HR 5192 IH

To amend titles XIX and XXI of the Social Security Act to improve the coverage of needy children under the State Children's Health Insurance Program (SCHIP) and the Medicaid Program.

September 14, 2000

Mr. WEYGAND introduced the following bill; which was referred to the Committee on Commerce

To amend titles XIX and XXI of the Social Security Act to improve the coverage of needy children under the State Children's Health Insurance Program (SCHIP) and the Medicaid Program.

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

SECTION 1. SHORT TITLE; REFERENCES IN ACT; TABLE OF CONTENTS.

(a) SHORT TITLE- This Act may be cited as the `Medicaid and SCHIP Improvement and Flexibility Act of 2000'.

(b) REFERENCES TO SOCIAL SECURITY ACT- Except as otherwise expressly provided, whenever in this Act an amendment or repeal 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 a section or other provision of the Social Security Act.

(c) TABLE OF CONTENTS- The table of contents of this Act is as follows:

Sec. 1. Short title; references in Act; table of contents.

Sec. 2. Simplified outreach and enrollment.

Sec. 3. Family friendly coverage and enrollment.

Sec. 4. Expanded coverage options.

Sec. 5. Availability of fiscal year 1998 and fiscal year 1999 allotments under SCHIP.

Sec. 6. Permitting increased share of SCHIP funds to be expended for prevention programs that ensure healthy childhoods and quality prenatal health care.

Sec. 7. Use of SCHIP funds for enhanced matching rate for coverage of additional children under the medicaid program.

SEC. 2. SIMPLIFIED OUTREACH AND ENROLLMENT.

(a) USE OF UNIFORM APPLICATION AND COORDINATED ENROLLMENT PROCESS-

(1) SCHIP PROGRAM- Section 2102 (42 U.S.C. 1397bb) is amended by adding at the end the following new subsection:

`(d) DEVELOPMENT AND USE OF UNIFORM APPLICATION FORMS AND COORDINATED ENROLLMENT PROCESS- A State child health plan shall provide, by not later than the first day of the first month that begins more than 6 months after the date of the enactment of this subsection, for--

`(1) the development and use of a uniform, simplified application form which is used both for purposes of establishing eligibility for benefits under this title and also under title XIX; and

`(2) an enrollment process that is coordinated with that under title XIX so that a family need only interact with a single State agency in order to determine whether a child is eligible for benefits under this title or title XIX and to apply for such benefits.'.

(2) MEDICAID CONFORMING AMENDMENT-

(A) IN GENERAL- Section 1902(a) (42 U.S.C. 1396a(a)) is amended--

(i) by striking the period at the end of paragraph (65) and inserting `; and', and

(ii) by inserting after paragraph (65) the following new paragraph:

`(66) provide, by not later than the first day of the first month that begins more than 6 months after the date of the enactment of this paragraph, in the case of a State with a State child health plan under title XXI for--

`(A) the development and use of a uniform, simplified application form which is used both for purposes of establishing eligibility for benefits under this title and also under title XXI; and

`(B) establishment and operation of an enrollment process that is coordinated with that under title XXI so that a family need only interact with a single State agency in order to determine whether a child is eligible for benefits under this title or title XXI and to apply for such benefits.'.

(B) EFFECTIVE DATE- The amendments made by subparagraph (A) apply to calendar quarters beginning more than 6 months after the date of the enactment of this Act.

(b) FINANCIAL INCENTIVES TO PROMOTE APPROPRIATE ENROLLMENT-

(1) EXPANDED AVAILABILITY OF FUNDING FOR ADMINISTRATIVE COSTS RELATED TO OUTREACH AND ELIGIBILITY DETERMINATIONS- Section 1931(h) (42 U.S.C. 1396u-1(h)), as amended by

section 602 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (113 Stat. 1501A-394), as enacted into law by section 1000(a)(6) of Public Law 106-113 is amended--

(A) in the matter preceding paragraph (1), by striking `TRANSITIONAL' and all that follows through `COSTS' and inserting `INCREASED FEDERAL MATCHING RATE FOR ADMINISTRATIVE COSTS RELATED TO CERTAIN OUTREACH AND ELIGIBILITY DETERMINATIONS';

(B) in paragraph (2), by inserting `either' after `attributable' and by inserting before the period at the end the following: `or to administrative costs of determinations of the eligibility of children and pregnant women for benefits under the State plan under this title or title XXI, outreach to children and pregnant women likely to be eligible for such benefits, and such other outreach- and eligibility-related activities as the Secretary may approve'; and

(C) by adding at the end the following new paragraph:

`(4) ENCOURAGING USE OF LOCAL AND COMMUNITY-BASED ORGANIZATIONS IN OUTREACH AND ENROLLMENT ACTIVITIES- The Secretary shall establish a procedure under which, if States do not otherwise obligate the amounts made available under this subsection, local and community-based public or nonprofit organizations (including local and county governments, public health departments, community health centers, children's hospitals, and disproportionate share hospitals) may seek to have administrative costs relating to outreach and enrollment of children and pregnant women under this title and title XXI be treated and reimbursed as administrative costs of a State described in section 1903(a)(7), if such organizations have the permission of the State involved. A State may require such an organization to provide payment of such amounts as the State would otherwise be responsible for in order to obtain payment under this paragraph.'.

(2) USE OF 3 PERCENT OF SCHIP FUNDS AT 90 PERCENT FEDERAL MATCH FOR ENROLLMENT AND OUTREACH ACTIVITIES- Section 2105(b) (42 U.S.C. 1397ee(b)) is amended--

(A) by designating the matter following the dash as a paragraph (1) with appropriate indentation and with the heading `(1) IN GENERAL';

(B) by inserting `subject to paragraph (2)' after `(a)';

(C) by striking `(1)' and `(2)' and inserting `(A)' and `(B)', respectively; and

(D) by adding at the end the following paragraph:

`(2) SPECIAL RULE FOR CERTAIN ENROLLMENT AND OUTREACH ACTIVITIES-

`(A) IN GENERAL- For purposes of subsection (a), in the case of a State that meets the requirement of subparagraph (B), and subject to subparagraph (C), the `enhanced FMAP' is equal to 90 percent with respect to amounts expended on enrollment and outreach activities.

`(B) REQUIREMENTS- Subparagraph (A) shall only apply to a State if the State meets the following requirements:

`(i) NO ASSET TEST- The State does not impose an asset test for eligibility under the State child health plan or under section 1902(l) with respect to children.

`(ii) COMPLIANCE WITH OUTSTATIONING REQUIREMENT- The Secretary finds that the State is providing for the receipt and initial processing of applications of certain individuals at facilities defined as disproportionate share hospitals under section 1923(a)(1)(A) and Federally-qualified health centers described in section 1905(1)(2)(B) consistent with the requirements of section 1902(a)(55).

`(iii) COMPLIANCE WITH SIMPLIFIED OUTREACH AND ENROLLMENT PROVISIONS- The Secretary finds that the State is providing for outreach and enrollment under this title and title XIX consistent with the requirements of sections 2102(c), 2102(d), and 1902(a)(66).

`(iv) ALLOWING MAIL AND TELEPHONE APPLICATIONS- The State allows applications for children under this title and title XIX to be submitted by mail or through telephone.

`(C) LIMITATION TO 3 PERCENT OF ANNUAL ALLOTMENT- Subparagraph (A) shall not apply to amounts expended by a State in a fiscal year in excess of 3 percent of the amount of the amount of its allotment under section 2104 for that fiscal year.'.

(3) EFFECTIVE DATE- The amendments made by this subsection take effect on the date of the enactment of this Act and apply to expenditures made on or after the date of the enactment of this Act.

(d) ADDITIONAL ENTITIES QUALIFIED TO DETERMINE MEDICAID PRESUMPTIVE ELIGIBILITY FOR LOW-INCOME CHILDREN- Section 1920A(b)(3)(A)(i) (42 U.S.C. 1396r-1a(b)(3)(A)(i)) is amended--

(1) by striking `or (II)' and inserting `, (II)'; and

(2) by inserting `eligibility of a child for medical assistance under the State plan under this title, or eligibility of a child for child health assistance under the program funded under title XXI, (III) is an elementary school or secondary school, as such terms are defined in section 14101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 8801), an elementary or secondary school operated or supported by the Bureau of Indian Affairs, a State child support enforcement agency, a child care resource and referral agency, or a State office or private contractor that accepts applications for or administers a program funded under part A of title IV or that determines eligibility for any assistance or benefits provided under any program of public or

assisted housing that receives Federal funds, including the program under section 8 or any other section of the United States Housing Act of 1937 (42 U.S.C. 1437 et seq.), or (IV) any other entity the State so deems' before the semicolon.

SEC. 3. FAMILY FRIENDLY COVERAGE AND ENROLLMENT.

(a) PROHIBITION OF WAITING PERIODS-

(1) IN GENERAL- Section 2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)) is amended--

(A) by striking `and' at the end of clause (i);

(B) by striking the period at the end of clause (ii) and inserting `; and'; and

(C) by adding at the end the following new clause:

`(iii) shall not permit the use of any mandatory waiting period (including any such period in order to carry out paragraph (3)(C)), unless the Secretary finds that the imposition of such a period would not be contrary to the provisions of this title.'.

(2) EFFECTIVE DATE- The amendments made by paragraph (1) apply to assistance furnished on or after the date of the enactment of this Act.

(b) GRACE PERIOD BEFORE DISENROLLMENT FOR NONPAYMENT OF PREMIUMS-

(1) IN GENERAL- Section 2103(e) (42 U.S.C. 1397ee(e)) is amended by adding at the end the following new paragraph:

`(5) GOOD CAUSE WAIVER OF DISENROLLMENT FOR NONPAYMENT OF PREMIUMS- The State child health plan shall establish rules allowing waiver for good cause of termination of enrollment for nonpayment of premiums and shall establish an appeals process that includes a hearing and a 3-month grace period prior to termination of coverage and includes waiver of any late payment penalties when premium payments are made in full.'.

(2) EFFECTIVE DATE- The amendment made by paragraph (1) applies to disenrollments occurring on or after the date that is 30 days after the date of the enactment of this Act.

SEC. 4. EXPANDED COVERAGE OPTIONS.

(a) AUTOMATIC REASSESSMENT OF ELIGIBILITY FOR SCHIP AND MEDICAID BENEFITS FOR CHILDREN LOSING MEDICAID OR SCHIP ELIGIBILITY-

(1) LOSS OF MEDICAID ELIGIBILITY- Section 1902(a)(66) (42 U.S.C. 1396a(a)(66)), as inserted by section 2(a)(2), is amended--

(A) by striking `and' at the end of subparagraph (B),

(B) by striking the period at the end of subparagraph (C) and inserting `; and'; and

(C) by adding at the end the following new subparagraph:

`(D) the automatic assessment, in the case of a child who loses eligibility for medical assistance under this title on the basis of changes in income, assets, or age, of whether the child is eligible for benefits under title XXI.'.

(2) LOSS OF SCHIP ELIGIBILITY- Section 2102(b)(3) (42 U.S.C. 1397bb(b)(3)) is amended by redesignating subparagraphs (D) and (E) as subparagraphs (E) and (F), respectively, and by inserting after subparagraph (C) the following new subparagraph:

`(D) that there is an automatic assessment, in the case of a child who loses eligibility for child health assistance under this title on the basis of changes in income, assets, or age,

of whether the child is eligible for medical assistance under title XIX;'.

(3) EFFECTIVE DATE- The amendments made by paragraphs (1) and (2) apply to children who lose eligibility under the medicaid program under title XIX, or under a State child health insurance plan under title XXI, respectively, of the Social Security Act on or after the date that is 30 days after the date of the enactment of this Act.

(b) OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED PREGNANT WOMEN UNDER A STATE CHILD HEALTH PLAN-

(1) IN GENERAL- Title XXI is amended by adding at the end the following new section:

`SEC. 2111. OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED PREGNANT WOMEN.

`(a) OPTIONAL COVERAGE- Notwithstanding any other provision of this title, a State child health plan may provide for coverage of pregnancy-related assistance for targeted low-income pregnant women in accordance with this section, but only if the State has established an income eligibility level under section 1902(l)(2)(A) for women described in section 1902(l)(1)(A) that is 185 percent of the income official poverty line.

`(b) 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) as if any reference to targeted low-income children were a reference to targeted low-income pregnant women, except that the assistance shall be limited to services related to pregnancy (which include prenatal, delivery, and postpartum services) and to other conditions that may complicate pregnancy and shall not include prepregnancy services and supplies.

`(2) TARGETED LOW-INCOME PREGNANT WOMAN- The term `targeted low-income pregnant woman' has the meaning given the term targeted low-income child in section 2110(b) as if any reference to a child were deemed a reference to a woman during pregnancy and through the end of the month in which the 60-day period (beginning on the last day of her pregnancy) ends.

`(c) REFERENCES TO TERMS AND SPECIAL RULES- In the case of, and with respect to, a State providing for coverage of pregnancy-related assistance to targeted low-income pregnant women under subsection (a), the following special rules apply:

`(1) Any reference in this title (other than subsection (b)) to a targeted low income child is deemed to include a reference to a targeted low-income pregnant woman.

`(2) Any such reference to child health assistance with respect to such women is deemed a reference to pregnancy-related assistance.

`(3) Any such reference to a child is deemed a reference to a woman during pregnancy and the period described in subsection (b)(2).

`(4) The medicaid applicable income level is deemed a reference to the income level established under section 1902(l)(2)(A).

`(5) Subsection (a) of section 2103 (relating to required scope of health insurance coverage) shall not apply insofar as a State limits coverage to services described in subsection (b)(1) and the reference to such section in section 2105(a)(1) is deemed not to require, in such case, compliance with the requirements of section 2103(a).

`(6) There shall be no exclusion of benefits for services described in subsection (b)(1) based on any pre-existing condition and no waiting period (including any waiting period imposed to carry out section 2102(b)(3)(C)) shall apply.

`(d) NO IMPACT ON ALLOTMENTS- Nothing in this section shall be construed as affecting the amount of any initial allotment provided to a State under section 2104(b).

`(e) APPLICATION OF FUNDING RESTRICTIONS- The coverage under this section (and the funding of such coverage) is subject to the restrictions of section 2105(c).

`(f) AUTOMATIC ENROLLMENT FOR CHILDREN BORN TO WOMEN RECEIVING PREGNANCY-RELATED ASSISTANCE- Notwithstanding any other provision of this title or title XIX, 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 children'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, in the case of a State that provides such assistance through the provision of medical assistance under a plan under title XIX, to have applied for medical assistance under such title and to have been found eligible for such assistance under such title) on the date of such birth and to remain eligible for such assistance until the child attains 1 year of age 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) STATE OPTION TO USE ENHANCED FMAP FOR COVERAGE OF ADDITIONAL PREGNANT WOMEN UNDER THE MEDICAID PROGRAM- Section 1905 (42 U.S.C. 1396d) is amended--

(A) in subsection (b), by inserting `and in the case of a State plan that meets the condition described in subsections (u)(1) and (u)(4)(A), with respect to expenditures described in subsection (u)(4)(B) for the State for a fiscal year' after `for a fiscal year,';

(B) by redesignating paragraph (4) of subsection (u) as paragraph (5); and

(C) by inserting after paragraph (3) of subsection (u) the following new paragraph:

`(4)(A) The condition described in this subparagraph for a State plan is that the plan has established an income level under section 1902(l)(2)(A) with respect to individuals described in section 1902(l)(1)(A) that is 185 percent of the income official poverty line.

`(B) For purposes of subsection (b), the expenditures described in this paragraph are expenditures for medical assistance for women described in section 1902(l)(1)(A) whose income exceeds the income level established for such women under section 1902(l)(2)(A)(i) as of the date of the enactment of this paragraph but does not exceed 185 percent of the income official poverty line.'.

(3) CONFORMING AMENDMENTS- Section 2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)) is amended--

(A) by striking `and' at the end of clause (i);

(B) by striking the period at the end of clause (ii) 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 child who is pregnant, if the State provides for coverage of pregnancy-related assistance for targeted low-income pregnant women in accordance section 2111.'.

(4) EFFECTIVE DATE- The amendments made by this subsection take effect on the date of the enactment of this Act and apply to allotments for all fiscal years.

(c) STATE OPTION FOR COVERAGE OF QUALIFIED ALIEN CHILDREN UNDER MEDICAID AND CHILDREN'S HEALTH INSURANCE PROGRAMS-

(1) MEDICAID-

(A) CATEGORICALLY NEEDY- Section 1902(a)(10)(a)(ii) (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--

(i) by striking `or' at the end of subclause (XIII);

(ii) by adding `or' at the end of subclause (XIV); and

(iii) by adding at the end the following new subclause:

`(XV) who are described in section 1905(a)(i) and who would be eligible for medical assistance (or for a greater amount of medical assistance) under the State plan under this title but for the provisions of section 403 or section 421 of Public Law 104-193, but the State may not exercise the option of providing medical assistance under this subclause with respect to a subcategory of individuals described in this subclause;'.

(B) MEDICALLY NEEDY- Section 1902(a)(10)(C)(i)(I) (42 U.S.C. 1396a(a)(10)(C)(i)(I)) is amended by inserting `(and such criteria may provide for eligibility of individuals described in subparagraph (A)(ii)(XV))' after `medical assistance'.

(2) CHILDREN'S HEALTH INSURANCE PROGRAM- Section 2110(b) (42 U.S.C. 1397jj(b)) is amended--

(A) in paragraph (1)(A), by inserting before the semicolon `(including, at the option of the State, a child described in paragraph (3)(B))'; and

(B) in paragraph (3)--

(i) by striking `SPECIAL RULE- ' and inserting `SPECIAL RULES-

`(i) HEALTH INSURANCE COVERAGE- ' by indenting the remainder of the text accordingly; and

(ii) by adding at the end the following new subparagraph:

`(B) ELIGIBILITY FOR QUALIFIED ALIEN CHILDREN- For purposes of paragraph (1)(A), a child is described in this subparagraph if--

`(i) the child would be determined eligible for child health assistance under this title but for any or all of the provisions of sections 403 and 421 of Public Law 104-193; and

`(ii) the State exercises the option to provide medical assistance to the category of individuals described in section 1902(a)(10)(A)(ii)(XV).'.

(3) PROHIBITION ON SEEKING SUPPORT FROM SPONSOR- Section 213A(b) of the Immigration and Nationality Act (8 U.S.C. 1183a(b)) is amended by adding at the end the following new paragraph:

`(4) EXCEPTION FOR CHILD MEDICAID OR SCHIP ASSISTANCE- The preceding provisions of this subsection shall not apply to--

`(A) medical assistance furnished under the State plan under title XIX of the Social Security Act to an individual eligible for such assistance because of subclause (XV) of paragraph (10)(A)(ii) of section 1902(a) of such Act (42 U.S.C. 1396a(a)) or because of the reference to such subclause in paragraph (10)(C) of such section; or

`(B) child health assistance furnished under the State child health plan under title XXI of such Act to a child eligible for such assistance because of the provisions of section 2110(b)(3)(B) of such Act (42 U.S.C. 1397jj(b)(3)(B)).'.

(d) ELIMINATION OF FUNDING OFFSET FOR EXERCISE OF PRESUMPTIVE ELIGIBILITY OPTION-

(1) IN GENERAL- Section 2104(d) (42 U.S.C. 1397dd(d)) is amended by striking `shall be reduced by the sum of' and all that follows through `(2) the amount of payments under such section' and inserting `shall be reduced by the amount of payments under section 1903(a)(1)'.

(2) EFFECTIVE DATE- The amendment made by paragraph (1) first applies for allotments for fiscal year 2001.

(f) PROGRAM COORDINATION WITH THE MATERNAL AND CHILD HEALTH PROGRAM (TITLE V)-

(1) IN GENERAL- Section 2102(b)(3) (42 U.S.C. 1397bb(b)(3)) is amended--

(A) by striking `and' at the end of subparagraph (D);

(B) by striking the period at the end of subparagraph (E) and inserting `; and'; and

(C) by adding at the end the following new subparagraph:

`(F) that operations and activities under this title are developed and implemented in consultation and coordination with the program operated by the State under title V in areas including outreach and enrollment, benefits and services, service delivery standards, public health and social service agency relationships, and quality assurance and data reporting.'.

(2) CONFORMING MEDICAID AMENDMENT- Section 1902(a)(11) (42 U.S.C. 1306a(a)(11)) is amended--

(A) by striking `and' before `(C)'; and

(B) by inserting before the semicolon at the end the following: `, and (D) provide that operations and activities under this title are developed and implemented in consultation and coordination with the program operated by the State under title V in areas including outreach and enrollment, benefits and services, service delivery standards, public health and social service agency relationships, and quality assurance and data reporting'.

(3) EFFECTIVE DATE- The amendments made by this subsection take effect on January 1, 2001.

SEC. 5. AVAILABILITY OF FISCAL YEAR 1998 AND FISCAL YEAR 1999 ALLOTMENTS UNDER SCHIP.

Notwithstanding subsection (e) of section 2104 of the Social Security Act (42 U.S.C. 1397dd), amounts allotted to a State under that section for each of fiscal years 1998 and 1999 shall remain available through September 30, 2002.

SEC. 6. PERMITTING INCREASED SHARE OF SCHIP FUNDS TO BE EXPENDED FOR PREVENTION PROGRAMS THAT ENSURE HEALTHY CHILDHOODS AND QUALITY PRENATAL HEALTH CARE.

Section 2105(c)(2) (42 U.S.C. 1397ee(c)(2)) is amended by adding at the end the following new subparagraph:

`(C) EXCEPTION FOR OUTREACH AND PREVENTION PROGRAMS IN STATES WITH SUBSTANTIAL ENROLLMENT AND THAT WOULD NOT OTHERWISE USE FULL ALLOTMENT-

`(i) IN GENERAL- In the case of a State described in clause (ii)--

`(I) the limitation under subparagraph (A) on expenditures for items described in subparagraphs (B) or (C) of subsection (a)(2) shall not apply, but only up to 30 percent of the sum described in subparagraph (A); and

`(II) in applying subparagraph (B) of subsection (a)(2), activities undertaken by the State in conjunction with the Centers for Disease Control and Prevention to carry out activities

to promote health pregnancies and healthy children shall be treated as expenditures described in such subparagraph, subject to the limitation under subclause (I) of this clause.

`(ii) STATE DESCRIBED- A State described in this clause is a State that establishes to the satisfaction of the Secretary that--

`(I) the State provides for an income level under section 2110(b)(1)(B)(i)(I) that is not less than 200 percent of the poverty line;

`(II) the State does not provide for any waiting list for enrollment under this title;

`(III) the State has enrolled under this title and title XIX at least 70 percent of the children eligible for enrollment under such titles; and

`(IV) without the application of this subparagraph, the State will not be able to expend all the funds allotted to it under this title.

The Secretary may waive the requirement of subclause (III) where the State demonstrates to the satisfaction of the Secretary that the State has made all possible efforts to achieve the enrollment level specified in the subclause.

`(iii) PUBLIC-PRIVATE PARTNERSHIPS- In conducting activities under clause (i), a State may build partnerships with outside organization whose primary goal involves the healthy development of mothers and children and may act to otherwise eradicate illnesses and environmental factors that impact these groups.

`(iv) ADDITIONAL PAYMENTS- The provisions of this subparagraph apply in addition to the expenditures permitted under subparagraph (A) for items described in subparagraphs (B) and (C) of subsection (a)(2).'.

SEC. 7. USE OF SCHIP FUNDS FOR ENHANCED MATCHING RATE FOR COVERAGE OF ADDITIONAL CHILDREN UNDER THE MEDICAID PROGRAM.

(a) IN GENERAL- Section 1905 (42 U.S.C. 1396d), as amended by section 4(b)(2), is amended--

(1) in subsection (b), by striking `or subsection (u)(3)' and inserting `, subsection (u)(3), or subsection (u)(5)(A)'; and

(2) in subsection (u)--

(A) by redesignating paragraph (5) as paragraph (6); and

(B) by inserting after paragraph (4) the following new paragraph:

`(5)(A) For purposes of subsection (b), the expenditures described in this subparagraph are expenditures for medical assistance for waivered low-income children described in subparagraph (B) but--

`(i) only in the case of children residing in a State described in subparagraph (C); and

`(ii) only to the extent the number of full-year equivalent waivered low-income children enrolled under the State plan under this title for the fiscal year exceeds the number of waivered low-income children described in subparagraph (D)(i) for the State for the fiscal year.

`(B) For purposes of this paragraph, the term `waivered low-income child' means a child whose family income exceeds the minimum income level required to be established for the age of such child under section 1902(l)(2) in order for the child to be eligible for medical assistance under this title, but does not exceed the medicaid applicable income level (as defined in section 2110(b)(4) but determined as if `June 1, 1997' were substituted for `March 31, 1997') for that child.

`(C) A State described in this subparagraph is a State that--

`(i) has under a waiver authorized by the Secretary or under section 1902(r)(2) established and is using a medicaid applicable income level (as defined in section 2110(b)(4) but determined as if `June 1, 1997' were substituted for `March 31, 1997') for children under 19 years of age residing in the State that is at or above 200 percent of the poverty line; and

`(ii) demonstrates to the satisfaction of the Secretary that the State has taken all of the following actions to reach and enroll children who are eligible for, but not enrolled under, the State plan:

`(I) Eliminating the assets test for eligibility of waivered low-income children.

`(II) Using shortened and simplified applications for such children.

`(III) Allowing applications for such children to be submitted by mail or through telephone.

`(IV) Outstationing State eligibility workers at sites that are frequented by families with children, including schools, child care centers, churches, centers providing Head Start services, local offices of the special supplemental food program for women, infants and young children (WIC) established under section 17 of the Child Nutrition Act of 1966, community centers, Job Corps centers established under part B of title IV of the Job Training Partnership Act or subtitle C of title I of the Workforce Investment Act of 1998, sites offering the recognized equivalent of a secondary school degree, offices of tribal organizations (as defined in section 4(l) of the Indian Self-Determination and Education Assistance Act), and Social Security Administration field offices.

`(V) Using presumptive eligibility for waivered low-income children.

`(VI) Collaborating with public and private entities to conduct outreach campaigns to enroll such children.

`(D)(i) For purposes of subparagraph (A)(ii), the number of waivered low-income children for a State described in this clause for--

`(I) fiscal year 1998, is equal to the number of full-year equivalent waivered low-income children enrolled under the State plan under this title for fiscal year 1997; and

`(II) fiscal year 1999 or a succeeding fiscal year, is equal to the number of waivered low-income children determined under this clause for the preceding fiscal year increased by the number of percentage points determined under clause (ii) for the State for the fiscal year involved.

`(ii) The number of percentage points determined under this clause for a State for a fiscal year is equal to the number of percentage points by which--

`(I) the arithmetic average of the total number of children in the State set forth in the 3 most recent March supplements to the Current Population Survey of the Bureau of the Census before the beginning of the fiscal year; exceeds

`(II) the arithmetic average of such total number set forth in the second, third, and fourth most recent March supplements to such Survey before the beginning of the fiscal year.

`(E) Each State shall submit to the Secretary such information, at such time and in such manner, as the Secretary determines is necessary to ensure that the requirements of this paragraph are satisfied. The Secretary shall ensure that information is provided under this subsection in a manner that is consistent with other reporting requirements for information required to be submitted by a State under this title and title XXI, and avoids duplication of reporting requirements.

`(F) The Secretary shall regularly examine the payments made to a State for the expenditures described in subparagraph (A) to confirm that the payments are attributable to expenditures described in such subparagraph.'.

(b) CONFORMING AMENDMENT- Section 1902(a)(10)(A)(ii)(XIV) (42 U.S.C. 1396a(a)(10)(A)(ii)(XIV)) is amended by striking `1905(u)(2)(C)' and inserting `1905(u)(2)(B)'.

(c) EFFECTIVE DATE- The amendments made by this section shall be effective as if included in the enactment of section 4911 of the Balanced Budget Act of 1997 (Public Law 105-33; 111 Stat. 570).

END