[Congressional Record Volume 155, Number 66 (Friday, May 1, 2009)]
[Senate]
[Pages S5022-S5027]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROCKEFELLER (for himself, Mr. Casey, and Mrs. Gillibrand):
  S. 958. A bill to amend the Social Security Act to guarantee 
comprehensive health care coverage for all children born after 2009; to 
the Committee on Finance.
  Mr. ROCKEFELLER, Mr. President, I rise today, with my colleagues, 
Senator Gillibrand and Senator Casey, to reintroduce an important piece 
of legislation--the MediKids Health Insurance Act of 2009. This 
legislation will finish the job we started with CHIP reauthorization by 
providing health care coverage for every child in the U.S. by 2015, 
regardless of family income.
  Congressman Stark and I have introduced our MediKids legislation in 
each of the last five Congresses because we know how vital health 
insurance is to a child. Year after year, study after study has shown 
that uninsured children are more likely to have unmet health care 
needs. Without adequate health care, childhood illnesses are more 
likely to turn into chronic conditions in adulthood with debilitating 
effects. Even something as simple as an ear infection, if left 
untreated, can cause hearing loss, which can hinder a child's speech 
and language development. Furthermore, children with unmet health care 
needs often underperform in the classroom and miss more days of school. 
Less time in school means students can struggle to develop the skills 
necessary to become productive members of society.
  Despite the well-documented benefits of providing health insurance 
coverage for children, according to the Kaiser Family Foundation, there 
were over 9 million uninsured children in America in 2007. A 
significant step forward in providing health insurance for our 
uninsured children was the reauthorization of the Children's Health 
Insurance Program, a bill I coauthored. Expansions in Medicaid and the 
Children's Health Insurance Program have helped reduce the percentage 
of low-income children that are uninsured from 28

[[Page S5023]]

percent to 15 percent since 1997, with another significant reduction 
probable after the 2009 CHIP reauthorization legislation is fully 
implemented. As pleased as I was with the reauthorization of this vital 
program, it is estimated that millions of children will still remain 
uninsured. This is unacceptable. We must provide universal coverage for 
children.
  Children are entirely reliant on others to care for them. They cannot 
go out and purchase their own health insurance. Just as Congress 
provides for the care of the other segment of our population that is 
heavily reliant on others, the elderly through Medicare, the time has 
come to make certain that all children also have access to 
comprehensive health care. Healthy, well educated children are the key 
to the future success of our country and we cannot allow them to 
continue to fall through the cracks. Now, more than ever, it is time to 
finally pass the MediKids Health Insurance Act.
  This legislation is a clear investment in our future--our children. 
Every child would be automatically enrolled at birth into a new, 
comprehensive, Federal safety net health insurance program beginning in 
2010 and would be eligible up to age 23. The benefits would be tailored 
to meet the needs of children and would be similar to those currently 
available to children through the Medicaid Early and Periodic 
Screening, Diagnosis, and Treatment, EPSDT, program.
  Families below 150 percent of poverty would pay no premiums or co-
payments, while those between 150 and 300 percent of poverty would pay 
graduated premiums up to 5 percent of income and a graduated refundable 
tax credit for cost-sharing. Families above 300 percent of poverty 
would pay a small premium equivalent to one fourth of the average 
annual cost per child. There would be no cost sharing for preventive or 
well-child visits for any child.
  MediKids children would remain enrolled in the program throughout 
childhood. When families move to another state, MediKids would be 
available until parents enroll their children in a new insurance 
program. Between jobs or during family crises, MediKids would offer 
extra security and ensure continuous health coverage to our nation's 
children. During the critical period when a family climbs out of 
poverty and out of the eligibility range for means-tested assistance 
programs, MediKids would fill in the gaps as parents move into jobs 
that provide reliable health insurance coverage. Our program rests on 
the premise that whenever other sources of health insurance fail, 
MediKids would stand ready to cover the health needs of our next 
generation. Ultimately, every child in America would grow up with 
consistent, continuous health insurance coverage.
  Congress cannot rest on the success we achieved by reauthorizing the 
Children's Health Insurance Program. Although CHIP was a remarkable 
step toward reducing the ranks of uninsured children, there is still 
much more work to be done. The MediKids Health Insurance Act is a 
comprehensive approach toward eliminating the damaging lack of health 
insurance for so many children in our country, and I urge my colleagues 
to support this legislation.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed. in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 958

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS; FINDINGS.

       (a) Short Title.--This Act may be cited as the ``MediKids 
     Health Insurance Act of 2009''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents; findings.
Sec. 2. Benefits for all children born after 2009.

                     ``TITLE XXII--MEDIKIDS PROGRAM

``Sec. 2201. Eligibility.
``Sec. 2202. Benefits.
``Sec. 2203. Premiums.
``Sec. 2204. MediKids Trust Fund.
``Sec. 2205. Oversight and accountability.
``Sec. 2206. Inclusion of care coordination services.
``Sec. 2207. Administration and miscellaneous.
Sec. 3. MediKids premium.
Sec. 4. Refundable credit for certain cost-sharing expenses under 
              MediKids program.
Sec. 5. Report on long-term revenues.
       (c) Findings.--Congress finds the following:
       (1) More than 9 million American children are uninsured.
       (2) Children who are uninsured receive less medical care 
     and less preventive care and have a poorer level of health, 
     which result in lifetime costs to themselves and to the 
     entire American economy.
       (3) Although CHIP and Medicaid are successfully extending a 
     health coverage safety net to a growing portion of the 
     vulnerable low-income population of uninsured children, they 
     alone cannot achieve 100 percent health insurance coverage 
     for our nation's children due to inevitable gaps during 
     outreach and enrollment, fluctuations in eligibility, 
     variations in access to private insurance at all income 
     levels, and variations in States' ability to provide required 
     matching funds.
       (4) As all segments of society continue to become more 
     transient, with many changes in employment over the working 
     lifetime of parents, the need for a reliable safety net of 
     health insurance which follows children across State lines, 
     already a major problem for the children of migrant and 
     seasonal farmworkers, will become a major concern for all 
     families in the United States.
       (5) The medicare program has successfully evolved over the 
     years to provide a stable, universal source of health 
     insurance for the nation's disabled and those over age 65, 
     and provides a tested model for designing a program to reach 
     out to America's children.
       (6) The problem of insuring 100 percent of all American 
     children could be gradually solved by automatically enrolling 
     all children born after December 31, 2009, in a program 
     modeled after Medicare (and to be known as ``MediKids''), and 
     allowing those children to be transferred into other 
     equivalent or better insurance programs, including either 
     private insurance, CHIP, or Medicaid, if they are eligible to 
     do so, but maintaining the child's default enrollment in 
     MediKids for any times when the child's access to other 
     sources of insurance is lost.
       (7) A family's freedom of choice to use other insurers to 
     cover children would not be interfered with in any way, and 
     children eligible for CHIP and Medicaid would continue to be 
     enrolled in those programs, but the underlying safety net of 
     MediKids would always be available to cover any gaps in 
     insurance due to changes in medical condition, employment, 
     income, or marital status, or other changes affecting a 
     child's access to alternate forms of insurance.
       (8) The MediKids program can be administered without 
     impacting the finances or status of the existing Medicare 
     program.
       (9) The MediKids benefit package can be tailored to the 
     special needs of children and updated over time.
       (10) The financing of the program can be administered 
     without difficulty by a yearly payment of affordable premiums 
     through a family's tax filing (or adjustment of a family's 
     earned income tax credit).
       (11) The cost of the program will gradually rise as the 
     number of children using MediKids as the insurer of last 
     resort increases, and a future Congress always can accelerate 
     or slow down the enrollment process as desired, while the 
     societal costs for emergency room usage, lost productivity 
     and work days, and poor health status for the next generation 
     of Americans will decline.
       (12) Over time 100 percent of American children will always 
     have basic health insurance, and we can therefore expect a 
     healthier, more equitable, and more productive society.

     SEC. 2. BENEFITS FOR ALL CHILDREN BORN AFTER 2009.

       (a) In General.--The Social Security Act is amended by 
     adding at the end the following new title:

                     ``TITLE XXII--MEDIKIDS PROGRAM

     ``SEC. 2201. ELIGIBILITY.

       ``(a) Eligibility of Individuals Born After December 31, 
     2009; All Children Under 23 Years of Age in Fifth Year.--An 
     individual who meets the following requirements with respect 
     to a month is eligible to enroll under this title with 
     respect to such month:
       ``(1) Age.--
       ``(A) First year.--As of the first day of the first year in 
     which this title is effective, the individual has not 
     attained 6 years of age.
       ``(B) Second year.--As of the first day of the second year 
     in which this title is effective, the individual has not 
     attained 11 years of age.
       ``(C) Third year.--As of the first day of the third year in 
     which this title is effective, the individual has not 
     attained 16 years of age.
       ``(D) Fourth year.--As of the first day of the fourth year 
     in which this title is effective, the individual has not 
     attained 21 years of age.
       ``(E) Fifth and subsequent years.--As of the first day of 
     the fifth year in which this title is effective and each 
     subsequent year, the individual has not attained 23 years of 
     age.
       ``(2) Citizenship.--The individual is a citizen or national 
     of the United States or is permanently residing in the United 
     States under color of law.
       ``(b) Enrollment Process.--An individual may enroll in the 
     program established under this title only in such manner and 
     form as may be prescribed by regulations, and only

[[Page S5024]]

     during an enrollment period prescribed by the Secretary 
     consistent with the provisions of this section. Such 
     regulations shall provide a process under which--
       ``(1) individuals who are born in the United States after 
     December 31, 2009, are deemed to be enrolled at the time of 
     birth and a parent or guardian of such an individual is 
     permitted to pre-enroll in the month prior to the expected 
     month of birth;
       ``(2) individuals who are born outside the United States 
     after such date and who become eligible to enroll by virtue 
     of immigration into (or an adjustment of immigration status 
     in) the United States are deemed enrolled at the time of 
     entry or adjustment of status;
       ``(3) eligible individuals may otherwise be enrolled at 
     such other times and manner as the Secretary shall specify, 
     including the use of outstationed eligibility sites as 
     described in section 1902(a)(55)(A) and the use of 
     presumptive eligibility provisions like those described in 
     section 1920A; and
       ``(4) at the time of automatic enrollment of a child, the 
     Secretary provides for issuance to a parent or custodian of 
     the individual a card evidencing coverage under this title 
     and for a description of such coverage.

     The provisions of section 1837(h) apply with respect to 
     enrollment under this title in the same manner as they apply 
     to enrollment under part B of title XVIII. An individual who 
     is enrolled under this title is not eligible to be enrolled 
     under an MA or MA-PD plan under part C of title XVIII.
       ``(c) Date Coverage Begins.--
       ``(1) In general.--The period during which an individual is 
     entitled to benefits under this title shall begin as follows, 
     but in no case earlier than January 1, 2010:
       ``(A) In the case of an individual who is enrolled under 
     paragraph (1) or (2) of subsection (b), the date of birth or 
     date of obtaining appropriate citizenship or immigration 
     status, as the case may be.
       ``(B) In the case of another individual who enrolls 
     (including pre-enrolls) before the month in which the 
     individual satisfies eligibility for enrollment under 
     subsection (a), the first day of such month of eligibility.
       ``(C) In the case of another individual who enrolls during 
     or after the month in which the individual first satisfies 
     eligibility for enrollment under such subsection, the first 
     day of the following month.
       ``(2) Authority to provide for partial months of 
     coverage.--Under regulations, the Secretary may, in the 
     Secretary's discretion, provide for coverage periods that 
     include portions of a month in order to avoid lapses of 
     coverage.
       ``(3) Limitation on payments.--No payments may be made 
     under this title with respect to the expenses of an 
     individual enrolled under this title unless such expenses 
     were incurred by such individual during a period which, with 
     respect to the individual, is a coverage period under this 
     section.
       ``(d) Expiration of Eligibility.--An individual's coverage 
     period under this section shall continue until the 
     individual's enrollment has been terminated because the 
     individual no longer meets the requirements of subsection (a) 
     (whether because of age or change in immigration status).
       ``(e) Entitlement to MediKids Benefits for Enrolled 
     Individuals.--An individual enrolled under this title is 
     entitled to the benefits described in section 2202.
       ``(f) Low-Income Information.--
       ``(1) Inquiry of income.--At the time of enrollment of a 
     child under this title, the Secretary shall make an inquiry 
     as to whether the family income (as determined for purposes 
     of section 1905(p)) of the family that includes the child is 
     within any of the following income ranges:
       ``(A) Up to 150 percent of poverty.--The income of the 
     family does not exceed 150 percent of the poverty line for a 
     family of the size involved.
       ``(B) Between 150 and 200 percent of poverty.--The income 
     of the family exceeds 150 percent, but does not exceed 200 
     percent, of such poverty line.
       ``(C) Between 200 and 300 percent of poverty.--The income 
     of the family exceeds 200 percent, but does not exceed 300 
     percent, of such poverty line.
       ``(2) Coding.--If the family income is within a range 
     described in paragraph (1), the Secretary shall encode in the 
     identification card issued in connection with eligibility 
     under this title a code indicating the range applicable to 
     the family of the child involved.
       ``(3) Provider verification through electronic system.--The 
     Secretary also shall provide for an electronic system through 
     which providers may verify which income range described in 
     paragraph (1), if any, is applicable to the family of the 
     child involved.
       ``(g) Construction.--Nothing in this title shall be 
     construed as requiring (or preventing) an individual who is 
     enrolled under this title from seeking medical assistance 
     under a State medicaid plan under title XIX or child health 
     assistance under a State child health plan under title XXI.

     ``SEC. 2202. BENEFITS.

       ``(a) Secretarial Specification of Benefit Package.--
       ``(1) In general.--The Secretary shall specify the benefits 
     to be made available under this title consistent with the 
     provisions of this section and in a manner designed to meet 
     the health needs of enrollees.
       ``(2) Updating.--The Secretary shall update the 
     specification of benefits over time to ensure the inclusion 
     of age-appropriate benefits to reflect the enrollee 
     population.
       ``(3) Annual updating.--The Secretary shall establish 
     procedures for the annual review and updating of such 
     benefits to account for changes in medical practice, new 
     information from medical research, and other relevant 
     developments in health science.
       ``(4) Input.--The Secretary shall seek the input of the 
     pediatric community in specifying and updating such benefits.
       ``(5) Limitation on updating.--In no case shall updating of 
     benefits under this subsection result in a failure to provide 
     benefits required under subsection (b).
       ``(b) Inclusion of Certain Benefits.--
       ``(1) Medicare core benefits.--Such benefits shall include 
     (to the extent consistent with other provisions of this 
     section) at least the same benefits (including coverage, 
     access, availability, duration, and beneficiary rights) that 
     are available under parts A and B of title XVIII.
       ``(2) All required medicaid benefits.--Such benefits shall 
     also include all items and services for which medical 
     assistance is required to be provided under section 
     1902(a)(10)(A) to individuals described in such section, 
     including early and periodic screening, diagnostic services, 
     and treatment services.
       ``(3) Inclusion of prescription drugs.--Such benefits also 
     shall include (as specified by the Secretary) benefits for 
     prescription drugs and biologicals which are not less than 
     the benefits for such drugs and biologicals under the 
     standard option for the service benefit plan described in 
     section 8903(1) of title 5, United States Code, offered 
     during 2008.
       ``(4) Cost-sharing.--
       ``(A) In general.--Subject to subparagraph (B), such 
     benefits also shall include the cost-sharing (in the form of 
     deductibles, coinsurance, and copayments) which is 
     substantially similar to such cost-sharing under the health 
     benefits coverage in any of the four largest health benefits 
     plans (determined by enrollment) offered under chapter 89 of 
     title 5, United States Code, and including an out-of-pocket 
     limit for catastrophic expenditures for covered benefits, 
     except that no cost-sharing shall be imposed with respect to 
     early and periodic screening and diagnostic services included 
     under paragraph (2).
       ``(B) Reduced cost-sharing for low income children.--Such 
     benefits shall provide that--
       ``(i) there shall be no cost-sharing for children in 
     families the income of which is within the range described in 
     section 2201(f)(1)(A);
       ``(ii) the cost-sharing otherwise applicable shall be 
     reduced by 75 percent for children in families the income of 
     which is within the range described in section 2201(f)(1)(B); 
     or
       ``(iii) the cost-sharing otherwise applicable shall be 
     reduced by 50 percent for children in families the income of 
     which is within the range described in section 2201(f)(1)(C).
       ``(C) Catastrophic limit on cost-sharing.--For a refundable 
     credit for cost-sharing in the case of cost-sharing in excess 
     of a percentage of the individual's adjusted gross income, 
     see section 36 of the Internal Revenue Code of 1986.
       ``(c) Payment Schedule.--The Secretary, with the assistance 
     of the Medicare Payment Advisory Commission, shall develop 
     and implement a payment schedule for benefits covered under 
     this title. To the extent feasible, such payment schedule 
     shall be consistent with comparable payment schedules and 
     reimbursement methodologies applied under parts A and B of 
     title XVIII.
       ``(d) Input.--The Secretary shall specify such benefits and 
     payment schedules only after obtaining input from appropriate 
     child health providers and experts.
       ``(e) Enrollment in Health Plans.--The Secretary shall 
     provide for the offering of benefits under this title through 
     enrollment in a health benefit plan that meets the same (or 
     similar) requirements as the requirements that apply to 
     Medicare Advantage plans under part C of title XVIII (other 
     than any such requirements that relate to part D of such 
     title). In the case of individuals enrolled under this title 
     in such a plan, the payment rate shall be based on payment 
     rates provided for under section 1853(c) in effect before the 
     date of the enactment of the Medicare Prescription Drug, 
     Modernization, and Improvement Act of 2003 (Public Law 108-
     173), except that such payment rates shall be adjusted in an 
     appropriate manner to reflect differences between the 
     population served under this title and the population under 
     title XVIII.

     ``SEC. 2203. PREMIUMS.

       ``(a) Amount of Monthly Premiums.--
       ``(1) In general.--The Secretary shall, during September of 
     each year (beginning with 2009), establish a monthly MediKids 
     premium for the following year. Subject to paragraph (2), the 
     monthly MediKids premium for a year is equal to \1/12\ of the 
     annual premium rate computed under subsection (b).
       ``(2) Elimination of monthly premium for demonstration of 
     equivalent coverage (including coverage under low-income 
     programs).--The amount of the monthly premium imposed under 
     this section for an individual for a month shall be zero in 
     the case of an individual who demonstrates to the 
     satisfaction of the Secretary that the individual has basic 
     health insurance coverage for that month. For purposes of the 
     previous sentence enrollment in a medicaid plan under title 
     XIX, a State child health insurance plan under title XXI, or 
     under the medicare program under title XVIII is deemed to

[[Page S5025]]

     constitute basic health insurance coverage described in such 
     sentence.
       ``(b) Annual Premium.--
       ``(1) National per capita average.--The Secretary shall 
     estimate the average, annual per capita amount that would be 
     payable under this title with respect to individuals residing 
     in the United States who meet the requirement of section 
     2201(a)(1) as if all such individuals were eligible for (and 
     enrolled) under this title during the entire year (and 
     assuming that section 1862(b)(2)(A)(i) did not apply).
       ``(2) Annual premium.--Subject to subsection (d), the 
     annual premium under this subsection for months in a year is 
     equal to 25 percent of the average, annual per capita amount 
     estimated under paragraph (1) for the year.
       ``(c) Payment of Monthly Premium.--
       ``(1) Period of payment.--In the case of an individual who 
     participates in the program established by this title, 
     subject to subsection (d), the monthly premium shall be 
     payable for the period commencing with the first month of the 
     individual's coverage period and ending with the month in 
     which the individual's coverage under this title terminates.
       ``(2) Collection through tax return.--For provisions 
     providing for the payment of monthly premiums under this 
     subsection, see section 59B of the Internal Revenue Code of 
     1986.
       ``(3) Protections against fraud and abuse.--The Secretary 
     shall develop, in coordination with States and other health 
     insurance issuers, administrative systems to ensure that 
     claims which are submitted to more than one payor are 
     coordinated and duplicate payments are not made.
       ``(d) Reduction in Premium for Certain Low-Income 
     Families.--For provisions reducing the premium under this 
     section for certain low-income families, see section 59B(d) 
     of the Internal Revenue Code of 1986.

     ``SEC. 2204. MEDIKIDS TRUST FUND.

       ``(a) Establishment of Trust Fund.--
       ``(1) In general.--There is hereby created on the books of 
     the Treasury of the United States a trust fund to be known as 
     the `MediKids Trust Fund' (in this section referred to as the 
     `Trust Fund'). The Trust Fund shall consist of such gifts and 
     bequests as may be made as provided in section 201(i)(1) and 
     such amounts as may be deposited in, or appropriated to, such 
     fund as provided in this title.
       ``(2) Premiums.--Premiums collected under section 59B of 
     the Internal Revenue Code of 1986 shall be periodically 
     transferred to the Trust Fund.
       ``(3) Transitional funding before receipt of premiums.--In 
     order to provide for funds in the Trust Fund to cover 
     expenditures from the fund in advance of receipt of premiums 
     under section 2203, there are transferred to the Trust Fund 
     from the general fund of the United States Treasury such 
     amounts as may be necessary.
       ``(b) Incorporation of Provisions.--
       ``(1) In general.--Subject to paragraph (2), subsection (b) 
     (other than the last sentence) and subsections (c) through 
     (i) of section 1841 shall apply with respect to the Trust 
     Fund and this title in the same manner as they apply with 
     respect to the Federal Supplementary Medical Insurance Trust 
     Fund and part B, respectively.
       ``(2) Miscellaneous references.--In applying provisions of 
     section 1841 under paragraph (1)--
       ``(A) any reference in such section to `this part' is 
     construed to refer to title XXII;
       ``(B) any reference in section 1841(h) to section 1840(d) 
     and in section 1841(i) to sections 1840(b)(1) and 1842(g) are 
     deemed references to comparable authority exercised under 
     this title;
       ``(C) payments may be made under section 1841(g) to the 
     Trust Funds under sections 1817 and 1841 as reimbursement to 
     such funds for payments they made for benefits provided under 
     this title; and
       ``(D) the Board of Trustees of the MediKids Trust Fund 
     shall be the same as the Board of Trustees of the Federal 
     Supplementary Medical Insurance Trust Fund.

     ``SEC. 2205. OVERSIGHT AND ACCOUNTABILITY.

       ``(a) Periodic GAO Reports.--The Comptroller General of the 
     United States shall periodically submit to Congress reports 
     on the operation of the program under this title, including 
     on the financing of coverage provided under this title.
       ``(b) Periodic MACPAC Reports.--The Medicaid and CHIP 
     Payment and Access Commission shall periodically report to 
     Congress concerning the program under this title.

     ``SEC. 2206. INCLUSION OF CARE COORDINATION SERVICES.

       ``(a) In General.--
       ``(1) Program authority.--The Secretary, beginning in 2010, 
     may implement a care coordination services program in 
     accordance with the provisions of this section under which, 
     in appropriate circumstances, eligible individuals under 
     section 2201 may elect to have health care services covered 
     under this title managed and coordinated by a designated care 
     coordinator.
       ``(2) Administration by contract.--The Secretary may 
     administer the program under this section through a contract 
     with an appropriate program administrator.
       ``(3) Coverage.--Care coordination services furnished in 
     accordance with this section shall be treated under this 
     title as if they were included in the definition of medical 
     and other health services under section 1861(s) and benefits 
     shall be available under this title with respect to such 
     services without the application of any deductible or 
     coinsurance.
       ``(b) Eligibility Criteria; Identification and Notification 
     of Eligible Individuals.--
       ``(1) Individual eligibility criteria.--The Secretary shall 
     specify criteria to be used in making a determination as to 
     whether an individual may appropriately be enrolled in the 
     care coordination services program under this section, which 
     shall include at least a finding by the Secretary that for 
     cohorts of individuals with characteristics identified by the 
     Secretary, professional management and coordination of care 
     can reasonably be expected to improve processes or outcomes 
     of health care and to reduce aggregate costs to the programs 
     under this title.
       ``(2) Procedures to facilitate enrollment.--The Secretary 
     shall develop and implement procedures designed to facilitate 
     enrollment of eligible individuals in the program under this 
     section.
       ``(c) Enrollment of Individuals.--
       ``(1) Secretary's determination of eligibility.--The 
     Secretary shall determine the eligibility for services under 
     this section of individuals who are enrolled in the program 
     under this section and who make application for such services 
     in such form and manner as the Secretary may prescribe.
       ``(2) Enrollment period.--
       ``(A) Effective date and duration.--Enrollment of an 
     individual in the program under this section shall be 
     effective as of the first day of the month following the 
     month in which the Secretary approves the individual's 
     application under paragraph (1), shall remain in effect for 
     one month (or such longer period as the Secretary may 
     specify), and shall be automatically renewed for additional 
     periods, unless terminated in accordance with such procedures 
     as the Secretary shall establish by regulation. Such 
     procedures shall permit an individual to disenroll for cause 
     at any time and without cause at re-enrollment intervals.
       ``(B) Limitation on reenrollment.--The Secretary may 
     establish limits on an individual's eligibility to reenroll 
     in the program under this section if the individual has 
     disenrolled from the program more than once during a 
     specified time period.
       ``(d) Program.--The care coordination services program 
     under this section shall include the following elements:
       ``(1) Basic care coordination services.--
       ``(A) In general.--Subject to the cost-effectiveness 
     criteria specified in subsection (b)(1), except as otherwise 
     provided in this section, enrolled individuals shall receive 
     services described in section 1905(t)(1) and may receive 
     additional items and services as described in subparagraph 
     (B).
       ``(B) Additional benefits.--The Secretary may specify 
     additional benefits for which payment would not otherwise be 
     made under this title that may be available to individuals 
     enrolled in the program under this section (subject to an 
     assessment by the care coordinator of an individual's 
     circumstance and need for such benefits) in order to 
     encourage enrollment in, or to improve the effectiveness of, 
     such program.
       ``(2) Care coordination requirement.--Notwithstanding any 
     other provision of this title, the Secretary may provide that 
     an individual enrolled in the program under this section may 
     be entitled to payment under this title for any specified 
     health care items or services only if the items or services 
     have been furnished by the care coordinator, or coordinated 
     through the care coordination services program. Under such 
     provision, the Secretary shall prescribe exceptions for 
     emergency medical services as described in section 
     1852(d)(3), and other exceptions determined by the Secretary 
     for the delivery of timely and needed care.
       ``(e) Care Coordinators.--
       ``(1) Conditions of participation.--In order to be 
     qualified to furnish care coordination services under this 
     section, an individual or entity shall--
       ``(A) be a health care professional or entity (which may 
     include physicians, physician group practices, or other 
     health care professionals or entities the Secretary may find 
     appropriate) meeting such conditions as the Secretary may 
     specify;
       ``(B) have entered into a care coordination agreement; and
       ``(C) meet such criteria as the Secretary may establish 
     (which may include experience in the provision of care 
     coordination or primary care physician's services).
       ``(2) Agreement term; payment.--
       ``(A) Duration and renewal.--A care coordination agreement 
     under this subsection shall be for one year and may be 
     renewed if the Secretary is satisfied that the care 
     coordinator continues to meet the conditions of participation 
     specified in paragraph (1).
       ``(B) Payment for services.--The Secretary may negotiate or 
     otherwise establish payment terms and rates for services 
     described in subsection (d)(1).
       ``(C) Liability.--Care coordinators shall be subject to 
     liability for actual health damages which may be suffered by 
     recipients as a result of the care coordinator's decisions, 
     failure or delay in making decisions, or other actions as a 
     care coordinator.
       ``(D) Terms.--In addition to such other terms as the 
     Secretary may require, an agreement under this section shall 
     include the terms specified in subparagraphs (A) through (C) 
     of section 1905(t)(3).

[[Page S5026]]

     ``SEC. 2207. ADMINISTRATION AND MISCELLANEOUS.

       ``(a) In General.--Except as otherwise provided in this 
     title--
       ``(1) the Secretary shall enter into appropriate contracts 
     with providers of services, other health care providers, 
     carriers, and fiscal intermediaries, taking into account the 
     types of contracts used under title XVIII with respect to 
     such entities, to administer the program under this title;
       ``(2) beneficiary protections for individuals enrolled 
     under this title shall not be less than the beneficiary 
     protections (including limits on balance billing) provided 
     medicare beneficiaries under title XVIII;
       ``(3) benefits described in section 2202 that are payable 
     under this title to such individuals shall be paid in a 
     manner specified by the Secretary (taking into account, and 
     based to the greatest extent practicable upon, the manner in 
     which they are provided under title XVIII); and
       ``(4) provider participation agreements under title XVIII 
     shall apply to enrollees and benefits under this title in the 
     same manner as they apply to enrollees and benefits under 
     title XVIII.
       ``(b) Coordination With Medicaid and CHIP.--Notwithstanding 
     any other provision of law, individuals entitled to benefits 
     for items and services under this title who also qualify for 
     benefits under title XIX or XXI or any other Federally funded 
     health care program that provides basic health insurance 
     coverage described in section 2203(a)(2) may continue to 
     qualify and obtain benefits under such other title or 
     program, and in such case such an individual shall elect 
     either--
       ``(1) such other title or program to be primary payor to 
     benefits under this title, in which case no benefits shall be 
     payable under this title and the monthly premium under 
     section 2203 shall be zero; or
       ``(2) benefits under this title shall be primary payor to 
     benefits provided under such title or program, in which case 
     the Secretary shall enter into agreements with States as may 
     be appropriate to provide that, in the case of such 
     individuals, the benefits under titles XIX and XXI or such 
     other program (including reduction of cost-sharing) are 
     provided on a `wrap-around' basis to the benefits under this 
     title.''.
       (b) Conforming Amendments to Social Security Act 
     Provisions.--
       (1) Section 201(i)(1) of the Social Security Act (42 U.S.C. 
     401(i)(1)) is amended by striking ``or the Federal 
     Supplementary Medical Insurance Trust Fund'' and inserting 
     ``the Federal Supplementary Medical Insurance Trust Fund, and 
     the MediKids Trust Fund''.
       (2) Section 201(g)(1)(A) of such Act (42 U.S.C. 
     401(g)(1)(A)) is amended by striking ``and the Federal 
     Supplementary Medical Insurance Trust Fund established by 
     title XVIII'' and inserting ``, the Federal Supplementary 
     Medical Insurance Trust Fund, and the MediKids Trust Fund 
     established by title XVIII''.
       (c) Maintenance of Medicaid Eligibility and Benefits for 
     Children.--
       (1) In general.--In order for a State to continue to be 
     eligible for payments under section 1903(a) of the Social 
     Security Act (42 U.S.C. 1396b(a))--
       (A) the State may not reduce standards of eligibility, or 
     benefits, provided under its State medicaid plan under title 
     XIX of the Social Security Act or under its State child 
     health plan under title XXI of such Act for individuals under 
     23 years of age below such standards of eligibility, and 
     benefits, in effect on the date of the enactment of this Act; 
     and
       (B) the State shall demonstrate to the satisfaction of the 
     Secretary of Health and Human Services that any savings in 
     State expenditures under title XIX or XXI of the Social 
     Security Act that results from children enrolling under title 
     XXII of such Act shall be used in a manner that improves 
     services to beneficiaries under title XIX of such Act, such 
     as through expansion of eligibility, improved nurse and nurse 
     aide staffing and improved inspections of nursing facilities, 
     and coverage of additional services.
       (2) Medikids as primary payor.--In applying title XIX of 
     the Social Security Act, the MediKids program under title 
     XXII of such Act shall be treated as a primary payor in cases 
     in which the election described in section 2207(b)(2) of such 
     Act, as added by subsection (a), has been made.
       (d) Expansion of MACPAC Duties.--Section 1900 of the Social 
     Security Act (42 U.S.C. 1396) is amended--
       (1) in subsection (b)(1)(A)--
       (A) by striking ``and the State'' and inserting ``, the 
     State''; and
       (B) by inserting ``and the MediKids program established 
     under title XXII (in this section referred to as 
     `MediKids')'' before ``affecting''; and
       (2) by striking ``and CHIP'' each place it appears (other 
     than in subsection (a)) and inserting ``, CHIP, and 
     MediKids''.

     SEC. 3. MEDIKIDS PREMIUM.

       (a) General Rule.--Subchapter A of chapter 1 of the 
     Internal Revenue Code of 1986 (relating to determination of 
     tax liability) is amended by adding at the end the following 
     new part:

                     ``PART VIII--MEDIKIDS PREMIUM

``Sec. 59B. MediKids premium.

     ``SEC. 59B. MEDIKIDS PREMIUM.

       ``(a) Imposition of Tax.--In the case of a taxpayer to whom 
     this section applies, there is hereby imposed (in addition to 
     any other tax imposed by this subtitle) a MediKids premium 
     for the taxable year.
       ``(b) Individuals Subject to Premium.--
       ``(1) In general.--This section shall apply to a taxpayer 
     if a MediKid is a dependent of the taxpayer for the taxable 
     year.
       ``(2) Medikid.--For purposes of this section, the term 
     `MediKid' means any individual enrolled in the MediKids 
     program under title XXII of the Social Security Act.
       ``(c) Amount of Premium.--For purposes of this section, the 
     MediKids premium for a taxable year is the sum of the monthly 
     premiums (for months in the taxable year) determined under 
     section 2203 of the Social Security Act with respect to each 
     MediKid who is a dependent of the taxpayer for the taxable 
     year.
       ``(d) Exceptions Based on Adjusted Gross Income.--
       ``(1) Exemption for very low-income taxpayers.--
       ``(A) In general.--No premium shall be imposed by this 
     section on any taxpayer having an adjusted gross income not 
     in excess of the exemption amount.
       ``(B) Exemption amount.--For purposes of this paragraph, 
     the exemption amount is--
       ``(i) $20,535 in the case of a taxpayer having 1 MediKid,
       ``(ii) $25,755 in the case of a taxpayer having 2 MediKids,
       ``(iii) $30,975 in the case of a taxpayer having 3 
     MediKids, and
       ``(iv) $35,195 in the case of a taxpayer having 4 or more 
     MediKids.
       ``(C) Phaseout of exemption.--In the case of a taxpayer 
     having an adjusted gross income which exceeds the exemption 
     amount but does not exceed twice the exemption amount, the 
     premium shall be the amount which bears the same ratio to the 
     premium which would (but for this subparagraph) apply to the 
     taxpayer as such excess bears to the exemption amount.
       ``(D) Inflation adjustment of exemption amounts.--In the 
     case of any taxable year beginning in a calendar year after 
     2010, each dollar amount contained in subparagraph (C) shall 
     be increased by an amount equal to the product of--
       ``(i) such dollar amount, and
       ``(ii) the cost-of-living adjustment determined under 
     section 1(f)(3) for the calendar year in which the taxable 
     year begins, determined by substituting `calendar year 2009' 
     for `calendar year 1992' in subparagraph (B) thereof.

     If any increase determined under the preceding sentence is 
     not a multiple of $50, such increase shall be rounded to the 
     nearest multiple of $50.
       ``(2) Premium limited to 5 percent of adjusted gross 
     income.--In no event shall any taxpayer be required to pay a 
     premium under this section in excess of an amount equal to 5 
     percent of the taxpayer's adjusted gross income.
       ``(e) Coordination With Other Provisions.--
       ``(1) Not treated as medical expense.--For purposes of this 
     chapter, any premium paid under this section shall not be 
     treated as expense for medical care.
       ``(2) Not treated as tax for certain purposes.--The premium 
     paid under this section shall not be treated as a tax imposed 
     by this chapter for purposes of determining--
       ``(A) the amount of any credit allowable under this 
     chapter, or
       ``(B) the amount of the minimum tax imposed by section 55.
       ``(3) Treatment under subtitle f.--For purposes of subtitle 
     F, the premium paid under this section shall be treated as if 
     it were a tax imposed by section 1.''.
       (b) Technical Amendments.--
       (1) Subsection (a) of section 6012 of the Internal Revenue 
     Code of 1986 is amended by inserting after paragraph (9) the 
     following new paragraph:
       ``(10) Every individual liable for a premium under section 
     59B.''.
       (2) The table of parts for subchapter A of chapter 1 of 
     such Code is amended by adding at the end the following new 
     item:

                    ``Part VIII. MediKids Premium''.

       (c) Effective Date.--The amendments made by this section 
     shall apply to months beginning after December 2009, in 
     taxable years ending after such date.

     SEC. 4. REFUNDABLE CREDIT FOR CERTAIN COST-SHARING EXPENSES 
                   UNDER MEDIKIDS PROGRAM.

       (a) In General.--Subpart C of part IV of subchapter A of 
     chapter 1 of the Internal Revenue Code of 1986 (relating to 
     refundable credits) is amended by inserting after section 36A 
     the following new section:

     ``SEC. 36B. CATASTROPHIC LIMIT ON COST-SHARING EXPENSES UNDER 
                   MEDIKIDS PROGRAM.

       ``(a) In General.--In the case of a taxpayer who has a 
     MediKid (as defined in section 59B) at any time during the 
     taxable year, there shall be allowed as a credit against the 
     tax imposed by this subtitle an amount equal to the excess 
     of--
       ``(1) the amount paid by the taxpayer during the taxable 
     year as cost-sharing under section 2202(b)(4) of the Social 
     Security Act, over
       ``(2) 5 percent of the taxpayer's adjusted gross income for 
     the taxable year.
       ``(b) Coordination With Other Provisions.--The excess 
     described in subsection (a) shall not be taken into account 
     in computing the amount allowable to the taxpayer as a 
     deduction under section 162(l) or 213(a).''.
       (b) Technical Amendments.--
       (1) The table of sections for subpart C of part IV of 
     subchapter A of chapter 1 of the Internal Revenue Code of 
     1986 is amended by

[[Page S5027]]

     inserting after the item relating to section 36A the 
     following new item:

``Sec. 36B. Catastrophic limit on cost-sharing expenses under MediKids 
              program.''.

       (2) Paragraph (2) of section 1324(b) of title 31, United 
     States Code, is amended by inserting ``36B,'' after ``36A,''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2009.

     SEC. 5. REPORT ON LONG-TERM REVENUES.

       Within one year after the date of the enactment of this 
     Act, the Secretary of the Treasury shall propose a gradual 
     schedule of progressive tax changes to fund the program under 
     title XXII of the Social Security Act, as the number of 
     enrollees grows in the out-years.

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