[Congressional Record Volume 155, Number 22 (Wednesday, February 4, 2009)]
[House]
[Pages H928-H975]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    CHILDREN'S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT OF 2009

  Mr. POLIS of Colorado. Madam Speaker, by direction of the Committee 
on Rules, I call up House Resolution 107 and ask for its immediate 
consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 107

       Resolved, That upon adoption of this resolution it shall be 
     in order to take from the Speaker's table the bill (H.R. 2) 
     to amend title XXI of the Social Security Act to extend and 
     improve the Children's Health Insurance Program, and for 
     other purposes, with the Senate amendment thereto, and to 
     consider in the House, without intervention of any point of 
     order except those arising under clause 10 of rule XXI, a 
     motion offered by the chair of the Committee on Energy and 
     Commerce or his designee that the House concur in the Senate 
     amendment. The Senate amendment and the motion shall be 
     considered as read. The motion shall be debatable for one 
     hour equally divided among and controlled by the chair and 
     ranking minority member of the Committee on Energy and 
     Commerce and the chair and ranking minority member of the 
     Committee on Ways and Means. The previous question shall be 
     considered as ordered on the motion to adoption without 
     intervening motion.

  The SPEAKER pro tempore. The gentleman from Colorado is recognized 
for 1 hour.
  Mr. POLIS of Colorado. Madam Speaker, for the purposes of debate 
only, I yield the customary 30 minutes to the gentleman from Texas and 
my colleague on the Rules Committee, Mr. Sessions. All time yielded 
during consideration of the rule is for debate only.


                             General Leave

  Mr. POLIS of Colorado. I ask unanimous consent that all Members may 
have 5 legislative days within which to revise and extend their remarks 
and insert extraneous material into the Record.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Colorado?
  There was no objection.
  Mr. POLIS of Colorado. Madam Speaker, I yield myself such time as I 
may consume.
  Madam Speaker, House Resolution 107 provides for consideration of the 
Senate amendment to H.R. 2, the Children's Health Insurance Program 
Reauthorization Act of 2009.
  I rise in support of House Resolution 107, the Children's Health 
Insurance Program Reauthorization Act. I again wish to thank Speaker 
Pelosi who has been an unrelenting champion on this important issue. I 
also want to thank Chairman Rangel and Chairman Dingell for sponsoring 
bills that were vetoed in the 110th Congress, and Chairman Waxman and 
all of my colleagues for their leadership on this issue in this 
Congress, and I want to recognize everyone's efforts to bring this bill 
to where it is today.
  Although I began my House service only a few weeks ago, I have 
received hundreds of letters from constituents who have serious 
concerns about health care cost and coverage. Too common is the story 
of hardworking, low-income moms and dads forced to choose between 
buying groceries and visiting their family doctor. I have heard from 
those who have either lost their health care coverage or feared that 
they will lose it because they simply can't afford it.

                              {time}  1030

  I have heard from parents who are denied necessary health care by 
their insurers, and as a result, their children are suffering too. I 
have heard from caregivers who have been laid off losing not only their 
health coverage, but that of their children's as well. This is a 
serious problem that we can no longer afford to ignore.
  No longer can we lay the blame at the front door of the White House. 
With the change in administration, we can ensure that this legislation 
passes the House today and reaches the President's desk as soon as 
possible. With our approval, President Obama has indicated he will sign 
this bill into law today and change the lives of millions of children 
and families. Delay is simply not an option.
  A large majority of Americans of all political persuasions support 
this important bill. It's a fiscally responsible way to not only extend 
the number of children in our Nation who will receive health care, but 
to improve the quality of that care. This bill relieves the burden of 
taxpayers who currently subsidize millions of costly and inefficient 
uninsured emergency room visits. By encouraging preventative care for 
children who lack insurance today, we can actually reduce costs from 
the system and provide healthier outcomes for young people.
  This bill is just common sense, given the Nation's skyrocketing 
health care costs, coupled with our current economic challenges. It is 
an investment where the return is a generation of healthy, happy and 
productive Americans. This legislation will provide health care 
coverage for more than 11 million children nationally.
  Tomorrow morning, 170,000 children in my home State of Colorado wake 
up without health insurance. That is 170,000 too many. This bill will 
change that terrible statistic for the better by

[[Page H929]]

giving States the vital tools needed to reach out to uninsured children 
who are eligible for SCHIP and Medicaid, but not yet enrolled. This is 
not only critical to Colorado, but to all our States and territories.
  Madam Speaker, the epidemic of the uninsured is not just a 
consequence of our struggling economy, it is a component of it. Under a 
new administration, with the political will of this new Congress, we 
have the power to set this particular wrong right. A healthy economy is 
supported by healthy people. Providing health care insurance for 
millions of uninsured Americans is an important beginning to keeping 
our people and our economy healthy. But it is just a beginning.
  Protecting the health of our Nation's young children is of paramount 
importance to society and the security of our Nation. A recent military 
study reveals that one-third of American teenagers are incapable of 
passing a basic physical test. This legislation will help give every 
child a chance at a healthy start.
  With rising unemployment, a battered economy and more layoffs coming 
every day, the plight of the uninsured is likely to only get worse. 
Next month, Madam Speaker, SCHIP will expire. Our failure today would 
add millions of children to the rolls of the uninsured. To me, my 
constituents, and hopefully to my colleagues, as well, this is 
unacceptable. Today we have an opportunity to protect millions of 
children across the Nation who don't have a voice and to safeguard 
their future.
  I urge you to vote for this legislation.
  I reserve the balance of my time.
  Mr. SESSIONS. Madam Speaker, I rise today in strong opposition to 
this completely closed rule and to the ill-conceived underlying 
legislation.
  Madam Speaker, the gentleman from Colorado, who has extended me the 
time, well understands, as a freshman, that we have a good number of 
new Members to this body and who will be making a decision and voting 
for very important public policy decisions. It's my hope today that I 
will be able to gather together an argument, not to rebut the 
gentleman, but to show him and many of his other new colleagues, my new 
colleagues, why the statement ``cost effective and common sense'' does 
not apply to the SCHIP bill that the gentleman brings forth today.
  Madam Speaker, 2 weeks ago I questioned my Democrat colleagues about 
their claim to be the most honest, open and transparent House in 
history when they tout that that is what the leadership of this body is 
attempting to accomplish. Once again, I will question that claim, 
because we're provided with a product and a process that is none of the 
above.
  I know that the gentleman on the Rules Committee had a chance, just 
last night, to hear a debate in the Rules Committee about this SCHIP 
bill. And I believe that that hearing would produce enough evidence to 
suggest that this bill is neither cost effective nor common sense. 
Since the beginning of the 111th Congress, my colleagues on the other 
side of the aisle have had no regard--no regard--for regular order and 
continue to cram legislation through this body without Republican 
input.
  When I came to the floor last month to oppose the previous version of 
this legislation, I explained my opposition on the way that it had been 
brought to the floor without a single legislative markup. So 
unfortunately, the new Members of this body, unless they serve on the 
Rules Committee, have not heard the real facts of the case.
  The real facts of the case, unfortunately, have not changed. In fact, 
neither Republican leadership nor Republican members on the Energy and 
Commerce Committee have had any opportunity to participate in crafting 
this 280-plus pages piece of legislation. I will repeat that. 
Republican members or Republican leadership have had no chance to craft 
any part of this 280-page legislative bill.
  On January 12 of this year, my Republican colleagues and myself sent 
to President Obama and Speaker Pelosi, which I would like included in 
the Record, a letter outlining what Republicans would like to see the 
majority party, the Democrats, consider before expanding the current 
SCHIP program. We still, as of this morning, have received no answer, 
no answer, to a forthright and open letter. In responding to this, we 
are simply asking today on the floor of the House of Representatives 
for the opportunity not only to be heard but also to make sure that the 
newest Members of this body have a chance to know the facts of the 
case. And in reauthorizing this program, the first priority should be, 
should be, to make sure that our Nation's poorest uninsured children 
are covered. The intent of the program is that. And we must first 
fulfill that goal.
  Currently, at least two-thirds of the children who do not have health 
insurance are already eligible for Federal help through either SCHIP or 
Medicaid. The second priority is to ensure that SCHIP does not replace 
or significantly impact those who already have private health insurance 
and replace it with a government-run program. Speaking of common sense, 
why would you take someone who has private health insurance and move 
them to a government-run program?
  Madam Speaker, if this legislation passes, we know that there are 2.4 
million children who will be moved from private insurance to SCHIP, a 
program that reimburses physicians 30 to 50 percent less than private 
health insurance. As a matter of fact, last night in the Rules 
Committee, there was in the debate that took place an acknowledgment 
from the Democrat side lead who said, yes, he did understand. They're 
even having problems getting physicians who will accept the patients 
because of the reduction in the reimbursement. Common sense would tell 
you that alone is not cost effective nor common sense.
  More to my point about the newest Members of this body understanding 
the facts of the case because regular order did not take place, how 
would we expect them to know what they were going to vote on? Congress 
should be encouraging superior health care for our Nation's children, 
not undermining it. That is common sense.
  Furthermore, a citizenship verification standard is critical to 
ensuring that only U.S. citizens and certain legal immigrants are 
allowed to access taxpayer-funded benefits, not illegal immigrants. The 
underlying legislation takes out from the law and offers no safeguards 
to ensure a check that it will be for American children before illegal 
immigrants. Once again, cost effective, and once again, common sense 
for the new Members of this body.

  The Democrats' proposed $32.8 billion expansion of a program that has 
yet to accomplish its original intent is typical of my friends on the 
other side. My friends, the Democrats, continue to push their 
government-run health care agenda, ``universal coverage'' as they call 
it, even though this legislation moves 2.4 million children currently 
on private health coverage to an inferior public program with less 
access. Common sense says you should not be doing that.
  So, then, with physicians scaling back on Medicaid and SCHIP due to 
the extremely low government reimbursement rate, why would we want to 
subject 4 million more children to this type of care? Once again, the 
standard of common sense. I don't know that this bill passes that 
hurdle. Madam Speaker, it seems likely that my Democratic colleagues 
are putting their agenda first, not our children's health care.
  In the days where Congress is faced with a second $350 billion 
financial services bailout and a proposed $1.2 trillion stimulus 
package, is the Federal Government in any financial shape to be 
financing health care costs for children who are already receiving 
priority health insurance? Once again, the test of common sense and 
cost effectiveness would fail this legislation.
  The current legislation before us recklessly increases entitlement 
spending by at least $73.3 billion over the next 10 years. That is 
increasing it due to the new entitlements. That is neither cost 
effective nor common sense. This expansion will allow SCHIP to grow at 
an annual rate of 23.7 percent over the next 5 years. Once again, not 
cost effective and not common sense. Based on the Treasury Department's 
financial report, the government has $56 trillion in unfunded 
liabilities, the majority of which are in the Federal Government's 
health care program. Why not do something that would be for the 
Nation's poorest children rather than

[[Page H930]]

trying to push 2.4 million more children, unless you have a political 
agenda rather than a public policy agenda?
  Each year that Congress fails to act on a solution, the long-term 
problem grows by $2 to $3 trillion. Do my friends on the other side of 
the aisle not see the writing on the wall? Where is common sense?
  Madam Speaker, last week, a bipartisan group of Members voted against 
the Democratic Party's $1.2 trillion stimulus package. Not only was the 
Democrat plan full of wasteful government spending that would not 
stimulate the economy, but my friends on the other side of the aisle 
shut out Republicans from the process much as they are doing today.
  The American people are hurting. And the economy is struggling. 
Americans know that we cannot borrow and spend our way back to a 
growing economy. Republicans have a plan for fast-acting tax relief 
that will release the resources and creativity of the American people 
to create 6.2 million new jobs. Madam Speaker, I ask my Democrat 
colleagues, if the American people had the choice between fast-acting 
tax relief and slow, wasteful government spending, which would they 
choose? Trust me. A number of Democrats and every single Republican 
knew the answer on this floor. It is common sense to vote ``no.''
  This so-called ``stimulus bill'' includes $524 billion in spending 
provisions, $3 billion in prevention and wellness, including $400 
million for STD prevention, sexually transmitted disease prevention, 
and $600 million to buy new cars for government workers. That will make 
sure we don't have to ask for reform out of the Big Three auto makers. 
We will just buy them at the current rate. The bill includes $150 
million for building repairs for the Smithsonian, $1 billion for 
follow-up on the 2010 Census that does not even begin until April 1, 
2010, $1 billion for Amtrak which has not turned a profit in 40 years, 
$400 million for global-warming research, and another $2.2 billion for 
carbon-capture demonstration projects. The list goes on and on and on.
  The American people deserve to know how their hard-earned tax dollars 
will stimulate the economy, not government spending where Washington 
gets fatter, but those with good explanations so that the American 
people have confidence, not only in Congress, but in their own 
individual Member of Congress who casts that vote.
  If expanding SCHIP to families making $80,000 a year isn't enough, as 
this bill does, last week my Democrat colleagues voted in favor of 
making Wall Street millionaires and billionaires, like the former 
Lehman Brothers CEO, who was reported to have earned nearly half a 
billion dollars in compensation, eligible for public health subsidies. 
Approximately $100 billion of our friends', the Democrats', $1.2 
trillion stimulus is the bailout for the failing Medicaid program. One 
such bailout provision is section 3003, which expands Medicaid 
eligibility to all individuals currently receiving unemployment 
benefits, regardless of their personal income or financial assets.

                              {time}  1045

  Boy, once again that standard of common sense and cost effectiveness 
that my good friend from Colorado talked about is simply not there.
  Madam Speaker, why are our friends, the Democrats, trying to force 
American taxpayers to pay for free health coverage for the very same 
executives who helped create the financial crisis in the stimulus 
package able to get this help?
  Adding another trillion dollars to the Federal deficit and swelling 
the number of persons dependent on subsidized, government-run health 
care is hazardous to the health of the American economy and an unfair 
burden to place on our grandchildren.
  The American people want more than just welfare. They want freedom. 
They want jobs. They want a real stimulus package and a real SCHIP 
bill. That's what this Congress is failing to provide. The American 
people want more innovation, more efficiency, more accountability, and 
they want cost effectiveness and common sense. Evidently, this body is 
in short supply of each of those items under this leadership.
  The American people hate waste in government, but our friends, the 
Democrats, who are the majority party, are spending like never before, 
delaying even the thought of addressing the underlying programs of the 
already burdensome Medicaid and SCHIP programs. My friends on the other 
side of the aisle seem to be playing with money that does not even 
exist. We are printing it at this time. The printing presses are alive 
and working 24 hours a day, just simply first to meet the $700 billion 
bailout, and then to prepare for the $1.3 trillion stimulus package 
that is prepared for the President's signature soon.
  So what's next? A $32.8 billion expansion of SCHIP, and finally, the 
massive omnibus which is expected this week or next.
  We should be demanding more accountability. We should be demanding 
cost effectiveness, and we should be demanding common sense. That's 
what the American people want, Madam Speaker.
  Madam Speaker, we need a fast-acting tax relief bill that will 
stimulate the economy and create jobs. We cannot borrow and spend our 
way out of this crisis. We need to secure the original intent of the 
current government programs before expanding additional programs.
  I came to Congress to protect the American taxpayer, which is why I 
encourage my colleagues to oppose this rule and the underlying 
legislation.

                                               Washington, DC,

                                                 January 12, 2009.
     President-elect Barack Obama,
     Presidential Transition Office,
     Washington, DC.
     Hon. Nancy Pelosi,
     Speaker, Capitol,
     Washington, DC.
       Dear President-elect Obama and Speaker Pelosi: Thank you 
     for expressing your desire to work with us to address the 
     needs of the American people. We recognize that reauthorizing 
     the State Children's Health Insurance Program (SCHIP) is an 
     early legislative priority, and we hope that you will 
     consider this legislation to be one of the first 
     opportunities for bipartisan cooperation.
       During the last Congress, significant efforts were made in 
     an attempt to address concerns raised by House Republicans 
     about how the underlying bills would impact uninsured 
     children. Despite the progress that was made, there are still 
     a few outstanding issues that we hope you agree should be 
     addressed when we work to reauthorize the program this year:


               Serving Eligible Low-income Children First

       SCHIP is intended to serve those that are neediest first. 
     As low-income families continue to face more economic 
     insecurity, providing access to affordable health care 
     coverage, regardless of any job change or displacement, 
     should be our first priority. The legislation should demand 
     success from the states in enrolling poor and low-income 
     children below 200 percent of the federal poverty level, 
     especially those who are currently eligible for Medicaid and/
     or SCHIP, but are not yet enrolled. Demanding success from 
     the states could be as simple as requiring that states meet a 
     threshold of enrollment before further expansions. Nearly all 
     the states have demonstrated over the past year to the 
     Centers for Medicare and Medicaid Services that meeting this 
     standard is indeed possible.
       Furthermore, in the current economic environment, several 
     states have indicated that they will be experiencing 
     shortfalls that could impact their ability to provide 
     Medicaid benefits and services. Asking states to expand their 
     SCHIP program before they are able to finance their existing 
     Medicaid program would be a mistake. Expanding SCHIP to 
     higher income families will only exacerbate the real access 
     to care problem in the Medicaid program.


                           Citizenship Status

       We believe that only U.S. citizens and certain legal 
     residents should be permitted to benefit from a program like 
     SCHIP. We also think it is fair to say that both parties 
     believe that our immigration system is broken. That is why it 
     is so important that the legislation include stronger 
     provisions to prevent fraud by including citizenship 
     verification standards to ensure that only eligible U.S. 
     citizens and certain legal residents are enrolled in the 
     program.


                  Protecting Private Insurance Options

       We agree that those with private coverage should not be 
     forced into a government-run plan. SCHIP legislation should 
     focus expansion efforts on children who are currently 
     uninsured instead of moving children who have private health 
     insurance options into government-run health insurance. 
     Moving a child from private health insurance to government-
     run health insurance should not be part of your stated goal 
     of providing SCHIP for 10 million children, a number we 
     assume to be targeted towards low-income uninsured children.


                         Stable Funding Source

       In order to guarantee access to the program and long term 
     stability, SCHIP should

[[Page H931]]

     be funded through a stable funding source, not budget 
     gimmicks. Further, the legislation should not include 
     extraneous provisions unrelated to SCHIP that limit patient 
     choice or prohibit access to quality medical care. Our 
     nation's Governors need a stable SCHIP program so they may 
     properly budget. Every American faces the crushing burden of 
     a declining economy. This should not be a time Congress 
     raises taxes, especially on the poorest Americans, to finance 
     program expansions as part of the SCHIP reauthorization bill.
       We believe these to be critical elements to improve this 
     vital program that if fully incorporated would dramatically 
     increase bipartisan support for the legislation. Thank you 
     for the consideration of this request. We look forward 
     hearing from you and working with you towards a bipartisan 
     agreement.
           Sincerely,
         Robert B. Aderholt, Steve Austria, Michele Bachmann, 
           Spencer Bachus, J. Gresham Barrett, Roscoe G. Bartlett, 
           Joe Barton, Judy Biggert, Gus M. Bilirakis, Rob Bishop, 
           Marsha Blackburn, Roy Blunt, John A. Boehner, Mary Bono 
           Mack, John Boozman, Charles W. Boustany, Jr., Kevin 
           Brady, Paul C. Broun, Henry E. Brown, Jr., Ginny Brown-
           Waite, Michael C. Burgess, Dan Burton, Steve Buyer, Ken 
           Calvert, Dave Camp, Eric Cantor, John R. Carter, Bill 
           Cassidy, Jason Chaffetz, Howard Coble,
         Mike Coffman, Tom Cole, K. Michael Conaway, Ander 
           Crenshaw, John Abney Culberson, Geoff Davis, Nathan 
           Deal, David Dreier, Mary Fallin, Jeff Flake, John 
           Fleming, J. Randy Forbes, Jeff Fortenberry, Virginia 
           Foxx, Trent Franks, Rodney P. Frelinghuysen, Phil 
           Gingrey, Louie Gohmert, Bob Goodlatte, Kay Granger, Sam 
           Graves, Ralph M. Hall, Doc Hastings, Dean Heller, Jeb 
           Hensarling, Wally Herger, Peter Hoekstra, Duncan 
           Hunter, Bob Inglis, Darrell E. Issa,
         Lynn Jenkins, Sam Johnson, Walter B. Jones, Jim Jordan, 
           Steve King, Jack Kingston, Mark Steven Kirk, John 
           Kline, Doug Lamborn, Christopher John Lee, Jerry Lewis, 
           Blaine Luetkemeyer, Cynthia M. Lummis, Daniel E. 
           Lungren, Donald A. Manzullo, Kevin McCarthy, Thaddeus 
           G. McCotter, Patrick T. McHenry, John M. McHugh, Cathy 
           McMorris Rodgers, Jeff Miller, Sue Wilkins Myrick, 
           Devin Nunes, Pete Olson, Erik Paulsen, Mike Pence, 
           Joseph R. Pitts, Todd Russell Platts, Ted Poe, Bill 
           Posey.
         Tom Price, Adam H. Putnam, George Radanovich, Harold 
           Rogers, Mike Rogers (MI), Thomas J. Rooney, Peter J. 
           Roskam, Paul Ryan, Steve Scalise, Jean Schmidt, Aaron 
           Schock, F. James Sensenbrenner, Jr., Pete Sessions, 
           John B. Shadegg, John Shimkus, Bill Shuster, Michael K. 
           Simpson, Adrian Smith, Lamar Smith, Cliff Stearns, John 
           Sullivan, Lee Terry, Glenn Thompson, Patrick J. Tiberi, 
           Fred Upton, Greg Walden, Zach Wamp, Lynn A. 
           Westmoreland, Ed Whitfield, Joe Wilson, Robert J. 
           Wittman.

  Madam Speaker, I reserve the balance of my time.
  Mr. POLIS of Colorado. Madam Speaker, as you know, children do not 
control what family they are born into. And an important part of the 
meritocracy that makes our country great is that every child should 
have the opportunity to succeed. Establishing healthy habits and a 
healthy life early in life, regardless of the parent's station, is an 
important part of making sure that a child has the opportunity to climb 
to whatever station they are capable of.
  Madam Speaker, I would like to yield 2 minutes to the gentlewoman 
from Connecticut (Ms. DeLauro).
  Ms. DeLAURO. Madam Speaker, at a time when more and more mothers and 
fathers are huddled around their kitchen table worried about how to 
cope with a job loss or pay their most basic expenses, we have an 
opportunity today, an opportunity to ensure that 11 million children 
can get affordable health care coverage through the Children's Health 
Insurance Program.
  In my home State of Connecticut, unemployment keeps rising, and 
people are going from worried to scared. At such a time, it is our most 
basic economic and moral responsibility to provide health care to the 
most vulnerable among us. In this country, where 9 million children are 
uninsured, we cannot let another day go by without passing this 
legislation.
  This is a smart investment in children, in their health and in their 
success at school and in life. It provides critical dental and mental 
health care for children, prenatal care to make sure every child has 
the best chance at a healthy start. It will help to discourage millions 
of children from smoking, a smart step towards a healthier Nation. We 
must shore up this vital safety net. We can afford it. It is a simple 
choice about fulfilling America's promise for our Nation's children and 
giving a small measure of peace of mind for their families.
  I might say to my colleague on the other side of the aisle that, on a 
bipartisan basis, overwhelmingly, this House voted to pass the 
children's health insurance bill. The United States Senate 
overwhelmingly on a bipartisan basis voted to pass the children's 
health insurance bill. It was the former President of the United States 
who decided to veto that legislation when a majority of the American 
public supports health insurance for our children. Today we have an 
opportunity to right a wrong. Let's pass the children's health 
insurance bill. Let's get it to the President's desk. Let's get it 
signed, and let's give relief to the millions of families out there who 
are struggling.
  Members of this body have health insurance, and their children have 
it. Why shouldn't the children of working and middle class Americans?
  Mr. SESSIONS. Madam Speaker, I would like to yield 1\1/2\ minutes to 
the gentleman from Lewisville, Texas, Dr. Burgess.
  Mr. BURGESS. I do urge my colleagues to look long and hard before 
voting on this rule today, and I urge a ``no'' vote on the rule.
  The fact is, Madam Speaker, that over half of the country has not had 
an opportunity to participate in this debate. 40 percent of this 
country is represented by Republican Members. We have not had input 
into this bill.
  12 percent of this Congress is new. They have had no input into this 
bill. That leaves over half the country who haven't been part of this 
debate.
  And what does it say about a bipartisan bill when the two principal 
Republican sponsors in the other body withdrew their support for this 
bill as it came through the Senate?
  Last night in the Rules Committee in one last attempt, I tried to 
modify the bill to perhaps make it a better product before it came 
before us on the floor of the House today. I brought amendments that 
would have required identity, a person to provide proper identification 
before they signed up for SCHIP; not another step, but just simply 
another line that needed to be filled out on the form, and that was 
rejected.
  You have to show your ID before you cash a check at the grocery 
store. Why should we not require someone to show identification before 
they sign up for this benefit?
  I also introduced an amendment, after all, we are, as the Member from 
Texas said, the gentleman from Texas said we are taking 2\1/2\ million 
children off of private health insurance and putting them on public 
health insurance. Why should we not at least ensure that we will pay 
the providers a sufficient amount so that they will participate in the 
system?
  Currently, it is difficult to find providers who will accept Medicaid 
and SCHIP. I introduced an amendment that would have required 90 
percent of the reimbursement from the Federal Blue Cross/Blue Shield 
program or the States' largest----
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. SESSIONS. I give the gentleman 30 additional seconds.
  Mr. BURGESS. Last night in the Rules Committee I introduced an 
amendment that would have required States to reimburse physicians at 90 
percent of the Blue Cross/Blue Shield rate or the largest State HMO 
rate in that State or the insurance that the State provides for their 
own employees. That amendment was not even allowed a vote on the floor. 
This is the type of exclusionary politics that is being practiced in 
the House of Representatives, and the sooner we get past this point, 
the President asked for a more open and bipartisan government, the 
sooner we get past that point, the better for the American people.
  Mr. POLIS of Colorado. Madam Speaker, a brief history on the SCHIP 
legislation and why this is so critical for us to pass here today. This 
rule before the House would permit the House to concur in the Senate 
amendment because this legislation has been considered repeatedly and 
thoroughly in the House in this Congress and the last.
  In July of 2007 the House considered H.R. 3162 to reauthorize and 
amend

[[Page H932]]

SCHIP and the bill passed. In September 2007 the House considered H.R. 
976 to reauthorize and amend SCHIP. The bill passed. The Senate also 
passed the bill and it was presented to President Bush and received a 
veto. In October of 2007 the House again tried to reauthorize SCHIP. 
3963 was the House bill. Passed the House, passed the Senate. The 
President again vetoed the bill and the House was unable to override 
the veto.
  Ultimately, legislation to merely extend SCHIP as it was enacted into 
law will expire next month. Children's lives are at stake. That's 
what's so critical about passing this bill today.
  When people lack health care insurance they often don't seek 
preventative care and are forced to use emergency rooms as their 
primary care provider. Not only does this cost more, this also provides 
for worse health outcomes, and conditions that could have been dealt 
with less expensively and more successfully in the onset are instead 
deferred, and incur more expense and worse health outcomes.
  By passing this bill today, we can ensure that hundreds of thousands 
of poor children across our country receive adequate health care and 
are able to succeed and grow in school and be able to succeed in their 
lives.
  Madam Speaker, I would like to reserve the balance of my time.
  Mr. SESSIONS. Madam Speaker, at this time I would like to yield 1\1/
2\ minutes to the gentleman from Marietta, Georgia, Dr. Gingrey.
  Mr. GINGREY of Georgia. Madam Speaker, I do rise in strong opposition 
to this closed rule, as well as the underlying legislation, the 
Children's Health Insurance Program Reauthorization Act of 2009.
  The Democratic majority has once again brought forward a closed rule 
that only tramples on the rights of the minority. And at no point in 
the development of this legislation has the majority even entertained 
the idea of allowing Republicans to work with them in a bipartisan 
manner to improve the bill.
  As a physician Member, I keenly know how important it is that the 
Federal Government plays a role in providing health care to low-income 
children. At the same time, we must pass legislation that first reaches 
those who are most in need of this assistance.
  During the initial consideration of H.R. 2 by the House, I offered an 
amendment that would have addressed a very important problem within 
current law that H.R. 2 overlooks, the practice of some States using 
loopholes to allow people to disregard significant portions of their 
income to make them eligible for CHIP and Medicaid. At the same time, 
some of these same States, these loophole States, have not provided for 
the children who demonstrate the most need for these programs.
  Madam Speaker, my commonsense amendment would have simply instituted 
a gross income cap of 250 percent of the Federal poverty level for both 
CHIP and Medicaid eligibility, and it would limit any income disregards 
to a maximum of $250 a month or $3,000 per year. This amendment would 
grandfather in those individuals who are already receiving Medicaid and 
CHIP so that we do not deprive current beneficiaries.
  Therefore, Madam Speaker, I urge all my colleagues oppose the closed 
rule.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. SESSIONS. I yield the gentleman 15 additional seconds.
  Mr. GINGREY of Georgia. I want to just in closing, Madam Speaker, 
urge all my colleagues, oppose the closed rule and this underlying 
legislation. Give us a chance, in a bipartisan spirit, to make this 
good law even better.
  Mr. POLIS of Colorado. Madam Speaker, I am proud to back a plan to 
help improve the health and chance for success of 11 million children. 
It also reduces the more costly nature of emergency room use, and moves 
us closer to providing every child in our Nation with affordable, high 
quality health care.
  This bill also extends health care coverage to 4.1 million additional 
low-income children who are currently uninsured.
  A healthy child is better prepared for learning and success. Studies 
show that early childhood health is indicative and can, in fact, impact 
the learning processes, the special education needs of the child and 
indeed, even the IQ of the child as the child matriculates through 
education. By making sure that children have health care coverage, we 
can, in fact, prevent a lot of gaps within our education system from 
arising before they arise, and ensure that children, regardless of 
their background, have the opportunity to succeed in our country. This 
is the change that America needs.
  Providing health care coverage for children and indeed, all 
Americans, is one of the reasons that I ran for Congress. Providing 
health care to 4 million more children will be a clear demonstration 
that change has come to Washington.
  This is legislation that President Bush vetoed twice in the 110th 
Congress. Today we have the opportunity to send this bill to a new 
President who has committed to sign it this very afternoon and begin 
implementing it immediately to help cover 4.1 million additional 
children in our Nation.
  Madam Speaker, I reserve the balance of my time.

                              {time}  1100

  Mr. SESSIONS. Madam Speaker, at this time, I would like to yield 2\1/
2\ minutes to the gentleman from San Dimas, California, the ranking 
member of the committee, Mr. Dreier.
  (Mr. DREIER asked and was given permission to revise and extend his 
remarks.)
  Mr. DREIER. Madam Speaker, in the spirit of comity in debate, I would 
like to yield to my good friend from Lafayette, Louisiana (Mr. 
Boustany). I am always happy to yield to people to engage in debate on 
the floor.
  Mr. BOUSTANY. Madam Speaker, I just want to make a correction here to 
the gentleman's comments. While providing coverage is one thing, 
providing real access to care, to a primary care physician, is another, 
and far too many of these children are receiving care in the emergency 
room, which is the most expensive and least effective way to provide 
care.
  Mr. DREIER. Let me say, Madam Speaker, that getting the American 
economy back on track is priority number one for all of us, and 
ensuring that children who are truly in need have access to the best 
quality health care is right there as a very high priority. It is 
obvious that this measure that is before us does not accomplish that.
  In his testimony last night before the Rules Committee, Dr. Burgess 
was very clear in addressing a number of the concerns that we have been 
raising consistently on this. Unfortunately, they undermine the 
opportunity for us to ensure that the dollars get to those who are 
truly in need.
  I find it very, very troubling that we are continuing down a path 
where potentially people who are in this country illegally will have 
access to the State Children's Health Insurance Program. We are with 
the crowd-out actually incentivizing people to move off of private 
insurance onto government insurance, and we are still creating an 
opportunity for those who are wealthy and adults to be beneficiaries of 
this program. No matter what it says in the bill, as Dr. Burgess has 
pointed out, those four concerns are very justified.
  So, as we seek to get the American economy back on track with an 
economic stimulus package that will, in fact, grow our economy--not a 
massive spending program--and as we address this issue of children's 
health, which is a very, very, very high priority, we need to do it in 
the most cost-effective way possible.
  Unfortunately, this rule is completely shutting out Members, like Dr. 
Burgess and others, from having the opportunity to participate, so I 
urge my colleagues to vote ``no'' on the rule and, if the rule passes, 
to defeat the underlying legislation. We can do better for our Nation's 
children.
  Mr. POLIS of Colorado. Madam Speaker, with regard to the delivery of 
the services, most SCHIP and Medicaid beneficiaries receive service 
delivery through private doctors and through private management care 
plans, not through government doctors. So, when we are talking about 
how the service is delivered, we are talking about an important aspect 
of what insurance and what coverage allows. Yes, separately, we 
certainly hope that we will be able to address universal coverage, in 
rural areas in particular, as an important component of health care in 
this country.

[[Page H933]]

  With regard to income limits, this bill does provide that if a State 
covers children in families of three with income over $52,800, which is 
300 percent of the poverty rate, then the States get the regular 
Medicaid match rate. There are, in fact, income provisions in here as 
well. There is also section 605 of the bill, which prevents payments to 
individuals not lawfully residing in the United States. So I believe 
that the issues that have been raised by my colleagues are addressed in 
the bill.
  It does, of course, matter what the bill says. The bill says very 
clearly that individuals not lawfully residing in the United States 
will not receive payments, and it also is very clear with regard to the 
income level. So I think that this bill has been clear.
  As I have mentioned, this bill has been voted on a number of times in 
Congress. The main difference now is we are sending it to a President 
who has indicated that he is, in fact, willing to sign it and, indeed, 
is willing to do so on this very afternoon.
  Madam Speaker, I reserve the balance of my time.
  Mr. SESSIONS. Madam Speaker, at this time, I would like to yield 2 
minutes to the gentleman from Lafayette, Louisiana (Mr. Boustany).
  Mr. BOUSTANY. Madam Speaker, I rise in opposition to the rule and to 
the underlying bill.
  Last week, the Democratic majority rushed a massive bill through the 
process, laden with wasteful spending of borrowed money that has not 
been shown or demonstrated to create jobs.
  The American people are hurting. They are clearly hurting. We have 
tough economic times, and we have a responsibility to legislate and to 
legislate in a responsible way. Too often, children on Medicaid or on 
SCHIP receive fewer visits with primary care providers than those with 
private coverage. According to the Center on Budget and Policy 
Priorities, children on these programs were 2 times more likely to 
visit hospital emergency rooms multiple times in a given year.
  As a physician, I know that government-run programs must achieve 
better results. My State has the eighth highest ER visit rate. This is 
unacceptable and we can do better. Now, the GAO has criticized 
government-run programs, like SCHIP, for disregarding patients' access 
problems. It warned: ``Coverage alone does not guarantee services will 
be available or that children will receive needed care.''
  It is disappointing to me that the majority rushed this flawed bill 
to the floor without permitting any opportunity for improvements. In 
fact, as proposed, this bill would exacerbate enrolled children's 
access problems. The CBO warned that a similar bill would force more 
than 2.4 million children out of private health care plans and onto 
government rolls.
  Working together, I know we can do better. I know we can make SCHIP 
help children who really need it--those who really already qualify for 
it but who are not enrolled. There are far too many of these children 
out there. This massive expansion fails to help those children most of 
all. States should measure also and report provider access problems in 
SCHIP programs to measure their progress. We asked for this, and it was 
not even entertained in the Rules Committee. I do not understand the 
closed debate here, the closed opportunity.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. SESSIONS. I yield the gentleman an additional 15 seconds.
  Mr. BOUSTANY. We also need to limit the crowd-out of private coverage 
and target the neediest children for enrollment first. We need to help 
poor children first. I know we can do better.
  Oppose this rule. Oppose this bill.
  Mr. POLIS of Colorado. Madam Speaker, I would also like to discuss 
that SCHIP provides quality dental care, alleviating the most common 
childhood disease--tooth decay.
  I cannot help but remember a story that was told to me when I was 
visiting a free dental clinic in Boulder, Colorado that provides 
services to those who are uninsured. This story is about a young girl 
who was in the third grade. Due to the lack of dental care and poor 
dental hygiene practices at home, her teeth had actually rotted out. 
This is when she was a young girl. She had received no care for that as 
well. As a result, she was very, very shy, and was constantly in pain. 
Her diet suffered. She suffered malnutrition because of the condition 
of her teeth. Fortunately, the community there was able to help her, 
but there are hundreds of thousands of young people across the country 
who suffer from no or from poor quality dental care, which has vast 
ramifications as well.
  In addition, this bill gives the option of providing pregnant women 
critical prenatal care. When we talk about the impact on reducing the 
need for special education and for increasing one's IQ, these things 
start in the prenatal stage, and they continue through early childhood. 
I think that that is a very important aspect in terms of giving States 
that option as well as covering 4.1 million additional low-income 
children who currently lack insurance.
  Madam Speaker, I reserve the balance of my time.
  Mr. SESSIONS. Madam Speaker, because there were no hearings held on 
this subject, many, many Republicans are coming down to the floor today 
to give their feedback and thoughts on this issue. Our next speaker is 
one of the most thoughtful and caring Members of Congress.
  I would like to yield 1\1/2\ minutes to the gentlewoman from Fort 
Worth, Texas (Ms. Granger).
  Ms. GRANGER. Madam Speaker, I rise in opposition to the rule for the 
consideration of the SCHIP bill we will be considering later today.
  The rule does not allow for the consideration of any amendments, and 
it bars the Republican motion to recommit. That is not a good way to 
reauthorize what has been a bipartisan program.
  In its original form, the SCHIP program is an excellent program that 
ensures medical care is available to uninsured children. During my 
first time in Congress, I voted to help create the SCHIP program, and I 
believe we need to responsibly reauthorize it. That is why I have 
introduced a bill to expand the SCHIP program to cover millions of 
uninsured kids. It is a bill that is paid for without budget gimmicks 
and without raising taxes.
  My bill, the Kids First Act, expands SCHIP by $19.3 billion over the 
same 4\1/2\-year period as the Democrat bill. According to the 
Congressional Budget Office, the Kids First Act will cover 3.6 million 
previously uninsured children. Without raising taxes and without budget 
gimmicks, the Kids First Act truly puts kids first, eliminating nearly 
all adults from this program designed for children so that more 
children can be covered.
  I urge my colleagues to oppose this rule as well as the majority's 
SCHIP bill and, instead, to support the Kids First Act.
  Mr. POLIS of Colorado. Madam Speaker, another story from Colorado is 
about someone who I know firsthand, a student at one of the schools 
that I was involved in running.
  Like many of the students I worked with, this student lacked health 
care insurance. She was diagnosed with diabetes, and she was not 
diagnosed early. She had severe symptoms, weakness, et cetera, but 
because of economic barriers to seeking health care and because of her 
lack of insurance, she did not seek any form of preventative treatment. 
When she then went in, she went into the emergency room, and she needed 
emergency dialysis immediately. So a condition that could have been 
dealt with through a combination of diet and insulin instead became an 
acute condition which had to be dealt with at a much greater cost and 
with a much worse health outcome for the individual.
  These are the stories that are taking place across our great Nation. 
By passing this bill today, we can make a dent in making sure that 
people have access to preventative care and to health care throughout 
their childhoods.
  Madam Speaker, I reserve the balance of my time.
  Mr. SESSIONS. Madam Speaker, if I could please inquire as to the time 
remaining on both sides.
  The SPEAKER pro tempore. The gentleman from Texas has 5 minutes 
remaining. The gentleman from Colorado has 16\1/2\ minutes remaining.
  Mr. SESSIONS. Madam Speaker, due to the time inequity at this point, 
I would like to reserve my time.
  Mr. POLIS of Colorado. Madam Speaker, I am the last speaker for this

[[Page H934]]

side. I would like to reserve my time until the gentleman has closed 
for his side and has yielded back his time.
  Mr. SESSIONS. Madam Speaker, we have had a series of Members who have 
come to the floor--Republican Members--who have talked, I believe, very 
adequately about the frailties of this bill. The frailties of this bill 
are obvious. The gentleman representing the Democratic majority has 
indicated that there were two tests laid forth--cost-effectiveness and 
common sense. I believe that the feedback from the Members of Congress 
on the Republican side have enunciated and have talked about several 
things that are important.
  First of all, no hearings were held. Second of all, no Republican or 
bipartisan feedback was allowed in this bill. Thirdly, it is a huge 
expansion that will place this great Nation in terrible financial 
circumstances for the future. It expands a program that was working 
well for poor children. Lastly, it will move 2.4 million children from 
a private-run insurance program to a government-run insurance program. 
We think that is a failure. We believe the two tests have not passed.
  In closing, I want to say that I oppose this closed rule. With the 
current program not expiring until March 31 of this year, we have seen 
enough Members question the underlying legislation, and it deserves to 
be debated, I believe, openly and, I believe, in the committees of 
jurisdiction before we take a vote to pass on such a large expansion of 
a government program.
  This legislation spends billions of dollars to substitute superior, 
private health care coverage with an inferior government-run program. 
It enables illegal aliens to fraudulently enroll in Medicaid and SCHIP. 
The majority party knows that, and so does every Member of this body. 
The legislation increases the number of adults on SCHIP, allowing even 
more resources to be taken away from low-income, uninsured children who 
need it the most and what this legislation should be about.
  Madam Speaker, this legislation moves us closer and closer and closer 
to not only financial insanity but also to a government-run health care 
program and further away from access to quality health care, which is 
what this should be about. It should be about quality health care for 
poor children. That is not what we are doing here today.
  I encourage all of my colleagues to vote ``no'' on the rule and 
``no'' on the underlying piece of legislation because, today, unlike 
before today, each of my colleagues has had a chance to hear the facts 
of the case. The facts of the case are compelling. The test that was 
established by our Democrat majority colleagues about cost-
effectiveness and commonsense simply does not hold water. For these 
reasons on these issues, I believe that the Republicans have stated the 
case of why we should not only vote ``no'' but why this is a bad deal 
not just for the taxpayers but for the children it was intended to 
help.
  I yield back the balance of my time.

                              {time}  1115

  Mr. POLIS of Colorado. Madam Speaker, SCHIP currently provides for 
coverage of 7 million children. This bill before us today would also 
allow for extending the coverage to 4.1 million uninsured children, 
every single one of them who is currently eligible for but not enrolled 
in SCHIP and Medicaid.
  Polls have shown that more than 8 percent of the American people 
support this bipartisan legislation, including large majorities of both 
major political parties. This is not only popular, Madam Speaker; this 
is the right thing to do for American families.
  I urge a ``yes'' vote on the previous question and on the rule.
  Ms. CASTOR of Florida. Madam Speaker, I rise in support of H.R. 2 as 
amended and this rule. We will finally pass the children's health care 
bill today, send it to President Obama for his signature, and provide 
affordable medical care to millions of children across America.
  I was in the pediatrician's office last Friday with my daughters. 
There is nothing like the feeling of knowing that your children are 
healthy after a checkup or that they are on the road to recovery. I 
speak for millions of parents who can share that sense of relief 
because they can take their kids to the doctor's office and do so 
without breaking the family bank.
  What good news for all Americans that one of the first bills 
President Obama will sign today will be one that improves access to 
quality affordable health care and reduces the cost of health care for 
families.
  More affordable health care is central to our economic recovery and 
it is fundamental for families.
  I am proud to say that the precursor to SCHIP originated in the 1990s 
as a novel health care initiative in my home State of Florida where the 
innovators enrolled kids in a health care plan at the start of the 
school year. They understood that healthy kids succeed in school at 
higher rates.
  President Clinton and the Congress were so impressed by what Florida 
was doing in Florida Kidcare, they took the blueprint and fashioned the 
national SCHIP partnership.
  Access to health care for working families in my community and all 
over America through this innovative partnership between Federal, State 
and local communities is a winning proposition.
  The new law will make it easier for parents and kids to afford the 
doctor's office visits, and encourage States to cut costly bureaucratic 
red tape.
  Our children's health care initiative ensures that newborn babies 
receive the medical checkups and immunizations they need, ensures that 
toddlers and children are taken care of as they grow, and ensures that 
we all save money through preventative care.
  Suffering through President Bush's opposition over the past years has 
been very costly, and we have lost ground. In Florida alone, over 
800,000 children lack health insurance and that's the third highest 
rate in the U.S. It's more than the population of some States and it is 
growing. The lack of affordable health care for these working families 
is making it more expensive for everyone.
  We are on a different path now.
  I thank the many members who championed SCHIP as an initiative that 
works within a broader health care system that leaves many unable to 
afford health care in America, especially Speaker Pelosi, who never 
gave up and kept the promise that in the first days of a new Congress 
with a new President, the health of America's kids and the pocketbooks 
of hardworking families would be paramount.
  Mr. POLIS of Colorado. I yield back the balance of my time, and I 
move the previous question on the resolution.
  The previous question was ordered.
  The resolution was agreed to.
  A motion to reconsider was laid on the table.
  Mr. WAXMAN. Madam Speaker, pursuant to House Resolution 107, I call 
up from the Speaker's table the bill (H.R. 2) to amend title XXI of the 
Social Security Act to extend and improve the Children's Health 
Insurance Program, and for other purposes, with the Senate amendment 
thereto, and I have a motion at the desk.
  The SPEAKER pro tempore. The Clerk will report the title of the bill, 
designate the Senate amendment, and designate the motion.
  The Clerk read the title of the bill.
  The text of the Senate amendment is as follows:

       Senate amendment:
       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT; 
                   REFERENCES; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Children's 
     Health Insurance Program Reauthorization Act of 2009''.
       (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 2009 
              through 2013.
Sec. 103. Child Enrollment Contingency Fund.
Sec. 104. CHIP performance bonus payment to offset additional 
              enrollment costs resulting from enrollment and retention 
              efforts.

[[Page H935]]

Sec. 105. Two-year initial availability of CHIP allotments.
Sec. 106. Redistribution of unused allotments.
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. Limitation on matching rate for States that propose to cover 
              children with effective family income that exceeds 300 
              percent of the poverty line.
Sec. 115. State authority under Medicaid.

                   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.
Sec. 214. Permitting States to ensure coverage without a 5-year delay 
              of certain children and pregnant women under the Medicaid 
              program and CHIP.

      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. Clarification of coverage of services provided through 
              school-based health centers.
Sec. 506. Medicaid and CHIP Payment and Access Commission.

     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. Adjustment in computation of Medicaid FMAP to disregard an 
              extraordinary employer pension contribution.
Sec. 615. Clarification treatment of regional medical center.
Sec. 616. Extension of Medicaid DSH allotments for Tennessee and 
              Hawaii.
Sec. 617. GAO report on Medicaid managed care payment rates.

                      Subtitle C--Other Provisions

Sec. 621. Outreach regarding health insurance options available to 
              children.
Sec. 622. Sense of the 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. Treasury study concerning magnitude of tobacco smuggling in 
              the United States.
Sec. 704. 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 
     April 1, 2009, 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) Coordination of CHIP Funding for Fiscal Year 2009.--
     Notwithstanding any other provision of law, insofar as funds 
     have been appropriated under section 2104(a)(11), 2104(k), or 
     2104(l) of the Social Security Act, as amended by section 201 
     of Public Law 110-173, to provide allotments to States under 
     CHIP for fiscal year 2009--
       (1) any amounts that are so appropriated that are not so 
     allotted and obligated before April 1, 2009 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 (10), by striking ``and'' at the end;
       (2) by amending paragraph (11), by striking ``each of 
     fiscal years 2008 and 2009'' and inserting ``fiscal year 
     2008''; and
       (3) by adding at the end the following new paragraphs:
       ``(12) for fiscal year 2009, $10,562,000,000;
       ``(13) for fiscal year 2010, $12,520,000,000;
       ``(14) for fiscal year 2011, $13,459,000,000;
       ``(15) for fiscal year 2012, $14,982,000,000; and
       ``(16) for fiscal year 2013, for purposes of making 2 semi-
     annual allotments--
       ``(A) $2,850,000,000 for the period beginning on October 1, 
     2012, and ending on March 31, 2013, and
       ``(B) $2,850,000,000 for the period beginning on April 1, 
     2013, and ending on September 30, 2013.''.

     SEC. 102. ALLOTMENTS FOR STATES AND TERRITORIES FOR FISCAL 
                   YEARS 2009 THROUGH 2013.

       Section 2104 (42 U.S.C. 1397dd) is amended--
       (1) in subsection (b)(1), by striking ``subsection (d)'' 
     and inserting ``subsections (d) and (m)'';
       (2) in subsection (c)(1), by striking ``subsection (d)'' 
     and inserting ``subsections (d) and (m)(4)''; and
       (3) by adding at the end the following new subsection:
       ``(m) Allotments for Fiscal Years 2009 Through 2013.--
       ``(1) For fiscal year 2009.--
       ``(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 2009 
     from the amount made available under subsection (a)(12), 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:

[[Page H936]]

       ``(i) The total Federal payments to the State under this 
     title for fiscal year 2008, multiplied by the allotment 
     increase factor determined under paragraph (5) for fiscal 
     year 2009.
       ``(ii) The amount allotted to the State for fiscal year 
     2008 under subsection (b), multiplied by the allotment 
     increase factor determined under paragraph (5) for fiscal 
     year 2009.
       ``(iii) The projected total Federal payments to the State 
     under this title for fiscal year 2009, as determined on the 
     basis of the February 2009 projections certified by the State 
     to the Secretary by not later than March 31, 2009.
       ``(B) For the commonwealths and territories.--Subject to 
     the succeeding provisions of this paragraph and paragraph 
     (4), the Secretary shall allot for fiscal year 2009 from the 
     amount made available under subsection (a)(12) 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 1999 through 
     2008, multiplied by the allotment increase factor determined 
     under paragraph (5) for fiscal year 2009, except that 
     subparagraph (B) thereof shall be applied by substituting 
     `the United States' for `the State'.
       ``(C) 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 a 
     revised projection described in subparagraph (A)(iii) in 
     order to take into account changes in such projections 
     attributable to the application of paragraph (4) of such 
     section.
       ``(2) For fiscal years 2010 through 2012.--
       ``(A) In general.--Subject to paragraphs (4) and (6), from 
     the amount made available under paragraphs (13) through (15) 
     of subsection (a) for each of fiscal years 2010 through 2012, 
     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 2010.--For 
     fiscal year 2010, the allotment of the State is equal to the 
     sum of--

       ``(I) the amount of the State allotment under paragraph (1) 
     for fiscal year 2009; and
       ``(II) the amount of any payments made to the State under 
     subsection (k), (l), or (n) for fiscal year 2009,

     multiplied by the allotment increase factor under paragraph 
     (5) for fiscal year 2010.
       ``(ii) Rebasing in fiscal year 2011.--For fiscal year 2011, 
     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 2010 (including payments made to 
     the State under subsection (n) for fiscal year 2010 as well 
     as amounts redistributed to the State in fiscal year 2010), 
     multiplied by the allotment increase factor under paragraph 
     (5) for fiscal year 2011.
       ``(iii) Growth factor update for fiscal year 2012.--For 
     fiscal year 2012, the allotment of the State is equal to the 
     sum of--

       ``(I) the amount of the State allotment under clause (ii) 
     for fiscal year 2011; and
       ``(II) the amount of any payments made to the State under 
     subsection (n) for fiscal year 2011,

     multiplied by the allotment increase factor under paragraph 
     (5) for fiscal year 2012.
       ``(3) For fiscal year 2013.--
       ``(A) First half.--Subject to paragraphs (4) and (6), from 
     the amount made available under subparagraph (A) of paragraph 
     (16) 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 
     2009, 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 
     (16) 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 2012 
     (including payments made to the State under subsection (n) 
     for fiscal year 2012 as well as amounts redistributed to the 
     State in fiscal year 2012), multiplied by the allotment 
     increase factor under paragraph (5) for fiscal year 2013.
       ``(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)(16)(A); and
       ``(II) the amount of the appropriation for such period 
     under section 108 of the Children's Health Insurance Program 
     Reauthorization Act of 2009; to

       ``(ii) the sum of the--

       ``(I) amount described in clause (i); and
       ``(II) the amount made available under subsection 
     (a)(16)(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 2013, 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 2010 and ending with fiscal 
     year 2013); 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 2010 or fiscal year 2012.
       ``(7) Availability of amounts for semi-annual periods in 
     fiscal year 2013.--Each semi-annual allotment made under 
     paragraph (3) for a period in fiscal year 2013 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:
       ``(n) 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 2009, an amount equal to 20 percent 
     of the amount made available under paragraph (12) of 
     subsection (a) for the fiscal year; and
       ``(ii) for each of fiscal years 2010 through 2012 (and for 
     each of the semi-annual allotment periods for fiscal year 
     2013), 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 2010 through 
     2012 (and for each of the semi-annual allotment periods for 
     fiscal year 2013), 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 2009, fiscal year

[[Page H937]]

     2010, fiscal year 2011, fiscal year 2012, or a semi-annual 
     allotment period for fiscal year 2013, 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 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 2009 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 
     2008 increased by the population growth for children in that 
     State for the year ending on June 30, 2007 (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 (m)(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 2009 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 2008, 
     increased by the annual percentage increase in the projected 
     per capita amount of National Health Expenditures (as 
     estimated by the Secretary) for 2009; 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 2009 and ending with fiscal year 2013), 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.
       ``(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, 
     respectively; exceeds
       ``(II) the baseline number of enrollees described in clause 
     (iii) for the State and fiscal year under title XIX, 
     respectively;

     but not to exceed 10 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 under 
     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 2009 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 from 2007 
     to 2008 (as estimated by the Bureau of the Census) plus 4 
     percentage points, and further increased by the population 
     growth for children in that State from 2008 to 2009 (as 
     estimated by the Bureau of the Census) plus 4 percentage 
     points;
       ``(II) for each of fiscal years 2010, 2011, and 2012, 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 from the 
     calendar year in which the respective fiscal year begins to 
     the succeeding calendar year (as estimated by the Bureau of 
     the Census) plus 3.5 percentage points;
       ``(III) for each of fiscal years 2013, 2014, and 2015, 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 from the 
     calendar year in which the respective fiscal year begins to 
     the succeeding calendar year (as estimated by the Bureau of 
     the Census) plus 3 percentage points; and
       ``(IV) 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 from the 
     calendar year in which the fiscal year involved begins to the 
     succeeding calendar year (as estimated by the Bureau of the 
     Census) plus 2 percentage points.

       ``(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 
     $3,225,000,000 for fiscal year 2009 for making payments under 
     this paragraph, to be available until expended.
       ``(ii) Transfers.--Notwithstanding any other provision of 
     this title, the following amounts

[[Page H938]]

     shall also be available, without fiscal year limitation, for 
     making payments under this paragraph:

       ``(I) Unobligated national allotment.--

       ``(aa) Fiscal years 2009 through 2012.--As of December 31 
     of fiscal year 2009, and as of December 31 of each succeeding 
     fiscal year through fiscal year 2012, 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 (m) for such fiscal year or set aside under 
     subsection (a)(3) or (b)(2) of section 2111 for such fiscal 
     year.
       ``(bb) First half of fiscal year 2013.--As of December 31 
     of fiscal year 2013, the portion, if any, of the sum of the 
     amounts appropriated under subsection (a)(16)(A) and under 
     section 108 of the Children's Health Insurance 
     Reauthorization Act of 2009 for the period beginning on 
     October 1, 2012, and ending on March 31, 2013, that is 
     unobligated for allotment to a State under subsection (m) for 
     such fiscal year or set aside under subsection (b)(2) of 
     section 2111 for such fiscal year.
       ``(cc) Second half of fiscal year 2013.--As of June 30 of 
     fiscal year 2013, the portion, if any, of the amount 
     appropriated under subsection (a)(16)(B) for the period 
     beginning on April 1, 2013, and ending on September 30, 2013, 
     that is unobligated for allotment to a State under subsection 
     (m) 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 2010 through 2013, 
     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, 2007, and 
     2008 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 2010 through 2013, any 
     amount in excess of the aggregate cap applicable to the Child 
     Enrollment Contingency Fund for the fiscal year under section 
     2104(n).
       ``(IV) Unexpended transitional coverage block grant for 
     nonpregnant childless adults.--As of October 1, 2011, any 
     amounts set aside under section 2111(a)(3) that are not 
     expended by September 30, 2011.

       ``(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.--
       ``(i) In general.--For purposes of this subsection, subject 
     to clauses (ii) and (iii), 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, 2008, for enrollment under 
     title XIX, taking into account criteria applied as of such 
     date under title XIX pursuant to a waiver under section 1115.
       ``(ii) Limitation.--A child described in clause (i) who is 
     provided medical assistance during a presumptive eligibility 
     period under section 1920A shall be considered to be a 
     `qualifying child' only if the child is determined to be 
     eligible for medical assistance under title XIX.
       ``(iii) Exclusion.--Such term does not include any children 
     for whom the State has made an election to provide medical 
     assistance under paragraph (4) of section 1903(v).
       ``(G) Application to commonwealths and territories.--The 
     provisions of subparagraph (G) of section 2104(n)(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 2008.--In the case 
     of a State that provides coverage under section 115 of the 
     Children's Health Insurance Program Reauthorization Act of 
     2009 for any fiscal year after fiscal year 2008--
       ``(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)(10) or section 1906A.''.

     SEC. 105. TWO-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 2008, shall 
     remain available for expenditure by the State through the end 
     of the second succeeding fiscal year; and
       ``(B) for fiscal year 2009 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. REDISTRIBUTION OF UNUSED ALLOTMENTS.

       (a) Beginning With Fiscal Year 2007.--
       (1) In general.--Section 2104(f) (42 U.S.C. 1397dd(f)) is 
     amended--
       (A) by striking ``The Secretary'' and inserting the 
     following:
       ``(1) In general.--The Secretary'';
       (B) 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
       (C) 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 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 (n); 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

[[Page H939]]

     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.''.
       (2) Effective date.--The amendments made by paragraph (1) 
     shall apply to redistribution of allotments made for fiscal 
     year 2007 and subsequent fiscal years.
       (b) Redistribution of Unused Allotments for Fiscal Year 
     2006.--Section 2104(k) (42 U.S.C. 1397dd(k)) is amended--
       (1) in the subsection heading, by striking ``the First 2 
     Quarters of'';
       (2) in paragraph (1), by striking ``the first 2 quarters 
     of''; and
       (3) in paragraph (6)--
       (A) by striking ``the first 2 quarters of''; and
       (B) by striking ``March 31'' and inserting ``September 
     30''.

     SEC. 107. OPTION FOR QUALIFYING STATES TO RECEIVE THE 
                   ENHANCED PORTION OF THE CHIP MATCHING RATE FOR 
                   MEDICAID COVERAGE OF CERTAIN CHILDREN.

       (a) In General.--Section 2105(g) (42 U.S.C. 1397ee(g)) is 
     amended--
       (1) in paragraph (1)(A), as amended by section 201(b)(1) of 
     Public Law 110-173--
       (A) by inserting ``subject to paragraph (4),'' after 
     ``Notwithstanding any other provision of law,''; and
       (B) by striking ``2008, or 2009'' and inserting ``or 
     2008''; and
       (2) by adding at the end the following new paragraph:
       ``(4) Option for allotments for fiscal years 2009 through 
     2013.--
       ``(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 
     2009 through 2013 (insofar as the allotment is available to 
     the State under subsections (e) and (m) 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.''.
       (b) Repeal of Limitation on Availability of Fiscal Year 
     2009 Allotments.--Paragraph (2) of section 201(b) of the 
     Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 
     Law 110-173) is repealed.

     SEC. 108. ONE-TIME APPROPRIATION.

       There is appropriated to the Secretary, out of any money in 
     the Treasury not otherwise appropriated, $11,706,000,000 to 
     accompany the allotment made for the period beginning on 
     October 1, 2012, and ending on March 31, 2013, under section 
     2104(a)(16)(A) of the Social Security Act (42 U.S.C. 
     1397dd(a)(16)(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(m) of the Social Security Act (42 U.S.C. 1397dd(i)), as 
     added by section 102, for the first 6 months of fiscal year 
     2013 in the same manner as allotments are provided under 
     subsection (a)(16)(A) of such section 2104 and subject to the 
     same terms and conditions as apply to the allotments provided 
     from such subsection (a)(16)(A).

     SEC. 109. IMPROVING FUNDING FOR THE TERRITORIES UNDER CHIP 
                   AND MEDICAID.

       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 2009, 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.''.

      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, 
     2008; 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 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.--

[[Page H940]]

       ``(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, 2008).
       ``(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 2009.--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 2009, 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, 2010, 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 2009.--
       ``(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, 2009.
       ``(B) Extension upon state request.--If an applicable 
     existing waiver described in subparagraph (A) would otherwise 
     expire before January 1, 2010, notwithstanding the 
     requirements of subsections (e) and (f) of section 1115, a 
     State may submit, not later than September 30, 2009, a 
     request to the Secretary for an extension of the waiver. The 
     Secretary shall approve a request for an extension of an 
     applicable existing waiver submitted pursuant to this 
     subparagraph, but only through December 31, 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 nonpregnant childless adult during the period beginning on 
     the date of the enactment of this subsection and ending on 
     December 31, 2009.
       ``(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, 2009, 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, 2009, on the application of a 
     State for a Medicaid nonpregnant childless adults waiver that 
     was submitted to the Secretary by September 30, 2009, 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 fiscal year 2010, 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 (2)(B) for fiscal year 2009, increased by the 
     percentage increase (if any) in the projected nominal per 
     capita amount of National Health Expenditures for 2010 over 
     2009, as most recently published by the Secretary; and
       ``(ii) in the case of any succeeding fiscal year, allow 
     such expenditures to not exceed the amount in effect under 
     this subparagraph for the preceding fiscal year, increased by 
     the percentage increase (if any) in the projected nominal per 
     capita amount of National Health Expenditures for the 
     calendar year that begins during the year involved over the 
     preceding calendar year, as most recently published by the 
     Secretary.
       ``(b) Rules and Conditions for Coverage of Parents of 
     Targeted Low-Income Children.--
       ``(1) Two-year period; automatic extension at state option 
     through fiscal year 2011.--
       ``(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 2009 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, 2011, 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, 2011, and the State requests an 
     extension of such waiver, the Secretary shall grant such an 
     extension, but only, subject to paragraph (2)(A), through 
     September 30, 2011.
       ``(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 the third and 
     fourth quarters of fiscal year 2009 and during fiscal years 
     2010 and 2011.
       ``(2) Rules for fiscal years 2012 through 2013.--
       ``(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 2012 or 2013, 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 2013, the set aside for any State shall 
     be computed separately for each period described in 
     subparagraphs (A) and (B) of section 2104(a)(16) and any 
     reduction in the allotment for either such period under 
     section 2104(m)(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 2012 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 2012 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

[[Page H941]]

     in any of subparagraph (A), (B), or (C) of paragraph (3) for 
     fiscal year 2011; 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 2013.--For 
     purposes of clause (ii), the applicable percentage for any 
     quarter of fiscal year 2013 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 2012; and
       ``(bb) the State met either of the coverage benchmarks 
     described in subparagraph (B) or (C) of paragraph (3) for 
     fiscal year 2012; 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 
     2009.
       ``(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 2011;
       ``(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 during fiscal year 2009.
       ``(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 
     2009 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 
     2009, 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. LIMITATION ON MATCHING RATE FOR STATES THAT PROPOSE 
                   TO COVER CHILDREN WITH EFFECTIVE FAMILY INCOME 
                   THAT EXCEEDS 300 PERCENT OF THE POVERTY LINE.

       (a) FMAP Applied to Expenditures.--Section 2105(c) (42 
     U.S.C. 1397ee(c)) is amended by adding at the end the 
     following new paragraph:
       ``(8) Limitation on matching rate for expenditures for 
     child health assistance provided to children whose effective 
     family income exceeds 300 percent of the poverty line.--
       ``(A) FMAP applied to expenditures.--Except as provided in 
     subparagraph (B), for fiscal years beginning with fiscal year 
     2009, the Federal medical assistance percentage (as 
     determined under section 1905(b) without regard to clause (4) 
     of such section) shall be substituted for the enhanced FMAP 
     under subsection (a)(1) with respect to 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 2009, has an 
     approved State plan amendment or waiver to provide, or has 
     enacted a State law to submit a State plan amendment 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.

       Notwithstanding any other provision of law, including 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, at State option, the Secretary shall provide 
     the State with the Federal medical assistance percentage 
     determined for the State for Medicaid with respect to 
     expenditures described in section 1905(u)(2)(A) of such Act 
     or otherwise made to provide medical assistance under 
     Medicaid to a child who could be covered by the State under 
     CHIP.

                   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 2009 through 2013 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

[[Page H942]]

     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 
     Match Required for Any Eligible Entity Awarded a Grant.--
       ``(1) State maintenance of effort.--In the case of a State 
     that is awarded a grant under this section, 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.
       ``(2) No matching requirement.--No eligible entity awarded 
     a grant under subsection (a) shall be required to provide any 
     matching funds as a condition for receiving the grant.
       ``(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 2009 through 
     2013, 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:

[[Page H943]]

     ``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:
       ``(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) or 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)(9), 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 in writing, by 
     telephone, orally, through electronic signature, or through 
     any other means specified by the Secretary or by 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

[[Page H944]]

     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 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 and Nutrition Act of 2008 (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) State option to rely on state income tax data or 
     return.--At the option of the State, a finding from an 
     Express Lane agency may include gross income or adjusted 
     gross income shown by State income tax records or returns.
       ``(I) Application.--This paragraph shall not apply with 
     respect to eligibility determinations made after September 
     30, 2013.''.
       (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, 2012, 
     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 2009 through 2012.
       (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

[[Page H945]]

     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 by adding at the end 
     the following new section:

     ``SEC. 1942. 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--
       ``(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 1942 (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 the date of the enactment of this Act.

              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 maintained 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

[[Page H946]]

     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 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) Subparagraphs (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 section 114(a), is amended by adding at the end 
     the following new paragraph:
       ``(9) 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 
     January 1, 2010.
       (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, 2009, 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.

[[Page H947]]

       (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 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).

     SEC. 214. PERMITTING STATES TO ENSURE COVERAGE WITHOUT A 5-
                   YEAR DELAY OF CERTAIN CHILDREN AND PREGNANT 
                   WOMEN UNDER THE MEDICAID PROGRAM AND CHIP.

       (a) Medicaid Program.--Section 1903(v) (42 U.S.C. 1396b(v)) 
     is amended--
       (1) in paragraph (1), by striking ``paragraph (2)'' and 
     inserting ``paragraphs (2) and (4)''; and
       (2) by adding at the end the following new paragraph:
       ``(4)(A) A State may elect (in a plan amendment under this 
     title) to provide medical assistance under this title, 
     notwithstanding sections 401(a), 402(b), 403, and 421 of the 
     Personal Responsibility and Work Opportunity Reconciliation 
     Act of 1996, to children and pregnant women who are lawfully 
     residing in the United States (including battered individuals 
     described in section 431(c) of such Act) and who are 
     otherwise eligible for such assistance, within either or both 
     of the following eligibility categories:
       ``(i) Pregnant women.--Women during pregnancy (and during 
     the 60-day period beginning on the last day of the 
     pregnancy).
       ``(ii) Children.--Individuals under 21 years of age, 
     including optional targeted low-income children described in 
     section 1905(u)(2)(B).
       ``(B) In the case of a State that has elected to provide 
     medical assistance to a category of aliens under subparagraph 
     (A), no debt shall accrue under an affidavit of support 
     against any sponsor of such an alien on the basis of 
     provision of assistance to such category and the cost of such 
     assistance shall not be considered as an unreimbursed cost.
       ``(C) As part of the State's ongoing eligibility 
     redetermination requirements and procedures for an individual 
     provided medical assistance as a result of an election by the 
     State under subparagraph (A), a State shall verify that the 
     individual continues to lawfully reside in the United States 
     using the documentation presented to the State by the 
     individual on initial enrollment. If the State cannot 
     successfully verify that the individual is lawfully residing 
     in the United States in this manner, it shall require that 
     the individual provide the State with further documentation 
     or other evidence to verify that the individual is lawfully 
     residing in the United States.''.
       (b) CHIP.--Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)), as 
     amended by sections 203(a)(2) and 203(d)(2), is amended by 
     redesignating subparagraphs (E) and (F) as subparagraphs (F) 
     and (G), respectively and by inserting after subparagraph (D) 
     the following new subparagraph:
       ``(E) Paragraph (4) of section 1903(v) (relating to 
     optional coverage of categories of lawfully residing 
     immigrant children or pregnant women), but only if the State 
     has elected to apply such paragraph with respect to such 
     category of children or pregnant women under title XIX.''.

      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) and 211(c), is amended by adding 
     at the end the following:
       ``(10) 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

[[Page H948]]

     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 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 
     2009.
       ``(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

[[Page H949]]

     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, 2010, 
     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 211(c)(2), is amended 
     by adding at the end the following new clause:
       ``(iii) 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 2009, 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 2009, 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

[[Page H950]]

     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 2009, 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 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

[[Page H951]]

     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 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 2009, 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, 2010, 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 
     2009, 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, 2011, 
     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, 2011, 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 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, 2013, and 
     annually thereafter, the Secretary shall publish recommended

[[Page H952]]

     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, 2010, 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 2009 
     through 2013, 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 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

[[Page H953]]

       ``(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 2009, 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 2009, 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 2009 through 2013.
       ``(f) Development of Model Electronic Health Record Format 
     for Children Enrolled in Medicaid or CHIP.--
       ``(1) In general.--Not later than January 1, 2010, 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, 2010, 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 2009 through 2013, $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).
       ``(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.''.

[[Page H954]]

       (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 2009 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, 2009, 
     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, 2009.
                 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 paragraphs (1) 
     and (2) shall apply to coverage of items and services 
     furnished on or after October 1, 2009.
       (b) State Option To Provide Dental-Only Supplemental 
     Coverage.--
       (1) In general.--Section 2110(b) (42 U.S.C. 1397jj(b)) is 
     amended--
       (A) in paragraph (1)(C), by inserting ``, subject to 
     paragraph (5),'' after ``under title XIX or''; and
       (B) by adding at the end the following new paragraph:
       ``(5) Option for states with a separate chip program to 
     provide dental-only supplemental coverage.--
       ``(A) In general.--Subject to subparagraphs (B) and (C), in 
     the case of any child who is enrolled in a group health plan 
     or health insurance coverage offered through an employer who 
     would, but for the application of paragraph (1)(C), satisfy 
     the requirements for being a targeted low-income child under 
     a State child health plan that is implemented under this 
     title, a State may waive the application of such paragraph to 
     the child in order to provide--
       ``(i) dental coverage consistent with the requirements of 
     subsection (c)(5) of section 2103; or
       ``(ii) cost-sharing protection for dental coverage 
     consistent with such requirements and the requirements of 
     subsection (e)(3)(B) of such section.
       ``(B) Limitation.--A State may limit the application of a 
     waiver of paragraph (1)(C) to children whose family income 
     does not exceed a level specified by the State, so long as 
     the level so specified does not exceed the maximum income 
     level otherwise established for other children under the 
     State child health plan.
       ``(C) Conditions.--A State may not offer dental-only 
     supplemental coverage under this paragraph unless the State 
     satisfies the following conditions:
       ``(i) Income eligibility.--The State child health plan 
     under this title--

       ``(I) has the highest income eligibility standard permitted 
     under this title (or a waiver) as of January 1, 2009;
       ``(II) does not limit the acceptance of applications for 
     children or impose any numerical limitation, waiting list, or 
     similar limitation on the eligibility of such children for 
     child health assistance under such State plan; and
       ``(III) provides benefits to all children in the State who 
     apply for and meet eligibility standards.

       ``(ii) No more favorable treatment.--The State child health 
     plan may not provide more favorable dental coverage or cost-
     sharing protection for dental coverage to children provided 
     dental-only supplemental coverage under this paragraph than 
     the dental coverage and cost-sharing protection for dental 
     coverage provided to targeted low-income children who are 
     eligible for the full range of child health assistance 
     provided under the State child health plan.''.
       (2) State option to waive waiting period.--Section 
     2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)), as amended by 
     section 111(b)(2), is amended--
       (A) in clause (ii), by striking ``and'' at the end;
       (B) in clause (iii), by striking the period and inserting 
     ``; and''; and
       (C) by adding at the end the following new clause:
       ``(iv) at State option, may not apply a waiting period in 
     the case of a child provided dental-only supplemental 
     coverage under section 2110(b)(5).''.
       (c) 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.
       (d) 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 (70);
       (B) by striking the period at the end of paragraph (71) and 
     inserting ``; and''; and
       (C) by inserting after paragraph (71) the following new 
     paragraph:
       ``(72) 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)

[[Page H955]]

     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)(72) (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, 2009.
       (e) Reporting Information on Dental Health.--
       (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.
       (f) 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.
       (g) 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,''.
       (h) 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 use disorder benefits, such plan shall 
     ensure that the financial requirements and treatment 
     limitations applicable to such mental health or substance use 
     disorder benefits comply with the requirements of section 
     2705(a) of the Public Health Service Act in the same manner 
     as such requirements apply to a group health 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, 2009.
       (b) Transition Grants.--
       (1) Appropriation.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated to the 
     Secretary for fiscal year 2009, $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, 2011, 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 the 
     date of the enactment of this Act.

     SEC. 505. CLARIFICATION OF COVERAGE OF SERVICES PROVIDED 
                   THROUGH SCHOOL-BASED HEALTH CENTERS.

       (a) In General.--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 (as defined in section 2110(c)(9)).''.
       (b) Definition.--Section 2110(c) (42 U.S.C. 1397jj) is 
     amended by adding at the end the following:
       ``(9) School-based health center.--
       ``(A) In general.--The term `school-based health center' 
     means a health clinic that--
       ``(i) is located in or near a school facility of a school 
     district or board or of an Indian tribe or tribal 
     organization;

[[Page H956]]

       ``(ii) is organized through school, community, and health 
     provider relationships;
       ``(iii) is administered by a sponsoring facility;
       ``(iv) provides through health professionals primary health 
     services to children in accordance with State and local law, 
     including laws relating to licensure and certification; and
       ``(v) satisfies such other requirements as a State may 
     establish for the operation of such a clinic.
       ``(B) Sponsoring facility.--For purposes of subparagraph 
     (A)(iii), the term `sponsoring facility' includes any of the 
     following:
       ``(i) A hospital.
       ``(ii) A public health department.
       ``(iii) A community health center.
       ``(iv) A nonprofit health care agency.
       ``(v) A school or school system.
       ``(vi) A program administered by the Indian Health Service 
     or the Bureau of Indian Affairs or operated by an Indian 
     tribe or a tribal organization.''.

     SEC. 506. MEDICAID AND CHIP PAYMENT AND ACCESS COMMISSION.

       (a) In General.--Title XIX (42 U.S.C. 1396 et seq.) is 
     amended by inserting before section 1901 the following new 
     section:


           ``medicaid and chip payment and access commission

       ``Sec. 1900.  (a) Establishment.--There is hereby 
     established the Medicaid and CHIP Payment and Access 
     Commission (in this section referred to as `MACPAC').
       ``(b) Duties.--
       ``(1) Review of access policies and annual reports.--MACPAC 
     shall--
       ``(A) review policies of the Medicaid program established 
     under this title (in this section referred to as `Medicaid') 
     and the State Children's Health Insurance Program established 
     under title XXI (in this section referred to as `CHIP') 
     affecting children's access to covered items and services, 
     including topics described in paragraph (2);
       ``(B) make recommendations to Congress concerning such 
     access policies;
       ``(C) by not later than March 1 of each year (beginning 
     with 2010), submit a report to Congress containing the 
     results of such reviews and MACPAC's recommendations 
     concerning such policies; and
       ``(D) by not later than June 1 of each year (beginning with 
     2010), submit a report to Congress containing an examination 
     of issues affecting Medicaid and CHIP, including the 
     implications of changes in health care delivery in the United 
     States and in the market for health care services on such 
     programs.
       ``(2) Specific topics to be reviewed.--Specifically, MACPAC 
     shall review and assess the following:
       ``(A) Medicaid and chip payment policies.--Payment policies 
     under Medicaid and CHIP, including--
       ``(i) the factors affecting expenditures for items and 
     services in different sectors, including the process for 
     updating hospital, skilled nursing facility, physician, 
     Federally-qualified health center, rural health center, and 
     other fees;
       ``(ii) payment methodologies; and
       ``(iii) the relationship of such factors and methodologies 
     to access and quality of care for Medicaid and CHIP 
     beneficiaries.
       ``(B) Interaction of medicaid and chip payment policies 
     with health care delivery generally.--The effect of Medicaid 
     and CHIP payment policies on access to items and services for 
     children and other Medicaid and CHIP populations other than 
     under this title or title XXI and the implications of changes 
     in health care delivery in the United States and in the 
     general market for health care items and services on Medicaid 
     and CHIP.
       ``(C) Other access policies.--The effect of other Medicaid 
     and CHIP policies on access to covered items and services, 
     including policies relating to transportation and language 
     barriers.
       ``(3) Creation of early-warning system.--MACPAC shall 
     create an early-warning system to identify provider shortage 
     areas or any other problems that threaten access to care or 
     the health care status of Medicaid and CHIP beneficiaries.
       ``(4) Comments on certain secretarial reports.--If the 
     Secretary submits to Congress (or a committee of Congress) a 
     report that is required by law and that relates to access 
     policies, including with respect to payment policies, under 
     Medicaid or CHIP, the Secretary shall transmit a copy of the 
     report to MACPAC. MACPAC shall review the report and, not 
     later than 6 months after the date of submittal of the 
     Secretary's report to Congress, shall submit to the 
     appropriate committees of Congress written comments on such 
     report. Such comments may include such recommendations as 
     MACPAC deems appropriate.
       ``(5) Agenda and additional reviews.--MACPAC shall consult 
     periodically with the chairmen and ranking minority members 
     of the appropriate committees of Congress regarding MACPAC's 
     agenda and progress towards achieving the agenda. MACPAC may 
     conduct additional reviews, and submit additional reports to 
     the appropriate committees of Congress, from time to time on 
     such topics relating to the program under this title or title 
     XXI as may be requested by such chairmen and members and as 
     MACPAC deems appropriate.
       ``(6) Availability of reports.--MACPAC shall transmit to 
     the Secretary a copy of each report submitted under this 
     subsection and shall make such reports available to the 
     public.
       ``(7) Appropriate committee of congress.--For purposes of 
     this section, the term `appropriate committees of Congress' 
     means the Committee on Energy and Commerce of the House of 
     Representatives and the Committee on Finance of the Senate.
       ``(8) Voting and reporting requirements.--With respect to 
     each recommendation contained in a report submitted under 
     paragraph (1), each member of MACPAC shall vote on the 
     recommendation, and MACPAC shall include, by member, the 
     results of that vote in the report containing the 
     recommendation.
       ``(9) Examination of budget consequences.--Before making 
     any recommendations, MACPAC shall examine the budget 
     consequences of such recommendations, directly or through 
     consultation with appropriate expert entities.
       ``(c) Membership.--
       ``(1) Number and appointment.--MACPAC shall be composed of 
     17 members appointed by the Comptroller General of the United 
     States.
       ``(2) Qualifications.--
       ``(A) In general.--The membership of MACPAC shall include 
     individuals who have had direct experience as enrollees or 
     parents of enrollees in Medicaid or CHIP and individuals with 
     national recognition for their expertise in Federal safety 
     net health programs, health finance and economics, actuarial 
     science, health facility management, health plans and 
     integrated delivery systems, reimbursement of health 
     facilities, health information technology, pediatric 
     physicians, dentists, and other providers of health services, 
     and other related fields, who provide a mix of different 
     professionals, broad geographic representation, and a balance 
     between urban and rural representatives.
       ``(B) Inclusion.--The membership of MACPAC shall include 
     (but not be limited to) physicians and other health 
     professionals, employers, third-party payers, and individuals 
     with expertise in the delivery of health services. Such 
     membership shall also include consumers representing 
     children, pregnant women, the elderly, and individuals with 
     disabilities, current or former representatives of State 
     agencies responsible for administering Medicaid, and current 
     or former representatives of State agencies responsible for 
     administering CHIP.
       ``(C) Majority nonproviders.--Individuals who are directly 
     involved in the provision, or management of the delivery, of 
     items and services covered under Medicaid or CHIP shall not 
     constitute a majority of the membership of MACPAC.
       ``(D) Ethical disclosure.--The Comptroller General of the 
     United States shall establish a system for public disclosure 
     by members of MACPAC of financial and other potential 
     conflicts of interest relating to such members. Members of 
     MACPAC shall be treated as employees of Congress for purposes 
     of applying title I of the Ethics in Government Act of 1978 
     (Public Law 95-521).
       ``(3) Terms.--
       ``(A) In general.--The terms of members of MACPAC shall be 
     for 3 years except that the Comptroller General of the United 
     States shall designate staggered terms for the members first 
     appointed.
       ``(B) Vacancies.--Any member appointed to fill a vacancy 
     occurring before the expiration of the term for which the 
     member's predecessor was appointed shall be appointed only 
     for the remainder of that term. A member may serve after the 
     expiration of that member's term until a successor has taken 
     office. A vacancy in MACPAC shall be filled in the manner in 
     which the original appointment was made.
       ``(4) Compensation.--While serving on the business of 
     MACPAC (including travel time), a member of MACPAC shall be 
     entitled to compensation at the per diem equivalent of the 
     rate provided for level IV of the Executive Schedule under 
     section 5315 of title 5, United States Code; and while so 
     serving away from home and the member's regular place of 
     business, a member may be allowed travel expenses, as 
     authorized by the Chairman of MACPAC. Physicians serving as 
     personnel of MACPAC may be provided a physician comparability 
     allowance by MACPAC in the same manner as Government 
     physicians may be provided such an allowance by an agency 
     under section 5948 of title 5, United States Code, and for 
     such purpose subsection (i) of such section shall apply to 
     MACPAC in the same manner as it applies to the Tennessee 
     Valley Authority. For purposes of pay (other than pay of 
     members of MACPAC) and employment benefits, rights, and 
     privileges, all personnel of MACPAC shall be treated as if 
     they were employees of the United States Senate.
       ``(5) Chairman; vice chairman.--The Comptroller General of 
     the United States shall designate a member of MACPAC, at the 
     time of appointment of the member as Chairman and a member as 
     Vice Chairman for that term of appointment, except that in 
     the case of vacancy of the Chairmanship or Vice Chairmanship, 
     the Comptroller General of the United States may designate 
     another member for the remainder of that member's term.
       ``(6) Meetings.--MACPAC shall meet at the call of the 
     Chairman.
       ``(d) Director and Staff; Experts and Consultants.--Subject 
     to such review as the Comptroller General of the United 
     States deems necessary to assure the efficient administration 
     of MACPAC, MACPAC may--
       ``(1) employ and fix the compensation of an Executive 
     Director (subject to the approval of the Comptroller General 
     of the United States) and such other personnel as may be 
     necessary to carry out its duties (without regard to the 
     provisions of title 5, United States Code, governing 
     appointments in the competitive service);
       ``(2) seek such assistance and support as may be required 
     in the performance of its duties from appropriate Federal 
     departments and agencies;
       ``(3) enter into contracts or make other arrangements, as 
     may be necessary for the conduct of the work of MACPAC 
     (without regard to section 3709 of the Revised Statutes (41 
     U.S.C. 5));
       ``(4) make advance, progress, and other payments which 
     relate to the work of MACPAC;
       ``(5) provide transportation and subsistence for persons 
     serving without compensation; and

[[Page H957]]

       ``(6) prescribe such rules and regulations as it deems 
     necessary with respect to the internal organization and 
     operation of MACPAC.
       ``(e) Powers.--
       ``(1) Obtaining official data.--MACPAC may secure directly 
     from any department or agency of the United States 
     information necessary to enable it to carry out this section. 
     Upon request of the Chairman, the head of that department or 
     agency shall furnish that information to MACPAC on an agreed 
     upon schedule.
       ``(2) Data collection.--In order to carry out its 
     functions, MACPAC shall--
       ``(A) utilize existing information, both published and 
     unpublished, where possible, collected and assessed either by 
     its own staff or under other arrangements made in accordance 
     with this section;
       ``(B) carry out, or award grants or contracts for, original 
     research and experimentation, where existing information is 
     inadequate; and
       ``(C) adopt procedures allowing any interested party to 
     submit information for MACPAC's use in making reports and 
     recommendations.
       ``(3) Access of gao to information.--The Comptroller 
     General of the United States shall have unrestricted access 
     to all deliberations, records, and nonproprietary data of 
     MACPAC, immediately upon request.
       ``(4) Periodic audit.--MACPAC shall be subject to periodic 
     audit by the Comptroller General of the United States.
       ``(f) Authorization of Appropriations.--
       ``(1) Request for appropriations.--MACPAC shall submit 
     requests for appropriations in the same manner as the 
     Comptroller General of the United States submits requests for 
     appropriations, but amounts appropriated for MACPAC shall be 
     separate from amounts appropriated for the Comptroller 
     General of the United States.
       ``(2) Authorization.--There are authorized to be 
     appropriated such sums as may be necessary to carry out the 
     provisions of this section.''.
       (b) Deadline for Initial Appointments.--Not later than 
     January 1, 2010, the Comptroller General of the United States 
     shall appoint the initial members of the Medicaid and CHIP 
     Payment and Access Commission established under section 1900 
     of the Social Security Act (as added by subsection (a)).
       (c) Annual Report on Medicaid.--Not later than January 1, 
     2010, and annually thereafter, the Secretary, in consultation 
     with the Secretary of the Treasury, the Secretary of Labor, 
     and the States (as defined for purposes of Medicaid), shall 
     submit an annual report to Congress on the financial status 
     of, enrollment in, and spending trends for, Medicaid for the 
     fiscal year ending on September 30 of the preceding year.

     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:
       ``(11) 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 new 
     final rule (in this section referred to as the ``new final 
     rule'') promulgated after the date of the enactment of this 
     Act and 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 new final rule in effect for all States 
     may only be inclusive of errors, as defined in such new final 
     rule or in guidance issued within a reasonable time frame 
     after the effective date for such new final rule that 
     includes detailed guidance for the specific methodology for 
     error determinations.
       (c) Requirements for New Final Rule.--For purposes of 
     subsection (b), the requirements of this subsection are that 
     the new 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 
     new 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 or under a final rule for fiscal year 
     2008 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 or fiscal year 2011 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 
     new 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, 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 
     the first fiscal year that begins on or after the date on 
     which the new final rule is in effect for all States, 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.
       (g) Time for Promulgation of Final Rule.--The final rule 
     implementing the PERM requirements under subsection (b) shall 
     be promulgated not later than 6 months after the date of 
     enactment of this Act.

     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 
     2009''.
       (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 2009, 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(m)(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).

[[Page H958]]

       ``(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.''.

     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, 
     2011, 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 2010 for the purpose 
     of conducting the evaluation authorized under this paragraph. 
     Amounts appropriated under this subparagraph shall remain 
     available for expenditure through fiscal year 2012.''.

     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. 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.
       (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, 2009, 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

[[Page H959]]

     1905(b) of the Social Security Act (42 U.S.C. 1396(d)).

     SEC. 615. 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. 616. EXTENSION OF MEDICAID DSH ALLOTMENTS FOR TENNESSEE 
                   AND HAWAII.

       Section 1923(f)(6) (42 U.S.C. 1396r-4(f)(6)), as amended by 
     section 202 of the Medicare Improvements for Patients and 
     Providers Act of 2008 (Public Law 110-275) is amended--
       (1) in the paragraph heading, by striking ``2009 and the 
     first calendar quarter of fiscal year 2010'' and inserting 
     ``2011 and the first calendar quarter of fiscal year 2012'';
       (2) in subparagraph (A)--
       (A) in clause (i)--
       (i) in the second sentence--

       (I) by striking ``and 2009'' and inserting ``, 2009, 2010, 
     and 2011''; and
       (II) by striking ``such portion of''; and

       (ii) in the third sentence, by striking ``2010 for the 
     period ending on December 31, 2009'' and inserting ``2012 for 
     the period ending on December 31, 2011'';
       (B) in clause (ii), by striking ``or for a period in fiscal 
     year 2010'' and inserting ``2010, 2011, or for period in 
     fiscal year 2012''; and
       (C) in clause (iv)--
       (i) in the clause heading, by striking ``2009 and the first 
     calendar quarter of fiscal year 2010'' and inserting ``2011 
     and the first calendar quarter of fiscal year 2012''; and
       (ii) in each of subclauses (I) and (II), by striking `` or 
     for a period in fiscal year 2010'' and inserting ``2010, 
     2011, or for a period in fiscal year 2012''; and
       (3) in subparagraph (B)--
       (A) in clause (i)--
       (i) in the first sentence, by striking ``2009'' and 
     inserting ``2011''; and
       (ii) in the second sentence, by striking ``2010 for the 
     period ending on December 31, 2009'' and inserting ``2012 for 
     the period ending on December 31, 2011''.

     SEC. 617. GAO REPORT ON 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 Medicaid 
     are actuarially sound.

                      Subtitle C--Other Provisions

     SEC. 621. 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.
       (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. 622. SENSE OF THE 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 ``$50.33 per thousand'',
       (2) by striking ``20.719 percent (18.063 percent on cigars 
     removed during 2000 or 2001)'' in paragraph (2) and inserting 
     ``52.75 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 ``40.26 cents 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 ``$50.33 per thousand'', and
       (2) by striking ``$40.95 per thousand ($35.70 per thousand 
     on cigarettes removed during 2000

[[Page H960]]

     or 2001)'' in paragraph (2) and inserting ``$105.69 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 ``3.15 
     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 ``6.30 
     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 
     ``$1.51'', and
       (2) by striking ``19.5 cents (17 cents on chewing tobacco 
     removed during 2000 or 2001)'' in paragraph (2) and inserting 
     ``50.33 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 ``$2.8311 
     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 
     ``$24.78''.
       (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 April 1, 2009, 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 April 1, 2009, 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 April 1, 2009, 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 August 1, 2009.
       (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 April 1, 2009, 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 March 31, 
     2009.

     SEC. 702. ADMINISTRATIVE IMPROVEMENTS.

       (a) Permit, Inventories, Reports, and Records Requirements 
     for Manufacturers and Importers of Processed Tobacco.--
       (1) Permit.--
       (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, reports, and packages.--
       (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''.
       (C) Packages, marks, labels, and notices.--Section 5723 of 
     such Code is amended by inserting ``, processed tobacco,'' 
     after ``tobacco products'' each place it appears.
       (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 amendments.--
       (A) Section 5702(h) of such Code is amended by striking 
     ``tobacco products and cigarette papers and tubes'' and 
     inserting ``tobacco products or cigarette papers or tubes or 
     any processed tobacco''.
       (B) Sections 5702(j) and 5702(k) of such Code are each 
     amended by inserting ``, or any processed tobacco,'' after 
     ``tobacco products or cigarette papers or tubes''.
       (6) Effective date.--The amendments made by this subsection 
     shall take effect on April 1, 2009.
       (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 legal proceedings involving a felony violation of any 
     other provision of Federal criminal law relating to tobacco 
     products, processed tobacco, 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, processed tobacco, 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, processed tobacco, 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, processed tobacco, 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 March 31, 
     2009.
       (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 manufactured 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.
       (f) Disclosure.--
       (1) In general.--Paragraph (1) of section 6103(o) of such 
     Code is amended by designating

[[Page H961]]

     the text as subparagraph (A), moving such text 2 ems to the 
     right, striking ``Returns'' and inserting ``(a) in general.--
     Returns'', and by inserting after subparagraph (A) (as so 
     redesignated) the following new subparagraph:
       ``(B) Use in certain proceedings.--Returns and return 
     information disclosed to a Federal agency under subparagraph 
     (A) may be used in an action or proceeding (or in preparation 
     for such action or proceeding) brought under section 625 of 
     the American Jobs Creation Act of 2004 for the collection of 
     any unpaid assessment or penalty arising under such Act.''.
       (2) Conforming amendment.--Section 6103(p)(4) of such Code 
     is amended by striking ``(o)(1)'' both places it appears and 
     inserting ``(o)(1)(A)''.
       (3) Effective date.--The amendments made by this subsection 
     shall apply on or after the date of the enactment of this 
     Act.
       (g) Transitional Rule.--Any person who--
       (1) on April 1, 2009 is engaged in business as a 
     manufacturer of processed tobacco or as an importer of 
     processed tobacco, and
       (2) before the end of the 90-day period beginning on such 
     date, submits an application under subchapter B of chapter 52 
     of such Code to engage in such business, may, notwithstanding 
     such subchapter B, continue to engage in such business 
     pending final action on such application. Pending such final 
     action, all provisions of such chapter 52 shall apply to such 
     applicant in the same manner and to the same extent as if 
     such applicant were a holder of a permit under such chapter 
     52 to engage in such business.

     SEC. 703. TREASURY STUDY CONCERNING MAGNITUDE OF TOBACCO 
                   SMUGGLING IN THE UNITED STATES.

       Not later than one year after the date of the enactment of 
     this Act, the Secretary of the Treasury shall conduct a study 
     concerning the magnitude of tobacco smuggling in the United 
     States and submit to Congress recommendations for the most 
     effective steps to reduce tobacco smuggling. Such study shall 
     also include a review of the loss of Federal tax receipts due 
     to illicit tobacco trade in the United States and the role of 
     imported tobacco products in the illicit tobacco trade in the 
     United States.

     SEC. 704. TIME FOR PAYMENT OF CORPORATE ESTIMATED TAXES.

       The percentage under subparagraph (C) of section 401(1) of 
     the Tax Increase Prevention and Reconciliation Act of 2005 in 
     effect on the date of the enactment of this Act is increased 
     by 0.5 percentage point.


                      Motion Offered by Mr. Waxman

  The text of the motion is as follows:

       Mr. Waxman moves to concur in the Senate amendment.

  The SPEAKER pro tempore. Pursuant to House Resolution 107, the motion 
shall be debatable for 1 hour equally divided and controlled by the 
Chair and ranking minority member of the Committee on Energy and 
Commerce and the Chair and ranking minority member of the Committee on 
Ways and Means.
  The gentleman from California (Mr. Waxman), the gentleman from Texas 
(Mr. Barton), the gentleman from New York (Mr. Rangel), and the 
gentleman from Michigan (Mr. Camp) each will control 15 minutes.
  The Chair recognizes the gentleman from California.
  Mr. WAXMAN. Madam Speaker, I yield myself 1\1/2\ minutes.
  I rise in strong support of H.R. 2, as amended by the Senate. This is 
the same bill, by and large, that we passed in the House by an 
overwhelming bipartisan majority a few weeks ago.
  The opportunity before us today is to make basic health insurance 
available to 11 million low-income children who would otherwise have no 
insurance.
  We know that without health insurance many children go without the 
health care they need to grow, to learn, to compete, and to contribute.
  The bill before us will extend the current program for 4\1/2\ years, 
ensuring that States will be able to maintain coverage for the 7 
million kids now enrolled and to extend coverage to an additional 4.1 
million uninsured low-income children.
  The bill is fully paid for. It will cost $33 billion over the next 5 
years, fully offset by a 62-cent per pack increase in the cigarette 
tax.
  The Senate made a few minor changes, adding a new option for CHIP to 
provide dental care for privately insured children and creating a new 
commission to evaluate provider payments and access in CHIP and 
Medicaid.
  The Senate did not retain the House provision closing a loophole in 
Medicare that allows physicians to refer patients to hospitals where 
they have ownership interest. We will continue to work on that matter.
  While this bill is short of our ultimate goal of health reform, it is 
a down payment, and it is an essential start. We need to pass this 
bill. We need to do so now.
  I urge my colleagues to vote for this bill and send it to the 
President for his signature.
  I reserve the balance of my time.
  Mr. BARTON of Texas. Madam Speaker, I recognize myself for 1 minute.
  Madam Speaker, we're here today to have another debate about SCHIP, 
another incidence of where we have a bill that's come over from the 
Senate slightly different than came from the House. In the case of this 
SCHIP bill, I don't recall there being a hearing on it. I don't recall 
there being a hearing last year before we had the vote.
  So, let us simply say from the Republican perspective that we're very 
supportive of continuing the State Children's Health Insurance Program. 
We do think that it should be limited to families that are under 200 
percent of poverty. We do think this is a children's health program. It 
ought to be for children. And we do think that there should be a 
verification to make sure that the program benefits go to citizens of 
the United States.
  None of those things are in this bill. So we would oppose the bill 
and hope at the appropriate time the House would also oppose it.
  With that, I reserve the balance of my time.
  Mr. WAXMAN. Madam Speaker, I still continue to reserve our time.
  Mr. BARTON of Texas. Madam Speaker, I yield 3 minutes to the 
distinguished ranking member of the Subcommittee on Health in the 
Energy and Commerce Committee, the Honorable Nathan Deal from Georgia.
  Mr. DEAL of Georgia. Madam Speaker, I thank the gentleman for 
yielding.
  I think it would be appropriate for us to review what the SCHIP 
program is designed and was originally designed to do and where it is 
in light of what this bill attempts to do.
  First of all, it stands for the State Children's Health Insurance 
Program. States call it by a variety of different names at the State 
level. In my State, it is called PeachCare. You would imagine that we 
would do that in Georgia, but it was originally designed in 1997 as a 
10-year program--it was a block grant program--designed to fill in the 
need of children who live in families that are above the Medicaid 
poverty level eligibility but are still below 200 percent of poverty, 
and that in that capacity was a worthwhile and useful program.
  During its 10-year initial lifespan as it moved forward, there were 
times when States had shortfalls. In other words, the allocation under 
the Federal matching rate formula for the SCHIP program, coupled with 
the State's contribution, was not sufficient to meet the demand and the 
cost of eligible children to be enrolled, and Congress stepped up to 
the plate, appropriated additional funds, and allowed those States to 
continue with their legitimate enrollment programs.
  When it came to the 10-year time frame expiring, we were faced with, 
well, what is the future of SCHIP going to be. After much debate, 
vetoes by the President, about a program that was going to take a huge 
step in the area of expanding government control of health care, we did 
an 18-month extension, and that 18 months will expire this next month.
  And what it did was it said let's take the legitimate needs of the 
200 percent of poverty and below, recognizing that some States had 
already far exceeded that limit, but nevertheless allowing them to be 
grandfathered in and provide enough money so that no State runs out of 
money to cover the eligible children.
  Unfortunately, the bill before us today continues to take a step, in 
my opinion, in the wrong direction.
  We talk about the millions of children that are supposedly going to 
be enrolled as new enrollees in the program, and yet when we look at 
those figures, we find that about 2.5 million of those so-called new 
enrollees will be children who are already enrolled in private health 
insurance plans, but because their family is now eligible for the 
government to pay for their health care, it is anticipated that their 
families will simply take them off of the private insurance and put 
them on the taxpayer-paid program of SCHIP. I don't think that's what 
most Americans in this country want this program to be.
  Couple that with the fact that we have no provision in this bill that 
requires States--
  The SPEAKER pro tempore. The time of the gentleman has expired.

[[Page H962]]

  Mr. BARTON of Texas. I yield the gentleman 1 additional minute.
  Mr. DEAL of Georgia. There is no provision in this bill that requires 
States to go out and make the extra effort to enroll children who are 
eligible for either Medicaid or the current SCHIP program under its 
current authorization of up to 200 percent of poverty but are still 
unenrolled.
  In fact, it is estimated that about a quarter of the children who are 
eligible are simply not enrolled in the current program. These are the 
children that are at the lowest levels of poverty but are not covered. 
They should be the part that are our first incentive. The Republican 
version of this incentivizes States to take that extra effort to enroll 
those children first before they started going up the poverty level and 
enrolling children in higher income families, many of whom already have 
private insurance.
  I thank the gentleman for yielding to me.
  Mr. WAXMAN. Madam Speaker, I'm pleased at this time to yield 3 
minutes to the gentleman from Washington State (Mr. McDermott).
  Mr. McDERMOTT. Madam Speaker, I rise in strong support of the SCHIP 
reauthorization legislation and want to thank the Speaker, Ms. Pelosi, 
for her leadership in bringing this bill to the floor. H.R. 2 clearly 
says that change has arrived for our country and our children.
  Instead of the veto pen that was used last year by the outgoing 
President to deny health care to children, our new President will sign 
this legislation and, in so doing, will write a new chapter in 
America's commitment to our children and our future.
  H.R. 2 is a real down payment on our efforts to ensure universal 
access to affordable health care for all Americans. It builds on 
successful models that have expanded access to millions of children 
nationwide.
  Health care should be a right, not a privilege for the rich in 
America. This legislation affirms the commitment of a new Congress to 
serve all the people, not merely those who have the means to pay any 
price for health care while the Nation pays a steep price by not 
covering its children.
  H.R. 2 represents an additional 4 million children that will have 
access to health care, and it will provide access to preventive health 
care, and this alone means America will raise healthier children who 
grow to become healthier and more productive adults.
  The American people have spoken. They want a more compassionate 
response to our Nation's problems. Today, we are voting with our heads 
and our hearts to do just that. This is not about ideology or party. It 
is about providing health care to children. H.R. 2 represents real 
change.
  I am proud of my own State that took the lead before SCHIP was put in 
place in 1994. Three years before the enactment of SCHIP, Washington 
State expanded coverage to children up to 200 percent of the Federal 
poverty line. That was a huge commitment, and clearly, my State took 
the lead. As a result, we have fewer children uninsured, we have a 
healthier population, and more integrated primary care. It's a 
commitment that worked for us in our State, and it recognizes that what 
worked for Washington State will work across the country.
  Thirty million dollars was the commitment we made. H.R. 2 rewards 
States like Washington who knew early on that providing quality 
affordable health care to children was a sound, humane investment, but 
also, it expands a successful program to cover more uninsured children 
and working families.
  The present economic difficulties in this country are going to make 
this program even more important than they've ever been in the past. 
This bill provides greater flexibility and will allow States to meet 
the needs of low-income working families.
  I'm grateful also that this legislation includes important access for 
legal immigrant children who are currently denied coverage, children 
who are born in the United States and are U.S. legal citizens. In 
Washington State, we have provided coverage for these children, but the 
State is doing this alone without the full partnership of the Federal 
Government. H.R. 2 corrects this error and will allow Washington State 
to maintain coverage for more than 3,000 children.
  Madam Speaker, we need to do the right thing. Providing universal 
coverage for children is an objective that we should all support. This 
legislation takes us one step closer to meeting this goal. I urge my 
colleagues to support this bill.

                              {time}  1130

  Mr. BARTON of Texas. Madam Speaker, I yield 2 minutes to a 
distinguished member of the committee, Dr. Gingrey of Georgia.
  Mr. GINGREY of Georgia. Madam Speaker, I appreciate the gentleman 
yielding, and I regretfully rise to oppose H.R. 2, not because I oppose 
the original legislation--which I think the bill was a very good bill 
and as a physician Member and a compassion for wanting to extend health 
care to our children--my concern with the bill with the reauthorization 
is that it doesn't really limit it to those children that need it the 
most, those, say, under 200 percent or between 100 and 200 percent of 
the Federal poverty level. This new bill actually allows that to go up 
to 300 percent.
  But, Madam Speaker, there is an even bigger problem. This is a 
situation that some States use called--well, they're loopholes, really, 
and they call them income disregards. I think there are about 13 
States, Madam Speaker, who utilize that loophole that just simply says 
to couples or families, If you're not eligible, that is, you make more 
than 300 percent of the Federal poverty level--well, what is that, 
about $65,000 a year for a family of 4--then we will just simply 
disregard the income that you make between 300 and 400 percent of the 
Federal poverty level and say, We're not going to count that. Let's 
count--a wink, wink, wink, nod, smoke and mirrors, shell game--not 
count a certain block of income.
  And I had an amendment--which I thought was a very good amendment; 
unfortunately it's a closed rule--but this amendment would simply say 
that there will be income disregards only in the amount of a maximum of 
$3,000 a year or $250 a month. Only income disregards may be something 
like childcare or something of that sort.
  But to completely disregard, that's where we get into this crowd-out 
situation, Madam Speaker, where people whose children are already 
covered in the private market, they're going to drop that, clearly 
they're going to drop it even though they can afford it so they can get 
on the government dole. And as was pointed out earlier, a lot of 
physicians are not going to take the SCHIP patient because of the 
reimbursement.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. BARTON of Texas. Madam Speaker, I am going to be magnanimous and 
give the gentleman 1 additional minute.
  Mr. GINGREY of Georgia. I thank my ranking member of the Energy and 
Commerce Committee for his generosity. He knows that this Georgia 
brogue is a little bit slow.
  But clearly it makes no sense, it makes no sense to crowd them out 
and put them into this program and then physicians are going to be less 
inclined to provide the service because their reimbursement under SCHIP 
or Medicaid is probably 30 percent less than it is in the private 
market.
  So while in trying to enroll more children and help more children, I 
think, unfortunately, you're going to get less coverage and less 
service for those children.
  So again, that was a good amendment. I'm sorry I didn't have a 
chance, Madam Speaker, to offer it. I think we could have made a good 
bill a whole lot better.
  And for that reason, I'm going to oppose this bill.
  Mr. WAXMAN. Madam Speaker, I am pleased at this time to yield 1 
minute to the distinguished majority leader of the House of 
Representatives, the gentleman from Maryland (Mr. Hoyer).
  Mr. HOYER. I thank the gentleman for yielding.
  Madam Speaker, I thank the chairman for bringing this bill to the 
floor in a timely fashion. I'm pleased that we're going to pass this 
bill, we're going to send it to the President, and he's going to sign 
it.
  Atul Gawande, a surgeon and writer on health care policy, recently 
described our medical system like this:

[[Page H963]]

``American health care is an appallingly patched-together ship, with . 
. . fifteen percent of the passengers thrown over the rails just to 
keep it afloat.''
  If you can afford health care in America, there is no better place in 
the world to get sick. You will be treated to the best hospitals by the 
most skilled doctors with the latest technology. However, if you're one 
of the Americans thrown overboard, if you're one of the 45 million 
uninsured Americans for whom even a checkup is a luxury, you might be 
better off in some other places in the world. Every other developed 
nation has figured out how to cover all of its citizens. Every one but 
ours.
  We're here today to start fixing that. Actually, we've been fixing 
that in a number of ways--Medicaid, Medicare, other programs that we've 
adopted--to patch the holes, however, that still exist in the leaking 
ship to make it into a vessel capable of carrying every passenger, 
every American.
  We can't patch every hole today, but if I could pick just one leak to 
stop, it would be the hold where we keep our sick children. If you 
asked me for the most efficient use of a single health care dollar, I 
would put it towards covering more children.
  I don't say that out of a misplaced sentimentality; I say it because 
it's well-established that childhood is the most medically pivotal time 
of life. A child who lives through the first years without a doctor's 
care, without regular checkups, without immunizations, and without 
booster shots is in for a lifetime of health danger. That child will 
live sicker and die sooner. In adulthood, he or she will be a less 
productive worker. And in old age, he or she will help swell the costs 
of our entitlement programs.
  That is the logic behind the final passage of this bill, which brings 
into the State Children's Health Insurance Program, as has been said 
already, four million children who are eligible but not yet enrolled.
  Very frankly, as a result of the veto of the legislation we passed in 
the last Congress, four million children went to bed last night with 
their parents worried if they got sick, what were they going to do, 
with the alternative being the emergency room: the most expensive, and 
in some cases least efficient, intervention in the health care system 
in our country.
  It does what President Bush promised to do when he ran for re-
election in 2004 accepting the Republican nomination. As I've said 
before, President Bush said this, ``In a new term''--that meant the 
2005 to the 2009 term that just expired--``In a new term, we will lead 
an aggressive effort to enroll millions of poor children who are 
eligible but not signed up for government health insurance programs.''
  Those millions of children of which President Bush spoke will be 
added by this bill. President Bush failed to deliver on his promise, 
but today, we will redeem that commitment. Today, the objective of 
years of work will be substantially advanced.
  With this vote, and with President Obama's immediate signature, this 
bill will at long last be law.
  Backed by overwhelming majorities of Americans, we can pass this bill 
and help raise a healthier generation of Americans. That's good for our 
country, it's good for our economy, and it's good for the international 
community.
  And in this recession, we can lend some vital assistance to the 
millions of family budgets that are stretched, literally stretched, to 
the breaking point and the point of letting the health care of our 
children be further at risk.
  Madam Speaker, renewing American health care, bringing the best care 
in the world, which we have right here--as Dr. Gingrey knows, we have 
right here--bringing it to all of our people is a hugely complex job. 
That work, of course, does not end today, as Chairman Waxman would 
emphasize. But this important inclusion of more than four million of 
our children and the guarantee of access to health care is a victory 
for America's values and its health care future.
  I urge my colleagues, each and every one of us, to vote for this 
legislation, vote for our children, vote for our families, vote for a 
healthier America.
  Mr. BARTON of Texas. Madam Speaker, can I inquire of the time 
remaining on each side?
  The SPEAKER pro tempore. The gentleman from Texas has 7 minutes 
remaining and the gentleman from California has 9\1/2\ minutes 
remaining.
  Mr. BARTON of Texas. Madam Speaker, I yield myself 3 minutes.
  Madam Speaker, my admiration for the majority leader knows no bounds. 
Mr. Hoyer is a great man, and he is an institutionalist, and he was 
personally involved in the negotiations of the last Congress who tried 
to get a compromise. But sometimes he doesn't tell the entire facts of 
the matter. So I want to just point out a few things that our 
distinguished majority leader failed to mention.
  Right now in America, the SCHIP law that we're operating under is a 
Barton-Deal bill--Mr. Deal and myself, two Republicans--that extends 
the existing program. And to Mr. Hoyer's credit and Ms. Pelosi's 
credit, they passed that extension in the last Congress when we 
couldn't get a political compromise.
  Under current law, if you're low income, below 200 percent of 
poverty, your children are covered under Medicaid 100 percent, 100 
percent. If you're a working family that's under 200 percent of the 
Federal poverty limit, you're automatically covered. In some States, 
they go up to 250 percent of poverty, and in some States they have 
asked for waivers to go even higher than that. I think Mr. Pallone's 
State of New Jersey may be at 300 percent. I think the State of New 
York may be at 300 percent.
  So it is a misnomer to say that there are all of these children out 
there that don't have health insurance. There are some.
  Now, the bill before us today really doesn't have an income test. It 
officially takes it to 300 percent of poverty but allows the States to 
ask for waivers and do what are called income disregards, which 
basically means you could have families at 400 or 500 percent of 
poverty and if that State disregards their income, they can be covered. 
That was admitted on the House floor in last year's debate, and that 
provision is unchanged in the bill before us.
  Now, President Obama has already scheduled a signing ceremony so 
there is no real suspense about whether this bill is going to pass with 
a Democrat majority of 258 votes and a Republican minority of 178 
votes, we're pretty sure that this bill is going to prevail.
  But the record should show that low-income children are covered, that 
children up to 200 percent of poverty are covered, and in some states 
it goes to 250 percent. This debate is about raising the level.
  This debate is about do we want a children's health insurance program 
that covers every child in America with State and Federal dollars 
regardless of their ability to pay; do we want to freeze out the 
private sector for health insurance. That's what this debate is about.
  Republicans are for children's health insurance. Republicans do 
believe, though, that we should target the help to those families that 
have less ability to help themselves.
  And on the question of citizen verification, since we didn't have a 
legislative hearing, I'm not sure what the verification measurement is, 
but I think it's personal affirmation.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. BARTON of Texas. Madam Speaker, I yield myself 15 seconds.
  If it is personal affirmation, when you sign up for SCHIP they say, 
``Are you U.S. citizen?'' And if your parent says you are, you are. 
That's what personal affirmation is.
  So I hope we could somehow pull out a miracle and defeat this bill 
and then do the bipartisan compromise that we almost pulled off in the 
last Congress.
  With that, I reserve the balance of my time.
  Mr. WAXMAN. Madam Speaker, I yield to the chairman of the Health 
Subcommittee and the author of the SCHIP bill in the House, Mr. Pallone 
from the State of New Jersey, 1 minute with an option for more.
  Mr. PALLONE. I thank the gentleman from California.
  Madam Speaker, on this historic day I'm reminded of a quote from the 
Pulitzer Prize winning American author, Pearl Buck, who said, ``If our 
American way of life fails the child, it fails us all.''
  Well, this is a day worthy of celebration. It comes nearly 2 years 
after

[[Page H964]]

Deamonte Driver, a young boy from suburban Maryland, lost his life 
because his family lost its health insurance. And this simply should 
not happen in America. And if Congress does not act today, I can't help 
but think of the millions of other children whose lives will be put at 
risk simply because they do not have access to health coverage.
  There can be no greater cause or worthier goal than protecting the 
wellbeing of our Nation's children. I emphasize this point now because 
in a recession parents are forced to make tough financial decisions: do 
they keep their families' health insurance, or do they put food on the 
table at night?
  And today we have an extraordinary opportunity to ensure that these 
children don't fall through the cracks. This is a very good bill. With 
its passage, 11 million children will have access to the health care 
coverage they need to lead healthy and strong lives. And these children 
are our Nation's future.
  Let's support them today by voting ``yes.''
  Mr. BARTON of Texas. Madam Speaker, I yield 1 minute to the gentleman 
from California, Congressman McClintock.

                              {time}  1145

  Mr. McCLINTOCK. I thank the gentleman for yielding, and I think it's 
a prime example of unintended consequences. Since its inception, we've 
watched as SCHIP has been slowly replacing employer health plans with 
government-paid plans--with spiraling costs to taxpayers. Employers 
discovered that they could avoid their own plans, knowing that their 
employees would be covered by SCHIP.
  This was supposed to provide health insurance for poor and working-
class families but, like all things bureaucratic, it's now morphed into 
one in which families earning as much as six-figure incomes and who 
would have good employer-paid health insurance are being pushed into 
the government program. And that is the fine point of it.
  This is no longer a program for the children of poor people. It's 
being used to insinuate government into the medical care of every 
American. Frankly, we don't need the same people who run the TSA to run 
our health insurance.
  Mr. WAXMAN. Madam Speaker, I yield 1 minute to a member of the Energy 
and Commerce Committee and a member as well of the Health Subcommittee, 
the gentlewoman from Illinois (Ms. Schakowsky).
  Ms. SCHAKOWSKY. I am delighted to rise today in support of the 
Children's Health Insurance Program Reauthorization Act. I thank 
Chairman Waxman and Chairman Pallone for their hard work on bringing it 
to us today.
  As a mother and proud grandmother of four, I can think of no higher 
priority than ensuring that our children get the health care they need. 
Unfortunately, 7 million children nationally and 350,000 children in 
Illinois are at risk of losing their coverage if we don't reauthorize 
this program.
  But this bill will not only prevent SCHIP from expiring on March 31, 
it will also expand coverage to 4 million uninsured children nationally 
and 300,000 children in Illinois. It makes many needed improvements, 
including dental coverage and providing mental health parity. I am 
particularly pleased that it gives States the discretion to cover more 
women and children by lifting the 5-year ban for legal immigrants.
  I am also pleased that after many thwarted efforts, we finally have a 
President that will sign this bill into law. It represents a renewed 
commitment to health care. This is the first step in making sure that 
every child, woman, and man in the United States has health care that 
is affordable, accessible, and high quality.
  Mr. BARTON of Texas. I yield 2 minutes to the gentleman from Georgia 
(Mr. Deal).
  Mr. DEAL of Georgia. I thank the gentleman for yielding.
  Let me clear up a couple of things. First of all, the majority leader 
has said that this is an effort to provide universal coverage for 
citizens of this country to health care. It obviously is a major step 
in that direction of government control of health care.
  The problem though is it may also include expanding and extending 
health care to citizens of other countries. In 2005, the Inspector 
General of HHS told us that some 46 States and the District of Columbia 
were using self-attestation of citizenship to enroll people in their 
Medicaid programs. Part of the reason was when they had asked for 
identification, they were accused of profiling or threatened with civil 
rights lawsuits. So most States backed off and said, Well, if you tell 
us you're a citizen, we'll take your word for it.
  In the Deficit Reduction Act, we changed that. And we require that 
you now prove you're a citizen and prove who you are. This bill changes 
that. And we go back.
  For those of us who think, Well, just tell us a name and a Social 
Security number--that means that if you believe that there are not 
people who are out there with fraudulent Social Security numbers, then 
I have some stories back home I'd like to tell you.
  We take a huge step backwards--and it's not just in the SCHIP 
program. It applies to the Medicaid program as well. Now, that means 
then at a time when we are hearing people saying that we want you to 
secure our borders, we want you to protect us, we are saying we are 
going to open it up to anybody who just wants to tell you they are a 
citizen and, by the way, even if they tell you wrong, this bill has no 
sanctions for them telling you they are a citizen, when they are not, 
and this bill requires you to provide them with medical care during the 
time period when they have defrauded.
  At a time when citizens are concerned about the economy of this 
country, we should not be taking a step in the direction of loosening 
up and encouraging fraud and abuse of this program.
  Mr. WAXMAN. Madam Speaker, I yield 1 minute to the gentlelady from 
California (Ms. Eshoo).
  Ms. ESHOO. Madam Speaker, I think today is really a great day in 
America because the legislation that is before us is one of the most 
important bills that we will pass in the 111th Congress, the Children's 
Health Insurance Program Reauthorization Act, or SCHIP.
  As we know, the same legislation was vetoed not once, but twice by 
President Bush, forcing the Congress to pass short-term extensions and 
no improvements to the program. But, today, a promise is being kept to 
America's children. They will be insured with health insurance. And the 
total will be 11 million. We are adding 4 million children to be 
covered. I think that that is a victory.
  The legislation invests more than $32 billion over 5 years, and it is 
fully paid for. So it is good fiscal policy, it is good health policy, 
and is good social policy.
  Forty years ago today, I gave birth to my daughter, Karen. Today, 
more children are being born, and the little ones can look forward to 
what the Congress is providing. Bravo, bravo, bravo.
  Mr. BARTON of Texas. May I inquire on the time remaining?
  The SPEAKER pro tempore. The gentleman has 45 seconds remaining.
  Mr. BARTON of Texas. How about my friends on the majority?
  The SPEAKER pro tempore. There are 6\1/2\ minutes remaining for the 
gentleman from California.
  Mr. BARTON of Texas. I reserve the balance of my time.
  Mr. WAXMAN. Madam Speaker, I yield 1 minute to the Speaker of the 
House, without whom we would not have this legislation before us today, 
who has been tireless in pushing forward the agenda to make sure that 
no child in this country goes without health insurance, the gentlewoman 
from California (Ms. Pelosi).
  Ms. PELOSI. This is a very happy day for me, for the Congress, and 
for the country, for all of America's children. I thank my colleagues 
for their extraordinary leadership in working on this very, very 
important legislation, which is strongly bipartisan, very carefully 
crafted, and again, a giant step forward for our children.
  Almost 2 years ago, when we first talked about this legislation--we 
have been talking about it for years. Of course, it has been the law, 
and now we are expanding it. But when we first brought it into the 
previous Congress, on that day, it was late in the afternoon when I 
came to the floor, and while the sun was setting in the sky--
coincidentally, I came at a time when

[[Page H965]]

it was, in poetry, described as the ``children's hour.''
  I quoted then Henry Wadsworth Longfellow's poem: Between the dark and 
the daylight, when the night is beginning to lower, comes a pause in 
the day's occupation that is known as the Children's Hour.
  Today, the children's hour has come to pass. With the bipartisan vote 
of this House, and the signature of the new President of the United 
States, we will provide health care to 11 million children in America.
  We owe a great deal of thanks to our chairman, Mr. Waxman, to the 
chairman emeritus, Mr. Dingell, and Chairman Frank Pallone, of the 
Energy and Commerce Committee; Chairman Rangel and Pete Stark of the 
Ways and Means Committee. So many women on the committees have worked 
for this. Congresswomen Schakowsky, Baldwin, DeGette, Eshoo, and many 
others. This has been a product of many women focusing on this 
important issue that involves our children.
  But our success really springs also from the outside mobilization 
that went with this. A compilation of more than 300 organizations--
everyone from AARP to YMCA, March of Dimes, Easter Seals, and every 
organization in between--supported providing quality, affordable health 
care to America's children.
  More than 80 percent of Americans support our bipartisan children's 
health insurance bill because they understand that with 2.6 million 
jobs lost last year, now even more children do not have health 
insurance. For every 1 percent increase in unemployment--for every 1 
percent increase in unemployment--it is estimated as many as 1.5 
million Americans will lose their health care coverage.
  The American people know that preventive care is more cost effective 
than relying on our Nation's emergency rooms. That phrase was used in 
the debate over the past 2 years. Everyone in America has access to 
health care. All they have to do is go to the emergency room. What a 
ridiculous statement. What a disservice to the debate.
  They know also that reducing smoking, which the Campaign for Tobacco-
Free Kids says this legislation will do, means healthier children 
leading longer lives.
  The bipartisan, fully paid for children's health insurance bill 
represents the new direction that Democrats have fought for that now, 
today, we join with our Republican colleagues to bring to the floor. 
This is the beginning of the change that the American people voted for 
in the last election and that we will achieve with President Barack 
Obama. We look forward to this afternoon when the President of the 
United States will sign this legislation.
  I see some of our new Members of Congress on the floor. I see 
Congresswoman Betsy Markey and Congresswoman Dahlkemper on the floor. I 
don't know if others are here. But they have taken a major interest. 
Tom Perriello of Virginia has taken a major interest in this 
legislation too. I commend them because their coming to Congress has 
already, only a few short weeks in the Congress, has already made a 
difference in the lives of the American people.
  It's a very happy day for me because, as you know, each time I have 
been sworn in as Speaker, I have gaveled this House to order in honor 
and on behalf of all of America's children. Right now, we are observing 
a children's hour that signifies that we are a Congress for those 
children.
  I urge all of my colleagues to support our effort to pass this with a 
tremendous, tremendous margin, and then also to celebrate the signing 
of the legislation this afternoon.
  Mr. BARTON of Texas. I continue to reserve the balance of my time 
until they are ready to close. We have one speaker remaining.
  Mr. WAXMAN. I yield 1 minute to a member of the Health Subcommittee 
and the full Energy and Commerce Committee who played a role in this 
legislation, the gentlelady from Wisconsin (Ms. Baldwin).
  Ms. BALDWIN. Thank you, Mr. Chairman.
  I rise in strong support today of the Senate amendment to H.R. 2, the 
Children's Health Insurance Program Reauthorization Act. Achieving 
health care for all in this country is the reason why I got into 
politics. It is my goal, it is my passion, it is my motivation. And, 
for the first time during my tenure in Congress, I see real promise 
that the Obama administration and this Congress will work together to 
achieve that goal.
  SCHIP takes an important first step in moving towards achieving this 
goal. I am proud to support this particular bill because it contains 
some key provisions. It provides increased Federal funding for States 
like my own State of Wisconsin that have proven successful in reducing 
the number of uninsured children. It also provides funding for outreach 
activities to find the children that are hardest to reach--the most in 
need of health care.
  Madam Speaker, this legislation will give 4.1 million uninsured 
children meaningful access to health care. And now we must move forward 
to cover the millions more who suffer every day due to lack of health 
insurance. Today, we must enact SCHIP legislation. Tomorrow, we must 
move forward to bring health care coverage to every American.
  Mr. WAXMAN. Madam Speaker, I yield 1 minute to the vice chairman of 
the Energy and Commerce Committee and a longtime member of the Health 
Subcommittee, the gentlelady from Colorado (Ms. DeGette).
  Ms. DeGETTE. We will pass this bill today. And we will pass this bill 
for millions of women, like Susan Molina, who are trying to work and 
support their children and do the right thing for them. Susan is a 
single mother in my district. Her abusive husband left her, and she has 
struggled to work and pay for health insurance for her two children as 
she worked tirelessly to move from a janitor to an apartment manager 
position.
  In 2006, Susan's two children lost their health insurance under SCHIP 
because her new job paid just slightly more than 200 percent of poverty 
level. Susan has tried to work her way up to be a responsible member of 
society. Eventually, she got her children in SCHIP, and they have 
health care, and she could work. But then after she lost her SCHIP 
coverage, as she testified to Congress, to our committee, she felt like 
a failure as a mom.

                              {time}  1200

  She was working, she was in school trying to get her GED, but she 
still had to take her kids to the emergency room when they got an ear 
infection. Frankly, Madam Speaker, it is about time that the most 
civilized country in the world give health care coverage to all of its 
children.
  Mr. WAXMAN. Madam Speaker, I am pleased to yield to the gentleman 
from Washington State, a member of the Energy and Commerce Committee, 
Mr. Inslee, for 1 minute.
  (Mr. INSLEE asked and was given permission to revise and extend his 
remarks.)
  Mr. INSLEE. Madam Speaker, I want to particularly commend this bill, 
because it honors the States that have been visionary and proactive in 
trying to get health insurance for their kids.
  Eleven States have moved forward ahead of the country in providing 
health insurance for their kids up to 300 percent of poverty, and this 
bill finally, due to the great efforts of Mr. Waxman, Mr. Dingell, and 
many others who have been working for years, Mr. Pallone, to fashion a 
provision that will allow the children in those States to in fact enjoy 
health insurance. In my State of Washington, over 5,000 kids are going 
to have health insurance as a result of this; the State will have $94 
million to help those families. This is long overdue.
  And to my friends across the aisle who somehow do not understand that 
parents who become unemployed in the downturn we are now experiencing, 
whether they are at 100 percent of poverty or 200 percent or 300 
percent, I don't know why they don't understand the pain of parents who 
can't provide health insurance for their kids. This does it today. 
Let's pass this bill.
  Mr. WAXMAN. Madam Speaker, I am pleased to yield to the gentleman 
from North Carolina (Mr. Butterfield), a very important and 
distinguished member of the Energy and Commerce Committee, 1 minute.
  Mr. BUTTERFIELD. Madam Speaker, I want to thank the chairman of the 
Ways and Means Committee for yielding this time. This is a very 
important subject in all of our States.

[[Page H966]]

  Madam Speaker, without question, the people of my State in North 
Carolina are hurting very badly. Unemployment figures show that the 
number of counties with double digit unemployment actually doubled to 
34 during the month of December. That is more than one-third of the 
counties in my State now suffering from double digit unemployment.
  When people lose their jobs, they lose access to affordable health 
care, and it is the children, just as the gentleman from Washington 
just said, it is the children who suffer most in these circumstances. 
Today, we have an opportunity to take another step toward ensuring that 
every American child has access to affordable health care regardless of 
family circumstances.
  With the passage of this bill, my State of North Carolina will reduce 
the number of children who lack health insurance by 46 percent. That is 
136,000 children. There will be similar impacts across the country. I 
urge my colleagues to join me in approving this important bill.
  The SPEAKER pro tempore. The gentleman from Texas has 45 seconds 
remaining; the gentleman from California has 1\1/2\ minutes remaining.
  Mr. WAXMAN. Madam Speaker, at this time it is my great honor to yield 
to speak on this legislation to the gentleman from Michigan (Mr. 
Dingell), who has been the author of this bill for child health 
insurance in the last Congress. Unfortunately, the bill was vetoed by 
President Bush. But we all have to recognize his strong commitment and 
leadership on this issue, and so I want to yield to him 1 minute to be 
able to speak in favor of the legislation.
  (Mr. DINGELL asked and was given permission to revise and extend his 
remarks.)
  Mr. DINGELL. I thank my friend, the chairman of the committee. I rise 
to voice my support for the extension of the Children's Health 
Insurance Program. As a long-time supporter of the program, I am 
delighted that we are sending a bill to the President that will be 
signed into law. This time there will be no veto pen to stand in the 
way of providing health coverage for 11 million of our kids.
  High health care costs are straining already strapped families 
nationwide. Nowhere is this truer than in my home State of Michigan, 
where unemployment now tops 10 percent. With families struggling to 
save for retirement, to save for college, to pay mortgages and bills, 
this legislation will help State governments provide health care to 
children who otherwise would be left out.
  Recently, there has been much talk about investments, good and bad. 
The bad kind has pushed our financial system into the brink of 
insolvency and has caused economic crisis on a scale unseen since the 
depression. But good investments, such as SCHIP, invest in our children 
and our future.
  This expansion is a bipartisan effort, a collaboration of my 
colleagues on both sides of the aisle. Of this, I am properly grateful, 
and I urge my colleagues to vote for this legislation. It will be 
signed into law, and I look forward to working with the administration 
on a program of national health reform.
  As someone who has spent 50 years on this effort, I know that this is 
just the beginning of what needs to be done.
  The SPEAKER pro tempore. The gentleman from Texas has 45 seconds 
remaining.
  Mr. BARTON of Texas. I am going to yield my last potent 45 seconds to 
a distinguished member of the committee, Marsha Blackburn of Tennessee, 
to close.
  Mrs. BLACKBURN. Madam Speaker, I think that, I would hope, that not 
only my colleagues but the American people realize that this bill today 
contains a $72 billion tax increase on the American people, what 
Congressional Research Service calls the most regressive of taxes, 
because it is tobacco taxes. But this is a tax increase that is coming 
full steam ahead at us. And, Madam Speaker, it is not there to go into 
a program that we all originally supported the way SCHIP was originally 
set up. This expanded SCHIP goes to middle-income children; it does not 
focus on low income and uninsured children. That is a sad day for us. 
Indeed, part of the 900,000 children that are expected to be added 
already have access to health insurance.
  I would encourage all of my colleagues to vote against the tax 
increase and vote ``no.''
  Mr. WAXMAN. Madam Speaker, I wish to yield the balance of our time to 
the gentlelady from Colorado (Ms. Markey).
  (Ms. MARKEY of Colorado asked and was given permission to revise and 
extend her remarks.)
  Ms. MARKEY of Colorado. As working class families struggle to make 
ends meet in these tough economic times, we have the opportunity to 
ease their burden by providing health care for 11 million children. 
Currently, more than 1 out of 8 children in Colorado lacks health 
insurance because they can't afford it. As the mother of three, I 
understand the burden of caring for sick children and the relief of 
being able to take my children to the doctor without worrying about 
costs.
  We need to expand access to children's health care, and make sure 
that every child has the ability to go to the doctor and receive 
treatment. This is not just the right thing to do; it makes fiscal 
sense to give children preventive health care.
  As working class families struggle to make ends meet in these tough 
economic times, we have the opportunity to ease their burden by 
providing health care for 11 million children. In my state of Colorado, 
we had 84,649 children enrolled in SCHIP in 2007. This legislation 
would preserve coverage for them, and extend it to thousands more 
children in the state. (Currently, more than one out of every eight 
children in Colorado lacks health insurance.)
  As a mother of three, I understand the burden of caring for sick 
children and the relief of being able to take my children to the doctor 
without worrying about costs.
  We need to expand access to children's health care and make sure that 
every child has the ability to go to the doctor and receive treatment. 
Today's children are the next generation of leaders, and we need to 
insure our future. This is not only the right thing to do, it makes 
fiscal sense to give children preventive healthcare. I ask all of my 
colleagues on both sides of the aisle to pledge their support for our 
children and vote for this bill.
  The SPEAKER pro tempore. The gentleman from New York (Mr. Rangel) is 
recognized.
  Mr. RANGEL. Madam Speaker, what a great opportunity for us in this 
august body, whether we are Republican or Democrat, to think in terms 
of the comfort that we are giving parents and grandparents by having 
assurances that, if anything happened to these very special people, 
that they would have health insurance.
  There is hardly a weekend that goes by that I don't thank God for my 
three grandchildren, and not have to worry that if anything, God 
forbid, should happen to them, that at least we would know they have 
access to health care. It reminded me when I was a young father and how 
precious my son and daughter would be. And then you think, of course, 
of the so many millions of people that go to work every day not being 
able to concentrate on their jobs and being productive and competitive, 
but thinking what would happen if their child became ill.
  And it is not just the compassionate and right thing to do, to know 
that all of us would be able to go to sleep at night and to know that 
we made our contribution to provide health care to 11 million kids, but 
even from a national security or fiscal point of view, as doctors and 
researchers indicate, the great burden of fiscal costs for diseases and 
ailments that could have been detected if the children had access to 
health care. So many kids drop out of school with people not even 
knowing that they couldn't hear, that they couldn't understand 
properly, that they couldn't see minor things that could have been 
detected if the child had the availability of health care. And, of 
course, in the long run I don't think any on the other side and 
certainly none of ours can challenge the fact that it is in the later 
years of life things that could have been prevented that increase the 
need for health care and of course increase the costs for health care. 
In other words, we can dramatically improve the quality of care and cut 
down the ever increasing costs of care by preventing these things from 
happening.
  I sat here trying to listen to some argument about why anyone would 
be against this bill. Sure, no one likes taxes. I am opposed to excise 
taxes. But, my God, cigarettes? You almost

[[Page H967]]

feel like you are doing the right thing by making it difficult for kids 
and others to smoke cigarettes. Indeed, from a Ways and Means point of 
view, it is a question of whether or not the bill could be adequately 
funded because last year we collected more taxes because there was more 
consumption. So something is really working in terms of curtailing of 
people from destroying the quality of their own lives.
  And so I do hope that we continue to have this as a bipartisan bill, 
that we can walk out at least and go home and say that we worked 
together on one initiative that was good for our children, good for our 
community, and good for our country.
  I now ask unanimous consent to yield the balance of my time to the 
chairman of our Health Subcommittee, and to have Dr. McDermott 
determine which Members he would like to yield to.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New York?
  There was no objection.
  Mr. McDERMOTT. I reserve the balance of my time.
  Mr. LINDER. Madam Speaker, I yield myself such time as I may consume.
  The State Children's Health Insurance Program, which started in 1997, 
was for children, for children who lived in families who did not 
qualify for Medicaid but still needed health insurance programs. Today, 
four States have more adults in the program than children. It is being 
abused.
  The health insurance program for children also required, originally, 
those in this country to show that they lived in this country legally, 
to have documentation. This program removes that proof. You now need 
only to say, ``Yes, I am here legally.'' It also removes the 5-year 
requirement. When you are here legally and you are sponsored by 
someone, they have to be responsible for taking care of your needs for 
5 years. This is removed. What will happen if we follow on with an 
amnesty bill for the 20 million illegals who would be immediately 
eligible for the SCHIP program? Would it then be fully funded?
  The funding, by the way, mostly by tobacco, falls on low-income 
people. The burden on the lowest 20 percent with the tobacco program is 
37 times more burdensome than were it funded by an income tax. It also 
requires 22 million new smokers just to pay the bill. I want to see the 
majority go recruit them.
  It is estimated that 2.4 million people will drop private insurance; 
families will drop because they qualify. Employers paying employees 
less than $80,000 a year will drop it. This isn't mean-spirited; it is 
in their interest. We saw this happen before.
  In 1965, every physician and dentist in America had a file drawer 
full of patients that they treated for free. It was their community 
responsibility. When Medicare and Medicaid came along, they said, 
``Well, my taxes are going up to pay for that. The government will now 
do it.'' And they dropped that responsibility, and the burden fell on 
the taxpayer.
  With the upper limit disregards in this program on income ceilings, 
we essentially make 75 percent of all Americans eligible for the 
program. Again, I repeat. I have heard it said many times it is fully 
funded. And Lyndon Johnson said that about Medicare and Medicaid. I was 
in dental school and watched his great society speech. He said, ``We 
know, using easily quantifiable user statistics that, by 1990, Medicare 
will only cost $9 billion and Medicaid will only cost $1 billion.'' He 
was wrong. Medicare costs over $100 billion; Medicaid costs over $75 
billion, and those entitlements are breaking this country.

                              {time}  1215

  The same is going to happen when the ceilings are taken off incomes 
and other people are put into this program. It will not be fully funded 
by tobacco.
  This program will pay less than one-half the reimbursement to 
providers through Medicare or SCHIP that currently Blue Cross pays. And 
those providers are going to disappear from the program. We are already 
seeing it in Medicare and Medicaid. Who is going to be left to treat 
these people?
  There was a real bipartisan effort to reauthorize this program last 
year, to expand its income protections and to increase the money to pay 
for it. It wasn't enough for the majority. They wanted to make it for 
everybody all of the time. This will not work.
  I will vote against it.
  I reserve the balance of my time.
  Mr. McDERMOTT. Madam Speaker, I yield 1 minute to the gentleman from 
North Dakota (Mr. Pomeroy).
  Mr. POMEROY. I thank the gentleman for yielding.
  A great country holds the interests of its children first and 
foremost. A great country responds to tough times and steep challenges 
by placing the interests of its children at the head of the line when 
it comes to advancing measures to help. Today we have a chance to 
reflect this dimension of America's greatness by passing this bill to 
extend vital health insurance to 11 million of our kids. We must take 
this action.
  Like last year, we will have bipartisan support when it comes to 
moving this bill forward. But unlike last year, this time our efforts 
will receive a different reception at the White House. Our prior 
President vetoed this bill. But we now have a new President. And this 
bill will be received with a resounding ``yes.'' And the effort to get 
coverage to our children will at last succeed.
  Mr. LINDER. Madam Speaker, at this time I yield 3 minutes to my 
friend from Texas (Mr. Culberson).
  Mr. CULBERSON. I thank the gentleman from Georgia.
  Each one of us as representatives of our districts have a fiduciary 
duty, the highest obligation of the law, to protect the Treasury of the 
United States to ensure that our children and grandchildren are not 
inheriting an unaffordable debt burden. Today the national debt exceeds 
$10 trillion. Today the national deficit, for the first time in 
history, exceeds $1 trillion. It is approaching $1.5 trillion. Today 
the unfunded liabilities of the United States exceed $60 trillion.
  And in that set of circumstances, it is essential that this Congress, 
on every bill, on every issue, on every vote and in every debate think 
first and foremost about that debt burden that we are passing on to our 
children and analyze every bill before us from that perspective. Is it 
physically responsible? Is it financially prudent to pass the 
legislation before us?
  Obviously the Federal Government has a longstanding existing 
obligation to provide health insurance for the very poorest of our 
citizens. But the key is, we fiscal conservatives want to see poor 
American children provided health insurance first and foremost. We 
fiscal conservatives want to limit the provision of health insurance 
coverage to those poor American children in circumstances where they 
can show that they are truly citizens, they are here legally--in our 
current law, they have to wait 5 years--and that they are truly poor.
  Yet with the legislation this unleashed liberal leadership of the new 
Congress has put before us, you are hiding behind campaign slogans. 
Step back and let's forget the next election. Think about the next 
generation. Let's legislate for the next generation, not the next 
election. And when you look at the next generation, the legislation 
that this unleashed liberal leadership of Congress asked us to support 
would allow Arnold Schwarzenegger in California to implement his plan 
of providing health insurance, quoting from the Washington Post, 
Schwarzenegger's health insurance plan would require everyone living in 
California, even illegal immigrants, to have health insurance at an 
estimated cost of $12 billion. You're changing existing law which 
requires the applicant to confirm, to verify and to prove that I am a 
citizen of the United States, you're repealing the requirement that if 
you are here legally you wait 5 years to apply for public assistance. 
You're repealing the requirement that if you come here legally that 
you're not going to become a burden on American taxpayers. Today it is 
required that you have a sponsor. If you come into the United States 
legally, I have got to have a sponsor who will sign an oath confirming 
that I as the sponsor will make sure this person I am sponsoring does 
not become a burden on American taxpayers.
  The SPEAKER pro tempore. The time of the gentleman from Texas has 
expired.

[[Page H968]]

  Mr. LINDER. I yield the gentleman 1 additional minute.
  Mr. CULBERSON. Under current law, if I enter the United States 
legally, I must have a sponsor who signs an oath ``I confirm and I will 
pay for this new, this person entering the United States legally. I 
will make sure they don't become a burden on taxpayers.'' That 
requirement is repealed. When you look at the cost of this legislation 
to future generations, it's a staggering bill to pass on to our kids. 
It's an unaffordable burden to add to our children, grandchildren and 
great-grandchildren's obligation. For the sake of a sound-bite, for the 
sake of a cheap election slogan, you're passing on an unaffordable 
burden to our kids when we as fiduciaries, as trustees of the public 
Treasury, of the public dollar at a time of all these bailouts, the 
repeated bailouts of Wall Street, of rewarding bad behavior, something 
that the fiscal conservatives in the Congress have fought, you're now 
adding to the problem by repealing the citizenship verification 
requirement. You're repealing the 5-year waiting period. You're 
allowing States to provide health care coverage to people up to 400 
percent of poverty. It's unaffordable. It's unacceptable. It's a 
dangerous trend. And I hope all of us vote against it.


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore. Members are reminded to address their 
remarks to the Chair.
  Mr. McDERMOTT. Madam Speaker, I yield 1 minute to the gentleman from 
California (Mr. Thompson).
  Mr. THOMPSON of California. Madam Speaker, investing in children's 
health care is one of the best investments our country can make. When 
kids see the doctor more regularly, they receive the preventive 
services that keep them healthier for longer. And they're less likely 
to end up in the emergency room, which saves everyone money.
  The State Children's Health Insurance Program has been an 
extraordinary success. Over 1.5 million children in my home State of 
California get their health care through this program. However, today, 
we still have 1.25 million uninsured kids in California. That is 
unacceptable in the United States of America.
  This bill will begin to address that tragedy by providing health care 
for almost 700,000 additional children in California alone. As a down 
payment toward health care reform, this legislation will reduce the 
percentage of uninsured children, just in California, by 55 percent. 
Our children deserve a healthy start. And this legislation ensures that 
4 million more children across the country will get just that.
  I ask for your ``aye'' vote.
  Mr. LINDER. Madam Speaker, I yield 4 minutes to my friend from Iowa 
(Mr. King).
  Mr. KING of Iowa. Madam Speaker, I thank the gentleman from Georgia 
for yielding time, and I appreciate the privilege to address this issue 
of SCHIP. This has been a significant frustration to me to grow up in a 
society where we have respect for the rule of law and fiscal 
responsibility, or we identify the pillars of American exceptionalism 
and our charter is to go out and refurbish them. And what we have 
instead is a bill before us that apparently is a bill that is endorsed 
by the White House, Madam Speaker, that doesn't reflect these values at 
all.
  And I start down through the issue that is my charge here more than 
any other in this Congress, and that is what this SCHIP does to 
undermine the integrity of the restraint that is shutting off, keeping 
the magnet shut off that attracts illegals into the United States. And 
it's clear. It's not a number that comes from my side. And it's not a 
number that comes from an activist group. These are numbers that come 
from the Congressional Budget Office. The requirement to verify the 
citizenship of Medicaid applicants by using a verified Social Security 
number has been taken out of this bill. And that amounts to a cost, 
according to the CBO, of $5.1 billion federally. It will bring an extra 
cost on to the States, according to CBO, of $3.85 billion. So just that 
component, lowering the standard to open the door for anybody that 
wants to walk in the door and say, well, here is a Social Security 
number for you, and they will sit there and say, well, we have a 
government program for you, even though your residence might well be in 
another state and you may have come across the border illegally, that 
number of illegals applying for and qualifying under this open rule 
comes to $8.95 billion between the State and the Federal portion of 
this.
  And then another egregious affront to the standards that we have had 
since the beginning of immigration law in America was, when you come 
here, you're to be self-sustained. And Ellis Island, where they 
processed my grandmother, they sent about 2 percent back because either 
they weren't physically able to sustain themselves or they didn't have 
a sponsor. And we had passed a law back in several previous Congresses 
that sets the 5-year bar where you will have a sponsor and they will be 
accountable that you will not go on the government dole for 5 years if 
you are a lawful permanent resident here in the United States. That is 
gone. That is gone if this bill passes. That is $6.5 billion, Madam 
Speaker. So those two pieces of this altogether are $15.45 billion in 
costs that either increase the magnet for legal immigration to come on 
welfare, open the door and says on the first day you come here, you 
will qualify for welfare legally. If you come here illegally, you can 
do the same thing for Medicaid by simply attesting to a Social Security 
number. It is no longer required to sign a form even that the 
information is right. That has been waived as well.
  If you add these costs all up, there is another huge cost to this, 
and that is this tax increase. Now, I remember, and I will go verbatim 
through the quote that came from then-candidate and now our President 
``No matter what John McCain may claim, here are the facts. If you make 
under $250,000 a year, you will not see your taxes increase by a single 
dime, not your income taxes, not your payroll taxes, not your capital 
gains taxes, no taxes, because the last thing we should do in this 
economy is raise taxes on the middle class. And we have been saying 
that throughout this campaign.''
  Now here is this policy that may well land on the President's desk. 
That is his quote. This is a tax increase on the middle class. It's a 
tax increase. Ninety-nine percent of this tax increase of the $72 
billion that comes goes on the middle class, those people making, by 
his definition, under $250,000 a year, Madam Speaker. So this is a huge 
tax increase on the middle class.
  And the final piece of this bill, and I think it is actually the 
biggest one, is that opening up the door beyond 200 percent of poverty 
and allowing waivers for States to go beyond 400 percent of poverty, in 
fact, Medicaid for millionaires, sets the stage. This is a foundation 
stone for socialized medicine in the United States. And I oppose the 
bill.
  Mr. McDERMOTT. Madam Speaker, I yield 1 minute to the gentlelady from 
Pennsylvania (Mrs. Dahlkemper).
  Mrs. DAHLKEMPER. Madam Speaker, I rise in support of SCHIP 
legislation before us today.
  As I have said before, perhaps the most important reason that I ran 
for Congress was to help ensure that all children in this Nation have 
access to quality health care. A healthy start in life is something 
that all children deserve. And I'm particularly pleased that this bill 
will offer coverage to pregnant women, because I often tell the story 
of how I could not get coverage during one of the most critical times 
in my life, the pregnancy of my second child, when it was deemed a 
preexisting condition by my private insurer.
  This legislation, which will be signed by President Obama later 
today, will expand the SCHIP program to cover an additional 4 million 
children. This is an accomplishment that our Nation can be proud of.
  I urge my colleagues' support of this legislation.
  Mr. LINDER. Madam Speaker, I yield 1 minute to the gentleman from 
Texas (Mr. Culberson).
  Mr. CULBERSON. I thank the gentleman from Georgia.
  To summarize very quickly, 4 minutes goes so quickly, Madam Speaker, 
I want to make sure that every opportunity I have to speak on this 
floor and that we as fiscal conservatives remind the American people 
that this new liberal leadership in Congress has been spending money at 
the rate of $100 million per minute. Let me let that sink in, $100 
million per minute. We've only

[[Page H969]]

been here the first 17 days of this Congress, and this new leadership 
managed to spend about $1.3 trillion more than the entire annual budget 
of the United States. And our primary concern about this legislation is 
that we want to see health insurance for poor American kids first. And 
the bill you have dropped in front of us is going to open the door for 
fraud, for illegal aliens to apply, and for people who are here legally 
to walk in and get coverage. The minute they enter the United States, 
they become a burden on American taxpayers.

                              {time}  1230

  This legislation is going to allow people up to age 21 who earn 
$80,000 a year to apply for health insurance as if they were poor. It's 
fiscally irresponsible, particularly at a time of record debt and 
record deficit. Let us remember the next generation. Let's legislate 
for the next generation and not the next election.
  Mr. McDERMOTT. Madam Speaker, I yield to the gentleman from 
California (Mr. Becerra) 1\1/2\ minutes.
  Mr. BECERRA. Madam Speaker, 200 years ago America's children would 
perish from illnesses that today are easily preventable. We benefit 
from 21st century medical advances and the best trained doctors and 
providers in the world. Yet 2 years ago, 2 years ago, a young boy at 
the age of 12, not far from this Capitol died after an infection in an 
abscessed tooth, an infection that spread beyond that tooth to his 
brain. Because his family did not have the money to remain on Medicaid 
coverage, and that Medicaid coverage had lapsed, he was unable, his 
family was unable to afford the $80 it would have cost to extract that 
tooth. And so 2 years ago, a young man by the name of Diamonte Driver 
died in America.
  Today we say this is the 21st century and America understands that no 
one should die of a preventable disease or illness. We have 11 million 
children in this country who are still uninsured. Today's legislation 
will make sure that about half of those kids, about 4 million of those 
kids will be insured, along with seven other million who today benefit 
on an ongoing basis from this SCHIP legislation.
  We know what it was like 200 years ago in America and we know now 
what it could be like 2 years ago in America. We know that today we 
must do better for our kids and that is why we pass this legislation 
today.
  Mr. LINDER. Madam Speaker, I reserve the balance of my time.
  Mr. McDERMOTT. Madam Speaker, I yield 1 minute to the gentleman from 
Virginia (Mr. Perriello).
  Mr. PERRIELLO. Madam Speaker, today I rise in support of H.R. 2, the 
State Children's Health Insurance Program Reauthorization Act of 2009.
  At a time of growing unemployment, and when more Americans are losing 
employer-sponsored health care for their children, this bill is needed 
urgently for the 150,000 Virginia children currently insured by the 
program, and the 55,000 more who will be covered.
  This approach makes good public health policy. It's morally the right 
thing to do by our children, and it's good economic policy because it 
rewards the very families and parents who are working their way out of 
poverty. At a time when the cost of health care is crushing America's 
families and America's businesses, this is an important lifeline to 
extend to children in Virginia and children throughout the country.
  While I am in full support of the underlying legislation, I am 
disappointed to learn that the Senate bill includes a disproportionate 
increase in the excise tax rate on tobacco products. The proposed 
tobacco tax could impact jobs and State revenues in already tight 
times.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. McDERMOTT. Madam Speaker, I yield the gentleman an extra 30 
seconds.
  Mr. PERRIELLO. In these very difficult times, we are in this together 
as a matter of public health and as a matter of economic growth.
  As the son of a pediatrician, I am pleased to have the opportunity to 
vote in favor of this critical legislation and in favor of children in 
the Fifth District.
  I urge my colleagues on both sides of the aisle to join me in putting 
America's children first and cast a vote in favor of this important 
bipartisan legislation.
  Mr. LINDER. Madam Speaker, I reserve the balance of the time.
  Mr. McDERMOTT. Madam Speaker, I yield 1 minute to the gentlewoman 
from Texas (Ms. Jackson-Lee).
  (Ms. JACKSON-LEE of Texas asked and was given permission to revise 
and extend her remarks.)
  Ms. JACKSON-LEE of Texas. Let me thank the chairman of the full 
Energy and Commerce Committee, Mr. Waxman. Let me thank the manager, 
Dr. McDermott, and the chairman of the Full Committee on Ways and 
Means.
  This is a miraculous accomplishment. The children of America are 
shouting today. It's important to know that there are 8.9 million 
uninsured children in America. Overall, 11.3 percent of children in the 
United States are uninsured. That is unacceptable, and it is not 
befitting of this great Nation.
  In Texas we have close to 1.5 million children that are uninsured. 
Today we say to them that they are a priority, and that their health 
care and their preventative health care is crucial; that it is not a 
waste of money. When 74 percent of uninsured children eligible for 
CHIP, for Medicaid are not enrolled, this is not a waste of money.
  I am gratified that pregnant women will have access. I am gratified 
that they will also have access for certain adults that meet certain 
criteria; and I am delighted that we still have an opportunity to 
protect certain hospitals owned by physicians that will continue to 
serve children that are uninsured as well.
  This is a great bill. We should vote on it enthusiastically and 
continue to work again to enroll more children for this great medical 
service.
  Madam Speaker, I rise today in strong support for the Senate 
Amendment to H.R. 2--``The Children's Health Insurance Program 
Reauthorization Act''. We stand today, closer to helping 4 million 
children without health insurance. No longer will these children be 
forced to live with fear of getting sick. Today is a great day. Today 
we are able to bring 4 million children in to the fold. Finally, we can 
tell those 4 million children that are begging for help that Yes We 
Can!


                        nationally and in texas

  There are an estimated 8.9 million uninsured children in America. 
Overall, about 11.3 percent of children in the United States are 
uninsured, but the percentage of uninsured children in each state 
varies widely. Based on a 3-year average, there were an estimated 20.9% 
of uninsured children (under 19 years of age) in the State of Texas 
representing 1,454,000 of the State's children.
  According to the Institute of Medicine, uninsured people are less 
likely to use preventive services and receive regular care. They are 
also more likely to delay care resulting in poorer health and outcomes. 
Texas has the highest uninsured rates of all 50 States and the District 
of Columbia (2005-2007). Almost one-quarter (24.4%) of Texans are 
uninsured compared to 15.3% of the general U.S. population.
  Recent studies estimate that for every 1 percent increase in U.S. 
unemployment, 1.1 million Americans lose health insurance and more than 
a million enroll in Medicaid and CHIP. While Texas' 6 percent December 
unemployment rate remains better than the national average of 7.2 
percent, the State rate is up from just 4.2 percent in December 2007. 
Widespread job losses continue, and leading economists predict that 
absent dramatic government action, the national unemployment rate could 
reach 10 percent by 2010. Many states, including Texas, already 
experience much higher Medicaid enrollment than projected due to job 
loss and lower incomes, and will be unable to support the higher demand 
without this relief.


                   how does chip help texas families?

  According to 2004 U.S. Census data, Texas has the highest rate of 
uninsured children in the country with 21.6% of children in Texas 
lacking health insurance coverage.
  Nearly 90% of uninsured children in Texas have at least one working 
parent. The high cost of health insurance means that it is unaffordable 
for many Texas families. According to the Milliman Medical Index, the 
annual cost of health insurance for a family of four is $13,382.
  Although many Texans have employer sponsored health care insurance, 
many cannot get affordable coverage for dependents through an employer.
  National data shows that virtually all the net reduction in SCHIP 
enrollment has been among children in families with incomes below 150% 
FPL. I want to share with you just some of the scary health statistics 
that are affecting children:

[[Page H970]]

  74% of uninsured children eligible for SCHIP or Medicaid but not 
enrolled.
  11% of uninsured children in families not eligible for Medicaid or 
SCHIP with incomes below.
  15% of uninsured children in families with incomes over 300 percent 
of the federal poverty-level who are ineligible for Medicaid and SCHIP.
  90% of uninsured children that come from families where at least one 
parent works.
  50% of two-parent families of uninsured children in which both 
parents work.
  3.4 million uninsured children who are white, non-Hispanic.
  1.6 million uninsured children who are African American.
  3.3 million uninsured children who are Hispanic.
  670,000 uninsured children of other racial and ethnic backgrounds.


                       physician-owned hospitals

  I am very pleased to see that this new version does not include the 
restrictions on physician owned hospitals. Along with many of my 
colleagues, I have been very concerned that we had with the 
prohibition on physician-owned hospitals. Which is why I worked with my 
colleagues to ensure that this language was not included.

  In my district of Houston, Texas the population has grown close to 
4.5 million people and there are only approximately 16,000 beds 
available in the city. Physician-owned hospitals like St. Joseph 
Medical Center in my district provide essential emergency, maternity, 
and psychiatric care for their patients. They delivered over 6,000 
babies in 2008, of which 3,700 were insured by Medicaid. Currently they 
provide $14M in uninsured care in the Houston Market. A Houston 
Institution for 120 years, St. Joseph Medical Center is also a major 
provider of psychiatric beds as it currently operates 102 of the 800 
licensed beds in Houston.
  In 2006, St. Joseph Medical Center, downtown Houston's first and only 
teaching hospital was on the verge of closing its doors. When I learned 
that they were going to shut down this hospital and turn it into high-
end condominiums, I personally worked with the hospital board, 
community leaders, and local government to ensure this did not take 
place.
  Eventually, after I was assured that it would be responsibly managed 
and it's doors would remain open, I was able to help a hospital 
corporation, which, in partnership with physicians, purchased the 
hospital and has made it the premier hospital in the region to keep 
open St. Joseph's doors including its qualified emergency room 
responsive to a heavily populated downtown Houston. This formerly 
troubled medical center is now in the process of reopening Houston 
Heights Hospital, the fourth oldest acute care hospital in Houston.


                      robin from texas--her story

  Her daughter has a developmental disorder, known as autism. She was 
not certain of the extent or the prognosis diagnosis of her disorder 
due to her lack of funds being a single mother, and lack of quality 
health insurance. She is one of the many uninsured in Texas.
  She scraped together money to take her daughter to the doctor when 
she gets sick and does not pay her electricity bill so she can pay for 
30 minutes of private speech therapy a week to complement what the 
school system provides.
  She cannot qualify for SSI or Medicaid, they say she makes just over 
the maximum allowable income. She had trouble qualifying for CHIP in 
the past as well. Sadly once this mother has paid for daycare, speech 
therapy, clothing, car insurance, food, shelter , transportation, the 
rising cost of gasoline etc., she can barely afford to pay her monthly 
bills let alone quality insurance on her salary.
  Robin wants the American dream for her and her daughter, but she is 
unable to obtain it. She is stuck in an old apartment building, with an 
even older car, and inadequate health coverage for her sweet 7 year old 
daughter. God help us, Robin and the many like her and her daughter 
deserve better.


                   the economic affect on healthcare

  The economy has now lost 1.2 million jobs since the beginning of the 
year, with nearly half of those losses occurring in the last three 
months alone, pointing to acceleration in the pace of erosion in labor 
markets. It is more important than ever in this economy that children's 
healthcare is not sacrificed.
  Madam Speaker, my faith is renewed in the process that is so often 
maligned in the media. Thoughtful and deliberate negotiations were 
taken to advance this legislation--and through your leadership we have 
succeeding in bringing this to the floor for passage.
  I look forward to a day when every child is covered and can play on 
football fields and jungle gyms without their parents fearing a 
bankrupting injury to their child. This legislation is piece of mind to 
4 million families and I will joyfully cast my vote for passage of this 
important legislation.
  Mr. LINDER. Madam Speaker, can I inquire as to the time remaining on 
each side?
  The SPEAKER pro tempore. The gentleman from Georgia (Mr. Linder) has 
2 minutes remaining. The gentleman from Washington (Mr. McDermott) has 
4\1/2\ minutes remaining.
  Mr. LINDER. Madam Speaker, I reserve.
  Mr. McDERMOTT. Madam Speaker, I listened to fiscal conservatives rail 
against this bill, and I think about an article I read in this 
morning's Washington Post. Over in Arlington, which is just across the 
river, they have a clinic where people go who don't have health 
insurance and hope that their number is drawn from a lottery so that 
they can get to see a doctor. Our health care system is in serious 
problems, from the seniors all the way down to the young people in this 
country.
  Now, this bill says to the States, here's some additional money for 
you to expand coverage to your youngsters. Through no fault of their 
own, they're born into a home where there is no way to pay for health 
care. And we are giving the States, in this time of economic collapse 
brought on by the fiscal conservatives in this body, who said that we 
could spend and spend and spend, and never have to meet the day of 
reckoning, the people who are now going to suffer from that will be 
women and children.
  Children have nobody to speak for them but us. And for us to put that 
money out there and give them the opportunity to have health care is 
humane in the very strongest sense of that word.
  How anybody could vote against this, I have no idea, after you've 
wasted a trillion dollars on a war in Iraq, and have the real estate 
industry totally out of control, and then you say to the children, you 
can't see a doctor. What kind of body is this if we don't take care of 
children?
  I yield the remaining 3 minutes of my time to Mr. Waxman.
  Mr. WAXMAN. Madam Speaker, we wish to reserve our time to close the 
debate.
  Mr. LINDER. Madam Speaker, I would like to point out that nobody on 
this side opposes children. The SCHIP program was started under the 
Republican majority in 1997, principal sponsor being Republican Senator 
Orrin Hatch.
  We believe the program was a good start in allowing for the health 
coverage of children whose parents did not qualify for Medicaid. What 
will destroy this program is a lack of restraint and irresponsible 
expansion of it.
  It is true we are in the midst of a global economic collapse. And 
what has caused that? Abuse, lack of restraint, corporate leaders 
spending other people's money, shareholders, ignored limitations, 
ignored risks, ignored warning signs, and gave us the problem we have 
in the economy.
  What makes us different? We are spending other people's money and 
we're spending more and more of it. We have a GAO study that says that 
if we continue to spend in our discretionary spending at the current 
percentage of the overall economy, and if we continue to tax at 19 
percent of GDP, which is about the average since 1945, that in just 31 
years from today, the entire Federal revenue stream will be 
insufficient to pay the interest on the debt because of entitlements, 
Social Security, Medicare, which is much worse than Social Security, 
Medicaid.
  And to solve those programs in the face of President Obama's desire 
to get a handle on entitlements, we stand here today proposed to add a 
new one. It is true that this is designed as a block grant program. But 
there are no limitations on it. This will go out of control just like 
all of the other programs have, and our children will pay.
  Madam Speaker, I hope we all oppose this.
  Mr. WAXMAN. Madam Speaker, Members of the House of Representatives, 
this bill is going to pass by an overwhelming bipartisan majority, as 
it passed in the last Congress as well, at least twice. But the 
difference is, this bill will be signed tonight by the President of the 
United States.
  President Bush vetoed this children's health bill twice. And it is 
interesting to review the arguments he gave for rejecting the 
legislation. First of all, he said, there's no problem for children 
getting health care when they need it. They can always go to an 
emergency

[[Page H971]]

room of a hospital. Of course, the care in an emergency room of a 
hospital is the most expensive care, and it often means that the child 
has gotten sicker than otherwise would be the case and is forced to go 
to that emergency room as the only option.
  And the second reason he gave for vetoing the bill is, to me, one of 
the most astounding. He said, why should taxpayers subsidize parents 
for their children's health insurance if the parents could afford to 
buy a private health insurance plan for their own children? Well, many 
parents just can't afford it or will not have that as an opportunity 
because of a pre-existing medical condition. But think of that 
argument.
  Suppose the President of the United States said, we ought not to have 
public schools for children whose parents could afford to send them to 
private schools. I find that a remarkable argument for him to have 
made.
  We, in this country, should value the opportunity for every child to 
succeed to the fullest extent of his or her ability, and that means 
education for all children and health care when those children need it.
  We will see the President of the United States sign this bill tonight 
because election results make a difference. And we will have a 
President who will sign this bill into law, along with a bipartisan 
majority in the House and the Senate. And that will be a happy day for 
America's children.
  Mr. ENGEL. Madam Speaker, today is another great day for American 
families. Later this afternoon, President Obama will sign the State 
Children's Health Insurance program Reauthorization into law.
  Just one week ago, President Obama signed the Lilly Ledbetter Fair 
Pay Act into law--a bill which restores basic protection against pay 
discrimination. When women do better, families do better, and the Lilly 
Ledbetter Act will make it easier for families to pay for day-to-day 
expenses like groceries, child care and doctor's visits.
  We build on the enactment of family security legislation today by 
providing health care coverage for 11 million children. In this 
commonsense legislation, we will preserve coverage for the roughly 7 
million children currently covered by SCHIP and extend coverage to 4.1 
million uninsured children who are currently eligible for, but not 
enrolled in, SCHIP and Medicaid.
  As the third largest S-CHIP program in the nation, New York reduced 
the number of uninsured children in the State by 40%. We are only one 
of seven states to achieve a decline of that magnitude and I am so 
pleased that we will further strengthen children's access to health 
care today.
  During this time of economic distress, we must remember that the S-
CHIP program is a critical part of our health care safety net and more 
broadly our family security safety net. S-CHIP has served New York and 
our country well, and I commend the Speaker for working so diligently 
on behalf of our nation's kids.
  Mr. TOWNS. Madam Speaker, esteemed colleagues on both sides of the 
aisle, I stand before you today, one happy man. I am happy that I have 
the opportunity to vote in favor and hopefully bear witness to the 
passage of this momentous bill, the State Children's Health Insurance 
Program Reauthorization Act.
  Our great leader, Dr. Martin Luther King Jr., once famously remarked, 
``Of all the forms of inequality, injustice in health care is the most 
shocking and inhumane.'' I wholeheartedly agree with Reverend King's 
sentiments and I would like to take his statement one step further. I 
contend neglecting adequate health care for all of our children is 
perhaps the most disgraceful and appalling atrocity this nation faces.
  Today we have an opportunity to take one step towards rectifying the 
wrongs of our past. Today we have the opportunity to vote in favor of a 
bipartisan piece of legislation that would expand health care to more 
than 11 million children nationwide and preserves the coverage of 7.1 
million children through 2013.
  This fine piece of legislation will reduce the number of uninsured 
children in my state by 66%; reducing the number from 400,000 to 
approximately 267,000. I don't know about you, but that's the type of 
change I can believe in.
  The State Children's Health Insurance Program catches the most 
overlooked segment of our population--those families and children that 
earn too much to qualify for Medicaid but too little to afford private 
health insurance. This land-breaking and much needed piece of 
legislation will provide coverage to those families that are eligible 
for but not yet enrolled in SCHIP and Medicaid.
  The legislation is truly bipartisan in nature, and is supported by 
numerous organizations including the American Hospital Association, 
AARP, and families USA.
  My Democratic friends and Republican comrades, I urge you to take a 
stand against health injustices and take a stand for our children. I 
urge you to vote in support of the Children's Health Insurance Health 
Program Reauthorization Act.
  Ms. HIRONO. Madam Speaker, I rise today in strong support of H.R. 2, 
the Children's Health Insurance Program (CHIP) Reauthorization Act. Our 
nation must show true compassion for the most vulnerable among us, and 
CHIP helps millions of low-income children receive healthcare.
  The last time we had a floor debate on H.R. 2, there were references 
made by those in opposition to the bill to a program in my state called 
Keiki Care. It was suggested by those individuals that the Keiki Care 
program was cancelled due to perceived crowd-out, where parents drop 
their children's private insurance in order to enroll into a free 
government program.
  That claim was entirely false, and I join Congressman Abercrombie in 
correcting the misstatements made by the opposition. The Keiki Care 
program did not have an issue with crowd-out. It was intentionally 
designed so that those who wish to enroll in the program must be 
continuously uninsured for six months. There was also no spike in 
program enrollment that even suggests that parents were indeed dropping 
their private insurance to join. I would like to insert into the Record 
a fact sheet on Keiki Care published by the group Hawaii Covering Kids.
  In Hawaiian, ``keiki'' means ``child'' or taken literally ``little 
one.'' H.R. 2 is a bill that provides for the health and well-being of 
the keiki most in need of our help. I urge my colleagues to join me in 
voting in support of H.R. 2 today.

                               Keiki Care


                                  Goal

       All children and youths living in Hawai`i are enrolled in 
     health insurance.


                           Children's Health

       Compelling national health care statistics drive Hawai`i 
     Covering Kids' goal:
       Children who are uninsured are twice as likely not to 
     receive any medical care;
       Only 45% of uninsured children had one or more well-child 
     visits in the past year compared with more than 70% of 
     insured children;
       More than one in three uninsured children do not have a 
     personal physician; and
       Uninsured children are less likely to receive proper 
     medical care for common childhood illnesses such as sore 
     throats, earaches, and asthma.


                         Background Information

       Approximately five percent of Hawai`i's children and youths 
     are uninsured statewide which means over 16,000 kids do not 
     have health insurance. Hawai`i Covering Kids sponsored 
     meetings in October 2006 and January 2007 to determine the 
     ``gap groups'' and possible solutions. We concluded these 
     children and youths are most likely uninsured:
       Eligible for QUEST or Medicaid Fee-for-Service in 
     households between 251-300% FPL but parents cannot afford 
     monthly premium payments;
       In families with incomes above 300% FPL and parents cannot 
     afford private health insurance;
       Have temporary visas (V, H, K, etc.);
       Undocumented immigrants; and
       Student dependents (F2 visa) whose parents cannot afford 
     university health insurance plans.


                            2007 Initiative

       The Hawai`i State Legislature introduced HB1008, now Act 
     236, to help uninsured children and youths in the gap groups. 
     It included paying QUEST and Medicaid Fee-for-Service monthly 
     premiums for children between 251-300% FPL and establishing a 
     free Keiki Care plan for children ages 31 days to 19 years 
     old who are ineligible for public health insurance. The Keiki 
     Care plan is modeled after the low-cost HMSA Children's Plan 
     with limited benefits and some out-of-pocket expenses. It 
     requires the child live in Hawai`i and be continuously 
     uninsured for six months. Exceptions to the six-month 
     uninsured provision include: (1) children who ``income 
     out'' of QUEST or Medicaid Fee-for-Service, (2) children 
     enrolled in a managed care children's plan on the 
     effective date (one-time only exemption), (3) newborns 
     uninsured since birth, and (4) children in families 
     affected by Aloha Airline's bankruptcy.


                                Timeline

       3 May 2007--HB1008 HD2 SD2 CD1 Passed by the Legislature;
       30 June 2007--Signed by the Governor as Act 236;
       1 March 2008--Enrollment Commenced;
       1 April 2008--Keiki Care Effective Date.


                               Enrollment

       1 April 2008--1,827;
       1 November 2008--2,021.


                               Crowd-Out

       Hawai`i has never experienced problems with parents 
     dropping their children's private health insurance to enroll 
     them in public-financed programs. Keiki Care specifically 
     discourages this tactic (called ``crowd-out'') through an 
     eligibility requirement that each child must be uninsured 
     continuously for six months, limited benefit package, and 
     some out-of-pocket expenses. The

[[Page H972]]

     fact enrollment in November 2008 isn't significantly greater 
     than when Keiki Care began illustrates crowd-out prevention 
     is working.


                                Outreach

       Hawai`i Covering Kids has conducted intensive outreach 
     through broadcast emails to state and community partners, 
     mailouts to statewide outreach workers, web site information, 
     211 hotline referrals, and natural points of contact 
     including community health centers, hospitals, public health 
     nurses, Head Start, WIC, and schools.


                            Economic Impact

       The modest investment in Keiki Care pays off in several 
     significant ways. It supports healthier children, confident 
     parents, and reliable payments to health care providers while 
     preserving precious charity care and limited uninsured funds 
     for those who are uninsurable. Keiki Care empowers parents by 
     connecting their children to a pediatrician and regular 
     preventive health care. Should a sudden illness or injury 
     occur, the children are also insured for emergency care which 
     averts personal and institutional financial crises. In fact, 
     as the number of insured kids has increased in Hawai`i, 
     hospital emergency department data for 2000-2006 show that 
     visits by uninsured children and youths have declined from 
     5.25% to 3.79%.
                                  ____


                   Keiki Care Helps Hawai`i's Economy

                          (By Barbara Luksch)

       Imagine your child awakens in the night with an asthma 
     attack and needs health care. The coughing and breathing 
     worsen, however your child has no health insurance. You 
     struggle to pay for food, rent, and other basic living 
     expenses and are fearful of the hospital emergency room 
     because of potentially ruinous medical bills. What do you do?
       This dilemma is familiar for thousands of parents and 
     guardians of uninsured children and youths throughout 
     Hawai`i. As state budgets face monetary shortfalls, taxpayers 
     should know it is cheaper to cover kids with health insurance 
     than cover expensive hospital costs for uninsured kids. That 
     is why federal, state, and community organizations 
     collaborated to create Keiki Care for uninsured children and 
     youths in ``gap groups''--those who do not qualify for public 
     health insurance and their parents cannot provide private 
     health insurance. It should be clarified that specific 
     provisions discourage parents from dropping their children's 
     private health insurance to enroll in Keiki Care: (1) child 
     must be continuously uninsured for six months, (2) limited 
     health care benefits, and (3) out-of-pocket expenses.
       A modest investment in Keiki Care helps Hawai`i's economy 
     because should a sudden illness or injury occur, children are 
     insured for emergency care which averts personal and 
     institutional financial crises. In fact, as the number of 
     insured kids has increased in Hawai`i, hospital emergency 
     department data for 2000-2006 show that visits by uninsured 
     children and youths have declined from 5.25% to 3.79%.
       Keiki Care also empowers parents by connecting their 
     children to a pediatrician and regular preventive health 
     care. Compelling national health care statistics published in 
     a recent Covering Kids & Families ``State of Coverage'' 
     report support this: (1) children who are uninsured are twice 
     as likely not to receive any medical care, (2) only 45% of 
     uninsured children had one or more well-child visits in the 
     past year compared with more than 70% of insured children, 
     (3) more than one in three uninsured children do not have a 
     personal physician, and (4) uninsured children are less 
     likely to receive proper medical care for childhood illnesses 
     such as sore throats, earaches, and asthma.
       Parents with uninsured children often face hard choices . . 
     . pay the electric bill or pay the doctor; fill the 
     refrigerator or fill a prescription. That is why uninsured 
     children often go to school without annual checkups and may 
     not participate in co-curricular activities--not only because 
     their parents fear an injury, but also because they fear the 
     impact medical bills could have on their family budget.
       Overall, Keiki Care supports healthier children, confident 
     parents, and reliable payments to health care providers while 
     allocating precious charity care and limited uninsured funds 
     for others who are uninsurable.

  Mr. HARE. Madam Speaker, I rise once again in strong support of the 
State Children's Health Insurance Program Reauthorization Act (also 
known as SCHIP). I commend the Senate for acting so promptly on the 
measure and the leadership of this House for bringing it to the floor 
for its final vote.
  One of the biggest moral failures of our nation is the fact that we 
allow nine million children to go without health insurance every day in 
the United States. This is unacceptable. Our children are the future of 
this great nation--a future that is compromised every day we let a 
single child go without health care.
  Since its inception, SCHIP has successfully filled the gap between 
those families qualifying for Medicaid and those who can afford private 
health insurance. In these times of economic hardship, SCHIP creates a 
fundamentally important safety net, providing health coverage for seven 
million low-income children; 345,000 children in Illinois.
  The legislation before us today reauthorizes the SCHIP program 
through Fiscal Year 2013, enabling states to maintain their current 
programs and extend them to an additional 4 million children.
  SCHIP is the first critical step to improving health coverage across 
the nation. I urge my colleagues to vote yes on H.R. 2 and finally send 
it to the President's desk.
  Mr. VAN HOLLEN. Madam Speaker, I rise in strong support for the 
Children's Health Insurance Program Reauthorization Act of 2009.
  This bipartisan legislation will improve the very successful State 
Children's Health Insurance Program (CHIP). The message and the 
substance of this bill is clear--we are going to preserve coverage for 
the 7 million children currently enrolled who otherwise have no access 
to health insurance while extending coverage to 4 million children who 
are from working families who earn too much to qualify for Medicaid, 
but do not earn enough to afford the very high costs of private health 
insurance.
  By reauthorizing this important program through 2013, we will 
strengthen CHIP's financing, improve the quality of health care 
children receive, and increase health insurance coverage for low-income 
children. The Congressional Research Service projects that under this 
legislation, Maryland's CHIP allotment will increase by 162 percent. 
The bill is fully paid for by a 62 cent increase in federal excise 
taxes on cigarettes. Increasing the tobacco tax will save millions of 
children from tobacco addiction and save billions in health care costs. 
The 2000 U.S. Surgeon General's report found that increasing the price 
of tobacco products will decrease the prevalence of tobacco use, 
particularly among kids and young adults.
  Just two weeks ago, a new President was sworn into office--President 
Obama. Passing this bill and sending it to his desk now sends a very 
important signal that change has come as a result of the last election. 
President Obama's predecessor twice vetoed this legislation. The new 
President will sign this legislation into law because he understands 
the hardships that American families are struggling under at a time 
when millions of Americans have lost their jobs and lost health 
coverage for their children.
  Madam Speaker, let's look out for America's children by providing 
them the health insurance coverage they deserve. I urge my colleagues 
to vote for this much-needed legislation.
  Mr. HASTINGS of Florida. Madam Speaker, for over a decade the State 
Children's Health Insurance Program (SCHIP) saved millions of America's 
low-income families from suffering the consequences of living without 
healthcare insurance, and exemplified our nation's commitment to equal 
opportunity.
  Former President Bush twice prevented this critically important 
program from benefiting people who fell through the cracks of America's 
flawed healthcare system.
  Thankfully, the new Congress and Administration exercised the power 
and political will to make a different choice. Finally, the American 
people can rest assured that Congress' vote to provide healthcare 
coverage to 11 million low-income children will not be in vain.
  The Senate-amended SCHIP bill authorizes 32.8 billion dollars over 
4\1/2\ years to cover the 7 million children who currently rely on 
SCHIP, and extends coverage to more than 4 million low-income children 
who are currently living without healthcare.
  The bill also offers comprehensive and wide ranging care that 
includes mental, dental, prenatal and maternal health services, 
increases health insurance enrollment, and fights geographical health 
disparities by offering additional support to under-funded states.
  Madam Speaker, the SCHIP program is known by different names around 
the country. But whether it's called Healthy Families, Health Wave, 
Healthy Steps, or Kid Care, SCHIP's mission remains the same--providing 
children from hard working low-income families with the care that they 
need and deserve.
  Thirteen years of SCHIP has shown that this program helps to decrease 
costly emergency room visits and invasive medical procedures. We know 
that extending healthcare insurance helps to combat the social, 
economic, and health disparities that continue to divide our nation and 
hinder our progress. And, we know that healthy children are better 
equipped to compete in school and help America compete in the global 
market. The facts are clear. Missed school days from untreated asthma, 
tooth decay and mental health disorders and other illnesses are also 
missed opportunities for our children to reach their full potential and 
successfully compete.
  However, some House and Senate Republicans were driven by ideological 
affiliation instead of economic prudence and moral obligation and 
attempted to halt the passage of this bill despite the fact that 19 
states enacted budget cuts to SCHIP and Medicaid for 2009.
  The 2008 financial crisis clearly exacerbated our long standing 
healthcare crisis and therefore failing to pass SCHIP would be 
disastrous in these hard economic times.
  Last year, skyrocketing gas and food prices, and the plummeting job 
market made it difficult for low- and middle-income Americans to

[[Page H973]]

finance their everyday needs--including healthcare. In 2008, one 
million additional children enrolled in Medicaid or SCHIP as a result 
of lost employment issued insurance.
  In a country where a large portion of people receive healthcare 
insurance through their employer, it comes as no surprise that when the 
economy and job market plunge, the number of uninsured Americans soars. 
And children frequently pay the highest price.
  This issue hits close to home. My state of Florida was recently 
ranked 45th in the nation in terms of overall health. Like other low 
ranking states, Florida has a large uninsured population and a high 
rate of child poverty. In fact, Florida has the second largest number 
of uninsured children in the country. What's more, a disproportionate 
number of Florida's uninsured and low-income children are black, 
Hispanic and reside in rural areas.
  However, the targeted provisions in the 2009 SCHIP Reauthorization 
bill give us reason to be hopeful. Make no mistake. SCHIP and other 
emergency and supplemental programs cannot repair the problems that are 
intrinsic in America's healthcare system. State, local and federal 
entities must execute a coordinated effort to lessen the burden of 
uninsured people in this country as we embark on the road to long-term 
economic and healthcare development.
  President Obama signing the 2009 SCHIP bill into law is a noble 
beginning to achieving healthcare reform, and sends a strong message to 
our nation's children.
  In 1981, the member of the Select Panel for the Promotion of Child 
Health said, ``Children are one third of our population and all of our 
future''.
  SCHIP is as much of an investment in addressing the issues of today 
as it is to ensure the welfare of our nation's economy and 
competitiveness tomorrow. I am pleased to see that we are giving 
millions of children the basic health benefits they rightly deserve.
  Mr. BACA. Madam Speaker, I rise today in strong support concurring to 
the Senate Amendment to H.R. 2--The Children's Health Insurance Program 
Reauthorization Act.
  In my District, home foreclosures and unemployment are devastating 
many families with no end in sight. A facility in my district, the 
Community Hospital of San Bernardino is being forced to eat the costs 
or turn children away.
  This bill will provide needed health care to our most vulnerable, our 
most in need, America's children. With this bill, the state of 
California alone will be able to cover an additional 694,000 children 
who are currently uninsured.
  SCHIP benefits will be further improved, providing for all children 
enrolled in SCHIP to receive dental coverage. Parents should not have 
to choose between putting food on the table or paying for health 
insurance.
  For too long we've faced partisan debates that only hinder our 
efforts. We now have the ``change'' voters want.
  I urge my colleagues to help these families, do the responsible thing 
and vote for S-CHIP.
  Mr. MEEK of Florida. Madam Speaker, I rise in full support of H.R. 2 
and am proud to cast this vote in favor of it.
  Providing health care coverage for 11 million children has been a top 
priority of mine and the vast majority of both the 110th and 111th 
Congresses.
  And, after several attempts, we are now only minutes away from 
sending this important legislation to a President that we know will 
sign it the moment it lands on his desk.
  This is a great piece of the change promised in November and a win 
for the families of 4.1 million currently uninsured children. In my 
home state of Florida, passage into law of this bill will mean that 
290,000 children will have affordable access to healthcare that they do 
not have right now. That will lessen the number of uninsured children 
in Florida by 36%.
  This bipartisan legislation renews and improves SCHIP, providing 
health care coverage for 11 million children--preserving coverage for 
the roughly 7 million children currently covered by SCHIP and extending 
coverage to 4.1 million uninsured children who are currently eligible 
for, but not enrolled in, SCHIP and Medicaid.
  Covering more eligible children is not only the right thing to do--
it's also much more cost-effective for taxpayers than using the 
emergency room as a primary care provider. In addition, a healthy child 
is better prepared for learning and success.
  I commend the willingness of those who are paying for this 
legislation, particularly the small businesses, local cigar importers, 
who showed a great willingness to do their part to see the SCHIP 
legislation passed despite the sacrifices they will have to make.
  This is a proud day in the House of Representatives. I ask all of my 
colleagues to join me in voting for this important legislation.
  Mr. GENE GREEN of Texas. Madam Speaker, I rise today in support of 
final passage of H.R. 2, the Children's Health Insurance Program 
Reauthorization Act of 2009.
  This bill should have been passed last year, but after working on 
this bill for an entire Congress, I am pleased with the final version 
before us today.
  This bill will extend the SCHIP program for four and a half years and 
provide SCHIP coverage for the 7 million children already enrolled in 
the SCHIP and will insure nearly 4 million additional children.
  The bill also includes a provision that will give 400,000 to 600,000 
legal immigrant children access to health care. These children are 
currently barred from SCHIP coverage because of a five year waiting 
period for Medicaid for legal immigrants.
  This provision, which was originally in H.R. 465, the Immigrant 
Children's Health Improvement Act, will give states the option to cover 
children and pregnant women lawfully residing in the United States.
  Current law requires these legal immigrants to endure a five year 
waiting period before they have access to Medicaid coverage when they 
would otherwise be eligible.
  The waiting period actually costs more than covering these children 
because they often have no health insurance and end up in emergency 
rooms for primary care treatment.
  The SCHIP reauthorization bill also includes language from a bill I 
originally introduced and will give one year of emergency Medicaid 
coverage for children born in the U.S. and their mothers, which is 
crucial in protecting the health and wellness of newborns born in this 
country.
  I hope my colleagues will join me in supporting this legislation and 
reauthorize the SCHIP program to extend coverage to nearly 11 million 
low-income children.
  Mr. SMITH of Texas. Madam Speaker, I oppose this bill for many 
reasons. In my role as the Ranking Member of the Judiciary Committee, 
though, I want to point out a few immigration provisions that undermine 
personal responsibility and burden American taxpayers.
  In 1996, Congress required that legal immigrants wait five years 
after coming to the United States before receiving welfare benefits.
  It's only fair that American taxpayers not foot the medical bills of 
foreign nationals who arrive with a sponsor's pledge not to let them 
become a ``public charge.''
  This bill, H.R. 2, changes current law and allows immigrants to get 
medical benefits at the expense of U.S. taxpayers.
  The five-year waiting period for immigrants to receive government 
benefits is the last line of defense for the U.S. taxpayer. It should 
not be repealed or altered.
  Prior to 1996, the cost of welfare for immigrants had jumped to $8 
billion a year. The number of noncitizens on Supplemental Security 
Income increased more than 600 percent between 1982 and 1995. Both of 
those numbers will be much higher if H.R. 2 is enacted.
  At a time when government spending is out of control, and when 
states, cities and American citizens are struggling to make ends meet, 
the last thing we need is to change good policy and further burden U.S. 
taxpayers.
  This legislation should be opposed.
  Mrs. CAPPS. Madam Speaker, I rise today in support of this bill and 
in support of America's children.
  As someone who spent over 20 years of my life as a school nurse 
dedicated to the betterment of children's healthcare, I can think of 
nothing greater than fulfilling the promise of quality healthcare for 
all deserving children.
  It was with great frustration I watched as President Bush repeatedly 
vetoed our proposals to improve the Children's Health Insurance 
Program.
  And I could not be prouder to know that the bill we pass today will 
be signed into law thanks to the commitment of President Obama to our 
nation's children.
  Signing this bill into law will mean 4 million more children get the 
care they need.
  Four million more children won't have to unnecessarily miss days of 
school because of preventable illness.
  Four million more children's parents won't have to wait in the 
emergency room for their daughters and sons to receive routine care.
  Earlier today I met with a school nurse who relayed to me that a 
child in her school district was injured on the playground and they 
can't find a doctor to perform a necessary MRI because the child is 
uninsured.
  I wish this was an isolated incident and that no other parent had to 
take their son from doctor to doctor and pray that someone will perform 
the procedure for free.
  But it is all too common.
  Passage of this legislation today may not help this one child's 
family in time, but we can be sure that four million more children's 
parents can take comfort that they will not ever face this situation in 
the future.
  I urge my colleagues to vote for this legislation and in favor of our 
children's future.
  Mr. MARKEY. Madam Speaker, I rise today in strong support of the 
Senate-amended version of the Children's Health Insurance Program 
Reauthorization Act (CHIPRA) of 2009.
  I am proud to be an original cosponsor of this important legislation 
to expand the highly

[[Page H974]]

successful State Children's Health Insurance Program (SCHIP). This bill 
will provide health insurance to an additional 4 million low-income 
children on top of the nearly 7 million who already benefit from the 
program. CHIPRA also improves access to dental care and mental health 
services and includes provisions to improve quality of care and utilize 
health information technology for children.
  In my home state, SCHIP enrollment is part of the reason why 
Massachusetts has the lowest rate of uninsured children in the country. 
More than 180,000 Massachusetts children receive health coverage 
through SCHIP, and this reauthorization will allow the state to cover 
about 56,000 more Massachusetts children who currently do not have 
health insurance.
  It is unfortunate that the previous two attempts to reauthorize SCHIP 
were vetoed by President Bush, who chose to side with big corporations 
over children. With the current economic crisis causing significant job 
losses, millions of Americans also are losing their health coverage, 
making today's vote even more urgent.
  While President Bush twice dashed the hopes of millions of low-income 
families in need of health care for their children, the Obama 
administration recognizes the value of ensuring that all low-income 
children get the health care they need.
  Three weeks ago this chamber approved CHIPRA by a larger margin than 
the two votes on SCRIP bills in the 110th Congress. I urge my 
colleagues to once again stand with the hard working families who want 
to provide their children with the health care they need. Vote yes on 
this critical legislation.
  Mr. ETHERIDGE. Madam Speaker, I am a strong supporter of the 
Children's Health Insurance Program, and I rise in support of this 
legislation. With one out of eight children in North Carolina lacking 
health insurance, and with the economic downturn making it even more 
difficult for families to afford health care, this legislation is more 
important than ever.
  At the same time, I feel it is important to say a few words about 
fairness. Time and time again, Congress has singled out tobacco to pay 
for benefits that are spread across this country's economy. North 
Carolina's tobacco farmers grow a legal crop. These hard working farm 
families who work hard to be able to pay their bills and provide a 
better life for their children have suffered greatly from 
transformations in the global economy. Because my district is the 
second largest tobacco producing district in the country, H.R. 2 
disproportionately affects my constituents. It is unfair for North 
Carolina's farm families to pay the entire cost of this bill, which has 
benefits that accrue to the entire country. We must find more equitable 
ways to pay for worthy initiatives like the Children's Health Insurance 
Program, and I urge my colleagues to work together to be fiscally 
responsible without placing the burden on one region of the country or 
one segment of the economy.
  In these difficult economic times, North Carolina will need 
additional help to bear the economic effects of reduced farming and 
manufacturing. According to researchers at North Carolina State 
University, increased taxes and decreased revenues due to the 
provisions in this bill may be more than $1 billion. Other analysis 
shows that North Carolina's citizens pay over four percent of the costs 
of this legislation while receiving only two percent of the benefit. 
This will mean lost jobs in a region that is already one of the top ten 
in the nation in unemployment, and is one of the top five fastest areas 
in unemployment growth. I am hopeful that we can work together to get 
my home State the economic support it needs to weather both the 
national economic downturn and the effects of this bill.
  At the same, it is vital that we expand and extend CHIP to provide 
much-needed health care to our most vulnerable citizens. North Carolina 
has 296,000 uninsured children, the sixth-largest number in the 
country, and nearly half of these children would be able to get 
insurance under the provisions of this bill. Together with the 240,000 
children currently served by NC Health Choice for Children, the new 
enrollees would be able to get the health care they need. Preventative 
care and timely treatment of disease ensures that children are healthy 
and productive, able to fulfill their potential. Access to health care 
also saves money for our health system in the long term, because it is 
more cost-effective to get primary care at a doctor's office than to go 
to the emergency room.
  The bill improves the benefits available under CHIP, including by 
ensuring dental coverage and mental health parity. It improves the 
quality of care, and prioritizes coverage for the lowest-income 
children. Together these provisions will enhance children's lives and 
keep children from suffering from preventable disease.
  As North Carolina's former Superintendent of Public Instruction, I 
have seen first hand that healthy children are better prepared for 
learning and success. My life's work has been to help children make the 
most of their God-given abilities, and CHIP plays a key role in giving 
children the environment they need to grow. Therefore, despite my 
misgivings about the funding mechanism, I will cast my vote in favor of 
H.R. 2.
  Madam Speaker, as we work together to provide health care to 
America's children, we should all remember the family farmers who grow 
tobacco. I ask that we take steps in future legislation to help all of 
those who are negatively impacted by provisions of this bill, 
especially including families in the Second District of North Carolina. 
However, today, for our children's health, I urge my colleagues to join 
me in supporting this bill.
  Mr. REYES. Madam Speaker, I rise in strong support of H.R. 2, the 
State Children's Health Insurance Program (SCHIP) Reauthorization Act 
of 2009, as amended by the Senate.
  At this time, the reauthorization of SCHIP is critically important 
for the nation and particularly my district of El Paso, Texas, where 
over 20,000 children in El Paso County are enrolled in the program. My 
district has one of the highest rates of uninsured children in the 
country, and the current economic recession is making it even harder 
for many more families to afford health insurance.
  I am deeply troubled that Texas has the highest number of uninsured 
children in the United States. It is simply unacceptable to have one in 
five children in my state without health insurance, and this 
legislation will expand coverage for millions who are uninsured.
  The current economic recession is affecting many families across our 
nation. Recent studies estimate that for every one percent increase in 
our national unemployment rate, 1.1 million Americans lose health 
insurance and more than a million enroll in Medicaid and SCHIP.
  Having a large number of uninsured children in our communities places 
a tremendous financial burden on parents and local hospitals, as 
families are forced to send their children to the emergency room 
because they cannot afford a regular doctor's visit. For the families 
of the children in El Paso and throughout our country who rely on SCHIP 
for scheduled checkups, prescriptions, eyeglasses, this program is 
vitally important. The cost of health care is ever-rising, and 
reauthorizing SCHIP for the next four and a half years is an important 
first step in stemming the rising tide of the uninsured.
  Today's bill provides sufficient federal funds to help states 
maintain their current programs and extend coverage to four million 
additional uninsured low-income children. Many states may experience 
much higher enrollment in SCHIP than projected due to job loss and 
lower incomes, and many would be unable to support the higher demand 
without this relief. By reauthorizing this program, we help states meet 
increased demand for SCHIP-enrollment and prevent them from cutting 
back on the program just when families need it the most.
  The health and quality of life of our children must be a priority, 
and I firmly believe that this bill addresses the need to provide 
quality health care to our Nation's uninsured children especially in a 
time of economic recession. For this reason, I am proud to support this 
legislation, and I applaud President Obama and my colleagues in 
Congress for this a top priority.
  Mr. ABERCROMBIE. Madam Speaker, it is my understanding that Section 
214 of the Children's Health Insurance Program Reauthorization Act of 
2009, H.R. 2, would apply to the citizens of the Republic of Palau, the 
Republic of the Marshall Islands, and the Federated States of 
Micronesia.
  According to the Compact of Free Association negotiated and agreed to 
by the United States, the citizens of these countries are here legally. 
However, the federal government currently does not provide any 
financial assistance to states to pay for the care of these individuals 
through such programs as Medicaid or SCHIP. Since Section 214 of this 
bill applies to those legally residing in the United States, I believe 
this clearly includes the citizens of the Republic of Palau, the 
Republic of the Marshall Islands, and the Federated States of 
Micronesia. Therefore, Madam Speaker, as this bill moves forward, it is 
my hope that compact migrants will be treated fairly under this new 
law.
  The SPEAKER pro tempore. All time for debate has expired.
  Pursuant to House Resolution 107, the previous question is ordered.
  The question is on the motion by the gentleman from California (Mr. 
Waxman).
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. LINDER. Madam Speaker, I object to the vote on the ground that a 
quorum is not present and make the point of order that a quorum is not 
present.
  The SPEAKER pro tempore. Evidently a quorum is not present.

[[Page H975]]

  The Sergeant at Arms will notify absent Members.
  The vote was taken by electronic device, and there were--yeas 290, 
nays 135, not voting 8, as follows:

                             [Roll No. 50]

                               YEAS--290

     Abercrombie
     Ackerman
     Adler (NJ)
     Altmire
     Andrews
     Arcuri
     Austria
     Baca
     Baird
     Baldwin
     Barrow
     Becerra
     Berkley
     Berman
     Berry
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Boccieri
     Bono Mack
     Boren
     Boswell
     Boucher
     Boyd
     Brady (PA)
     Braley (IA)
     Brown, Corrine
     Buchanan
     Butterfield
     Cao
     Capito
     Capps
     Capuano
     Cardoza
     Carnahan
     Carney
     Carson (IN)
     Castle
     Castor (FL)
     Chandler
     Childers
     Clarke
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly (VA)
     Conyers
     Cooper
     Costa
     Costello
     Courtney
     Crowley
     Cuellar
     Cummings
     Dahlkemper
     Davis (AL)
     Davis (CA)
     Davis (IL)
     Davis (TN)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Dent
     Diaz-Balart, L.
     Diaz-Balart, M.
     Dicks
     Dingell
     Doggett
     Donnelly (IN)
     Doyle
     Driehaus
     Edwards (MD)
     Edwards (TX)
     Ehlers
     Ellison
     Ellsworth
     Emerson
     Engel
     Eshoo
     Etheridge
     Farr
     Fattah
     Filner
     Foster
     Frank (MA)
     Frelinghuysen
     Fudge
     Gerlach
     Giffords
     Gonzalez
     Gordon (TN)
     Grayson
     Green, Al
     Green, Gene
     Griffith
     Grijalva
     Gutierrez
     Hall (NY)
     Halvorson
     Hare
     Harman
     Hastings (FL)
     Heinrich
     Herseth Sandlin
     Higgins
     Hill
     Himes
     Hinchey
     Hinojosa
     Hirono
     Hodes
     Holden
     Holt
     Honda
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson-Lee (TX)
     Johnson (GA)
     Johnson, E. B.
     Kagen
     Kanjorski
     Kaptur
     Kennedy
     Kildee
     Kilpatrick (MI)
     Kilroy
     Kind
     King (NY)
     Kirk
     Kirkpatrick (AZ)
     Klein (FL)
     Kosmas
     Kratovil
     Kucinich
     Lance
     Langevin
     Larsen (WA)
     Larson (CT)
     LaTourette
     Lee (CA)
     Lee (NY)
     Levin
     Lewis (GA)
     Lipinski
     LoBiondo
     Loebsack
     Lofgren, Zoe
     Lowey
     Lujan
     Lynch
     Maffei
     Maloney
     Markey (CO)
     Markey (MA)
     Massa
     Matheson
     Matsui
     McCarthy (NY)
     McCollum
     McCotter
     McDermott
     McGovern
     McHugh
     McIntyre
     McMahon
     McNerney
     Meek (FL)
     Meeks (NY)
     Melancon
     Michaud
     Miller (MI)
     Miller (NC)
     Miller, George
     Minnick
     Mitchell
     Mollohan
     Moore (KS)
     Moore (WI)
     Moran (KS)
     Moran (VA)
     Murphy (CT)
     Murphy, Patrick
     Murphy, Tim
     Murtha
     Nadler (NY)
     Napolitano
     Neal (MA)
     Nye
     Oberstar
     Obey
     Olver
     Ortiz
     Pallone
     Pascrell
     Pastor (AZ)
     Paulsen
     Payne
     Pelosi
     Perlmutter
     Perriello
     Peters
     Peterson
     Petri
     Pingree (ME)
     Platts
     Polis (CO)
     Pomeroy
     Price (NC)
     Rahall
     Rangel
     Rehberg
     Reichert
     Reyes
     Richardson
     Rodriguez
     Rogers (AL)
     Ros-Lehtinen
     Ross
     Rothman (NJ)
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Salazar
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schauer
     Schiff
     Schrader
     Schwartz
     Scott (GA)
     Scott (VA)
     Serrano
     Sestak
     Shea-Porter
     Sherman
     Shuler
     Simpson
     Sires
     Skelton
     Slaughter
     Smith (NJ)
     Smith (WA)
     Snyder
     Solis (CA)
     Space
     Speier
     Spratt
     Stupak
     Sutton
     Tanner
     Tauscher
     Taylor
     Teague
     Thompson (CA)
     Thompson (MS)
     Thompson (PA)
     Tiberi
     Tierney
     Titus
     Tonko
     Towns
     Tsongas
     Turner
     Upton
     Van Hollen
     Velazquez
     Visclosky
     Walz
     Wasserman Schultz
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Welch
     Wexler
     Wilson (OH)
     Wolf
     Woolsey
     Wu
     Yarmuth
     Young (AK)
     Young (FL)

                               NAYS--135

     Akin
     Alexander
     Bachmann
     Bachus
     Barrett (SC)
     Bartlett
     Barton (TX)
     Biggert
     Bilbray
     Bilirakis
     Bishop (UT)
     Blackburn
     Blunt
     Boehner
     Bonner
     Boozman
     Boustany
     Brady (TX)
     Bright
     Broun (GA)
     Brown (SC)
     Brown-Waite, Ginny
     Burgess
     Burton (IN)
     Buyer
     Calvert
     Camp
     Cantor
     Carter
     Cassidy
     Chaffetz
     Coble
     Coffman (CO)
     Cole
     Conaway
     Crenshaw
     Culberson
     Davis (KY)
     Deal (GA)
     Dreier
     Duncan
     Fallin
     Fleming
     Forbes
     Fortenberry
     Foxx
     Franks (AZ)
     Gallegly
     Garrett (NJ)
     Gingrey (GA)
     Gohmert
     Goodlatte
     Granger
     Graves
     Guthrie
     Hall (TX)
     Harper
     Hastings (WA)
     Heller
     Hensarling
     Herger
     Hoekstra
     Hunter
     Inglis
     Issa
     Jenkins
     Johnson (IL)
     Johnson, Sam
     Jones
     Jordan (OH)
     King (IA)
     Kingston
     Kline (MN)
     Lamborn
     Latham
     Latta
     Lewis (CA)
     Linder
     Lucas
     Luetkemeyer
     Lummis
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     Marshall
     McCarthy (CA)
     McCaul
     McClintock
     McHenry
     McKeon
     McMorris Rodgers
     Mica
     Miller (FL)
     Miller, Gary
     Myrick
     Neugebauer
     Nunes
     Olson
     Paul
     Pence
     Pitts
     Posey
     Price (GA)
     Putnam
     Radanovich
     Roe (TN)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Rooney
     Roskam
     Royce
     Ryan (WI)
     Scalise
     Schmidt
     Schock
     Sensenbrenner
     Sessions
     Shadegg
     Shimkus
     Shuster
     Smith (NE)
     Smith (TX)
     Souder
     Stearns
     Sullivan
     Terry
     Thornberry
     Tiahrt
     Walden
     Westmoreland
     Whitfield
     Wilson (SC)
     Wittman

                             NOT VOTING--8

     Aderholt
     Bean
     Campbell
     Flake
     Kissell
     Poe (TX)
     Stark
     Wamp

                              {time}  1310

  Mr. HUNTER, Mrs. LUMMIS and Mr. BACHUS changed their vote from 
``yea'' to ``nay.''
  So the motion was agreed to.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.
  Stated for:
  Ms. BEAN. Madam Speaker, on rollcall No. 50, had I been present, I 
would have voted ``yea.''
  Stated against:
  Mr. WAMP. Mr. Speaker, on rollcall No. 50, I was unavoidably detained 
and missed the rollcall vote. However, had I been present, I would have 
voted ``nay.''

                          ____________________