 6,000 who should be on it not covered,
and yet all of them have significant access problems.
I ask the question, why did our Democratic friends block debate on
any amendments that would have addressed these and other concerns? We
really shouldn't be playing political games with this. We shouldn't be
playing games with children's medical care.
I urge my colleagues to oppose this bill, and let's work together in
good faith to improve coverage and access for children.
Mr. DINGELL. Madam Speaker, I yield to a Member for whom I have great
personal affection and respect, Mr. Andrews of New Jersey, for 1
minute.
(Mr. ANDREWS asked and was given permission to revise and extend his
remarks.)
Mr. ANDREWS. I thank my dear friend for yielding.
Madam Speaker, why would someone not vote for health insurance for 10
million American children? There is the excuse that the bill covers
illegal aliens.
Read section 605 of the bill; it doesn't. There is the excuse that it
covers adults, not children. Read section 112 of the bill, which is
called termination of coverage of nonpregnant childless adults. There
is the excuse that it covers a lot of wealthy kids, but there is the
fact that 91.3 percent of the children covered come from families that
make less than $40,000 a year, and the rest live in States that are
very, very expensive to live in, like mine in New Jersey.
Then there is the excuse that, well, it's bad for the budget somehow,
unlike the $109 billion they want to send to Iraq. But the
Congressional Budget Office, the nonpartisan Congressional Budget
Office says that over 10 years this bill saves $200 million for the
Federal Treasury.
Ladies and gentlemen, no more excuses, vote ``yes''.
Mr. BARTON of Texas. Madam Speaker, I yield myself 1\1/2\ minutes.
I want to talk about enforcement of this 300 percent above the
poverty line. The people that wrote the bill claimed that we have got
this hard cap above 300 percent in terms of family income.
But if you look on page 76 of the bill, the first part of it,
starting with line 5, says, ``no payment shall be made under this
section for any expenditures for providing child health assistance or
health benefits coverage for a targeted low-income child whose
effective family income would exceed 300 percent of the poverty line.''
That sounds okay, but then here is the gotcha, beginning on line 13,
``but for the application of a general exclusion of a block of income
that is not determined by type of expense or type of income.''
So you leave it up to the States to say you can't have an income
level over 300 percent, but you can deduct $20,000 for a housing
allowance or you can deduct $15,000 for shelter or whatever.
{time} 1515
So what you've got here is the classic bait and switch. I would say
that the majority has listened to some of the concerns of the minority,
but you're not really ready to address them substantively. You put the
right verbiage in the first paragraph and then you take it away in the
second. At some point in time we need to sit down together and really
work these things out to make sure that you not only have the verbiage,
you also have the enforcement. Now when that day comes, we will have a
bipartisan bill. But that day is not today.
Mrs. JONES of Ohio. Madam Speaker, it gives me great pleasure to
yield 1 minute to one of our new Members from the great State of
Florida, Mr. Tim Mahoney.
Mr. MAHONEY of Florida. Madam Speaker, as a father, it is
unfathomable to me why the President chose to deny health care coverage
to children. It's incomprehensible to me that some of my colleagues
would play politics with a child's health.
I always tell my daughter that in life you don't get do-overs. Well,
apparently here in Congress you do.
The President and my colleagues across the aisle have the opportunity
that is very rare, and that is to have a second chance to do it right.
Last week I met with pediatricians at a hospital in Port St. Lucie
where doctors painted a stark picture of the challenges faced by
children without insurance.
I then went across the street to a daycare center and visited
children who rely on Florida's CHIP program, KidCare, for the health
care needs, kids like 4-year-old Samantha, and 2-year-old Hannah, 4-
year-old Rafael and 2-year-old Julian.
The President opposes SCHIP because he thinks that children from
working families that go to work, pay their taxes but can't afford
health insurance shouldn't go to the doctor. He says it's too many kids
and too expensive, even though the bill is paid for without putting our
country further into debt.
Madam Speaker, I would ask the President, which child would you deny
health care coverage to, Julian or Hannah? Which child is one too many?
Mr. CAMP of Michigan. Mr. Speaker, at this time I yield 1\1/2\
minutes to the gentleman from Georgia (Mr. Price).
(Mr. PRICE of Georgia asked and was given permission to revise and
extend his remarks.)
Mr. PRICE of Georgia. Madam Speaker, I want to say to my friend from
Michigan, the chairman of the committee, that he says that this bill is
coming to the floor today because all of the concerns in a letter that
were about this bill have been addressed.
Well, as a physician and a coauthor of that letter, I respectfully
disagree. The letter said that SCHIP ought to be reserved for low-
income kids first. In fact, what this bill does is provide incentives
to ensure higher-income kids before poor kids.
The letter said that SCHIP ought to be for children only. In fact,
CBO estimates that over 700,000 adults will be on the program in 2012,
not in 1 year, in 2012.
The letter said that SCHIP ought to cover low-income American
children. In fact, the bill weakens both Medicaid and SCHIP citizenship
verification, and all with a huge tax increase.
Madam Speaker, Members ought to know that there's an alternative.
There are multiple alternatives. One of them is H.R. 3888. It would
provide insurance for the same number of kids. It would not move any
kids from private personal insurance to government-run insurance. It
would make certain that personal choices were respected, and it would
not increase taxes.
So why proceed today? Why is the majority party proceeding today?
Because it's all about politics. In fact, they've already had their
cronies purchase TV and radio ads in the districts of folks that they
believe aren't going to support this for political gain. It's all about
politics. Not about policy and it certainly isn't about the kids.
As a physician, there's a specific diagnosis for that. It's called
``a crying shame.''
Mr. DINGELL. Madam Speaker, it's a privilege for me to yield at this
time 1 minute to a very valuable Member of this body, our friend and
colleague, Mr. Altmire of Pennsylvania.
Mr. ALTMIRE. Madam Speaker, I want to thank my colleagues on the
other side for their weeks of expressing to us what their concerns were
about the SCHIP bills that we've passed. And I'm happy to say that
we've heard
[[Page H12079]]
those concerns, and in this bill that we're voting on today we address
those concerns.
They were concerned, as am I, about coverage for illegal immigrants.
And this bill expressly prohibits coverage of illegal immigrants.
They were concerned about the coverage of adults, including adults
who are currently covered in the SCHIP program. This bill eliminates
coverage for those adults and all childless adults.
And they were concerned about income levels. They wanted to keep this
program for low-income children, and this bill today caps at 300
percent of poverty the qualification level for families to get into the
SCHIP program. So there should be no reason for any of my colleagues on
the other side to vote against this bill.
Let's vote to ensure 10 million children receive the health care that
they deserve.
Mr. BARTON of Texas. Madam Speaker, I'd like to yield 2 minutes to
the distinguished policy chairman of the Republican Conference,
Congressman McCotter.
Mr. McCOTTER. Madam Speaker, as a husband, as a father, as a former
child, I respect very much what we are endeavoring to accomplish today.
But we always have to remember that it is not simply enough to do the
right thing; we must do the right thing the right way. And again, that
is the purpose of this debate.
Much of what we hear outside of these walls tends to mute the serious
discussion that we have. I know that following this debate there will
be those ads or others that will say that Republicans do not like kids.
I assure you, Republicans like kids, and not just medium rare with a
side of fries. We do care about the future of children. But it is the
comprehensive holistic approach to the care of children which we
discuss too little in this body.
It is my belief that what we should have done, to truly put poor kids
first, was that from the first moments of the first 100 hours this
should have been the first bill we could have done. Instead, other
bills were passed and billions were spent.
We have seen appropriation bills come through this Chamber repeatedly
where billions are spent, and there was no talk of putting kids first
and helping poor kids have health insurance.
And now today we reach the point where the only way we can help poor
children is to raise taxes on the American people. This is not a
prioritization of children and their health care.
I am prepared to accept the majority when they say that they have,
the second time around is the charm and they have fixed access of
illegals to this program. I am prepared to be concerned about poor kids
and kids who are in the margins. But I do ask them to reconsider
raising taxes, because we do not want to see one day where our children
grow up to be the healthiest people in the unemployment line.
Mrs. JONES of Ohio. I reserve the balance of my time.
Mr. CAMP of Michigan. Madam Speaker, at this time I yield 2 minutes
to the distinguished minority whip, the gentleman from Missouri (Mr.
Blunt).
Mr. BLUNT. Madam Speaker, here we are again. It seems to be just the
same act in the same play, the same time.
Why are we having this vote today? I really don't know. Many of our
Members believe it's because the TV ads, the radio ads have already
been bought in their districts, and if they didn't have this vote today
somehow that money might be wasted. I don't know that I believe that.
Many of our Members believe we're having the vote on a day when seven
Republicans from California can't be here to make our ``no'' votes on
this bill appear to be less than they really are. In fact, I asked that
this bill not be voted on today for that reason.
What I wonder is why we weren't allowed to see the bill. If this bill
is such a great bill, if this bill solved these problems, what would
have been the harm of seeing the bill? In fact, a lot of the debate
today would have been a different debate if the bill would have been
laid down last night and we'd have had the vote next Wednesday or next
Thursday.
This idea that somehow we have to get it done before November 16
because that's the day that this extension ends doesn't make any sense
to anybody. We're going to be here well beyond that.
Once again we go through this process where we're told we've checked
the boxes, but then when you look at where the boxes have been checked,
they really don't do the job.
We ought to get to poor kids first. When we get to kids at 300
percent of the level of poverty, that's 54 percent of all the families
in America would have their kids have insurance through the government.
I've talked to several people in my district that say, I don't mind
helping poor kids, but I'm really offended when I'm helping kids whose
families make more than I do. I'm really offended as someone who has
raised their family when I'm paying taxes to provide insurance for
families who make $20,000 more than I do.
And the Congressional Budget Office believes that the verification
standards aren't right yet. I think this is a step in that direction.
Let's get this bill right. Let's see the bill. Let's vote ``no''
today and get to work on a serious proposal.
Mr. DINGELL. Madam Speaker, at this time I reserve.
Mr. BARTON of Texas. Madam Speaker, I yield 2 minutes to the
distinguished gentleman from Texas (Mr. Hensarling).
Mr. HENSARLING. Madam Speaker, we're not having a debate today on
whether or not to reauthorize SCHIP. What we're really having a debate
about is a tale of two SCHIPs, because it was 10 years ago that
Republicans created SCHIP to provide health insurance benefits to
uninsured low-income American children. And every Republican stands
ready today to reauthorize that program and fund that program.
But yet, again, Democrats are coming with their tale of SCHIP, an
SCHIP that instead is transforming this program to give additional
benefits to adults before children, illegal immigrants before
Americans, the insured before the uninsured, and, finally, the higher-
income before lower-income.
These are the facts. The program was designed for those up to 200
percent of the Federal poverty level. The Democrats will increase it
explicitly up to 300 percent; but with all their loopholes, even
wealthier families will qualify, shortchanging low-income, uninsured
American children to subsidize higher-income families.
Although the program was designed for children, 13 States insure
adults. Three cover more adults than children. Democrats continue this
practice, shortchanging low-income, uninsured American children in
order to subsidize adults.
Although the program was designed for the Americans, the Democrats
still strip out proof of citizenship measures. Democrats shortchange
low-income, uninsured American children in order to subsidize illegal
immigrants.
Although the program was designed to help the uninsured, CBO reports
that the plan will, in effect, take 2 million off of private health
insurance. Democrats shortchange low-income, uninsured American
children in order to subsidize the already insured.
Let's put the children first and the politics second. Let's reject
this bill, and let's reauthorize the real SCHIP program for our
children.
Mrs. JONES of Ohio. Madam Speaker, we continue to reserve our time.
Mr. CAMP of Michigan. Madam Speaker, at this time I yield myself 2
minutes.
This bill, both in terms of its scope, expanding a low-income
children's program to cover adults and middle-class families, and cost,
$35 billion in new taxes and spending, remains unacceptable. And it's
truly unfortunate.
This House, this Congress, and this President support SCHIP. The
failure to form a bipartisan compromise to provide low-income American
children with health insurance is nothing short of a failure of the
majority's leadership. The minor changes, tinkering, clarifications we
see today do not a compromise make.
Compromise, by definition, is a settlement of differences in which
each side makes concessions. The previous bill doubled the cost of this
program, and this bill costs a half billion more beyond that than the
last one. The majority has not made one concession in this cosmetic re-
draft. It's the same
[[Page H12080]]
bill with the same objections, and we should not compromise our
principles to satisfy their political aims.
What we have before us is a bill that continues to allow Federal
resources, 10 percent or more, to be diverted away from low-income
children and given to adults, a bill that provides a back door to
illegal immigrants to get Federal benefits to the tune of $3.7 billion,
and a bill that continues to force at least 2 million families out of
their current plan and into a government program.
{time} 1530
While Southern California has burned, the Speaker has this House
fiddling and posturing. Worse yet, the majority is manipulating that
tragedy and is tying this vote to ensure our votes are reduced. It's as
crass a tactic as I have seen in my time in Congress.
It is past time for the game to end, and it is past time for the
majority to engage in a serious negotiation with us on how to renew and
improve this program.
I urge my colleagues to again vote ``no'' and again send a message
that low-income children's health insurance is not an issue to be
politicized. We can do better than this.
Madam Speaker, I reserve the balance of my time.
Mr. DINGELL. Madam Speaker, at this time I yield 1 minute to the very
distinguished gentleman from North Carolina (Mr. Butterfield).
Mr. BUTTERFIELD. Madam Speaker, I want to thank the gentleman for
yielding this time to me and also thank him for his leadership as the
chairman of the Energy and Commerce Committee.
I also want to thank the Democratic leadership for bringing this bold
and visionary legislation to the House floor today. I also want to
thank my Republican friends who are willing to vote with us on this
important measure.
Madam Speaker, I represent the 15th poorest district in the United
States of America. Thirty percent of the children in my congressional
district live below the poverty level. So this is not an academic
discussion; that is real serious business for the people of my district
in North Carolina.
So I ask my friends and colleagues today to listen to this debate.
Don't let it just go over your head. But if you would please listen to
this debate, listen to the plea of the children of America, and please
consider voting for this very important legislation. The children of my
district, the children of America need you.
Mr. BARTON of Texas. Madam Speaker, I think I only have 2 minutes
left.
The SPEAKER pro tempore (Mrs. Tauscher). The gentleman is correct.
Mr. BARTON of Texas. I reserve that time.
Mrs. JONES of Ohio. Madam Speaker, I yield myself such time as I may
consume. I wish to submit a letter from the Congressional Budget
Office, dated October 25, 2007, to Speaker Pelosi. And it specifically
says under current law individuals who apply for Medicaid and claim to
be U.S. citizens are required to provide certain documents, passport or
birth certificate, in order to receive any such health care.
``Section 211 would allow States the option to either use the
requirements created in the DRA for citizenship documentation under
Medicaid or instead verify an individual's name and Social Security
number with the Social Security Administration. Some States have
reported a drop in enrollment since implementation of the DRA because
some Medicaid applicants have had difficulty satisfying the
documentation requirement. Available evidence, based on State reports
and other information provided by State officials, suggests that
virtually all of those who have been unable to provide the required
documentation are U.S. citizens.''
U.S. Congress,
Congressional Budget Office,
Washington, DC., October 25, 2007.
Hon. Nancy Pelosi,
Speaker, House of Representatives,
Washington, DC, October 25, 2007.
Dear Madam Speaker: As you requested, I am providing
additional information on CBO's estimate of the budgetary
impact of section 211 of H.R. 3963, the Children's Health
Insurance Program Reauthorization Act of 2007, as introduced
on October 24, 2007.
Under current law, individuals who apply for Medicaid and
claim to be U.S. citizens are required to provide certain
documents (such as a passport or birth certificate, and, in
certain circumstances, a driver's license or other
documentation that establishes identity) to demonstrate that
they are citizens. That provision was enacted in the Deficit
Reduction Act of 2005 (DRA, Public Law 109-171), and has been
effective since July 1, 2006. (Before the DRA provision took
effect, those individuals were permitted to attest to their
citizenship, under penalty of perjury.)
Section 211 would allow states the option to either use the
requirements created in the DRA for citizenship documentation
under Medicaid or instead verify an individual's name and
Social Security number with the Social Security
Administration. Some states have reported a drop in
enrollment since implementation of the DRA because some
Medicaid applicants have had difficulty satisfying the
documentation requirement. Available evidence, based on state
reports and other information provided by state officials,
suggests that virtually all of those who have been unable to
provide the required documentation are U.S. citizens.
Under H.R. 3963, CBO expects that most states would use the
option to rely on the Social Security Administration to
verify eligibility. CBO estimates that change would result in
an additional 500,000 enrollees in Medicaid in fiscal year
2008 and an additional 200,000 enrollees in subsequent years.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contacts are Matt
Kapuscinski and Eric Rollins.
Sincerely,
Peter R. Orszag,
Director.
Madam Speaker, I reserve the balance of my time.
Mr. CAMP of Michigan. I reserve the balance of my time.
Mr. DINGELL. Madam Speaker, at this time I reserve the balance of my
time.
Mr. BARTON of Texas. Madam Speaker, may I inquire as to the order of
close.
The SPEAKER pro tempore. The Chair will recognize Members for closing
speeches in reverse order of opening: Mr. Camp, Mrs. Tubbs Jones, Mr.
Barton and Mr. Dingell.
Mr. CAMP of Michigan. At this time I ask unanimous consent to have
the gentleman from Texas (Mr. Barton) control the remainder of my time.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Michigan?
There was no objection.
Mrs. JONES of Ohio. Madam Speaker, at this time I seek unanimous
consent to have the gentleman from California (Mr. Stark), the Chair of
the Health Subcommittee of the Ways and Means Committee, manage the
balance of the time on this bill.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman from Ohio?
There was no objection.
Mr. STARK. Madam Speaker, at this time I am honored to yield 3
minutes to the distinguished gentleman from North Dakota (Mr. Pomeroy).
Mr. POMEROY. Madam Speaker, I got to be a father late in life so that
now I have got an 11-year-old and a 14-year-old at home.
And last winter I had a real long, miserable, anxious weekend, one
that any parent probably has experienced. I had a sick kid and I didn't
know what to do. A fever higher than I was comfortable with. The
disposition of my little fellow, very different than usual. And in the
end, we sought some medical care.
I have spent a lot of time thinking about that weekend as we have
thought about this SCHIP because there are families with sick young'uns
and they don't know what to do, but they cannot afford medical care.
They don't have coverage. They don't have Medicaid for the poorest of
the poor. But by virtue of working in a place that doesn't provide
employer-provided health insurance, by virtue of earning an income that
doesn't let them afford it, they're uncovered.
What do you do? The cost of one trip to an emergency room is a
month's rent. What do you do? You pray and you hope that the little one
gets better. And, fortunately, they often do. But, tragically, they
sometimes don't. So when that long-delayed trip to the doctor or the
hospital occurs, we have got a runaway health issue that the parent has
had to sit and watch develop, all the while trying to figure out how to
handle this situation.
We can make this problem go away for 10 million children by moving
this legislation forward. To me, this isn't a Democrat, this isn't a
Republican matter. This is a matter of basic morality. Are we going to
help families get access to medical care by getting insurance coverage
for their kids so they don't have to pick between bankruptcy
[[Page H12081]]
and trying to address their kids' medical problem in a more timely way?
It's as simple as that.
Gosh, the rhetoric has gotten so heated, this and that, one charge or
another. But what we have tried to do is take many of the issues that
were offered in support of sustaining the veto of the President
stopping this insurance coverage for children from taking place. We
tried to address it in this bill.
They said families earning $83,000 can get this kind of coverage. It
wasn't true, but we have taken steps in this bill to make absolutely
certain it couldn't happen under any circumstances.
They said parents are getting coverage. Well, there are a few
isolated examples of where grandfathered programs allowed that, but we
have phased that out.
We have listened and we have responded, and it's time for this side
to take ``yes'' for an answer because there is something that has got
to rise above the daily squabbling in this place, and that is
responding to the needs of families to get their kids the health care
they need. Vote ``yes'' on this bill.
Mr. BARTON of Texas. Madam Speaker, I yield myself 2 minutes.
(Mr. BARTON of Texas asked and was given permission to revise and
extend his remarks.)
Mr. BARTON of Texas. Madam Speaker, I'm reminded of a homeowner who
is getting ready to sell their home. It's a little older shop and it's
shopworn and has not seen its best day. So they have a building
inspector come out to inspect the home before they put it up for
market. And the inspector gives the report, and the inspector says,
``You've got some major termite damage in the walls, and I think you
need to really rebuild the walls.''
And the homeowner says, ``We'll paint over it.''
He says, ``Your plumbing is all rusted out. I think you really need
to replace the plumbing.''
And the homeowner says, ``We'll paint over it.''
Then he says, ``I think your insulation and your electrical system's
very frayed and you need to replace it.''
And the homeowner says, ``Well, we'll paint over it.''
What we have here today is basically the same bill that we had last
week where we sustained the President's veto. Our friends on the
majority side of the aisle have just painted over it.
Now, they are saying the right rhetorical things. They're saying that
nobody above 300 percent of poverty is going to get a benefit, but they
then disregard the enforcement mechanisms that would enforce that.
They say in section 605 that no illegal alien is going to get a
benefit, but then they change the enforcement mechanisms so that if
somebody has a Social Security card and a name to it, that's all they
have to do to prove citizenship, and the Social Security
Administration, rightfully so, says that is really not a proof of
citizenship if you are able to get a Social Security card.
And they claim that they're going to take the adults off the program
within a year, but according to the CBO, at least a half million adults
are still going to be on the program in 5 years.
So it's the same bill with a little bit different paint. In Texas we
have a saying, ``You can put lipstick on a pig, but it's still a pig.''
This bill is a pig. It may be a good pig. It may be a nice pig. It
may be intended to be the right kind of pig. But it's still a pig.
Vote ``no'' on the bill.
Mr. DINGELL. Madam Speaker, at this time I yield 2 minutes to the
distinguished gentleman from New Jersey, the chairman of the
Subcommittee on Health, my friend (Mr. Pallone).
Mr. PALLONE. Madam Speaker, I continue to be upset by the Republican
characterizations of this bill as a ``pig'' or the effort to trivialize
what we do here today. I think it's very unfortunate we have gotten to
that point.
There have been a lot of distortions on the other side from the
Republicans. But the one that I have to correct today is the continued
mention of the fact that this bill is not going to cover 10 million
children or that somehow the CBO has said it's not 10 million but it's
7.4 million.
What they have neglected to point out is that the difference are the
kids that we are going to enroll under Medicaid, and CBO has emphasized
that over and over again. There are 7.4 million covered by SCHIP, but
the addition up to the 10 is essentially covered by Medicaid. And those
are the lowest income kids of all. This bill does the best job of
making sure that those low-income children who are eligible for
Medicaid and not enrolled would, in fact, get insurance.
The Republicans continue to forget and eliminate the fact that this
bill also addresses the Medicaid program. There are a lot of kids at
the very lowest end, less than 100 percent of poverty, who are not
enrolled in Medicaid because there hasn't been the proper outreach to
get them enrolled. So what we are doing here is providing for that
outreach.
So don't tell me we're not covering 10 million children. We are. And
the ones you are not mentioning are the lowest income of all.
And then I heard my colleagues talk about the illegal aliens again.
Once again, we have put in provisions here that you have to verify
whether it's through the Social Security Administration or it's through
documentation. Now, there is probably some person to come and
misrepresent who they are. But the fact of the matter is that the CBO
says in that letter that was introduced by the gentlewoman from Ohio
into the Record that virtually no one that's on this program is an
illegal alien.
The fact of the matter is that the Republicans continue these
distortions. There are no illegal aliens. There are 10 million children
covered.
{time} 1545
Mr. BARTON of Texas. Madam Speaker, to close the debate on the
minority side, I'm very pleased to yield 1 minute to the distinguished
minority leader from the great State of Ohio (Mr. Boehner).
Mr. BOEHNER. I want to thank my colleague for yielding.
Madam Speaker and my colleagues, if you feel as though we've been
here before, it's because we have.
Last week, we had a vote to override the President's veto. The votes
were here to sustain the President's veto. I said during that debate
that Republicans and Democrats had created this program together;
Republicans and Democrats want to reauthorize this program together.
The issues that separate us are not that great; we can sit down and
resolve those issues. That has not happened.
As has been pointed out during this debate today, there are
differences. There were some attempts to address those differences; but
by and large most of them, as my colleague from Texas pointed out, were
just painted over, little tweaks with words here and little tweaks with
words there. And you've already heard about the deficiencies in this
bill.
But that's not why I rise. Why I rise is because this doesn't have to
be this way. There is no reason why we, on both sides of the aisle,
can't come together and resolve the few differences we have in this
bill that are well known now.
This bill is not being brought up today in a rush, delivered by 7:30
last night, a 293-page bill with all kinds of changes in it. We're not
debating this bill today to pass it. We're debating this bill again
today to play another political game. You know it; I know it. I sat
with the majority leader yesterday, along with the minority whip, to
say, Mr. Majority Leader, we can resolve these differences. We can fix
this and we can reauthorize this program. We were turned down.
The chairman of the Democrat Caucus stopped my staffer and said, We
don't care whether you'll give us the votes to pass this or not because
if you don't, we'll just pull this bill and we'll wrap it around your
necks in the next election. Political games, political games, political
games. Exactly what the American public are sick of, and you all know
it. Everyone knows this is nothing more than a political game, trying
to score political points, getting ready for the next legislation. I
thought the American people sent us here to deal with their problems. I
think they sent us here to work together to deal with their problems in
a way that we can be proud of.
Nothing has happened this year in this Congress. You think about it.
Step back over the course of this year, nothing has happened yet. And
let me tell
[[Page H12082]]
you, we've got another 14 months left in this Congress and nothing is
going to happen. Why? Because all the majority wants to do is play
political games and not reach across the aisle and get things done.
My promised accomplishments over the 17 years that I've been here,
three big legislative projects that I've worked on, were all done in a
bipartisan manner. Members from both sides of the aisle that played a
significant role in coming together, dealing with issues like education
reform, dealing with issues like financial services modernization,
dealing with issues like the Pension Protection Act that we did last
year, we did it together.
And when you think about the little bit of differences in this bill,
you begin to wonder once again why Congress' approval rating is at a
dismal 10 or 15 percent. Why? Because people are tired of watching this
process not work.
This bill is not going to become law. The votes are there to sustain
the President's veto; the President has made it clear he is going to
veto it. How long are we going to play the games before we get serious
about resolving our differences?
This is a sad day. And I think a lot of my friends on both sides of
the aisle realize this is a sad day when we can't come together and
deal with the issues the American people want us to deal with and deal
with them like adults, adults that are willing to sit down and work
together and to resolve those differences.
So I say to my colleagues, even those of my colleagues who voted for
this, if you're tired of the political games, if you're tired of
Congress' approval rating being at these ridiculous levels, let's all
just vote ``no.'' Let's vote ``no'' and stop this bill. And then we can
sit down and resolve the differences we have, and we can do it in a
bipartisan manner and show the American people that we can, in fact,
work together on their behalf.
Mr. RANGEL. Madam Speaker, at this time I would like to yield 2
minutes to the gentleman from Illinois, an outstanding member of the
Ways and Means Committee, Mr. Rahm Emanuel.
Mr. EMANUEL. Madam Speaker, I helped negotiate the original SCHIP
when I worked for President Clinton. It was President Clinton who
proposed the SCHIP bill, not the Republicans; in fact, they opposed it.
Then they agreed, after the Balanced Budget Agreement, that we would
have pediatric care, eye and dental; but it was President Clinton that
demanded it and made it a precondition before any agreement on the
Balanced Budget Agreement.
Now, I believe the sincerity that my colleagues support this, and I
believe the sincerity of what they said in their letter, which is why
we answered every one of those questions, both the sincerity in
supporting it, and the sincerity of those remarks. At some point, you
have to understand that you can take yes for an answer, and that is, we
have provided that answer.
Second is, Dolores Sweeney lives in my district. She works for an
insurance company. Dolores Sweeney has three kids. Her insurance
company does not provide her or her kids health care. She does right by
her kids; she earns a paycheck, not a welfare check. If her kids got
sick, she would go to Medicaid and go to welfare, but she's doing right
by her children because she's working and teaching them right from
wrong. Her kids are in SCHIP. And without this program, her kids will
live one illness away from Medicaid. Medicaid is for them, for the
poor. SCHIP is for parents who work full time earning a paycheck, not a
welfare check. They're doing right by their children.
Now, I believe in the sincerity of your position, which is why we
answered that in the last two weeks. This vote is to say whether 10
million children will get the health care they deserve, whose parents
work full-time. These are parents who are doing right.
Now, the President at one time referred to SCHIP, the Children's
Health Insurance Program, as excessive spending; yet this week he
submitted a request for $200 billion more for Iraq. These kids are our
future. Iraq is stealing our future from America.
Mr. DINGELL. Madam Speaker, I yield to my distinguished friend, the
majority leader, the balance of my time for purposes of closing.
Mr. HOYER. I thank my friend for yielding.
This is a good day. This is a good day because we have another
opportunity to extend to children, 4 million of whom are not covered by
health insurance, coverage.
I don't know how many families that is, but it's obviously millions
of families who will have the confidence that if their child gets sick,
they will have insurance. They can access health care. They can try to
make their children well.
I want to refer briefly to my friend Mr. Boehner's comments because I
agree with him that the American public expected us to come here and
work together. But let us review this legislative process.
First of all, we had committee hearings. I want to tell my friend
from Texas, those committee hearings were difficult. We didn't really
get to the committee hearings and committee markups that we wanted to
have. I think that's unfortunate. That was not our fault, I suggest to
you.
Secondly, let me say that we passed a major bill through this House,
approximately $90 billion. It dealt with a number of subjects,
including doctor reimbursements so that they would continue to serve
those who are poor under Medicaid and, indeed, under Medicare, so the
reimbursement levels under Medicare would be appropriate.
We dealt with rural hospitals so that they would be reimbursed at
levels that allowed them to continue to serve our rural communities. We
dealt with some other issues. And, yes, we dealt with children's health
insurance.
That bill went to the Senate. And there were a lot of Members of your
party who didn't like the expansive bill. But before it got there, you
offered a motion to recommit on our bill. You cut our spending cuts,
you did not agree with those, but you adopted the revenues from the tax
increase in cigarettes in your motion to recommit. Most of you, perhaps
not all, but most of you voted for that motion to recommit. So this
funding source is one that we have agreed to and everybody has voted
for.
When it got to the Senate, we made a tremendous compromise. And we
went from a $90 billion bill covering rural hospitals and doctors'
reimbursement and poor people who would have been marginalized,
perhaps, by the cuts to Medicare Advantage. And we made a compromise,
mainly with Republicans in the Senate who felt that they wanted a more
restricted bill. So that bill that is confronting us now is now a $35
billion bill, a very substantial compromise, I will suggest to you.
That bill then passed the Senate, went to the President, he vetoed
it, it came back here, and you made a determination, some of you, not
to vote to override the President's veto. So those 4 million children
don't yet have a health insurance bill.
Then 38 of you wrote to the Speaker and said that you wanted to see
certain changes. We addressed that. We addressed it very substantively,
we addressed it very carefully, and we addressed it in a bipartisan
way. And because this bill has to go through the Senate, we then
engaged Senator Hatch and Senator Grassley so that it would not be
simply Democrats saying, well, we'll take this and not that. And it was
a very considered judgment applied, and almost all of the points raised
in that letter were addressed.
Now, I had the opportunity this morning to meet with, not all 38, but
the majority of those 38. Obviously they were correct that there was
not more time to discuss this. I think that was a fair analysis. But
the fact of the matter is that careful attention and compromise was
taken.
Mr. Boehner is correct, I met with Mr. Boehner and Mr. Blunt. We have
a good relationship; we have the ability to talk. But I will tell you
that one of the indications I had was that those changes would not
affect at least one of those votes because, philosophically, that
leader is not for this bill. I understand that, that's a fair position
to take. We're for this bill. We want to see this bill go forward.
But I will say to my friends on this side of the aisle, on the
Republican side of the aisle, I want to continue to work with those who
really want to see, as that letter of 38 said, reauthorization effected
because that's what we want to see. And we will continue to work
[[Page H12083]]
with you. This bill will go to the Senate; it will be considered there
in the Senate.
We have significant, concrete changes to the legislation vetoed by
President Bush, changes that are designed to address the concerns
expressed by the President and by a number of Republican Members. We
listened carefully to the criticisms of the vetoed bill. We reviewed
the letter, as I've said, that the 38 Republicans sent to the
President, as well as other letters that were distributed. I misspoke,
I said it was sent to the Speaker. I observe only that apparently you
wanted to negotiate with the President.
We also worked closely with Senators Grassley and Hatch, who met
extensively with House Republicans. The bottom line is this: we have
taken a bipartisan compromise that was strongly supported by the
American people and by the overwhelming Members of both Houses of the
Congress of the United States and worked to make it an even stronger
bipartisan compromise.
Specifically, this legislation clarifies that it targets low-income
children. That was one of the concerns. The compromises we have reached
in the legislative language appended to the legislation today do, in
fact, accomplish that objective. Prohibiting CHIP coverage above 300
percent of the Federal poverty level that the President talked a lot
about, talked about the 83,000, we have prevented that. We said that is
not going to happen.
{time} 1600
It clarifies that illegal immigrants are not eligible for coverage
under CHIP. I have not reviewed the prescription drug bill that you
passed, but the legislation, I think, in this bill is stronger on that
issue.
It clarifies that this bill is focused on children. That was a
legitimate objection raised on your side of the aisle. We took that
into consideration because we believed it was something we should
respond to because that was our intent, to focus on children. As a
result, we have phased out coverage for childless adults over 1 year,
not 2. Some said that this is just tweaking. To have the time of
phaseout, it seems to me, is a very significant change.
And, it clarifies that this bill seeks to minimize the number of
children moving from private insurance to CHIP, ``crowd-out,''
requiring all States to develop plans and implement recommended best
practices for minimizing so-called ``crowd-out.''
We think we tried to respond, and we did respond, we believe, to the
concerns you raised. These are significant, concrete changes, changes
that neither affect nor undermine our principal objective and
commitment: to ensure that 10 million American children from low-income
working families who are eligible for coverage under CHIP guidelines
today can participate in this successful program.
I, again, remind my colleagues that this indeed was the stated
objective of the President of the United States, when, at the
Republican National Convention in 2004, he promised, in seeking
reelection by the American public, he promised this: ``In a new term,
we will lead an aggressive effort to enroll millions,'' with an S,
``millions of children who are eligible but not signed up for
government health insurance programs.'' He went on to say this: ``We
will not allow a lack of attention, or information, to stand between
these children and the health care they need.''
Unfortunately, what stands between the children and the health care
they need is the President's veto. We continue to try to achieve the
President's expressed objective. I urge my colleagues, I urge my
colleagues on both sides of the aisle. Mr. Boehner is correct. This is
not a partisan issue. There is not a Member on your side of the aisle
that doesn't care about our children. There is not a Member on our side
of the aisle that doesn't care about our children. We have an
opportunity to add 4 million children to the health coverage of our
country, just as the President said he wanted to do.
I urge you to stand with the bipartisan majorities in Congress,
including 45 House Republicans and 18 Senate Republicans who voted for
the first CHIP bill. This bill, in some ways, in my opinion, is a
better bill for the suggestions made from your side of the aisle.
Stand with the States' Governors, the American Medical Association,
the Association of Health Insurance Plans, the pharmaceutical
companies, nurses, children's advocates and others who support this
bill. Stand with the American people, 81 percent of whom support this
legislation. Stand with the 10 million American children who will
receive the health coverage they need and deserve under this
legislation.
This bipartisan compromise addresses your concerns.
Let us give ``yes'' for an answer to America's children. Vote for
this bill. It is good for America. It is good for our children.
Ms. KILPATRICK. Madam Speaker, today, Congress, once again, wrote a
prescription to the President for American children and their families
that needs to be filled immediately. I am proud of the fact that
Congress has sent to the Senate, and will soon send to the President,
an insurance remedy for so many working families. I strongly support
H.R. 3963, the Children's Health Insurance Program Reauthorization Act
of 2007, the modified bill to reauthorize and expand the State
Children's Health Insurance Program or SCHIP. Working with the
Minority, we were able to quickly craft a bill that addresses the
concerns of most, if not all, Members of Congress.
In the wealthiest country in the world, far too many children are
without health insurance. We can afford to spend $10 billion per month
in a war in Iraq, but we cannot spend $35 billion over 5 years to
protect our children? We cannot support those working families who
cannot afford or do not have access to affordable health insurance?
Over 81 percent of Americans, when asked this very question, agree with
the Democratic Party that we need to take care of our children, and we
need to take care of them now. Since the inception of SCHIP, the number
of uninsured children has been reduced by one third. However, millions
of children still remain uninsured or underinsured.
The revised bill before Congress today still would expand SCHIP to
cover 10 million children and increase spending on the program to $35
billion over 5 years, funded with a 61 cent per pack increase in the
federal cigarette tax. The bill would limit coverage to children in
families with annual incomes below 300 percent of the federal poverty
level, and performance bonuses would be offered to states that enroll
greater numbers of children in Medicaid. The bill also would offer
performance bonuses to states that provide subsidies to employed
parents to offset the cost of enrolling their children in a private
health insurance plan.
Passing this legislation should be a bipartisan issue. SCHIP was
created to address the growing problem of children in the United States
without health insurance. SCHIP assists children whose family's income
falls above the threshold for Medicaid, but who still cannot afford to
purchase medical insurance coverage. More than two thirds of the
children who will be covered under this bill are ethnic minorities.
A lack of medical insurance not only harms children, but their
families and the community as a whole. Reauthorizing this bill is so
important because children without health insurance do not receive
regular checkups and doctor visits that every child needs. May I remind
my colleagues that less than 10 miles from where we vote, a little boy
died from the lack of getting a simple dental examination. Furthermore,
millions of children won't get the preventive care they need and will
likely receive care in emergency rooms if this bill is not
reauthorized. This only drives up the cost of medical care for
everyone.
SCHIP gives working families the peace of mind that their children
will have accessible and affordable health care. Healthy children do
not get unnecessary diseases and go to school ready to learn. Healthy
children become healthy teenagers, who ultimately will become healthy
adults. Although children are about 30 percent of our population, they
are 100 percent of our future. This $35 billion is a wise investment in
the future of America.
In the Bible, in the chapter of Isaiah, it says that ``the wolf shall
dwell with the lamb, and the leopard shall lie down with the kid, and
the calf and the young lion and the fatted domestic animal together;
and a little child shall lead them.'' Today, Congress worked together
to stand up for the children of our Nation. The President, and
Congress, ignored the wisdom in protecting our children one time too
many; it is now time to erase that mistake. We have that opportunity
now.
SCHIP is a smart investment in our Nation's children and working
families. Congress has changed the course of the discussion of health
care for our children and working families; we have confronted the
crises of the lack of health insurance; we will continue the legacy of
caring for some of the least of our brothers and sisters. I look
forward to quick passage of this bill in the Senate, and the
President's enacting this bill into law. Our children deserve no less.
Mr. SALI. Madam Speaker, for the third time this Congress, the House
of Representatives
[[Page H12084]]
is again addressing the reauthorization of the State Children's Health
Insurance Program, or SCHIP. For the third time, this House is
considering a bill that would move millions of children away from
private health insurance into government-run health care, substantially
raise taxes, and dramatically increase federal spending.
Recently the President vetoed an SCHIP bill precisely because of
these concerns. Yet here we are today with a bill that is remarkably
similar. I am afraid that this Congress is not serious in addressing
America's health care challenges, particularly health care for
America's children. The majority purports that this bill is ``for the
children.'' That phrase--``for the children''--is used like a club by
our friends across the aisle whenever they want to pass bad bills. If
we really care about children, we won't pass legislation that takes a
giant step toward government-run health care.
That said, Madam Speaker, I am interested in more than this bill's
title or good intentions. The success or failure of all legislation
must be judged not by its intentions, but how it will affect real
people, real families.
Madam Speaker, this bill is not the right policy for our children.
Government health care is the most expensive and least efficient health
care you can get. And that's exactly what this bill will produce. The
Congressional Budget Office states that 2 million people actually will
lose their private health insurance coverage and become enrolled in a
government-run program.
This bill explodes funding for SCHIP above current law by $35.4
billion over 5 years and $71.5 billion over 10 years. The majority
claims to fund this by raising taxes on tobacco products, yet the irony
is that 22 million more smokers will be needed in just the next 5 years
to fund the SCHIP bill we're considering.
Let me get this straight: We want healthy children and cancerous
adults. I'm pretty new here in Congress, but even for a new kid on the
Congressional block that doesn't seem to add up.
This bill is not about poor children. The bill defines the poverty
level to qualify for SCHIP at 300 percent, which is around $62,000 for
a family of four. That's $16,000 more than the median income in my home
state.
Additionally, loopholes will allow states to define this poverty
level and employ ``income disregards,'' thereby allowing families with
even higher incomes to qualify for this expensive program.
Ostensibly ``for the children,'' this bill actually would increase
the number of adults on SCHIP. The CBO projects that over 700,000
adults may be enrolled in SCHIP in FY2012. Shouldn't we be working to
move people off of government health care and into private-sector care
that works much better? We say we're for personal responsibility, free
markets and red tape, yet this bill would create dependency, bigger
government and more bureaucracy.
Finally, this bill substantially weakens the citizenship requirements
to qualify for SCHIP, inviting fraud and abuse of this program by
illegal aliens. The CBO projects that this fiscal disaster could cost
the taxpayer around $3.7 billion in increased federal spending over the
next 10 years.
This bill also changes the period of time a state has to spend its
SCHIP allotment from 3 years to 2 years. This will significantly
increase the strain on state budgets.
This proposal is not about good intentions, soothing sentiments, or
warm feelings. It's about real people, real taxpayers, and real,
quality, affordable and accessible health care. It fails miserably in
every category.
I urge my colleagues to vote ``no'' on this fatally flawed bill.
Mr. CONYERS. Madam Speaker, today the House votes yet again on
legislation that never should have been a subject of controversy: a
bill that provides health care for our Nation's children. When we
debated overriding the President's veto of the original SCHIP bill last
week, most House Republicans offered excuses for denying children
health care based on a series of misrepresentations and distortions of
the facts. Today the bill's opponents have no more excuses to hide
behind. We have consulted with Republicans who want to support this
bill and have amended it to address their concerns. It should now be
clear to all that the real reason some continue to oppose SCHIP is
because they oppose universal health care for all Americans.
Republicans voting no on last week's veto override offered four
reasons for their unwillingness to support health coverage for
America's children. These concerns had, in fact, already been addressed
in the original bill, but now we have dealt with them even more
explicitly.
Republicans argued that the bill did not focus enough on covering
poor children. I find this particular objection rather ironic, since
the same Republicans who used this argument rarely support legislation
designed to help the poor. But, it is not surprising that they would
use disingenuous tactics to block health care for children. For them,
anything goes when it comes to stopping Americans from getting the
radical idea that the government should guarantee this basic human
right. This revised bill addresses those arguments by mandating that
SCHIP eligibility will be capped at families earning 300 percent of the
federal poverty level, around $60,000 for a family of four, and by
offering bonus payments to States for enrolling the lowest income
children into Medicaid.
Opponents of health care for children contended that the original
bill provided coverage to illegal immigrants. In reality, this bill
denied coverage to all immigrants, even legal ones, explicitly stating
that illegal immigrants were ineligible. But these facts did not hinder
the Republicans from making their false claim. We have now clarified
our intent that illegal immigrants will not be covered by requiring
that applicants for SCHIP provide their Social Security number, which
must be verified by the Social Security Administration.
Republicans opposed the original bill because it allowed States to
use the funding to cover adults. For them, a person's right to health
care ends at age 18. I would disagree, but in any case this bill now
phases out any adults covered under SCHIP over a 1-year period, instead
of the 2-year period under the original bill.
Finally, further changes have been made to clarify that this
legislation is designed to minimize children moving from private
insurance to SCHIP, also known as ``crowd-out.'' I am a critic of
private health insurance, with its costly and unnecessary
administrative, waste, advertising and profits, but this bill should
allay any concern that a government health plan, with its much lower
overhead costs and more comprehensive coverage, would diminish the role
of private insurance companies. We will actually allow States to
subsidize people to buy private coverage under this bill to prevent
them from moving to government coverage.
The President and his supporters are now left with only one argument
for opposing this bill: that it costs too much. The original House-
passed version authorized an additional $50 billion for SCHIP over 5
years; our compromise with the Senate brought the total down to $35
billion. This additional funding will ensure that SCHIP will cover 10
million children who otherwise would not have access to health care.
The President began this debate by offering to add only $5 billion,
which would have resulted in 800,000 children currently covered by
SCHIP losing their coverage. He is now saying that he's willing to go
to up to $20 billion, but no more. I would like the President to
explain to the American people how he can afford $12 billion for a
single month in Iraq but can't seem to find $35 billion over 5 years to
give our children health care. Supporters of the contention that we
can't afford this bill either care more about war than children, or are
simply not serious.
Now that the Republicans' stated reasons for opposing this
legislation have been addressed, one wonders what is actually
motivating those who will continue to vote no. I believe that the
President and his supporters continue to oppose this legislation
because they are afraid. They are afraid of SCHIP because it
demonstrates that health care guaranteed by the government is workable,
it is affordable, and it is popular. They worry that if SCHIP is
expanded, even more Americans will begin to demand that the government
guarantee health care to all our citizens, not just to poor children.
After all, every other industrialized nation does so, while spending
less than we do and while achieving better health outcomes for its
citizens. These Republicans apparently intend to use every means at
their disposal to ensure that health care in this country remains a
privilege for those who can afford it, rather than a right guaranteed
to all.
Madam Speaker, today's vote raises a moral question. Simply put: will
we, as a nation, take responsibility for ensuring that our children
have the health care they need? Any other issue raised in this debate,
particularly given the revisions to the bill, is an obfuscation meant
to hide the fact that the party claiming the mantle of ``family
values'' is in fact unwilling to back that slogan with substance. There
is only one vote today that truly supports America's families. It is a
vote in favor of this legislation.
Mrs. CHRISTENSEN. Madam Speaker, I rise in strong support of the bill
to continue and expand the Children's Health Insurance Program that is
on the floor today and to urge every member of this body to vote for
it.
Certainly there is no better investment that we can make than in our
children, and this bill does so by ensuring that an additional almost 4
million children will have access to comprehensive health care--care
that includes dental care and other important services.
And while many of us would have wished to cover every single child
who currently lives without health insurance without regard to legality
of their presence in this country, we are happy that at least all who
are legally here have the opportunity for coverage. I am also
disappointed that the Territories will not get full
[[Page H12085]]
state-like treatment, but there are improvements for us as well.
This is a big step forward for our country, which continues to lag
behind every other industrialized country in the quality of its
people's health.
And every penny that is spent on increasing access to care when
needed, on providing preventive care and early care will save this
country many more billions, and has the potential to help reduce health
care costs and save Medicare into the future.
Madam Speaker, as we move to keep our promise to America's children,
I only hope that we can continue on this road to invest in the health
and health care of minority and rural populations. I only hope that we
stand together to close the gaps in our health care system and reduce
the racial and ethnic, as well as geographic and gender differences in
health status because certainly providing preventive, early and
culturally competent care to these will pay further dividends, further
reduce the cost of health care and make this a better and stronger
country.
I urge all of my colleagues to vote in favor of our Nation's
children's health and health care; I urge my colleagues to vote in
favor of expanding and strengthening the Children's Health Insurance
Program. Today is the day for us to stop talking about doing better;
today is the day to actually start doing better, and, the children
shall lead the way.
Ms. ESHOO. Madam Speaker, I rise in strong support of this children's
health insurance bill, and I'm proud to be a cosponsor of it.
This bill is the result of a great deal of work to meet concerns of
colleagues in the minority. We want them to join us in voting for it in
order to override a presidential veto and finally enroll 10 million
children in the State Children's Health Insurance Program.
The bill makes it legislatively clear that no adults will be
covered--only children are.
The bill makes it legislatively clear that non-citizens will not be
covered.
The bill makes it legislatively clear that only low-income children
will be covered.
The bill makes it legislatively clear that no one earning $83,000 a
year will receive coverage under this bill.
While we've addressed every significant objection to this bill, we
have not compromised on the number of children covered. Our goal has
been to cover ten million low-income, uninsured children and we do.
Virtually everyone with a stake in public health and healthcare is
calling for this bill to be passed. There are 270 groups supporting
this bill: 43 Republican and Democratic governors; the American Medical
Association; AARP; America's Health Insurance Plans (AHIP); the
Healthcare Leadership Council; and Catholic Charities, among others.
This is an extraordinary investment in our children and our
collective future. I urge every Member of the House to vote for it, and
when we do it, it will be a major victory for the little ones in our
country.
Mr. HINOJOSA. Madam Speaker, I rise today in strong support of the
reauthorization of the State Children Health Insurance Program. In the
decade since its enactment, the SCHIP block grant program has exceeded
expectations by providing quality health care to millions of American
children.
In my state of Texas, over 20 percent of all children--that's
approximately 1.4 million kids--are not covered by health insurance
today. This means that 1.4 million young Texans have no access to
adequate medical care and are not receiving the preventive or primary
care they need to lead productive lives. This is a moral travesty and
an unacceptable failure of our Nation's leadership.
The SCHIP program invests in our children and our future. Without
adequate health care, our efforts to improve our educational and child
care systems are less effective. Should our children not begin their
lives in good health, they will surely be hampered by increasing
medical problems as they reach adulthood.
The President has already demonstrated his unwillingness to make this
commitment to America's children once. No one should withhold
healthcare from children in order to score cheap political points or to
make divisive partisan attacks. I urge my colleagues in Congress and
President Bush to join together in support of American families and
children by voting for the reauthorization of SCHIP.
Mr. ORTIZ. Madam Speaker, this is the second time in so many weeks we
are standing up for America's children. After the President vetoed the
State Children's Health Insurance bill, he has still not seen the light
. . . but he has felt the heat.
Since that veto, and a flurry of negotiations to tweak the bill to
engage the President to sign it, the American people have spoken out
with gusto: they believe this is a commonsense bill that will serve our
children.
And so this bill is before us again.
I urge Members of the House and the President to stand this time with
working families and children . . . not with insurance companies. The
President's veto cut off health care for over 120,000 kids in Texas.
Congress created SCHIP in 1997 with broad bipartisan support. This
year, 6 million children have health care because of SCHIP. The program
has worked well in Texas. This has been an excellent investment for our
nation, given that health care costs without insurance would be much
more expensive.
The President highlighted his support for SCHIP while running for re-
election in 2004. Today we are giving him--and those who stood with him
in sustaining his veto--one more chance to do the right thing for
America's children.
This children's healthcare program was never intended to replace
Medicaid. It only covers the children of parents who earn too much to
qualify for Medicaid, but earn too little to purchase private health
insurance. For the President to continue to misrepresent this fact
shows a tremendous lack of sensitivity for working Americans who often
take on two jobs to simply feed and clothe their children.
It is these families who need to know we are on their side, and I
urge the President this time around to join us in taking care of ``the
least of these.''
I urge my colleagues to support this bill. We are the last hope of
children and families all over this country.
Mr. UDALL of Colorado. Madam Speaker, I rise in strong support of
this bill.
Dr. Martin Luther King, Jr. said ``of all the forms of inequality,
injustice in health care is the most shocking and inhumane.'' H.R. 3963
does not end health care inequality, but it would PROVIDE continued
coverage for children not covered by Medicaid, whose parents cannot
afford to buy insurance and whose employers do not provide it.
These children--currently 6 million of them--are now eligible for
coverage under the Children's Health Insurance Program (CHIP)--but that
program is set to expire and the President should have accepted this
compromise legislation. Because the President would not accept the bi-
partisan compromise bill we passed earlier, these six million children
will go without health insurance unless Congress acts.
This legislation would assure continued coverage for those now
enrolled and would ALSO provide coverage for an additional four million
children who currently qualify, but who are not yet enrolled under
CHIP.
The past concerns raised against SCHIP reauthorization by some have
been addressed. The language concerning coverage levels and citizenship
have been clarified and strengthened to remove any doubt that illegal
immigrants are not covered under SCHIP.
The majority of uninsured children are currently eligible for
coverage--but better outreach and adequate funding are needed to
identify and enroll them. This bill gives States the tools and
incentives necessary to reach millions of uninsured children who are
eligible for, but not enrolled in, the program.
Earlier this year, I voted for the ``CHAMP'' bill to extend CHIP. The
House of Representatives passed that bill, and I had hoped the Senate
would follow suit. It would have increased funding for the CHIP program
to $50 million, instead of the lesser amount provided by this bill. The
CHAMP bill would have also addressed major health care issues, first by
protecting traditional Medicare and second by addressing the
catastrophic 10 percent payment cuts to physicians who serve Medicare
patients.
However, in a compromise with the Senate, Congress did not send the
CHAMP bill to the president. Instead, we passed a more limited,
bipartisan compromise. Regrettably, the president chose to veto it and
his veto was sustained.
So here we are again, the bill in front of us today deserves our
strong support. It will pay for continued CHIP coverage by raising the
federal tax by $0.61 per pack of cigarettes and similar amounts on
other tobacco products. According to the American Cancer society, this
means that youth smoking will be reduced by seven percent while overall
smoking will be reduced by four percent, with the potential that
900,000 lives will be saved.
H.R. 3963 has the support of the American Medical Association,
American Association of Retired Persons, Catholic Health Association,
Healthcare Leadership Council, National Associations of Children's
Hospitals, American Nurses Association, U.S. Conference of Mayors,
NAACP, American Cancer Society Cancer Action Network, and United Way of
America.
It is imperative that we pass this legislation in order to protect
those that are most vulnerable in our society by increasing health
insurance coverage for low-income children. I hope that we have the
opportunity to take up the other important Medicare issues addressed in
the CHAMP bill soon.
Mr. STEARNS. Madam Speaker, today we will again vote on a Government-
run health insurance program for children: one that only a handful of
people in the Democrat leadership have crafted, and one which only a
handful of
[[Page H12086]]
people received before it was introduced under the cover of night. The
Democrat leadership, in the 110th Congress, has continually attempted
to ram through legislation that has completely ignored the legislative
process, and time after time nothing has been accomplished. This
behavior is why this Democrat-led Congress has an abysmal 11 percent
approval rate.
The facts provided by the Congressional Budget Office, CBO, state
that the bill before us today will provide free Government-run health
care to a family, including adults, earning more than $60,000 a year.
This bill will also increase taxes on tobacco, the revenue of which
will not be set aside for this program, but rather will be put into the
Treasury for general use. In addition, this bill allows over 10 percent
of the funds allotted to provide health care for low-income children to
be used by adults, therefore limiting the amount of money available for
needy children. Finally, this legislation fails to ensure that illegal
aliens, both children and adults, will not take money away from low-
income American children. CBO estimates that under current
documentation requirements, 3.7 billion taxpayer dollars will be spent
on providing health care to people who have broken our laws and come to
our country illegally.
The flaws in this legislation are evident and, in my opinion,
correctable. Yet, the Democrat leadership refuses to allow this bill to
go through the legislative process, a process that has worked in this
Chamber for centuries. It is my hope that the Democrat leadership will
release their grip on power and allow the legislative process to create
a true bipartisan bill so that our Nation's low-income children may
receive quality, efficient, and responsible health care.
Mr. McGOVERN. Madam Speaker, I rise in strong support of the
Children's Health Insurance Program Reauthorization Act. I thank and
commend the distinguished Chair of the Energy and Commerce Committee,
Mr. Dingell, and the chair of the Ways and Means Committee, Mr. Rangel,
as well as the subcommittee chairs, Mr. Pallone and Mr. Stark, for
their hard work and dedication in bringing this bill to the floor
today. I also want to commend the Speaker of the House, Nancy Pelosi,
for her dedication to the children of America and her steadfast support
for a strong, inclusive S-CHIP bill.
The issue before us is simple. Either you believe that 10 million
low-income kids deserve health care or you don't.
I know the President and some of my Republican colleagues don't want
to have this debate. They don't want another vote on the S-CHIP bill.
They want this issue to just go away.
Well, I have some news.
This isn't going away. We're going to keep fighting until 10 million
kids get the health care they so desperately need.
It is astounding to me--it literally takes my breath away--to watch
President Bush fight to deny health care to children. It is shameful.
From day one, President Bush and the Republican leadership in the
House trashed Democratic proposals to insure children who--at no fault
of their own--are falling through the cracks of the health care system.
It's clear that America's health care system is broken. Too many are
uninsured. Too many rely on emergency rooms for their health care. And,
at the same time, health care costs continue to rise--making it harder
for businesses to provide their workers with the health care they need
and making it too expensive for individual families to buy on their
own. And God forbid if you have a pre-existing condition--you can
forget it.
All of us here in Congress have world-class health care, and so do
our kids. Maybe the problem is that not enough members of Congress
understand what it's like to struggle, to spend sleepless nights
worrying about a sick child, wondering how you're going to pay for
their doctor's visits.
Today, the Democratic majority--with the help of some brave
Republican Members--will once again approve an S-CHIP bill that
provides health care to 10 million children.
This is what we were sent to Congress to do.
The only logical conclusion we can take from President Bush's veto,
from the partisan political attacks on a 12-year-old boy and his
family, and from the continued stonewalling of this bill, is that the
majority of Republicans don't want to provide health care to children.
It's that simple. Republican leaders tried to block this bill in the
Energy and Commerce Committee. Then they stretched the truth about who
would be covered.
Let's be honest here--the House and the Senate will approve this bill
and President Bush--the former compassionate conservative candidate--
will veto it. The question is, how many Republicans will continue to
vote to deny health care to 10 million children and how many will--for
the well-being of these children--decide to stop playing politics and
vote to override the veto?
Madam Speaker, House Democrats have come more than halfway. This bill
doesn't go as far as I would like, but it's a good, bipartisan effort.
It addresses the issues raised by some on the other side of the aisle.
The bill President Bush vetoed never provided health care to illegal
immigrants--despite the incorrect claims coming from the other side.
This bill makes that even clearer. The bill President Bush vetoed never
provided health care to families making $83,000 a year and neither does
this bill. The bill President Bush vetoed took 2 years to phase out
adults currently on the S-CHIP program and this bill speeds that
timeline up to 1 year.
Let me be clear--under this bill, families who can afford health care
will not be eligible for S-CHIP. Under this bill, illegal immigrants
will not be eligible for S-CHIP. Under this bill, adults will not be
eligible for S-CHIP.
But 10 million American children who don't have health care will get
the help they so desperately need. The time has come for the members of
this body to make a choice--will they stand with the children of
America, or will they stand with President Bush?
I know where I stand, Madam Speaker.
It's time to stop playing games with the lives of children. It's time
to pass this bill.
Mr. MORAN of Virginia. Madam Speaker, I rise today in strong support
of the Children's Health Insurance Program Reauthorization Act of 2007.
Truly, we face a health care crisis in this country--in the richest
country on Earth, 46 million Americans do not have health insurance,
including 9 million children. Today's bipartisan, bicameral compromise
is not a perfect solution to that problem but is a decisive, strong
step towards covering uninsured kids and fulfilling our moral
obligation to our children.
In my home state of Virginia, the CHIP program currently provides
coverage to 137,642 low-income children each year; 171,642 children in
Virginia remain uninsured, and the CHIP Reauthorization Act will help
us cover 74,200 of these children. The CHIP Reauthorization Act will
ensure that these children have access to high quality health care,
including the preventative services that children need to be healthy
and successful in school and later in life. This bill will provide
dental and mental health benefits on par with medical and surgical
services--truly ensuring that the whole child's health is provided for.
The CHIP Reauthorization Act does this without increasing the
deficit, by increasing the Federal excise tax on cigarettes. In my view
as chairman of the Congressional Prevention Caucus, an increase in the
Federal tobacco tax is sound public health policy. It provides a
reliable revenue source to offset the costs of expanding coverage to
low-income children and it will reduce health care costs in this
country by reducing the prevalence of chronic disease.
This bill also addresses a serious problem arising from the
implementation of the Deficit Reduction Act of 2005. Opponents of this
responsible, common-sense, humane adjustment claim that language in the
2005 Deficit Reduction Act, DRA, that imposed harsher citizenship
verification requirements on state Medicaid programs, is the only
barrier protecting taxpayer dollars from being spent on healthcare for
illegal immigrants. Madam Speaker, nothing could be further from the
truth.
First and foremost, existing Federal law and provisions in the CHIP
Reauthorization Act prevent Federal funds from being spent to provide
benefits for illegal immigrants. Section 605 specifically states that
``nothing in this act allows Federal payment for individuals who are
not legal immigrants.'' Illegal immigrants have never been eligible for
Medicaid, and nothing in the CHIP Reauthorization Act would change that
fact.
Secondly, the DRA requirements have overwhelmingly failed to save
taxpayer dollars. Instead, they have imposed substantial additional
costs on taxpayers while reducing health care benefits available to
poor children. Wait times have skyrocketed, and measures to streamline
the application process have been rendered impossible.
Third, these draconian requirements, which are far stricter than
those employed by other government programs, have caused tens of
thousands of U.S. citizen children to lose health insurance coverage.
In Virginia, there was a net decline of more than 11,000 children
enrolled in Medicaid during the first 9 months of implementation.
Kansas has seen a net decline of 14,000 children. The Virginia State
Medicaid Office has identified a total of two undocumented immigrants
during this period.
The debate about reauthorizing SCHIP should be about the public
health and improving the health of our children. In a recent survey, 90
percent of parents applying for Medicaid for their children indicated
that they have no other health coverage available. Allowing State
flexibility in citizenship verification is sound public health policy
that would enable thousands of American children access to vital
[[Page H12087]]
health services to help them live better, healthier, and more
productive lives. Twenty-four Senators, twelve Governors, and fifty-one
other House Members joined me in requesting that this important
provision be included. I thank the Committees for including this
provision, and for working with our Republican colleagues to improve
the provision and ensure that SCHIP and Medicaid serve the low-income
American children they were aimed at.
Reauthorizing SCHIP is sound public health policy--research shows
that children who have access to health insurance are substantially
more likely to access key preventative services, miss fewer days of
school due to illness, get better grades, and continue to have superior
outcomes later in life. Moreover, the financial benefits of covering
children vastly outweigh the costs--one need only compare the cost of a
visit to a primary care provider to the cost of a night spent in the
emergency room to see this. But above all, covering all our children is
a moral imperative--it is the only possible humane, responsible course
of action. I urge a yes vote on the underlying bill, and furthermore,
would urge the President, in the strongest possible terms, not to veto
this vitally needed, responsible legislation to cover the most
vulnerable members of our society: our children.
The SPEAKER pro tempore. All time for debate has expired.
Pursuant to House Resolution 774, the bill is considered read and the
previous question is ordered.
The question is on the engrossment and third reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
Motion to Recommit Offered by Mr. Barton of Texas
Mr. BARTON of Texas. Madam Speaker, I have a motion to recommit at
the desk.
The SPEAKER pro tempore. Is the gentleman opposed to the bill?
Mr. BARTON of Texas. In its current form I am.
The SPEAKER pro tempore. The Clerk will report the motion to
recommit.
The Clerk read as follows:
Mr. Barton of Texas moves to recommit the bill H.R. 3963 to
the Committee on Energy and Commerce with instructions to
report the same back to the House forthwith with the
following amendments:
Strike section 104 (relating to CHIP performance bonus
payments) (page 28, line 1, through page 42, line 20).
After section 109 (page 51, after line 9), insert the
following:
SEC. 110. REQUIRING OUTREACH AND COVERAGE BEFORE EXPANSION OF
ELIGIBILITY.
(a) State Plan Required To Specify How It Will Achieve
Coverage for 90 Percent of Targeted Low-Income Children.--
(1) In general.--Section 2102(a) (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
2009) will allow for the State's annual funding allotment to
cover at least 90 percent of the eligible targeted low-income
children in the State.''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to State child health plans for fiscal years
beginning with fiscal year 2009.
(b) Limitation on Program Expansions Until Lowest Income
Eligible Individuals Enrolled.--Section 2105(c) (42 U.S.C.
1397dd(c)), as amended in this Act, is amended by adding at
the end the following new paragraph:
``(13) Limitation on increased coverage of higher income
children.--For child health assistance furnished in a fiscal
year beginning with fiscal year 2008:
``(A) Special rules for payment for children with family
income above 200 percent of poverty line.--In 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 300 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 90 percent retrospective
coverage test specified in subparagraph (B)(i) for the
previous fiscal year; and
``(ii) the State will meet the 90 percent prospective
coverage test specified in subparagraph (B)(ii) for the
fiscal year.
``(B) 90 percent coverage tests.--
``(i) Retrospective test.--The 90 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 90
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) Prospective test.--The 90 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 90 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.
``(C) Grandfather.--Subparagraphs (A) and (B) shall not
apply to the provision of child health assistance--
``(i) to a targeted low-income child who is enrolled for
child health assistance under this title as of September 30,
2007;
``(ii) to a pregnant woman who is enrolled for assistance
under this title as of September 30, 2007, through the
completion of the post-partum period following completion of
her pregnancy; and
``(iii) for items and services furnished before October 1,
2008, to an individual who is not a targeted low-income child
and who is enrolled for assistance under this title as of
September 30, 2007.''.
(c) Standardization of Income Determinations.--
(1) In general.--Section 2110 (42 U.S.C. 1397jj) is amended
by adding at the end the following new subsection:
``(d) Standardization of Income Determinations.--In
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).''.
(2) Effective date.--the amendment made by paragraph (1)
shall apply to determinations (and redeterminations) of
income made on or after October 1, 2008.
Amend section 112 (page 59, line 13, through page 74, line
15) to read as follows:
SEC. 112. PHASE-OUT OF COVERAGE FOR NONPREGNANT ADULTS UNDER
CHIP; CONDITIONS FOR COVERAGE OF PARENTS.
(a) In General.--Title XXI (42 U.S.C. 1397aa et seq.) is
amended by adding at the end the following new section:
``SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT ADULTS.
``(a) Termination of Coverage for Nonpregnant Adults.--
``(1) No new chip waivers; automatic extensions at state
option through 2008.--Notwithstanding 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 Children's Health Insurance Program
Reauthorization Act of 2007, 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, 2009, 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 chip coverage under applicable
existing waivers at the end of 2008.--
``(A) In general.--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, 2008.
``(B) Application of enhanced fmap.--The 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, 2008.
``(3) State option to apply for medicaid waiver to continue
coverage for nonpregnant adults.--
``(A) In general.--Each State for which coverage under an
applicable existing waiver is terminated under paragraph
(2)(A) may submit, not later than September 30, 2008, an
application to the Secretary for a waiver under section 1115
of the State plan under title XIX to provide medical
assistance to a nonpregnant childless adult whose coverage is
so terminated (in this subsection referred to as a `Medicaid
nonpregnant childless adults waiver').
``(B) Deadline for approval.--The Secretary shall make a
decision to approve or deny an application for a Medicaid
nonpregnant childless adults waiver submitted under
subparagraph (A) within 90 days of the date of the submission
of the application. If no decision has been made by the
Secretary as of December 31, 2008, on the application of a
[[Page H12088]]
State for a Medicaid nonpregnant childless adults waiver that
was submitted to the Secretary by September 30, 2008, the
application shall be deemed approved.
``(C) Standard for budget neutrality.--The budget
neutrality requirement applicable with respect to
expenditures for medical assistance under a Medicaid
nonpregnant childless adults waiver shall--
``(i) in the case of 2009, allow expenditures for medical
assistance under title XIX for all such adults to not exceed
the total amount of payments made to the State under
paragraph (3)(B) for 2008, increased by the percentage
increase (if any) in the projected nominal per capita amount
of National Health Expenditures for 2009 over 2008, as most
recently published by the Secretary; and
``(ii) in the case of any succeeding year, allow such
expenditures to not exceed the amount in effect under this
subparagraph for the preceding year, increased by the
percentage increase (if any) in the projected nominal per
capita amount of National Health Expenditures for the year
involved over the preceding year, as most recently published
by the Secretary.
``(b) Applicable Existing Waiver.--For purposes of this
section--
``(1) In general.--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, 2007.
``(2) Definitions.--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) Conforming Amendments.--
(1) Section 2107(f) (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
Children's Health Insurance Program Reauthorization Act of
2007 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 112 of the
Children's Health Insurance Program Reauthorization Act of
2007, nothing''.
In the paragraph (8)(A) added by section 114(a), strike (on
page 76, line 12)``would exceed 300 percent of the poverty
line'' and all that follows through ``type of expense or type
of income'' (on line 16) and insert ``will exceed 300 percent
of the poverty line.''.
Amend the paragraph (9)(B) added by section 116(e) (page
85, beginning on line 21) to read as follows:
``(B) Higher income eligibility state.--A higher income
eligibility State described in this clause is a State that
applies under its State child health plan an eligibility
income standard for targeted low-income children that exceeds
300 percent of the poverty line.''.
Amend section 211 (page 130, line 9, through page 146, line
11) to read as follows:
SEC. 211. APPLICATION OF CITIZENSHIP DOCUMENTATION
REQUIREMENTS.
(a) In General.--Section 2105(c) (42 U.S.C. 1397dd(c)), as
amended by sections 114(a) and 116(c), is amended by adding
at the end the following new paragraph:
``(10) Application of citizenship documentation
requirements.--
``(A) In general.--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 women.--For 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 such section 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) Effective Date.--The amendment made by paragraph (1)
shall apply to eligibility determinations and
redeterminations made after March 31, 2008.
In the paragraph (11) added by section 301(a), add at the
end the following (page 160, after line 13):
``(O) Requirement for certain states.--Effective October 1,
2009, any State that provides for child health assistance
under this title for children in families with income that
exceeds 200 percent of the poverty line shall elect and
implement the option under this paragraph.''.
In section 605 (on page 251, beginning on line 8), strike
``Nothing in this Act allows Federal payment for individuals
who are not legal residents.'' and insert ``Notwithstanding
any other provision of law, no Federal payment shall be made
under title XXI of the Social Security Act for any individual
who is not a legal resident of the United States.''.
Strike section 613 (page 255, lines 14 through 20).
Mr. BARTON of Texas (during the reading). Madam Speaker, I ask
unanimous consent that the motion to recommit be considered as read.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
Mr. DINGELL. I object. I reserve a point of order.
The SPEAKER pro tempore. Objection is heard.
The point of order is reserved.
The Clerk will continue to read.
{time} 1615
Mr. DINGELL. Madam Speaker, I withdraw my point of order.
The SPEAKER pro tempore. The gentleman withdraws his point of order.
Pursuant to the rule, the gentleman from Texas is recognized for 5
minutes in support of his motion.
Mr. BARTON of Texas. Madam Speaker, I appreciate my good friend, Mr.
Dingell, asking that the motion to recommit be read. I did the same
thing in committee on the 593-page bill, so I think payback is fair. So
I don't have a problem with that. I hope that the Members in the
Chamber actually listened to the reading of the Clerk, because those
that did will agree with me on the following things.
First of all, we have taken the 293-page bill that we got at
approximately 7 p.m. last evening and left most of it untouched. We
have changed approximately 15 pages of a 293-page bill. We have
listened carefully to our friends on the majority side at what they say
they want, and we have tried to implement those changes in this motion
to recommit.
We start out with the fact that our friends on the majority side
agree with us that SCHIP should be for the poor and the near-poor in
American society. This motion to recommit eliminates the loophole for
income-disregards that would allow States to actually cover children
and families in all probability well above 300 percent. So we have an
elimination action in this motion to recommit that would eliminate that
loophole.
We also believe that before you go above 200 percent of poverty, you
should cover the children below 200 percent of poverty, so we have a
requirement in the motion to recommit that States cannot go above 200
percent of poverty until they have covered at least 90 percent of the
eligible SCHIP and Medicare children below 200 percent of the poverty
line.
We take statements like Chairman Rangel of the Ways and Means
Committee and Chairman Dingell of the Energy and Commerce Committee at
face value when they say they don't want illegal aliens to be covered
in the bill. We put a requirement in the motion to recommit that
applies the same citizenship documentation requirements for SCHIP as we
have for Medicaid in the Deficit Reduction Act and applies those to the
16 States that it does not currently apply to.
We also take the majority at their word when they say that they
really want SCHIP to be for children. The motion to recommit would take
all adults off the program within 1 year except for pregnant women. We
would continue to cover pregnant women under the SCHIP program.
We have a concern about when you begin to go above 200 percent of
poverty that you actually begin to crowd out the private insurance
market, so we do have a requirement in the motion to recommit that if a
State wants to go above 200 percent of poverty, they have to have, they
must have, a premium support assistance program that would give those
families that have private insurance the option to continue to receive
the private insurance, and they get premium assistance from that State
government.
[[Page H12089]]
Finally, the motion to recommit has been scored by the CBO as saving
at least $10 billion from the pending bill.
Also, in full disclosure, I need to point out we do not change in the
motion to recommit the pay-for, so the portion of the underlying bill
that does have a tobacco tax, we do not touch that. We don't try to
move it up, we don't try to move it down, we don't try to substitute
for it. The motion to recommit that we offered in August had that same
provision, but I think in the interests of full disclosure, we need to
put that on the table.
Madam Speaker, I yield back the balance of my time.
Mr. DINGELL. Madam Speaker, I rise in opposition to the motion to
recommit.
The SPEAKER pro tempore. The gentleman from Michigan is recognized
for 5 minutes.
Mr. DINGELL. Madam Speaker, I begin with an expression of my
affection and respect for my good friend from Texas (Mr. Barton). In
most matters he is an extraordinarily fine legislator, except on
occasions when he offers these motions to recommit.
I begin by pointing out that my good friend's motion to recommit is
the same tax about which there have been such prodigious complaints by
my Republican colleagues, but that fewer kids are covered, and that
there are many impediments inserted into the bill by the motion to
recommit to covering the number of kids.
Having said that, my colleagues on the other side say they want to
ensure that lowest-income States are covered, but they strike the bonus
payments that CBO says will get 1.9 million of the lowest-income
children covered who would not otherwise be covered.
{time} 1630
Second, they say they are for working families. But it is interesting
to note that they are forcing, by this, many of the working families
who would receive coverage under the bill before us are forced to go
onto welfare in order to get health care because they strike the
provisions which would discourage that kind of unfortunate event. My
colleagues, I would observe, still have the wrong medicine for the
problem.
Now, in addition to this, the recommit would prohibit States looking
to expand coverage to a family of three at $52,000 from doing so unless
they meet arbitrary enrollment targets. The result of that is, of
course, again harder for people who deserve and need this kind of
relief to get this kind of benefit.
The last point I want to make here is their proposal does not remedy
the current problem that has caused thousands of children to lose
health coverage due to Republican bureaucratic requirements. I would
point out something else, and that is my good friends have essentially
in this, as near as I can figure, reenacted the President's proposal,
which would set forth a directive to the States as to how they will
administer this, something that has caused a huge outrage amongst the
States, amongst persons affected and amongst advocates for the poor and
the unfortunate. This is perhaps the worst part of what the proposal to
recommit does.
Let's look at what the bill does. The bill increases the number of
children who are eligible for coverage, for health insurance, from 6.6
to 10 million young Americans. It must be observed that we are doing
this amidst a circumstance where we have seen significant increases in
the number of our children joining the ranks of the uninsured.
The bill does more. It sees to it that we take care of the problem.
Nearly 70 percent of all uninsured children are from families below
$41,300 for a family of four. Of the 9 million uninsured children,
nearly two-thirds are either preschool or elementary school age. This
is the time when health care becomes singularly precious and important
to them.
I would remind my colleagues that a Nation is judged by how it treats
and cares for those who are most vulnerable and least able to help
themselves. The bill sees to it that we amplify and include greater
numbers of those who are most dependent upon others for their survival.
But in addition to that, I would remind my colleagues that this
legislation is something which is of great importance because we are
talking about the future of the kids. Giving them health care now when
they have need of it is something that ensures that Americans in the
future will be the kind of productive, valuable citizens who are able
to carry forward the competition of this Nation in some of its most
difficult, competitive times.
Now, this bill would significantly increase and improve access for
needed health care to children. The proposal in the motion to recommit
significantly cuts back on that.
I urge my colleagues to vote ``no'' on the motion to recommit and
vote for the bill.
The SPEAKER pro tempore (Mrs. Tauscher). Without objection, the
previous question is ordered on the motion to recommit.
There was no objection.
The SPEAKER pro tempore. The question is on the motion to recommit.
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Mr. BARTON of Texas. Madam Speaker, on that I demand the yeas and
nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 9 of rule XX, the Chair
will reduce to 5 minutes the minimum time for any electronic vote on
the question of passage.
The vote was taken by electronic device, and there were--yeas 164,
nays 242, not voting 26, as follows:
[Roll No. 1008]
YEAS--164
Aderholt
Akin
Alexander
Bachmann
Bachus
Baker
Barrett (SC)
Bartlett (MD)
Barton (TX)
Biggert
Bilirakis
Bishop (UT)
Blackburn
Blunt
Boehner
Bonner
Bono
Boozman
Boustany
Brady (TX)
Broun (GA)
Brown (SC)
Brown-Waite, Ginny
Buchanan
Burgess
Burton (IN)
Camp (MI)
Campbell (CA)
Cannon
Cantor
Carter
Castle
Chabot
Coble
Cole (OK)
Conaway
Crenshaw
Cubin
Culberson
Davis (KY)
Davis, David
Davis, Tom
Deal (GA)
Dent
Doolittle
Drake
Duncan
Ehlers
English (PA)
Everett
Fallin
Feeney
Flake
Forbes
Fortenberry
Foxx
Franks (AZ)
Frelinghuysen
Garrett (NJ)
Gerlach
Gilchrest
Gingrey
Gohmert
Goode
Goodlatte
Granger
Hall (TX)
Heller
Hensarling
Herger
Hobson
Hoekstra
Hulshof
Inglis (SC)
Johnson (IL)
Johnson, Sam
Jones (NC)
Jordan
Keller
King (IA)
Kingston
Kirk
Kline (MN)
Knollenberg
Kuhl (NY)
Lamborn
Latham
LaTourette
Lewis (KY)
Linder
Lucas
Lungren, Daniel E.
Mack
Manzullo
Marchant
McCarthy (CA)
McCaul (TX)
McCotter
McCrery
McKeon
McMorris Rodgers
Mica
Miller (FL)
Miller (MI)
Moran (KS)
Murphy, Tim
Musgrave
Myrick
Neugebauer
Nunes
Paul
Pearce
Pence
Peterson (PA)
Petri
Pickering
Pitts
Platts
Poe
Porter
Price (GA)
Pryce (OH)
Putnam
Radanovich
Regula
Rehberg
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Roskam
Royce
Ryan (WI)
Sali
Saxton
Schmidt
Sensenbrenner
Sessions
Shadegg
Shimkus
Simpson
Smith (NE)
Smith (TX)
Souder
Stearns
Sullivan
Terry
Thornberry
Tiahrt
Tiberi
Turner
Upton
Walberg
Walden (OR)
Walsh (NY)
Wamp
Weldon (FL)
Weller
Westmoreland
Whitfield
Wicker
Wilson (SC)
Young (FL)
NAYS--242
Abercrombie
Ackerman
Allen
Altmire
Andrews
Arcuri
Baca
Baird
Baldwin
Barrow
Bean
Becerra
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blumenauer
Boswell
Boucher
Boyd (FL)
Boyda (KS)
Brady (PA)
Braley (IA)
Brown, Corrine
Butterfield
Capito
Capps
Capuano
Cardoza
Carnahan
Carney
Castor
Chandler
Clarke
Clay
Cleaver
Clyburn
Cohen
Conyers
Cooper
Costa
Costello
Courtney
Cramer
Crowley
Cuellar
Cummings
Davis (AL)
Davis (IL)
Davis, Lincoln
DeGette
Delahunt
DeLauro
Diaz-Balart, L.
Diaz-Balart, M.
Dicks
Dingell
Doggett
Donnelly
Doyle
Edwards
Ellison
Ellsworth
Emanuel
Emerson
Engel
Eshoo
Etheridge
Farr
Fattah
Ferguson
Fossella
Frank (MA)
Giffords
Gillibrand
Gonzalez
Gordon
Graves
Green, Al
Green, Gene
Grijalva
Gutierrez
Hall (NY)
Hare
Harman
Hastings (FL)
Hayes
Herseth Sandlin
Higgins
Hill
Hinchey
Hinojosa
Hirono
Hodes
Holden
Holt
Honda
Hooley
Hoyer
Inslee
Israel
Jackson (IL)
Jackson-Lee (TX)
Jefferson
Johnson (GA)
Jones (OH)
Kagen
Kanjorski
Kaptur
Kennedy
Kildee
Kind
[[Page H12090]]
King (NY)
Klein (FL)
Kucinich
LaHood
Lampson
Langevin
Lantos
Larsen (WA)
Larson (CT)
Lee
Levin
Lewis (GA)
Lipinski
LoBiondo
Loebsack
Lofgren, Zoe
Lowey
Lynch
Mahoney (FL)
Maloney (NY)
Markey
Marshall
Matheson
Matsui
McCarthy (NY)
McCollum (MN)
McDermott
McGovern
McHugh
McNerney
McNulty
Meek (FL)
Meeks (NY)
Melancon
Michaud
Miller (NC)
Miller, George
Mitchell
Mollohan
Moore (KS)
Moore (WI)
Moran (VA)
Murphy (CT)
Murphy, Patrick
Murtha
Nadler
Napolitano
Neal (MA)
Oberstar
Obey
Olver
Ortiz
Pallone
Pascrell
Pastor
Payne
Perlmutter
Peterson (MN)
Pomeroy
Price (NC)
Rahall
Ramstad
Rangel
Reichert
Renzi
Reyes
Richardson
Rodriguez
Ros-Lehtinen
Ross
Rothman
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Salazar
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Schakowsky
Schiff
Schwartz
Scott (GA)
Scott (VA)
Serrano
Sestak
Shays
Sherman
Shuler
Sires
Skelton
Slaughter
Smith (NJ)
Smith (WA)
Snyder
Solis
Space
Spratt
Stark
Stupak
Sutton
Tanner
Tauscher
Taylor
Thompson (CA)
Thompson (MS)
Tierney
Towns
Tsongas
Udall (CO)
Udall (NM)
Van Hollen
Velazquez
Visclosky
Walz (MN)
Wasserman Schultz
Waters
Watson
Watt
Waxman
Weiner
Welch (VT)
Wexler
Wilson (NM)
Wolf
Woolsey
Wu
Wynn
Yarmuth
NOT VOTING--26
Bilbray
Boren
Buyer
Calvert
Carson
Davis (CA)
DeFazio
Dreier
Filner
Gallegly
Hastert
Hastings (WA)
Hunter
Issa
Jindal
Johnson, E. B.
Kilpatrick
Lewis (CA)
McHenry
McIntyre
Miller, Gary
Shea-Porter
Shuster
Tancredo
Wilson (OH)
Young (AK)
{time} 1657
Ms. TSONGAS, Mr. GORDON of Tennessee, Mr. TOWNS and Mrs. CAPITO
changed their vote from ``yea'' to ``nay.''
Mr. SHIMKUS changed his vote from ``nay'' to ``yea.''
Mr. COSTA changed his vote from ``present'' to ``nay.''
So the motion to recommit was rejected.
The result of the vote was announced as above recorded.
Stated for:
Mr. McHENRY. Madam Speaker, on rollcall No. 1008 I am not recorded
because I was unavoidably detained on my return to the Capitol. Had I
been present, I would have voted ``yea.''
Stated against:
Mr. FILNER. Madam Speaker, on rollcall No. 1008, I was not present
because I was helping my constituents cope with the fire crisis in San
Diego, CA. Had I been present, I would have voted ``nay.''
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. BARTON of Texas. Madam Speaker, on that I demand the yeas and
nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. This will be a 5-minute vote.
The vote was taken by electronic device, and there were--yeas 265,
nays 142, not voting 26, as follows:
[Roll No. 1009]
YEAS--265
Abercrombie
Ackerman
Allen
Altmire
Andrews
Arcuri
Baca
Baird
Baldwin
Barrow
Bean
Becerra
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blumenauer
Bono
Boswell
Boucher
Boyd (FL)
Boyda (KS)
Brady (PA)
Braley (IA)
Brown, Corrine
Buchanan
Butterfield
Capito
Capps
Capuano
Cardoza
Carnahan
Carney
Castle
Castor
Chandler
Clarke
Clay
Cleaver
Clyburn
Cohen
Conyers
Cooper
Costa
Costello
Courtney
Cramer
Crowley
Cuellar
Cummings
Davis (AL)
Davis (IL)
Davis, Lincoln
Davis, Tom
Delahunt
DeLauro
Dent
Dicks
Dingell
Doggett
Donnelly
Doyle
Edwards
Ellison
Ellsworth
Emanuel
Emerson
Engel
English (PA)
Eshoo
Etheridge
Farr
Fattah
Ferguson
Fossella
Frank (MA)
Gerlach
Giffords
Gilchrest
Gillibrand
Gonzalez
Gordon
Green, Al
Green, Gene
Grijalva
Gutierrez
Hall (NY)
Hare
Harman
Hastings (FL)
Herseth Sandlin
Higgins
Hill
Hinchey
Hinojosa
Hirono
Hobson
Hodes
Holden
Holt
Honda
Hooley
Hoyer
Inslee
Israel
Jackson (IL)
Jackson-Lee (TX)
Jefferson
Johnson (GA)
Jones (OH)
Kagen
Kanjorski
Kaptur
Kennedy
Kildee
Kind
King (NY)
Kirk
Klein (FL)
Kucinich
LaHood
Lampson
Langevin
Lantos
Larsen (WA)
Larson (CT)
Latham
LaTourette
Lee
Levin
Lewis (GA)
Lipinski
LoBiondo
Loebsack
Lofgren, Zoe
Lowey
Lynch
Mahoney (FL)
Maloney (NY)
Markey
Matheson
Matsui
McCarthy (NY)
McCollum (MN)
McDermott
McGovern
McHugh
McIntyre
McMorris Rodgers
McNerney
McNulty
Meek (FL)
Meeks (NY)
Melancon
Michaud
Miller (MI)
Miller (NC)
Miller, George
Mitchell
Mollohan
Moore (KS)
Moore (WI)
Moran (KS)
Moran (VA)
Murphy (CT)
Murphy, Patrick
Murphy, Tim
Murtha
Nadler
Napolitano
Neal (MA)
Oberstar
Obey
Olver
Ortiz
Pallone
Pascrell
Pastor
Payne
Pelosi
Perlmutter
Peterson (MN)
Petri
Platts
Pomeroy
Porter
Price (NC)
Pryce (OH)
Rahall
Ramstad
Rangel
Regula
Rehberg
Reichert
Renzi
Reyes
Richardson
Rodriguez
Ross
Rothman
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Salazar
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Schakowsky
Schiff
Schwartz
Scott (GA)
Scott (VA)
Serrano
Sestak
Shays
Sherman
Shuler
Simpson
Sires
Skelton
Slaughter
Smith (NJ)
Smith (WA)
Snyder
Solis
Space
Spratt
Stark
Stupak
Sutton
Tanner
Tauscher
Taylor
Thompson (CA)
Thompson (MS)
Tiberi
Tierney
Towns
Tsongas
Turner
Udall (CO)
Udall (NM)
Upton
Van Hollen
Velazquez
Visclosky
Walsh (NY)
Walz (MN)
Wasserman Schultz
Waters
Watson
Watt
Waxman
Weiner
Welch (VT)
Wexler
Wilson (NM)
Wolf
Woolsey
Wu
Wynn
Yarmuth
Young (FL)
NAYS--142
Aderholt
Akin
Alexander
Bachmann
Bachus
Baker
Barrett (SC)
Bartlett (MD)
Barton (TX)
Biggert
Bilirakis
Bishop (UT)
Blackburn
Blunt
Boehner
Bonner
Boozman
Boustany
Brady (TX)
Broun (GA)
Brown (SC)
Brown-Waite, Ginny
Burgess
Burton (IN)
Camp (MI)
Campbell (CA)
Cannon
Cantor
Carter
Chabot
Coble
Cole (OK)
Conaway
Crenshaw
Cubin
Culberson
Davis (KY)
Davis, David
Deal (GA)
Diaz-Balart, L.
Diaz-Balart, M.
Doolittle
Drake
Duncan
Ehlers
Everett
Fallin
Feeney
Flake
Forbes
Fortenberry
Foxx
Franks (AZ)
Frelinghuysen
Garrett (NJ)
Gingrey
Gohmert
Goode
Goodlatte
Granger
Graves
Hall (TX)
Hayes
Heller
Hensarling
Herger
Hoekstra
Hulshof
Inglis (SC)
Johnson (IL)
Johnson, Sam
Jones (NC)
Jordan
Keller
King (IA)
Kingston
Kline (MN)
Knollenberg
Kuhl (NY)
Lamborn
Lewis (KY)
Linder
Lucas
Lungren, Daniel E.
Mack
Manzullo
Marchant
Marshall
McCarthy (CA)
McCaul (TX)
McCotter
McCrery
McKeon
Mica
Miller (FL)
Musgrave
Myrick
Neugebauer
Nunes
Paul
Pearce
Pence
Peterson (PA)
Pickering
Pitts
Poe
Price (GA)
Putnam
Radanovich
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Ros-Lehtinen
Roskam
Royce
Ryan (WI)
Sali
Saxton
Schmidt
Sensenbrenner
Sessions
Shadegg
Shimkus
Smith (NE)
Smith (TX)
Souder
Stearns
Sullivan
Terry
Thornberry
Tiahrt
Walberg
Walden (OR)
Wamp
Weldon (FL)
Weller
Westmoreland
Whitfield
Wicker
Wilson (SC)
NOT VOTING--26
Bilbray
Boren
Buyer
Calvert
Carson
Davis (CA)
DeFazio
DeGette
Dreier
Filner
Gallegly
Hastert
Hastings (WA)
Hunter
Issa
Jindal
Johnson, E. B.
Kilpatrick
Lewis (CA)
McHenry
Miller, Gary
Shea-Porter
Shuster
Tancredo
Wilson (OH)
Young (AK)
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (during the vote). Members are advised there
are 2 minutes remaining on this vote.
{time} 1706
So the bill was passed.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
Stated for:
Mr. FILNER. Madam Speaker, on rollcall No. 1009, I was not present
because I was helping my constituents cope with the fire crisis in San
Diego, CA. Had I been present, I would have voted ``yea.''
Mr. McHENRY. Mr. Speaker, on rollcall No. 1009 I am not recorded
because I was unavoidably detained on my return to the Capitol. Had I
been present, I would have voted ``nay.''
____________________