HR 4932 IH

To amend titles XIX and XXI of the Social Security Act to expand access of children to health care.

July 24, 2000

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

To amend titles XIX and XXI of the Social Security Act to expand access of children to health care.

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.

(a) SHORT TITLE- This Act may be cited as the `Medikid Health Care Expansion Act of 2000'.

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

Sec. 1. Short title; table of contents.

Sec. 2. Permitting States to increase SCHIP eligibility to up to 250 percent of poverty line.

Sec. 3. Allowing higher income families to buy into program.

Sec. 4. Simplified outreach and enrollment.

Sec. 5. Expediting eligibility process.

Sec. 6. Availability of enrollment performance incentive bonuses from reallotment.

Sec. 7. Encouraging school-based outreach.

Sec. 8. Extending authorization of graduate medical education funding for children's hospitals.

Sec. 9. Optional coverage of low-income, uninsured pregnant women under a state child health plan.

SEC. 2. PERMITTING STATES TO INCREASE SCHIP ELIGIBILITY TO UP TO 250 PERCENT OF POVERTY LINE.

(a) IN GENERAL- Section 2110(c)(4) of the Social Security Act (42 U.S.C. 1397jj(c)(4)) is amended by inserting `(or, at the option of the State, a higher percent not to exceed 250 percent)' after `200 percent'.

(b) EFFECTIVE DATE- The amendment made by subsection (a) takes effect as of the date of the enactment of this Act.

SEC. 3. ALLOWING HIGHER INCOME FAMILIES TO BUY INTO PROGRAM.

Title XXI of the Social Security Act is amended by adding at the end the following new section:

`SEC. 2111. OPTIONAL STATE BUY-IN PERMITTED FOR OTHER CHILDREN.

`Nothing in this title shall be construed as preventing a State from permitting families of children who are not low-income children to enroll in the State child health plan in return for payment of such premium as the State may establish.'.

SEC. 4. SIMPLIFIED OUTREACH AND ENROLLMENT.

Section 2102 of the Social Security Act (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 agency in order to determine whether a child is eligible for benefits under this title or title XIX.'.

SEC. 5. EXPEDITING ELIGIBILITY PROCESS.

(a) APPLICATION OF PRESUMPTIVE ELIGIBILITY UNDER SCHIP AND REDUCTION OF STATE MATCH FOR OUTREACH IF ELECT PRESUMPTIVE ELIGIBILITY-

(1) IN GENERAL- Section 2102 of the Social Security Act (42 U.S.C. 1397bb), as amended by section 4, is further amended by adding at the end the following new subsection:

`(e) APPLICATION OF PRESUMPTIVE ELIGIBILITY PROVISIONS- A State may elect to apply the provisions of section 1920A under this title in the same manner as the State may elect to apply such provisions under title XIX.'.

(2) REDUCTION OF STATE MATCHING REQUIREMENT- Section 2105 of such Act (42 U.S.C. 1397ee) is amended--

(A) in subsection (b), by inserting `subject to subsection (g),' after `For purposes of subsection (a),'; and

(B) by adding at the end the following new subsection:

`(g) 90 PERCENT FEDERAL MATCH FOR ADDITIONAL OUTREACH EXPENDITURES IF STATE ELECTS TO USE PRESUMPTIVE ELIGIBILITY FOR BOTH MEDICAID AND SCHIP- The enhanced FMAP with respect to child health assistance for outreach services described in section 2102(c)(1) for a State shall be, with respect to expenditures for such services above the level of such expenditures in fiscal year 2000, equal to 90 percent if the State has both--

`(1) elected to apply the provisions of section 1920A under title XIX for the entire fiscal year; and

`(2) elected under section 2102(e) to apply the provisions of section 1920A under this title for the entire 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 fiscal years beginning on or after such date.

(b) Clarification of Use of SCHIP Funds To Provide Enrolling Centers With Incentives To Enroll Low-Income Children-

(1) IN GENERAL- Section 2105 of such Act (42 U.S.C. 1397ee), as amended by subsection (b), is further amended--

(A) in subsection (g), by inserting `and for expenditures described in subsection (h)' after `described in section 2102(c)(1)'; and

(B) by adding at the end the following new subsection:

`(h) TREATMENT OF ENROLLMENT INCENTIVES- Reasonable expenditures to enrolling centers to provide an incentive to enroll targeted low-income children under this

title shall be treated as reasonable costs incurred by the State to administer the plan for purposes of subsection (a)(2)(D).'.

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

SEC. 6. AVAILABILITY OF ENROLLMENT PERFORMANCE INCENTIVE BONUSES FROM REALLOTMENT.

Section 2105 of the Social Security Act (42 U.S.C. 1397ee), as amended by section 5(a)(2), is amended by adding at the end the following new subsection:

`(h) ENROLLMENT PERFORMANCE INCENTIVE BONUS PAYMENTS-

`(1) IN GENERAL- In the case of a bonus eligible State described in paragraph (2), the Secretary shall pay to the State, from the amount of an allotment redistributed to the State under section 2104(f) during a fiscal year (beginning with fiscal year 2001), an incentive performance bonus payment equal to such percent (not less than 2 percent, and not to exceed 5 percent) of the amount of such allotment as the Secretary determines appropriate based on the State's performance in meeting or exceeding objectives referred to in paragraph (2)(B).

`(2) BONUS ELIGIBLE STATE- A bonus eligible State described in this paragraph for a fiscal year is a State that--

`(A) has not had any allotment for any previous fiscal year redistributed to another State under section 2104(f); and

`(B) meets or exceeds reasonable objectives established by the Secretary for the enrollment of low-income children under this title (and title XIX).

`(3) TREATMENT OF PAYMENT- The amount paid under paragraph (1)--

`(A) shall be paid without the need for any non-Federal contribution under subsection (a);

`(B) may be used for any expenditures permitted under subsection (b)(1) and without regard to any limitations under paragraphs (2) and (3) of subsection (b); but

`(C) may not be included in determining the amount of non-Federal contributions otherwise required under subsection (a).'.

SEC. 7. ENCOURAGING SCHOOL-BASED OUTREACH.

(a) IN GENERAL- Section 2102(c)(1) of such Act (42 U.S.C. 1397bb(c)(1)) is amended by adding at the end the following: `Such outreach shall include school-based programs targeted at schools with high rates of uninsured children.'.

(b) EFFECTIVE DATE- The amendment made by subsection (a) takes effect on October 1, 2000.

SEC. 8. EXTENDING AUTHORIZATION OF GRADUATE MEDICAL EDUCATION FUNDING FOR CHILDREN'S HOSPITALS.

Section 340E of the Public Health Service Act (42 U.S.C. 256e) is amended--

(1) in subsection (a), by striking `and 2001' and inserting `through 2005'; and

(2) in subsection (f)--

(A) in paragraph (1)(A)(ii), by striking `for fiscal year 2001' and inserting `for each of fiscal years 2001 through 2005';

(B) in paragraph (1)(B), by striking `for fiscal year 2000 shall remain available for obligation through the end of fiscal year 2001' and inserting `for a fiscal year shall remain available for obligation through the end of the succeeding fiscal year'; and

(C) in paragraph (2)(B), by striking `for fiscal year 2001' and inserting `for each of fiscal years 2001 through 2005'.

SEC. 9. OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED PREGNANT WOMEN UNDER A STATE CHILD HEALTH PLAN.

(a) IN GENERAL- Title XXI of the Social Security Act, as amended by section 3, is further amended by adding at the end the following new section:

`SEC. 2112. 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. 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).'.

(b) STATE OPTION TO USE ENHANCED FMAP FOR COVERAGE OF ADDITIONAL PREGNANT WOMEN UNDER THE MEDICAID PROGRAM- Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended--

(1) 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,';

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

(3) 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 than 185 percent of the income official poverty line.'.

(c) CONFORMING AMENDMENTS- Section 2102(b)(1)(B) of the Social Security Act (42 U.S.C. 1397bb(b)(1)(B)) is amended--

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

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

(3) 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 2112.'.

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

END