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 123STA T . 12 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9‘ ‘ (i i )Theamount a l lotte d to the S tate f o r fi sc al y ear 20 0 8 under su b section (b) , multi p lied by the allot - ment increase factor determined under para g raph ( 5 ) for fiscal year 200 9. ‘‘(iii) The pro j ected total F ederal payments to the State under this title for fiscal year 2009, as deter- mined on the basis of the February 2009 projections certified by the State to the Secretary by not later than M arch 31, 2009. ‘‘( B )F ORTHEC O M MO NW E AL TH S AN D TERR I TORIES. — Subject to the succeeding pro v isions of this paragraph and paragraph ( 4 ), the Secretary shall allot for fiscal year 2009 from the amount made available under subsection (a)(12) to each of the common w ealths and territories described in subsection (c)(3) an amount e q ual to the highest amount of Federal payments to the commonwealth or territory under this title for any fiscal year occurring during the period of fiscal years 1999 through 2008, multiplied by the allotment increase factor determined under paragraph (5) for fiscal year 2009, e x cept that subparagraph (B) thereof shall be applied by substituting ‘the U nited States ’ for ‘the State’. ‘‘( C ) A D JU STMENT F OR Q UALIF Y IN G STATES.— I n the case of a qualifying State described in paragraph (2) of section 2105(g), the Secretary shall permit the State to submit a revised projection described in subparagraph (A)(iii) in order to ta k e into account changes in such projections attributable to the application of paragraph (4) of such section. ‘‘(2) FOR FISCAL YEARS 201 0 THROUGH 2012.— ‘‘(A) IN GENERAL.—Subject to paragraphs (4) and ( 6 ), from the amount made available under paragraphs (13) through (15) of subsection (a) for each of fiscal years 2010 through 2012, respectively, the Secretary shall compute a State allotment for each State (including the D istrict of Columbia and each commonwealth and territory) for each such fiscal year as follows ‘‘(i) G ROWTH FACTOR U P DATE FOR FISCAL YEAR 2010.—For fiscal year 2010, the allotment of the State is equal to the sum of— ‘‘(I) the amount of the State allotment under paragraph (1) for fiscal year 2009 and ‘‘(II) the amount of any payments made to the State under subsection (k), (l), or (n) for fiscal year 2009, multiplied by the allotment increase factor under para- graph (5) for fiscal year 2010. ‘‘(ii) R E B ASING IN FISCAL YEAR 2011.—For fiscal year 2011, the allotment of the State is equal to the Federal payments to the State that are attributable to (and countable towards) the total amount of allotments available under this section to the State in fiscal year 2010 (including payments made to the State under subsection (n) for fiscal year 2010 as well as amounts redistributed to the State in fiscal year 2010), multi- plied by the allotment increase factor under paragraph (5) for fiscal year 2011. Ap p licab ili ty.Cer ti f icati on . D ea d line.


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 123STA T . 13 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9‘ ‘ (i ii )GROWTHFAC TOR UPD AT E FOR F IS CA LY EAR 201 2 .—Forf i scalye ar 201 2 ,th e allot m e n tofthe S tate ise qu al to the sum of— ‘‘( I ) the amount of the State allotment un d er clause (ii) for fiscal year 2011 and ‘‘(II) the amount of any p ayments made to the State under su b section (n) for fiscal year 2011, multiplied by the allotment increase factor under para -g raph ( 5 ) for fiscal year 2012. ‘‘( 3 ) FOR FISCAL YEAR 201 3 .— ‘‘( A ) FIRST HALF.—Sub j ect to paragraphs ( 4 )and( 6 ), from the amount made a v ailable under subparagraph (A) of paragraph (16) of subsection (a) for the semi-annual period described in such paragraph, increased by the amount of the appropriation for such period under section 10 8 of the C hildren ’ s H ealth Insurance P rogram R eauthor- i z ation Act of 200 9, the Secretary shall compute a State allotment for each State (including the D istrict of Columbia and each common w ealth and territory) for such semi- annual period in an amount equal to the first half ratio (described in subparagraph (D)) of the amount described in subparagraph (C). ‘‘( B ) SECO N D HALF.—Subject to paragraphs (4) and (6), from the amount made available under subparagraph (B) of paragraph (16) of subsection (a) for the semi-annual period described in such paragraph, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the amount made available under such subparagraph, multi- plied by the ratio of— ‘‘(i) the amount of the allotment to such State under subparagraph (A); to ‘‘(ii) the total of the amount of all of the allotments made available under such subparagraph. ‘‘(C) FULL YEAR A M OUNT B ASED ON REBASED AMOUNT.— T he amount described in this subparagraph for a State is equal to the Federal payments to the State that are attributable to (and countable towards) the total amount of allotments available under this section to the State in fiscal year 2012 (including payments made to the State under subsection (n) for fiscal year 2012 as well as amounts redistributed to the State in fiscal year 2012), multiplied by the allotment increase factor under paragraph (5) for fiscal year 2013. ‘‘(D) FIRST HALF RATIO.—The first half ratio described in this subparagraph is the ratio of— ‘‘(i) the sum of— ‘‘(I) the amount made available under sub- section (a)(16)(A); and ‘‘(II) the amount of the appropriation for such period under section 108 of the Children’s Health Insurance Program Reauthorization Act of 2009; to ‘‘(ii) the sum of the— ‘‘(I) amount described in clause (i); and

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The New International Encyclopædia/White, Edward Douglass

WHITE, (1845—). An American jurist, associate justice of the United States Supreme Court. He was born in La Fourche Parish, La.; was educated at Mount Saint Mary's College (Emmitsburg, Md.), Georgetown College (Georgetown, D. C.), and the Jesuit College at New Orleans; and served in the Confederate Army during part of the Civil War. In 1868 he was admitted to the Louisiana bar, and soon attained considerable prominence in his profession. He was a member of the State Senate from 1874 to 1878, was an associate justice of the Supreme Court of Louisiana from 1878 to 1801, was then a Democratic member of the United States Senate for three years, and in February, 1894, was appointed an associate justice of the United States Supreme Court.


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 123STA T . 1 4PUBLIC LA W 111 – 3 —FE B.4 , 2 0 0 9‘ ‘ (I I )theamoun tma d ea v a il a b le unde rs ub - se c tion (a)( 16 )( B ) . ‘‘( 4 ) PRO R ATI O N R ULE . — I f, after the a p plication of this sub- section w ithout re g ard to this paragraph, the sum of the allot- ments determined under paragraph (1), ( 2 ),or( 3 ) for a fiscal y ear (or, in the case of fiscal year 2 0 13, for a semi-annual period in such fiscal year) e x ceeds the amount available under subsection (a) for such fiscal year or period, the S ecretary shall reduce each allotment for any State under such paragraph for such fiscal year or period on a proportional basis. ‘‘( 5 ) A LLOT M ENT IN C REA S E F ACTOR.— T he allotment increase factor under this paragraph for a fiscal year is e q ual to the product of the following ‘‘(A) PER CA P ITA H EALTH CARE G RO W TH FACTOR.—1 plus the percentage increase in the pro j ected per capita amount of N ational H ealth E xpenditures from the calendar year in which the previous fiscal year ends to the calendar year in which the fiscal year involved ends, as most recently published by the Secretary before the beginning of the fiscal year. ‘‘(B) C HIL D POPULATION GROWTH FACTOR.—1 plus the percentage increase (if any) in the population of children in the State from J uly 1 in the previous fiscal year to July 1 in the fiscal year involved, as determined by the Secretary based on the most recent published estimates of the Bureau of the Census before the beginning of the fiscal year involved, plus 1 percentage point. ‘‘(6) INCREASE IN ALLOTMENT TO ACCOUNT FOR APPRO V ED PROGRAM E X PANSIONS.—In the case of one of the 50 States or the D istrict of Columbia that— ‘‘(A) has submitted to the Secretary, and has approved by the Secretary, a State plan amendment or waiver request relating to an expansion of eligibility for children or benefits under this title that becomes effective for a fiscal year (beginning with fiscal year 2010 and ending with fiscal year 2013) and ‘‘(B) has submitted to the Secretary, before the August 31 preceding the beginning of the fiscal year, a request for an expansion allotment adjustment under this para- graph for such fiscal year that specifies— ‘‘(i) the additional expenditures that are attrib- utable to the eligibility or benefit expansion provided under the amendment or waiver described in subpara- graph (A), as certified by the State and submitted to the Secretary by not later than August 31 preceding the beginning of the fiscal year; and ‘‘(ii) the extent to which such additional expendi- tures are projected to exceed the allotment of the State or District for the year, subject to paragraph (4), the amount of the allotment of the State or District under this subsection for such fiscal year shall be increased by the excess amount described in subpara- graph (B)(i). A State or District may only obtain an increase under this paragraph for an allotment for fiscal year 2010 or fiscal year 2012. ‘‘( 7 ) AVAILA B ILIT Y OF AMOUNTS FOR SEMI-ANNUAL PERIODS IN FISCAL YEAR 2013 .—Each semi-annual allotment made under Certif i ca ti on.D ea dl ine.


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 123STA T . 1 5PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9par a g rap h(3)fo rap e r i o d i n fi sc a ly ear 201 3 shall re m ain a v aila b lefore x pendi tu re under this title for periods after the end of such fiscal year in the same manner as if the allotment had been made available for the entire fiscal year .’ ’. SEC.103 .C HILD E NRO LL M EN T CONTIN G ENC YFU ND. S ection 210 4 (42 U .S. C . 13 97 dd) , as amended by section 102, is amended by adding at the end the follo w ing new subsection

‘(n) C HILDENRO LL ME N T CONTIN G EN CYFU ND. — ‘‘(1) E S T AB LISHMENT.— T here is hereby established in the Treasury of the United States a fund which shall be k nown as the ‘Child Enrollment Contingency Fund’ (in this subsection referred to as the ‘Fund’). A mounts in the Fund shall be avail - able without further appropriations for payments under this subsection. ‘‘(2) D E P OSITS INTO F UND.— ‘‘(A) I NITIAL AND SUBSE Q UENT APPROPRIATIONS.—Sub- j ect to subparagraphs ( B ) and (D), out of any money in the Treasury of the United States not otherwise appro- priated, there are appropriated to the Fund— ‘‘(i) for fiscal year 2009, an amount e q ual to 20 percent of the amount made available under paragraph (12) of subsection (a) for the fiscal year and ‘‘(ii) for each of fiscal years 2010 through 2012 (and for each of the semi-annual allotment periods for fiscal year 2013), such sums as are necessary for making payments to eligible States for such fiscal year or period, but not in excess of the aggregate cap described in subparagraph (B). ‘‘(B) AGGREGATE CAP.—The total amount available for payment from the Fund for each of fiscal years 2010 through 2012 (and for each of the semi-annual allotment periods for fiscal year 2013), taking into account deposits made under subparagraph (C), shall not exceed 20 percent of the amount made available under subsection (a) for the fiscal year or period. ‘‘(C) IN V ESTMENT OF FUND.—The Secretary of the Treasury shall invest, in interest bearing securities of the United States, such currently available portions of the Fund as are not immediately required for payments from the Fund. The income derived from these investments con- stitutes a part of the Fund. ‘‘(D) AVAILABILITY OF E X CESS FUNDS FOR PERFORMANCE BONUSES.—Any amounts in excess of the aggregate cap described in subparagraph (B) for a fiscal year or period shall be made available for purposes of carrying out section 210 5 (a)(3) for any succeeding fiscal year and the Secretary of the Treasury shall reduce the amount in the Fund by the amount so made available. ‘‘(3) CHILD ENROLLMENT CONTINGENCY FUND PAYMENTS.— ‘‘(A) IN GENERAL.—If a State’s expenditures under this title in fiscal year 2009, fiscal year 2010, fiscal year 2011, fiscal year 2012, or a semi-annual allotment period for fiscal year 2013, exceed the total amount of allotments available under this section to the State in the fiscal year or period (determined without regard to any redistribution


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 123STA T . 1 6PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9itrec ei v e sund er su b secti o n (f) t ha t is avai l able for e xp endi - ture durin g such fiscal y ear or period , but including any carryover fro m a previous fiscal year) and if the average monthly unduplicated number of children enrolled under the S tate plan under this title (including children receiving health care coverage through funds under this title pursu- anttoa w aiver under section 1 11 5 ) during such fiscal year or period exceeds its target average number of such enrollees (as determined under subparagraph ( B )) for that fiscal year or period, sub j ect to subparagraph ( D ), the Sec- retary shall pay to the State from the F und an amount e q ual to the product of —‘ ‘(i) the amount by which such average monthly caseload exceeds such target number of enrollees and ‘‘(ii) the projected per capita expenditures under the State child health plan (as determined under subparagraph ( C ) for the fiscal year), multiplied by the enhanced F MAP (as defined in section 2 1 0 5(b)) for the State and fiscal year involved (or in which the period occurs) . ‘‘(B) TARGET A V ERAGE NUMB ER OFCHILD ENROLLEE S .— I n this paragraph, the target average number of child enrollees for a State— ‘‘(i) for fiscal year 200 9 is equal to the monthly average unduplicated number of children enrolled in the State child health plan under this title (including such children receiving health care coverage through funds under this title pursuant to a waiver under section 1115) during fiscal year 200 8 increased by the population growth for children in that State for the year ending on J une 3 0, 200 7 (as estimated by the Bureau of the Census) plus 1 percentage point; or ‘‘(ii) for a subsequent fiscal year (or semi-annual period occurring in a fiscal year) is equal to the target average number of child enrollees for the State for the previous fiscal year increased by the child popu- lation growth factor described in subsection (m)(5)(B) for the State for the prior fiscal year. ‘‘(C) PRO J ECTED P ER CAPITA E X PENDITURES.—For pur- poses of subparagraph (A)(ii), the projected per capita expenditures under a State child health plan— ‘‘(i) for fiscal year 2009 is equal to the average per capita expenditures (including both State and Fed- eral financial participation) under such plan for the targeted low-income children counted in the average monthly caseload for purposes of this paragraph during fiscal year 2008, increased by the annual percentage increase in the projected per capita amount of N ational H ealth E xpenditures (as estimated by the Secretary) for 2009; or ‘‘(ii) for a subsequent fiscal year (or semi-annual period occurring in a fiscal year) is equal to the pro- jected per capita expenditures under such plan for the previous fiscal year (as determined under clause (i) or this clause) increased by the annual percentage increase in the projected per capita amount of National


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 123STA T . 1 7PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9HealthExp e ndi t ur e s( as esti m ated by the S e c retary )fo r the year in w hich such subse q uent fiscal year ends .‘ ‘( D ) PRO R ATI O N R ULE . —I f the amounts a v ailable for payment from the F und for a fiscal year or period are less than the total amount of payments determined under subpara g raph ( A ) for the fiscal year or period , the amount to be paid under such subparagraph to each eligible State shall be reduced proportionally. ‘‘(E) T I M EL YP AYMENT RE C ONCILIATION.—Payment under this paragraph for a fiscal year or period shall be made before the end of the fiscal year or period based upon the most recent data for expenditures and enrollment and the provisions of subsection (e) of section 2105 shall apply to payments under this subsection in the same manner as they apply to payments under such section. ‘‘(F) C ONTINUE D REPORTIN G .—For purposes of this paragraph and subsection (f), the State shall submit to the Secretary the State ’ s pro j ected Federal expenditures, even if the amount of such expenditures exceeds the total amount of allotments available to the State in such fiscal year or period. ‘‘( G ) APPLICATION TO COMMON W EALT HS AND TERRI - TORIES.— N o payment shall be made under this paragraph to a commonwealth or territory described in subsection (c)( 3 ) until such time as the Secretary determines that there are in effect methods, satisfactory to the Secretary, for the collection and reporting of reliable data regarding the enrollment of children described in subparagraphs (A) and ( B ) in order to accurately determine the common- wealth’s or territory’s eligibility for, and amount of pay- ment, under this paragraph.’’. SEC.104 .C HIP PE RFO R MAN CE B ON U SPA Y MEN T TO OFFSET A D DI - TIONA L ENROLLMENT COSTS RESULTIN G FROM ENROLL- MENT AND RETENTION EFFORTS. Section 2105(a) ( 4 2 U .S.C. 13 97 ee(a)) is amended by adding at the end the following new paragraphs ‘‘(3) PER F ORMANCE B ONUS PAYMENT TO OFFSET ADDITIONAL MEDICAID AND CHIP CHILD ENROLLMENT COSTS RESULTING FROM ENROLLMENT AND RETENTION EFFORTS.— ‘‘(A) IN GENERAL.—In addition to the payments made under paragraph (1), for each fiscal year (beginning with fiscal year 2009 and ending with fiscal year 2013), the Secretary shall pay from amounts made available under subparagraph (E), to each State that meets the condition under paragraph (4) for the fiscal year, an amount equal to the amount described in subparagraph (B) for the State and fiscal year. The payment under this paragraph shall be made, to a State for a fiscal year, as a single payment not later than the last day of the first calendar quarter of the following fiscal year. ‘‘(B) AMOUNT FOR ABO V E BASELINE MEDICAID CHILD ENROLLMENT COSTS.—Subject to subparagraph (E), the amount described in this subparagraph for a State for a fiscal year is equal to the sum of the following amounts: ‘‘(i) FIRST TIER ABOVE BASELINE MEDICAID ENROLLEES.—An amount equal to the number of first Deadlin e .Ap pli c a b ili ty .


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 123STA T . 1 8PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9tierabov eba s e l i n e ch il d enrollees ( as deter m ined u nder sub p ara g raph ( C) (i)) under title XI X f or the S tate and fiscal y ear , multiplied by 15 percent of the pro j ected per capita State M edicaid e x penditures (as determined under subparagraph ( D )) for the State and fiscal year under title XIX .‘ ‘(ii) S ECONDTI E RAB O V EBA S E L INE M EDICAID ENROLLEES. —A n amount e q ual to the number of second tier above baseline child enrollees (as determined under subparagraph (C)(ii)) under title XIX for the State and fiscal year, multiplied by 62 .5 percent of the projected per capita State Medicaid expenditures (as determined under subparagraph (D)) for the State and fiscal year under title XIX. ‘‘(C) NU MBER O F FIRST AND SECOND TIER ABOVE BASE - LINE C H ILD ENROLLEES BASELINE NUMBER OF CHILD ENROLLEES.— F or purposes of this paragraph ‘‘(i) FIRST TIER ABOVE BASELINE CHILD ENROLLEES.— T he number of first tier above baseline child enrollees for a State for a fiscal year under title XIX is equal to the number (if any, as determined by the Secretary) by w hich— ‘‘(I) the monthly average unduplicated number of qualifying children (as defined in subparagraph (F)) enrolled during the fiscal year under the State plan under title XIX, respectively; exceeds ‘‘(II) the baseline number of enrollees described in clause (iii) for the State and fiscal year under title XIX, respectively; but not to exceed 1 0 percent of the baseline number of enrollees described in subclause (II). ‘‘(ii) SECOND TIER ABOVE BASELINE CHILD ENROLLEES.—The number of second tier above baseline child enrollees for a State for a fiscal year under title XIX is equal to the number (if any, as determined by the Secretary) by which— ‘‘(I) the monthly average unduplicated number of qualifying children (as defined in subparagraph (F)) enrolled during the fiscal year under title XIX as described in clause (i)(I); exceeds ‘‘(II) the sum of the baseline number of child enrollees described in clause (iii) for the State and fiscal year under title XIX, as described in clause (i)(II), and the maximum number of first tier above baseline child enrollees for the State and fiscal year under title XIX, as determined under clause (i). ‘‘(iii) B ASELINE NUMBER OF CHILD ENROLLEES.— Subject to subparagraph ( H ), the baseline number of child enrollees for a State under title XIX— ‘‘(I) for fiscal year 200 9 is equal to the monthly average unduplicated number of qualifying chil- dren enrolled in the State plan under title XIX during fiscal year 200 7 increased by the population growth for children in that State from 2007 to 200 8 (as estimated by the Bureau of the Census) plus 4 percentage points, and further increased


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 123STA T . 1 9PUBLIC LA W 111 – 3 —FE B. 4, 2 0 09 bythepo p ula t i o ngr o w th f or c hil d ren in that S tate fro m20 0 8 to 200 9( a s estimated by the B ureau of the C ensus ) plus 4 percentage points ‘( I I) for each of fiscal years 20 1 0, 2011, and 2012, is e q ual to the baseline number of child enrollees for the State for the pre v ious fiscal year under title X IX, increased by the population growth for children in that State from the calendar year in which the respective fiscal year begins to the succeeding calendar year (as estimated by the Bureau of the Census) plus 3.5 percentage points; ‘‘(III) for each of fiscal years 2013, 2014, and 2015, is equal to the baseline number of child enrollees for the State for the previous fiscal year under title XIX, increased by the population growth for children in that State from the calendar year in which the respective fiscal year begins to the succeeding calendar year (as estimated by the Bureau of the Census) plus 3 percentage points; and ‘‘(I V ) for a subsequent fiscal year is equal to the baseline number of child enrollees for the State for the previous fiscal year under title XIX, increased by the population growth for children in that State from the calendar year in which the fiscal year involved begins to the succeeding calendar year (as estimated by the Bureau of the Census) plus 2 percentage points. ‘‘( D ) PROJECT E DP ERC A P I TA S TATE M EDICAID E X PE N DI - T U RES. —F or purposes of subparagraph (B), the pro j ected per capita State M edicaid e x penditures for a State and fiscal year under title XIX is equal to the average per capita expenditures (including both State and Federal financial participation) for children under the State plan under such title, including under waivers but not including such children eligible for assistance by virtue of the receipt of benefits under title XVI, for the most recent fiscal year for which actual data are available (as determined by the Secretary), increased (for each subsequent fiscal year up to and including the fiscal year involved) by the annual percentage increase in per capita amount of N ational H ealth E xpenditures (as estimated by the Secretary) for the calendar year in which the respective subsequent fiscal year ends and multiplied by a State matching percentage equal to 100 percent minus the Federal medical assistance percentage (as defined in section 1905(b)) for the fiscal year involved. ‘‘(E) A MOUNTS A V AI L A B LE F OR PA Y MENTS.— ‘‘(i) INITIAL APPROPRIATION.— O ut of any money in the T reasury not otherwise appropriated, there are appropriated $ 3,225,000,000 for fiscal year 2009 for ma k ing payments under this paragraph, to be available until expended. ‘‘(ii) TRANSFERS.—Notwithstanding any other provision of this title, the following amounts shall also


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 123STA T . 2 0PUBLIC LA W 111 – 3 —FE B. 4, 200 9beav a il able ,w i thou t f i sc al y ea r li m itatio n ,forma k in gp ayments un d er this paragraph

‘ (I)UNOBLIGATED NATIONAL ALLOT M ENT .— ‘‘(aa) F I SC AL Y EA R S 20 0 9 T H RO U GH 20 1 2.— A sof D ecember 31 of fiscal year 20 0 9, and as of December 31 of each succeeding fiscal year through fiscal year 2012, the portion, if any, of the amount appropriated under sub - section (a) for such fiscal year that is unobli- gated for allotment to a S tate under subsection (m) for such fiscal year or set aside under subsection (a)(3) or (b)(2) of section 2111 for such fiscal year. ‘‘(bb) FIRST HAL F OF FISCAL YEAR 201 3 .— As of December 31 of fiscal year 2013, the portion, if any, of the sum of the amounts appropriated under subsection (a)(1 6 )(A) and under section 10 8 of the C hildren ’ s H ealth Insurance R eauthori z ation Act of 2009 for the period beginning on O ctober 1, 2012, and ending on M arch 31, 2013, that is unobligated for allotment to a State under subsection (m) for such fiscal year or set aside under sub- section (b)(2) of section 2111 for such fiscal year. ‘‘(cc) SECOND HALF OF FISCAL YEAR 2013.— As of J une 30 of fiscal year 2013, the portion, if any, of the amount appropriated under sub- section (a)(16)( B ) for the period beginning on April 1, 2013, and ending on September 30, 2013, that is unobligated for allotment to a State under subsection (m) for such fiscal year or set aside under subsection (b)(2) of section 2111 for such fiscal year. ‘‘(II) UNE XP ENDED ALLOTMENTS NOT USED FOR REDISTRIBUTION.—As of N ovember 1 5 of each of fiscal years 2010 through 2013, the total amount of allotments made to States under section 210 4 for the second preceding fiscal year (third pre- ceding fiscal year in the case of the fiscal year 2006, 200 7, and 2008 allotments) that is not e x pended or redistributed under section 2104(f) during the period in which such allotments are available for obligation. ‘‘(III) E XCESS CHILD ENROLLMENT CONTIN- GENCY FUNDS.—As of October 1 of each of fiscal years 2010 through 2013, any amount in excess of the aggregate cap applicable to the Child Enroll- ment Contingency Fund for the fiscal year under section 2104(n). ‘‘(I V ) UNEXPENDED TRANSITIONAL CO V ERAGE BLOC K GRANT FOR NONPREGNANT CHILDLESS ADULTS.—As of October 1, 2011, any amounts set aside under section 2111(a)(3) that are not expended by September 30, 2011. ‘‘(iii) P ROPORTIONAL REDUCTION.—If the sum of the amounts otherwise payable under this paragraph for


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 123STA T . 21 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9afisc a lye a r e x cee d s th ea moun ta v aila b le for the fiscal year under this sub p ara g raph , the amount to be paid under this paragraph to each S tate shall be reduced proportionally .‘ ‘ (F)QUALIFY I NGCH IL DRE N DEFINED. — ‘‘(i) I N GENERAL.—For purposes of this subsection, sub j ect to clauses (ii) and (iii), the term ‘ q ualifying children ’ means children w ho meet the eligibility cri - teria (including income, categorical eligibility, age, and immigration status criteria) in effect as of J uly 1, 20 0 8 , for enrollment under title X IX, ta k ing into account criteria applied as of such date under title XIX pursu- ant to a waiver under section 111 5 . ‘‘(ii) L I M I T ATI O N.— A child described in clause (i) who is provided medical assistance during a presump- tive eligibility period under section 1 9 20A shall be considered to be a ‘qualifying child’ only if the child is determined to be eligible for medical assistance under title XIX. ‘‘(iii) EX CLU S ION.—Such term does not include any children for whom the State has made an election to provide medical assistance under paragraph ( 4 )of section 190 3 (v). ‘‘( G )A P PLICATION TO COMMON W EALTHS AND TERRI- TORIES.— T he provisions of subparagraph (G) of section 2104(n)(3) shall apply with respect to payment under this paragraph in the same manner as such provisions apply to payment under such section. ‘‘( H ) APPLICATION TO STATES THAT IMPLEMENT A M ED- ICAID EXPANSION FOR CHILDREN AFTER FISCAL YEAR 20 0 8 .— In the case of a State that provides coverage under section 115 of the C hildren’s Health Insurance P rogram R eauthor- i z ation Act of 2009 for any fiscal year after fiscal year 2008— ‘‘(i) any child enrolled in the State plan under title XIX through the application of such an election shall be disregarded from the determination for the State of the monthly average unduplicated number of qualifying children enrolled in such plan during the first 3 fiscal years in which such an election is in effect and ‘‘(ii) in determining the baseline number of child enrollees for the State for any fiscal year subsequent to such first 3 fiscal years, the baseline number of child enrollees for the State under title XIX for the third of such fiscal years shall be the monthly average unduplicated number of qualifying children enrolled in the State plan under title XIX for such third fiscal year. ‘‘(4) ENROLLMENT AND RETENTION PRO V ISIONS FOR CHIL- DREN.—For purposes of paragraph (3)(A), a State meets the condition of this paragraph for a fiscal year if it is implementing at least 5 of the following enrollment and retention provisions (treating each subparagraph as a separate enrollment and retention provision) throughout the entire fiscal year ‘‘(A) CONTINUOUS ELIGI B ILITY.—The State has elected the option of continuous eligibility for a full 12 months


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 123STA T . 22 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9foral l chi l d r en de s cri b ed in sec t ion 1902( e ) (12) u nder title XI X under 19 y ears of a g e , as w ellasa p plying such policy under its S tate child health plan under this title .‘ ‘( B ) LIBERAL I Z A T I ON O F A S SET RE QU IRE M ENTS. —T he State m eets the re q uirement specified in either of the fol - lowing clauses ‘‘(i) E LIMINATION OF ASSET TEST.—The State does not apply any asset or resource test for eligibility for children under title XIX or this title. ‘‘(ii) AD MINISTRATI V E VERIFI C ATION OF ASSETS.— The State— ‘‘(I) permits a parent or careta k er relati v e who is applying on behalf of a child for medical assist- ance under title XIX or child health assistance under this title to declare and certify by signature under penalty of per j ury information relating to family assets for purposes of determining and redetermining financial eligibility and ‘‘(II) takes steps to verify assets through means other than by requiring documentation from parents and applicants e x cept in individual cases of discrepancies or where otherwise justified. ‘‘( C ) ELIMINATION OF IN- P ERSON INTERVIE W REQUIRE- MENT.—The State does not require an application of a child for medical assistance under title XIX (or for child health assistance under this title), including an application for renewal of such assistance, to be made in person nor does the State require a face-to-face interview, unless there are discrepancies or individual circumstances justifying an in-person application or face-to-face interview. ‘‘( D ) U SE OF J OINT APPLICATION FOR MEDICAID AND C H IP.—The application form and supplemental forms (if any) and information verification process is the same for purposes of establishing and renewing eligibility for chil- dren for medical assistance under title XIX and child health assistance under this title. ‘‘(E) AUTOMATIC RENEWAL ( USE OF ADMINISTRATIVE RENEWAL ) .— ‘‘(i) IN G ENERAL.—The State provides, in the case of renewal of a child ’ s eligibility for medical assistance under title XIX or child health assistance under this title, a pre-printed form completed by the State based on the information available to the State and notice to the parent or caretaker relative of the child that eligibility of the child will be renewed and continued based on such information unless the State is provided other information. N othing in this clause shall be con- strued as preventing a State from verifying, through electronic and other means, the information so pro- vided. ‘‘(ii) SATISFACTION THROUGH DEMONSTRATED USE OFE X PARTE PROCESS.—A State shall be treated as satisfying the requirement of clause (i) if renewal of eligibility of children under title XIX or this title is determined without any requirement for an in-person interview, unless sufficient information is not in the State’s possession and cannot be acquired from other


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 123STA T . 23 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9source s (in c l u d in g o th er S t a te agencies )w ithout the p articipation o f the applicant or the applicant ’ s parent or careta k er relati v e .‘ ‘( F ) PRESUMPTIV EE L I G I B ILIT YFO R CH IL D RE N . —T he State is i m plementing section 1920A under title XI Xas well as , pursuant to section 210 7 (e)(1), under this title. ‘‘( G ) EX PRESS L A NE.—The State is implementing the option descri b ed in section 1902(e)(1 3 ) under title XIX as well as, pursuant to section 2107(e)(1), under this title. ‘‘( H ) PREMIUM ASSISTANCE SUBSIDIES.—The State is implementing the option of providing premium assistance subsidies under section 210 5 (c)(10) or section 190 6 A.’’. SEC.105 . TWO-Y E ARIN ITIA L A V AILA B ILITY O F C H I P ALLOT M ENTS. Section 210 4 (e) (42 U .S. C . 1397dd(e)) is amended to read as follows ‘‘(e) AVAILABILITY OF AMOUNTS ALLOTTED.— ‘‘(1) IN GENERAL.—E x cept as provided in paragraph (2), amounts allotted to a State pursuant to this section— ‘‘(A) for each of fiscal y ears 199 8 through 2008, shall remain available for expenditure by the State through the end of the second succeeding fiscal year and ‘‘( B ) for fiscal year 2009 and each fiscal year thereafter, shall remain available for expenditure by the State through the end of the succeeding fiscal year. ‘‘(2) AVAILABILITY OF AMOUNTS REDISTRIBUTED.—Amounts redistributed to a State under subsection (f) shall be available for expenditure by the State through the end of the fiscal year in which they are redistributed.’’. SEC. 10 6 .RE D ISTRIB U TION OF UNUSED ALLOTMENTS. (a) BEGINNING W ITH FISCAL Y EAR 2007.— (1) IN GENERAL.—Section 2104(f) (42 U.S.C. 1397dd(f)) is amended— (A) by striking ‘‘The Secretary’’ and inserting the fol - lowing: ‘‘(1) IN GENERAL.—The Secretary’’; (B) by striking ‘‘States that have fully expended the amount of their allotments under this section.’’ and inserting ‘‘States that the Secretary determines with respect to the fiscal year for which unused allotments are available for redistribution under this subsection, are short- fall States described in paragraph (2) for such fiscal year, but not to exceed the amount of the shortfall described in paragraph (2)(A) for each such State (as may be ad j usted under paragraph (2)(C)).’’; and (C) by adding at the end the following new paragraph: ‘‘(2) SHORTFALL STATES DESCRIBED.— ‘‘(A) IN GENERAL.—For purposes of paragraph (1), with respect to a fiscal year, a shortfall State described in this subparagraph is a State with a State child health plan approved under this title for which the Secretary estimates on the basis of the most recent data available to the Sec- retary, that the projected expenditures under such plan for the State for the fiscal year will exceed the sum of— ‘‘(i) the amount of the State’s allotments for any preceding fiscal years that remains available for


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 123STA T . 2 4PUBLIC LA W 111 – 3 —FE B.4 , 2 0 0 9exp e nditur e a ndt h at w i l ln o t b e expended b y the end o f the i m mediately pre c edin g fi s cal year ‘ ( ii ) the amount (if any) of the child enrollment contingency fund payment under subsection (n); and ‘‘(iii) the amount of the S tate ’ s allotment for the fiscal year . ‘‘( B ) PRO R ATI O N R ULE . —I f the amounts a v ailable for redistribution under paragraph ( 1 ) for a fiscal year are less than the total amounts of the estimated shortfalls determined for the year under subparagraph ( A ) , the amount to be redistributed under such paragraph for each shortfall State shall be reduced proportionally. ‘‘( C ) R ETRO SP E C TI V EA DJ UST M ENT.— T he Secretary may ad j ust the estimates and determinations made under para - graph (1) and this paragraph with respect to a fiscal year as necessary on the basis of the amounts reported by States not later than N ovember 30 of the succeeding fiscal year, as approved by the Secretary.’’. ( 2 ) EF FECTIVE DATE.—The amendments made by paragraph (1) shall apply to redistribution of allotments made for fiscal year 200 7 and subse q uent fiscal years. (b) REDISTRI B UTION OF U NUSED ALLOTMENTS FOR F ISCAL Y EAR 200 6 .—Section 210 4 ( k ) (42 U.S.C. 13 9 7dd(k)) is amended— (1) in the subsection heading, by striking ‘‘T H E FIRST 2 Q UARTERS OF’’; (2) in paragraph (1), by striking ‘‘the first 2 quarters of’’; and (3) in paragraph (6)— (A) by striking ‘‘the first 2 quarters of’’; and (B) by striking ‘‘ M arch 31’’ and inserting ‘‘September 30’’. SEC.107 . OPTI O NF O RQUAL IF Y IN G STATES TO RECEI V ET H E ENHANCE D PORTION OF THE CHIP M ATCHING RATE FOR MEDICAID COVERAGE OF CERTAIN CHILDREN. (a) IN G ENERAL.—Section 210 5 (g) (42 U.S.C. 1397ee(g)) is amended— (1) in paragraph (1)(A), as amended by section 201(b)(1) of Public L aw 110 – 173— (A) by inserting ‘‘subject to paragraph (4),’’ after ‘‘Not- withstanding any other provision of law,’’; and (B) by striking ‘‘200 8, or 2009’’ and inserting ‘‘or 2008’’; and (2) by adding at the end the following new paragraph ‘‘(4) O PTION FOR ALLOTMENTS FOR FISCAL Y EARS 20 0 9 THROU G H20 13 .— ‘‘(A) PAYMENT OF ENHANCED PORTION OF MATCHING RATE FOR CERTAIN E X PENDITURES.—In the case of expendi- tures described in subparagraph (B), a qualifying State (as defined in paragraph (2)) may elect to be paid from the State’s allotment made under section 2104 for any of fiscal years 2009 through 2013 (insofar as the allotment is available to the State under subsections (e) and (m) of such section) an amount each quarter equal to the addi- tional amount that would have been paid to the State under title X IX with respect to such expenditures if the enhanced FMAP (as determined under subsection (b)) had 42USC1397d d note.D e a d li ne.


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 123STA T . 2 5PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9be e nsu bs ti tute dfor t h e F eder alm edi c al assistance p ercenta g e ( as defined in section 1905 (b ) ) .‘ ‘( B ) EXPENDITUR E S DES C RI B ED. — For purposes of subparagraph ( A ) , the e x penditures described in this subparagraph are expenditures made after the date of the enactment of this paragraph and during the period in w hich funds are a v ailable to the q ualif y ing S tate for use under subparagraph (A), for the provision of medical assistance to individuals residing in the State who are eligible for medical assistance under the State plan under title XI X or under a waiver of such plan and who have not attained age 19 (or, if a State has so elected under the State plan under title XIX, age 2 0 or 21), and whose family income equals or exceeds 1 3 3 percent of the poverty line but does not exceed the M edicaid applicable income level. ’ ’. (b) R EPE ALOFL I M ITATION ON A V AILABILIT Y OF FISCAL Y EAR 2009 ALLOTMENTS.— P aragraph (2) of section 201(b) of the Medicare, Medicaid, and S CH IP Extension Act of 200 7 (Public Law 110 – 173) is repealed. SEC.108 . ON E -TIM E AP P R OPRIATION. T here is appropriated to the Secretary, out of any money in the Treasury not otherwise appropriated, $ 11,70 6 ,000,000 to accom - pany the allotment made for the period beginning on O ctober 1, 2012, and ending on March 31, 2013, under section 210 4 (a)(16)(A) of the Social Security Act (42 U .S.C. 1397dd(a)(16)(A)) (as added by section 101), to remain available until expended. Such amount shall be used to provide allotments to States under paragraph (3) of section 2104(m) of the Social Security Act (42 U.S.C. 1397dd(i)), as added by section 102, for the first 6 months of fiscal year 2013 in the same manner as allotments are provided under subsection (a)(16)(A) of such section 2104 and sub j ect to the same terms and conditions as apply to the allotments provided from such subsection (a)(16)(A). SEC. 10 9 . IMPRO V IN GFU N D ING FOR T H E TERRITORIES UNDER CHIP AND MEDICAID. Section 110 8 (g) (42 U.S.C. 1308(g)) is amended by adding at the end the following new paragraph ‘‘(4) EXCLUSION OF CERTAIN EXPENDITURES FROM PAYMENT LIMITS.— W ith respect to fiscal years beginning with fiscal year 2009, if Puerto Rico, the V irgin Islands, G uam, the N orthern Mariana Islands, or American Samoa qualify for a payment under subparagraph (A)(i), (B), or (F) of section 1903(a)(3) for a calendar quarter of such fiscal year, the payment shall not be ta k en into account in applying subsection (f) (as increased in accordance with paragraphs (1), (2), and (3) of this subsection) to such commonwealth or territory for such fiscal year.’’. 42USC1397e e not e .


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 123STA T . 2 6PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9Subti t leB—Foc u s o nL o w-I nco m e Ch il dr en a nd P re g nant W omen SEC.1 11. S TA TE OP T I O N TO CO V E RL O W- INCO M E PRE G NANT WOMEN U N D ERC H IP THROUGH A STATE PLAN AMENDMENT. (a)INGE NE RAL.—TitleX XI( 42U . S . C . 1397 aa et s e q .) , as a m e nd ed by se c ti o n 112(a), is amended by addin g att h e end the f ollo w ing new section

‘SEC. 2 112. OPTIONAL COVERAGE O F TARGETED LOW-INCOME PREG- NANT WOMEN THROUGH A STATE PLAN AMENDMENT. ‘ ‘(a) IN GENERAL.—S u b j ect to the succeeding pr o v isions of this section, a State may elect through an amendment to its State child health plan under section 21 0 2 to provide pregnancy - related assistance under such plan for targeted low-income pregnant women. ‘‘(b) C O N DIT ION S .— A State may only elect the option under subsection (a) if the following conditions are satisfied: ‘‘(1) M INI MU MIN C OME ELI G I B ILIT Y LE V ELS F OR P REGNANT W OMEN AND C H ILDREN.—The State has established an income eligibility level— ‘‘(A) for pregnant women under subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(I V ), or (l)(1)(A) of section 1902 that is at least 1 85 percent (or such higher percent as the State has in effect with regard to pregnant women under this title) of the poverty line applicable to a family of the si z e involved, but in no case lower than the percent in effect under any such subsection as of J uly 1, 2008 and ‘‘( B ) for children under 19 years of age under this title (or title XIX) that is at least 200 percent of the poverty line applicable to a family of the size involved. ‘‘(2) N O CHIP INCOME ELIGIBILITY LEVEL FOR PREGNANT WOMEN LOWER THAN THE STATE ’ S MEDICAID LEVEL.—The State does not apply an effective income level for pregnant women under the State plan amendment that is lower than the effective income level (e x pressed as a percent of the poverty line and considering applicable income disregards) specified under sub- section (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) of section 1902, on the date of enactment of this paragraph to be eligible for medical assistance as a pregnant woman. ‘‘(3) NO COVERAGE FOR HIGHER INCOME PREGNANT WOMEN WITHOUT COVERING LOWER INCOME PREGNANT WOMEN.—The State does not provide coverage for pregnant women with higher family income without covering pregnant women with a lower family income. ‘‘(4) APPLICATION OF RE Q UIREMENTS FOR COVERAGE OF TAR- GETED LOW-INCOME CHILDREN.—The State provides pregnancy- related assistance for targeted low-income pregnant women in the same manner, and subject to the same requirements, as the State provides child health assistance for targeted low- income children under the State child health plan, and in addition to providing child health assistance for such women. ‘‘(5) NO PREE X ISTING CONDITION EXCLUSION OR WAITING PERIOD.—The State does not apply any exclusion of benefits 42USC1397l l note.


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 123STA T . 2 7PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9forp r egna n cy- re l a t e d a s s i stance b ased on any pree x isting condi- tion or any w aiting period ( incl u ding any waiting period i m posed to carry out section 210 2(b ) ( 3 )( C )) for receipt of suc h assistance .‘ ‘( 6 ) AP P LICAT I ON O F CO S T-S H A R IN G PROT E CTION. —T he S tate pro v ides pregnancy-related assistance to a targeted low-income woman consistent with the cost-sharing protections under sec- tion 2103(e) and applies the limitation on total annual aggre- gate cost sharing imposed under paragraph (3)( B ) of such sec- tion to the family of such a woman. ‘‘( 7 ) N O W AITING LIST FOR CHIL D REN.—The State does not impose , with respect to the enrollment under the State child health plan of targeted low-income children during the q uarter, any enrollment cap or other numerical limitation on enrollment, any waiting list, any procedures designed to delay the consider- ation of applications for enrollment, or similar limitation with respect to enrollment. ‘‘(c) O PTION TO P RO V IDE PRES UM PTIVE E LIGI B ILIT Y .—A State that elects the option under subsection (a) and satisfies the condi- tions described in subsection (b) may elect to apply section 1 9 20 (relating to presumptive eligibility for pregnant women) to the State child health plan in the same manner as such section applies to the State plan under title XI X. ‘‘(d) D EFINITIONS.— F or purposes of this section ‘‘(1) PREGNANCY-RELATED ASSISTANCE.—The term ‘preg- nancy-related assistance ’ has the meaning given the term ‘child health assistance’ in section 2110(a) with respect to an indi- vidual during the period described in paragraph (2)(A). ‘‘(2) TARGETED LOW-INCOME PREGNANT WOMAN.—The term ‘targeted low-income pregnant woman’ means an individual— ‘‘(A) during pregnancy and through the end of the month in which the 60-day period (beginning on the last day of her pregnancy) ends ‘‘(B) whose family income exceeds 1 85 percent (or, if higher, the percent applied under subsection (b)(1)(A)) of the poverty line applicable to a family of the si z e involved, but does not exceed the income eligibility level established under the State child health plan under this title for a targeted low-income child; and ‘‘(C) who satisfies the requirements of paragraphs (1)(A), (1)(C), (2), and (3) of section 2110(b) in the same manner as a child applying for child health assistance would have to satisfy such requirements. ‘‘(e) AUTOMATIC ENROLLMENT FOR CHILDREN BORN TO W OMEN R ECEIVING PREGNANCY-RELATED ASSISTANCE.—If a child is born to a targeted low-income pregnant woman who was receiving preg- nancy-related assistance under this section on the date of the child’s birth, the child shall be deemed to have applied for child health assistance under the State child health plan and to have been found eligible for such assistance under such plan or to have applied for medical assistance under title XIX and to have been found eligible for such assistance under such title, as appropriate, on the date of such birth and to remain eligible for such assistance until the child attains 1 year of age. During the period in which a child is deemed under the preceding sentence to be eligible for child health or medical assistance, the child health or medical assistance eligibility identification number of the mother shall also


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 123STA T . 2 8PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9serv e a s th e id e n ti f i c ati o nn umb er of the chi l d , and all claims shall be submitted and p aid under such number ( unless the S tate issues a separate identification number for the child before such period e x pires ).‘ ‘(f) S TA T ESPROVID I NGA SSISTAN C E TH RO U GH O THER O P TIONS. — ‘‘( 1 ) C ONTINUATION O F OTHER OPTIONS FOR PROVIDING ASSISTANCE.—The option to provide assistance in accordance w ith the precedin g subsections of this section shall not limit an y other option for a State to provide— ‘‘(A) child health assistance through the application of sections 457 .1 0, 457. 3 50(b)( 2 ), 457. 6 22(c)(5), and 457.626(a)(3) of title 42, Code of F ederal R egulations (as in effect after the final rule adopted by the Secretary and set forth at 67 Fed. Reg. 61 9 56 – 61974 (October 2, 2002)), or ‘‘( B ) pregnancy - related services through the application of any waiver authority (as in effect on J une 1, 200 8 ). ‘‘(2) C L ARIFICATION OF AUTHORIT Y TO PROVIDE POSTPARTU M SERVICES.—Any State that provides child health assistance under any authority described in paragraph (1) may continue to provide such assistance, as well as postpartum services, through the end of the month in which the 60-day period (beginning on the last day of the pregnancy) ends, in the same manner as such assistance and postpartum services would be provided if provided under the State plan under title XI X, but only if the mother would otherwise satisfy the eligibility re q uirements that apply under the State child health plan (other than with respect to age) during such period. ‘‘(3) N O INFERENCE.—Nothing in this subsection shall be construed— ‘‘(A) to infer congressional intent regarding the legality or illegality of the content of the sections specified in para- graph (1)(A) or ‘‘(B) to modify the authority to provide pregnancy- related services under a waiver specified in paragraph (1)(B). ’ ’. (b) ADDITIONAL CONFORMING AMENDMENTS.— (1) NO COST SHARING FOR PREGNANCY-RELATED B ENEFITS.— Section 2103(e)(2) (42 U .S.C. 1397cc(e)(2)) is amended— (A) in the heading, by inserting ‘‘OR PREGNANCY- RELATED ASSISTANCE’’ after ‘‘PREVENTIVE SERVICES’’; and (B) by inserting before the period at the end the fol- lowing ‘‘or for pregnancy-related assistance’’. (2) NO W AITING PERIOD.—Section 2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)) is amended— (A) in clause (i), by stri k ing ‘‘, and’’ at the end and inserting a semicolon; (B) in clause (ii), by striking the period at the end and inserting ‘‘; and’’; and (C) by adding at the end the following new clause: ‘‘(iii) may not apply a waiting period (including a waiting period to carry out paragraph (3)(C)) in the case of a targeted low-income pregnant woman pro- vided pregnancy-related assistance under section 2112.’’.


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 123STA T . 2 9PUBLIC LA W 111 – 3 —FE B. 4, 2 0 09 SEC.1 1 2 . PHA SE -OUT O F CO V E R A G E FOR N ONPREGNANT CH ILD LESS ADULTS UNDER CHIP CONDITIONS FOR COVERAGE OF PARENTS. (a)PHASE-OUTR U L ES .— ( 1 ) ING ENE R AL.— TitleX XI( 42U . S . C . 1 397 aa et s e q .) is a m e nd ed by addin g att h e end the fo llo w ing new se c tion

‘SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS ADULTS; CONDITIONS FOR COVERAGE OF PARENTS. ‘ ‘(a) TER MI NATI O NO F CO V ERAGE FOR N ON P REGNANT CHIL D LESS A DULTS.— ‘‘(1) NO NE WC HIP WAIVERS AUTOMATIC E X TENSIONS AT STATE OPTION THROUGH 20 0 9 .—Notwithstanding section 111 5 o r any other p ro v ision of this title , e x cept as provided in this s u bsection— ‘‘(A) the Secretary shall not on or after the date of the enactment of the Children ’ s H ealth Insurance Program Reauthori z ation Act of 2 0 09, approve or renew a waiver, experimental, pilot, or demonstration pro j ect that would allow funds made available under this title to be used to provide child health assistance or other health benefits coverage to a nonpregnant childless adult; and ‘‘( B ) notwithstanding the terms and conditions of an applicable existing waiver, the provisions of paragraph (2) shall apply for purposes of any period beginning on or after J anuary 1, 2010, in determining the period to which the waiver applies, the individuals eligible to be covered by the waiver, and the amount of the F ederal payment under this title. ‘‘(2) TERMINATION OF CHIP COVERAGE UNDER APPLICA B LE EXISTING WAIVERS AT THE END OF 2009.— ‘‘(A) IN GENERAL.—No funds shall be available under this title for child health assistance or other health benefits coverage that is provided to a nonpregnant childless adult under an applicable existing waiver after D ecember 31, 2009. ‘‘(B) E XTENSION UPON STATE RE Q UEST.—If an applicable existing waiver described in subparagraph (A) would other- wise expire before January 1, 2010, notwithstanding the requirements of subsections (e) and (f) of section 1115, a State may submit, not later than September 30, 2009, a request to the Secretary for an extension of the waiver. The Secretary shall approve a request for an extension of an applicable existing waiver submitted pursuant to this subparagraph, but only through December 31, 2009. ‘‘(C) APPLICATION OF ENHANCED FMAP.—The enhanced F M AP determined under section 2105(b) shall apply to expenditures under an applicable existing waiver for the provision of child health assistance or other health benefits coverage to a nonpregnant childless adult during the period beginning on the date of the enactment of this subsection and ending on December 31, 2009. ‘‘(3) STATE OPTION TO APPL Y FOR MEDICAID WAIVER TO CON- TINUE COVERAGE FOR NONPREGNANT CHILDLESS ADULTS.— ‘‘(A) IN GENERAL.—Each State for which coverage under an applicable existing waiver is terminated under para- graph (2)(A) may submit, not later than September 30, Deadlin e . Deadline. Ap pli c a b ili ty . 42USC1397k k.


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 123STA T . 3 0PUBLIC LA W 111 – 3 —FE B. 4, 200 920 0 9,an a p p lic a t i o ntot heS ec r etar yf ora w ai v er u n d er s ection 1 11 5 of the State plan under title XI X to provide m edical assistance to a nonpre g nant childless adult whose coverage is so terminated ( in this su b section referred to asa ‘M edicaid nonpregnant childless adults waiver ’). ‘‘( B ) DEADLIN E FOR A P PRO V AL. —T he Secretary shall ma k e a decision to approve or deny an application for a Medicaid nonpregnant childless adults waiver submitted under subparagraph ( A ) within 90 days of the date of the submission of the application. If no decision has been made by the Secretary as of December 3 1, 2009, on the application of a State for a Medicaid nonpregnant childless adults waiver that was submitted to the Secretary by Sep - tember 30, 2009, the application shall be deemed approved. ‘‘( C )S T ANDARD FOR BU D G ET NEUTRALIT Y .—The budget neutrality re q uirement applicable with respect to e x pendi- tures for medical assistance under a Medicaid nonpregnant childless adults waiver shall— ‘‘(i) in the case of fiscal year 2010, allow expendi- tures for medical assistance under title XIX for all such adults to not exceed the total amount of payments made to the State under paragraph (2)(B) for fiscal year 2009, increased by the percentage increase (if any) in the pro j ected nominal per capita amount of N ational H ealth E xpenditures for 2010 over 2009, as most recently published by the Secretary and ‘‘(ii) in the case of any succeeding fiscal year, allow such expenditures to not exceed the amount in effect under this subparagraph for the preceding fiscal year, increased by the percentage increase (if any) in the projected nominal per capita amount of National Health Expenditures for the calendar year that begins during the year involved over the preceding calendar year, as most recently published by the Secretary. ‘‘(b) R ULE S AND CONDITIONS FOR COVERAGE OF P ARENTS OF TARGETED L O W -IN C O M EC H ILDREN.— ‘‘(1) TWO-YEAR PERIOD; AUTOMATIC E X TENSION AT STATE OPTION THROUGH FISCAL YEAR 201 1.— ‘‘(A) NO NEW CHIP WAIVERS.—Notwithstanding section 1115 or any other provision of this title, except as provided in this subsection— ‘‘(i) the Secretary shall not on or after the date of the enactment of the Children’s Health Insurance Program Reauthori z ation Act of 2009 approve or renew a waiver, experimental, pilot, or demonstration project that would allow funds made available under this title to be used to provide child health assistance or other health benefits coverage to a parent of a targeted low- income child; and ‘‘(ii) notwithstanding the terms and conditions of an applicable existing waiver, the provisions of para- graphs (2) and (3) shall apply for purposes of any fiscal year beginning on or after O ctober 1, 2011, in determining the period to which the waiver applies, the individuals eligible to be covered by the waiver, and the amount of the F ederal payment under this title. Ap p licab ili ty.Ef f e cti v e d ate.


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 123STA T . 31 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9‘ ‘ (B)EXTENSIO N UP ON ST A TE R E Q UEST .—Ifan a p p lic a b l e e x i st in gw ai v e rd escribed in s u bparagrap h ( A )w o uld other - wise expire before O ctober 1,20 11, and the S tate re q uests an extension of such waiver, the Secretar y shall grant such an extension, but only, sub j ect to paragraph (2)(A), through Septe m ber 3 0, 2011. ‘‘( C ) APP L I C ATION O F EN H ANCE D F M AP.— T he enhanced FM A P determined under section 210 5 (b) shall apply to expenditures under an applicable existing waiver for the provision of child health assistance or other health benefits coverage to a parent of a targeted low-income child during the third and fourth quarters of fiscal year 200 9 and during fiscal years 2010 and 2011. ‘‘(2) R ULES FOR FISCAL Y EARS 201 2 THROU G H 201 3 .— ‘‘(A) PAYMENTS FOR CO V ERAGE LIMITED TO B LOC K GRANT FUNDED FROM STATE ALLOTMENT.—Any State that provides child health assistance or health benefits coverage under an applicable existing waiver for a parent of a targeted low-income child may elect to continue to provide such assistance or coverage through fiscal year 2012 or 2013, subject to the same terms and conditions that applied under the applicable existing waiver, unless otherwise modified in subparagraph (B). ‘‘(B) TERMS AND CONDITIONS.— ‘‘(i) BLOCK GRANT SET ASIDE FROM STATE ALLOT- MENT.—If the State ma k es an election under subpara- graph (A), the Secretary shall set aside for the State for each such fiscal year an amount equal to the Fed- eral share of 110 percent of the State ’ s projected expenditures under the applicable existing waiver for providing child health assistance or health benefits coverage to all parents of targeted low-income children enrolled under such waiver for the fiscal year (as cer- tified by the State and submitted to the Secretary by not later than August 31 of the preceding fiscal year). In the case of fiscal year 2013, the set aside for any State shall be computed separately for each period described in subparagraphs (A) and (B) of sec- tion 210 4 (a)(1 6 ) and any reduction in the allotment for either such period under section 2104(m)(4) shall be allocated on a pro rata basis to such set aside. ‘‘(ii) PAYMENTS FROM BLOCK GRANT.—The Secretary shall pay the State from the amount set aside under clause (i) for the fiscal year, an amount for each quarter of such fiscal year equal to the applicable percentage determined under clause (iii) or (iv) for expenditures in the quarter for providing child health assistance or other health benefits coverage to a parent of a targeted low-income child. ‘‘(iii) ENHANCED FMAP ONLY IN FISCAL YEAR 2012 FOR STATES W ITH SIGNIFICANT CHILD OUTREACH OR THAT ACHIEVE CHILD COVERAGE BENCHMARKS FMAP FOR ANY OTHER STATES.—For purposes of clause (ii), the applicable percentage for any quarter of fiscal year 2012 is equal to— ‘‘(I) the enhanced FMAP determined under section 2105(b) in the case of a State that meets Certif i ca ti on.D ea dl ine.


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 123STA T . 32 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9theou t r e ac horco v era g e b e n ch m ar ksd escr i bed in an y o f sub p aragraph (A), ( B ),or( C ) of paragraph ( 3 ) for fisca l year 201 1 or ‘ ‘( I I) the F ederal medical assistance percentage (as determined under section 1 9 0 5 (b) w ithout regard to clause ( 4 ) of such section) in the case of any other S tate . ‘‘(iv) A MOUNT O F F ED E RAL MAT CHI N GP A Y MENT IN 2013 . — For purposes of clause (ii), the applicable percentage for any q uarter of fiscal year 2013 is equal to— ‘‘(I) the REM A P percentage if— ‘‘(aa) the applicable percentage for the State under clause (iii) was the enhanced FMAP for fiscal year 2012; and ‘‘(bb) the State met either of the coverage benchmarks described in subparagraph (B) or (C) of paragraph (3) for fiscal year 2012; or ‘‘(II) the Federal medical assistance percentage (as so determined) in the case of any State to which subclause (I) does not apply. For purposes of subclause (I), the REMAP percentage is the percentage which is the sum of such Federal medical assistance percentage and a number of percentage points equal to one - half of the difference between such Federal medical assistance percentage and such enhanced FMAP. ‘‘(v) N O FEDERAL PAYMENT S OTHER THAN FROM B LOC K GRANT SET ASIDE.—No payments shall be made toaStatefore x penditures described in clause (ii) after the total amount set aside under clause (i) for a fiscal year has been paid to the State. ‘‘(vi) NO INCREASE IN INCOME ELIGIBILITY LE V EL FOR PARENTS.—No payments shall be made to a State from the amount set aside under clause (i) for a fiscal year for expenditures for providing child health assist- ance or health benefits coverage to a parent of a tar- geted low-income child whose family income exceeds the income eligibility level applied under the applicable existing waiver to parents of targeted low-income chil- dren on the date of enactment of the Children ’ s H ealth Insurance Program Reauthori z ation Act of 2009. ‘‘(3) O UTREACH OR COVERAGE BENCHMARKS.—For purposes of paragraph (2), the outreach or coverage benchmarks described in this paragraph are as follows ‘‘(A) SIGNIFICANT CHILD OUTREACH CAMPAIGN.— T he State— ‘‘(i) was awarded a grant under section 2113 for fiscal year 2011; ‘‘(ii) implemented 1 or more of the enrollment and retention provisions described in section 2105(a)(4) for such fiscal year; or ‘‘(iii) has submitted a specific plan for outreach for such fiscal year. ‘‘(B) HIGH-PERFORMING STATE.—The State, on the basis of the most timely and accurate published estimates of the Bureau of the Census, ranks in the lowest 1⁄3 of States


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 123STA T . 33 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9intermsof t h e S t a te ’ s p er c enta g eof l o w- income chil d ren witho u t health insurance .‘ ‘ (C) S TA T EINCR EA S IN G ENR OL L M ENT O F LO W -INCOME C H IL D REN. —T he State q ualified for a performance b onus pa y ment under section 2105 (a)( 3 )( B ) for the most recent fiscal year applicable under such section. ‘‘( 4 ) RU LES OF CONSTRUCTION.— N othing in this subsection shall be construed as prohibiting a State from submitting an application to the Secretary for a wai v er under section 1115 of the State plan under title XI X to provide medical assistance to a parent of a targeted low-income child that was provided child health assistance or health benefits coverage under an applicable e x isting waiver. ‘‘(c) AP PLICA B LE EX ISTING W AI V ER.— F or purposes of this sec- tion— ‘‘(1) IN GENERAL.—The term ‘applicable existing waiver’ means a waiver , experimental, pilot, or demonstration pro j ect under section 1115, grandfathered under section 6 102(c)(3) of the D eficit Reduction Act of 2005, or otherwise conducted under authority that— ‘‘(A) would allow funds made available under this title to be used to provide child health assistance or other health benefits coverage to— ‘‘(i) a parent of a targeted low-income child ‘‘(ii) a nonpregnant childless adult; or ‘‘(iii) individuals described in both clauses (i) and (ii); and ‘‘(B) was in effect during fiscal year 200 9 . ‘‘(2) DEFINITIONS.— ‘‘(A) P ARENT.—The term ‘parent’ includes a careta k er relative (as such term is used in carrying out section 1931) and a legal guardian. ‘‘(B) NONPREGNANT CHILDLESS ADULT.—The term ‘non- pregnant childless adult’ has the meaning given such term by section 210 7 (f).’’. (2) CONFORMING AMENDMENTS.— (A) Section 2107(f) (42 U .S.C. 1397gg(f)) is amended— (i) by striking ‘‘, the Secretary’’ and inserting ‘‘ ‘‘(1) The Secretary’’; (ii) in the first sentence, by inserting ‘‘or a parent (as defined in section 2111(c)(2)(A)), who is not preg- nant, of a targeted low-income child’’ before the period; (iii) by striking the second sentence; and (iv) by adding at the end the following new para- graph: ‘‘(2) The Secretary may not approve, extend, renew, or amend a waiver, experimental, pilot, or demonstration project with respect to a State after the date of enactment of the Children’s H ealth Insurance Program Reauthori z ation Act of 2009 that would waive or modify the requirements of section 2111.’’. (B) Section 6102(c) of the Deficit Reduction Act of 2005 (Public L aw 109 – 171; 120 Stat. 131) is amended by striking ‘‘Nothing’’ and inserting ‘‘Subject to section 2111 of the Social Security Act, as added by section 112 of the Children’s Health Insurance Program Reauthoriza- tion Act of 2009, nothing’’. 42USC1397g g note.


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 123STA T . 3 4PUBLIC LA W 111 – 3 —FE B.4 , 2 0 0 9(b)GAOSTUDYAN D REPOR T .— ( 1 ) I N G ENERA L .— TheComptr o l ler Ge n er a lo f the U n i te d State s shall c ond u ct a stud y of w hether— (A) the co v era g e of a parent , a careta k er relative (as such term is used in carrying out section 1 93 1), or a legal guardian of a targeted low - income child under a State health plan under title X XI of the Social Security Act increases the enrollment of, or the q uality of care for, children, and ( B ) such parents, relatives, and legal guardians who enroll in such a plan are more likely to enroll their children in such a plan or in a State plan under title XIX of such Act. ( 2 ) REPORT.— N ot later than 2 years after the date of the enactment of this Act, the Comptroller General shall report the results of the study to the Committee on F inance of the Senate and the Committee on E nergy and Commerce of the H ouse of Representatives, including recommendations (if any) for changes in legislation. SEC.1 1 3 .E LIM I NAT I O NO F CO U NTIN G ME D ICAID C H ILD PR ESUMPTI V E ELIGI B ILIT Y COSTS AGAINST TITLE X XI ALLOTMENT. (a) IN GENERAL.—Section 21 05 (a)(1) ( 4 2 U.S.C. 139 7 ee(a)(1)) is amended— (1) in the matter preceding subparagraph (A), by striking ‘ ‘(or, in the case of e x penditures described in subparagraph (B), the Federal medical assistance percentage (as defined in the first sentence of section 1905(b))) ’ ’ and (2) by striking subparagraph (B) and inserting the following new subparagraph ‘‘(B) [ reserved ] ’’. (b) A M ENDMENT S TO M ED IC AID.— (1) ELIGI B ILITY O F ANE W BORN.—Section 1902(e)(4) (42 U.S.C. 139 6 a(e)(4)) is amended in the first sentence by striking ‘‘so long as the child is a member of the woman’s household and the woman remains (or would remain if pregnant) eligible for such assistance’’. (2) APPLICATION OF Q UALIFIED ENTITIES TO PRESUMPTI V E ELIGIBILITY FOR PREGNANT WOMEN UNDER MEDICAID.—Section 1920(b) (42 U.S.C. 1396r – 1(b)) is amended by adding after paragraph (2) the following flush sentence: ‘‘The term ‘qualified provider’ also includes a qualified entity, as defined in section 1920A(b)(3).’’. SEC. 11 4 . LIMITATION ON MATCHING RATE FOR STATES THAT PRO - POSE TO COVER CHILDREN W ITH EFFECTIVE FAMILY INCOME THAT EXCEEDS 3 0 0 PERCENT OF THE POVERTY LINE. (a) FMA P APPLIED TO E X PENDITURES.—Section 2105(c) (42 U.S.C. 1397ee(c)) is amended by adding at the end the following new paragraph: ‘‘( 8 ) L IMITATION ON MATC H ING RATE FOR EXPENDITURES FOR CHILD HEALTH ASSISTANCE PROVIDED TO CHILDREN WHOSE EFFECTIVE FAMILY INCOME EXCEEDS 30 0 PERCENT OF THE POV- ERTY LINE.— ‘‘(A) FMAP APPLIED TO EXPENDITURES.—Except as pro- vided in subparagraph (B), for fiscal years beginning with fiscal year 2009, the Federal medical assistance percentage


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 123STA T . 3 5PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9(asdet e rmin ed u nder se c ti o n 1905 ( b)w it h out re g ard to c l ause ( 4 )o f such section) shall be substituted for the enhanced FMAP under subsection (a)(1) with res p ect to an y e x penditures for pro v iding child health assistance or health benefits coverage for a targeted low - income child whose effective family income would exceed 3 00 percent of the poverty line but for the application of a general exclusion of a bloc k of income that is not determined by type of expense or type of income .‘ ‘( B ) EXCEPTION . —S ubparagraph (A) shall not apply to any State that , on the date of enactment of the C hildren ’ s H ealth I nsurance Program R eauthori z ation Act of 2 009, has an approved State plan amendment or waiver to pro- vide, or has enacted a State law to submit a State plan amendment to provide, expenditures described in such subparagraph under the State child health plan.’’. (b) R UL EO F CON S T R UCTION.— N othing in the amendments made by this section shall be construed as— (1) changing any income eligibility level for children under title X XI of the Social Security Act or (2) changing the flexibility provided States under such title to establish the income eligibility level for targeted low- income children under a State child health plan and the meth- odologies used by the State to determine income or assets under such plan. SEC.1 1 5 .S TA TEA U T HORI T Y U ND ER M EDICAID. Notwithstanding any other provision of law, including the fourth sentence of subsection (b) of section 1905 of the Social Secu- rity Act (42 U .S.C. 139 6 d) or subsection (u) of such section, at State option, the Secretary shall provide the State with the Federal medical assistance percentage determined for the State for Medicaid with respect to expenditures described in section 1905(u)(2)(A) of such Act or otherwise made to provide medical assistance under Medicaid to a child who could be covered by the State under CHIP. TI T LE II —OU T R E ACH A ND ENROLL M ENT Subti t le A—Out r e ach a nd Enr o ll m ent Acti v itie s SEC. 20 1. G RANTS AND ENHANCED ADMINISTRATI V E F UNDING FOR OUTREACH AND ENRO L LMENT. (a) G R A NTS.— T itle XXI (42 U.S.C. 139 7 aaetse q .), as amended by section 111, is amended by adding at the end the following

‘SEC. 211 3 . GRANTS TO IM P ROVE OUTREACH AND ENROLLMENT. ‘‘(a) O UTREAC H AN D ENROLL M ENT GRANTS; NATIONAL CAM- PAI G N.— ‘‘(1) IN GENERAL.—From the amounts appropriated under subsection (g), sub j ect to paragraph (2), the Secretary shall award grants to eligible entities during the period of fiscal years 2009 through 2013 to conduct outreach and enrollment 42USC1397m m . 42 USC 139 6dnote . 42 USC 1397ee note.


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 123STA T . 3 6PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9ef f orts t ha t are d es ign edtoin c rease the enro l l m ent and p artici - pation of eligi b le children u nder this title and title XI X .‘ ‘ (2)TENP E RC EN TS ET A S ID E FO R NATIONA L ENROLL M ENT CAMPAI G N. —A n amount e q ual to 10 percent of such amounts shall be used b y the S ecretary for e x penditures during such period to carry out a national enrollment campaign in accord- ance w ith subsection (h). ‘‘(b) P RIORIT Y FOR A W ARD OF G RANTS.— ‘‘(1) IN GENERAL.—In awarding grants under subsection (a) , the Secretary shall gi v e priority to eligible entities that— ‘‘(A) propose to target geographic areas with high rates of— ‘‘(i) eligible but unenrolled children, including such children who reside in rural areas or ‘‘(ii) racial and ethnic minorities and health dis- parity populations, including those proposals that address cultural and linguistic barriers to enrollment; and ‘‘( B ) submit the most demonstrable evidence required under paragraphs (1) and (2) of subsection (c). ‘‘(2) TEN PERCENT SET ASIDE FOR O U TREAC H TO INDIAN CHILDREN.—An amount equal to 10 percent of the funds appro- priated under subsection (g) shall be used by the Secretary to award grants to Indian H ealth Service providers and urban Indian organi z ations receiving funds under title V of the Indian Health C are Improvement Act (2 5U .S.C. 1 6 51 et seq.) for outreach to, and enrollment of, children who are Indians. ‘‘(c) APPLICATION.—An eligible entity that desires to receive a grant under subsection (a) shall submit an application to the Secretary in such form and manner, and containing such informa- tion, as the Secretary may decide. Such application shall include— ‘‘(1) evidence demonstrating that the entity includes mem- bers who have access to, and credibility with, ethnic or low- income populations in the communities in which activities funded under the grant are to be conducted; ‘‘(2) evidence demonstrating that the entity has the ability to address barriers to enrollment, such as lac k of awareness of eligibility, stigma concerns and punitive fears associated with receipt of benefits, and other cultural barriers to applying for and receiving child health assistance or medical assistance; ‘‘( 3 ) specific quality or outcomes performance measures to evaluate the effectiveness of activities funded by a grant awarded under this section; and ‘‘( 4 ) an assurance that the eligible entity shall— ‘‘(A) conduct an assessment of the effectiveness of such activities against the performance measures; ‘‘(B) cooperate with the collection and reporting of enrollment data and other information in order for the Secretary to conduct such assessments; and ‘‘(C) in the case of an eligible entity that is not the State, provide the State with enrollment data and other information as necessary for the State to make necessary pro j ections of eligible children and pregnant women. ‘‘(d) D ISSEMINATION OF E NROLLMENT DATA AND INFORMATION DETERMINED F ROM EFFECTI V ENESS ASSESSMENTS; ANNUAL R EPORT.—The Secretary shall—


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 123STA T . 3 7PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9‘ ‘ (1)makepublic l y a v ailable th ee nro llment d ata and in f ormation collected and reported in accordance w ith s ub - section (c)( 4 )( B ) and ‘‘( 2 ) submit an annual report to C on g ress on the outreach and enrollment activities conducted with funds appropriated under this section . ‘‘(e) MAINTE NAN C E OFE FFO R T FOR S TATE SAW AR D ED G RANTS; N O MATC HR E QU IRED FOR AN Y E L I G I B LE ENTITY AWARDED A GRANT. — ‘‘(1) STATE M AINTENANCE OF EFFORT.— I nthecaseofa State that is awarded a grant under this section , the State share of funds e x pended for outreach and enrollment activities under the State child health plan shall not be less than the State share of such funds expended in the fiscal year preceding the first fiscal year for which the grant is awarded. ‘‘(2) NO MATCHING REQUIREMENT.—No eligible entity awarded a grant under subsection (a) shall be re q uired to provide any matching funds as a condition for receiving the grant. ‘‘(f) D EFINITIONS.—In this section ‘‘(1) ELIGIBLE ENTITY.— T he term ‘eligible entity ’ means any of the following: ‘‘(A) A State with an approved child health plan under this title. ‘‘(B) A local government. ‘‘(C) An Indian tribe or tribal consortium, a tribal organi z ation, an urban Indian organization receiving funds under title V of the Indian H ealth Care Improvement Act (2 5U .S.C. 1 6 51 et seq.), or an Indian Health Service pro- vider. ‘‘(D) A F ederal health safety net organization. ‘‘(E) A national, State, local, or community-based public or nonprofit private organization, including organizations that use community health workers or community-based doula programs. ‘‘(F) A faith-based organization or consortia, to the extent that a grant awarded to such an entity is consistent with the requirements of section 1 9 55 of the P ublic Health Service Act (42 U.S.C. 30 0x – 65) relating to a grant award to nongovernmental entities. ‘‘(G) An elementary or secondary school. ‘‘(2) FEDERAL HEALTH SAFETY NET ORGANI Z ATION.—The term ‘Federal health safety net organization’ means— ‘‘(A) a Federally-qualified health center (as defined in section 1905(l)(2)(B)); ‘‘(B) a hospital defined as a disproportionate share hospital for purposes of section 1923; ‘‘(C) a covered entity described in section 340B(a)(4) of the Public Health Service Act (42 U.S.C. 256b(a)(4)); and ‘‘(D) any other entity or consortium that serves children under a federally funded program, including the special supplemental nutrition program for women, infants, and children ( W IC) established under section 1 7 of the Child Nutrition Act of 1966 (42 U.S.C. 17 8 6), the Head Start and Early Head Start programs under the Head Start Act (42 U.S.C. 9801 et seq.), the school lunch program


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 123STA T . 3 8PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9establi s h e dun de r the R i c hard B. Russell N ati o nal S chool L unch A ct , and an ele m entar y or secondary school. ‘ ‘ (3)INDIA N S; INDIAN TR I BE LO R G ANI Z ATION; U RBAN INDIAN ORGANIZATION. —T he terms ‘Indian ’, ‘Indian tribe’, ‘tribal or g ani z ation’, and ‘urban Indian organization’ ha v e the meanings given such terms in section 4 o f the Indian H ealth C are Im p rovement Act ( 25U .S.C. 160 3). ‘‘(4) CO M MUNIT YH EALTH W OR K ER.—The term ‘community health w or k er’ means an individual who promotes health or nutrition within the community in which the individual resides— ‘‘(A) by serving as a liaison between communities and health care agencies; ‘‘(B) by providing guidance and social assistance to community residents; ‘‘(C) by enhancing community residents’ ability to effec - tively communicate with health care providers; ‘‘( D ) by providing culturally and linguistically appro- priate health or nutrition education; ‘‘( E ) by advocating for individual and community health or nutrition needs; and ‘‘( F ) by providing referral and followup services. ‘‘(g) A P PROPRIATION.—There is appropriated, out of any money in the Treasury not otherwise appropriated, $ 100,000,000 for the period of fiscal years 200 9 through 2013, for the purpose of awarding grants under this section. Amounts appropriated and paid under the authority of this section shall be in addition to amounts appro- priated under section 2104 and paid to States in accordance with section 2105, including with respect to e x penditures for outreach activities in accordance with subsections (a)(1)(D)(iii) and (c)(2)(C) of that section. ‘‘(h) NATIONAL ENROLLMENT CAMPAIGN.—From the amounts made available under subsection (a)(2), the Secretary shall develop and implement a national enrollment campaign to improve the enrollment of underserved child populations in the programs estab- lished under this title and title X IX. Such campaign may include— ‘‘(1) the establishment of partnerships with the Secretary of Education and the Secretary of Agriculture to develop national campaigns to link the eligibility and enrollment sys- tems for the assistance programs each Secretary administers that often serve the same children; ‘‘(2) the integration of information about the programs established under this title and title XIX in public health aware- ness campaigns administered by the Secretary; ‘‘(3) increased financial and technical support for enroll- ment hotlines maintained by the Secretary to ensure that all States participate in such hotlines; ‘‘(4) the establishment of j oint public awareness outreach initiatives with the Secretary of Education and the Secretary of Labor regarding the importance of health insurance to building strong communities and the economy; ‘‘(5) the development of special outreach materials for Native Americans or for individuals with limited English pro- ficiency; and ‘‘(6) such other outreach initiatives as the Secretary deter- mines would increase public awareness of the programs under this title and title XIX.’’.
 * TRIBA


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 123STA T . 3 9PUBLIC LA W 111 – 3 —FE B. 4, 2 0 09 (b)ENHA N CEDA D MI NI STR ATI V E FU NDIN GFO R T RANS L ATION OR I NTER P RETATION S ERVICES U NDER CH I P AND M EDICAID .— ( 1 ) CHIP.—S ection2 1 05 ( a )(1) ( 4 2 U.S.C. 1 397 ee(a)(1)) , a s a m en d edb y section 113, is amended— (A)int h e matte rp recedin g s u bparagraph (A), by inserting ‘ ‘(or, in the case o f e x penditures described in subparagraph ( D )(i v ), the higher of 75 percent or the sum of the enhanced FMAP p l us 5 percentage points) ’ ’ after ‘‘enhanced FMAP’’ and ( B ) in subparagraph (D)— (i) in clause (iii), by stri k ing ‘‘and’’ at the end; (ii) by redesignating clause (iv) as clause (v); and (iii) by inserting after clause (iii) the follo w ing new clause ‘‘(iv) for translation or interpretation services in connection with the enrollment of, retention of, and use of services under this title by, individuals for whom English is not their primary language (as found nec - essary by the Secretary for the proper and efficient administration of the State plan); and’’. (2) MEDICAID.— (A) USE OF MEDICAID FUNDS.—Section 1903(a)(2) (42 U.S.C. 139 6 b(a)(2)) is amended by adding at the end the following new subparagraph: ‘‘(E) an amount e q ual to 75 percent of so much of the sums expended during such quarter (as found necessary by the Secretary for the proper and efficient administration of the State plan) as are attributable to translation or interpreta- tion services in connection with the enrollment of, retention of, and use of services under this title by, children of families for whom English is not the primary language; plus’’. (B) USE OF COMMUNIT Y HEALTH W OR K ERS FOR OUT- REACH ACTIVITIES.— (i) IN GENERAL.—Section 2102(c)(1) of such Act (42 U.S.C. 1397bb(c)(1)) is amended by inserting ‘‘(through community health workers and others)’’ after ‘‘ O utreach’’. (ii) IN FEDERAL EVALUATION.—Section 210 8 (c)(3)(B) of such Act (42 U.S.C. 1397hh(c)(3)(B)) is amended by inserting ‘‘(such as through community health workers and others)’’ after ‘‘including practices’’. SEC.20 2. IN C R E A SE DOUT REAC H AND ENRO L L M ENT O F INDIANS. (a) IN G ENERAL.—Section 1139 (42 U.S.C. 1320b – 9) is amended to read as follows: ‘ ‘SEC. 1 1 39 .IM P RO V ED ACCESS TO , AND DELIVER Y OF, HEALTH CARE FOR INDIANS UNDER TITLES X IX AND XXI. ‘‘(a) AGREEMENTS W ITH STATES FOR MEDICAID AND CHIP OUT- REACH ONOR N EAR R ESERVATIONS TO INCREASE THE ENROLLMENT OF INDIANS IN THOSE PROGRAMS.— ‘‘(1) IN GENERAL.—In order to improve the access of Indians residing on or near a reservation to obtain benefits under the Medicaid and State children’s health insurance programs established under titles X IX and XXI, the Secretary shall encourage the State to take steps to provide for enrollment on or near the reservation. Such steps may include outreach efforts such as the outstationing of eligibility workers, entering


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 123STA T .40PUBLIC LA W 111 – 3 —FE B.4 , 200 9intoagre e m ent sw it h the I n d ian H ea l th S er v i c e , Indian T ri b es, Tribal O rgani z ations, and U rban Indian Organizations to p ro - vide o u treach, education regarding eligibilit y and bene f its, enrollment, and translation services when such services are appropriate .‘ ‘ (2)CONSTRUC T I ON. —N othing in paragraph ( 1 ) shall be construed as affecting arrangements entered into between States and the Indian Health Service, Indian Tribes, Tribal Organizations, or Urban Indian Organizations for such Service, Tribes, or Organizations to conduct administrative activities under such titles. ‘‘(b) REQ UIRE M ENT TO FA CI L ITATE COO P ERATION.—The Sec- retary, acting through the Centers for M edicare & Medicaid Serv- ices, shall ta k e such steps as are necessary to facilitate cooperation with, and agreements between, States and the Indian Health Service, Indian Tribes, Tribal Organizations, or Urban Indian Organizations with respect to the provision of health care items and services to Indians under the programs established under title X IX or XXI. ‘‘(c) D E F INITION OF IN D IAN INDIAN TRI B E; INDIAN HEALT HP RO- G RAM; TRIBAL ORGANI Z ATION; URBAN INDIAN ORGANIZATION.—In this section, the terms ‘Indian ’, ‘Indian Tribe’, ‘Indian Health Pro- gram’, ‘Tribal Organization’, and ‘Urban Indian Organization’ have the meanings given those terms in section 4 of the Indian Health Care Improvement A ct.’’. (b) NONAPPLICATION OF 1 0 PERCENT L IMIT ON OUTREACH AND CERTAIN OTHER EX PENDITURES.—Section 210 5 (c)(2) (42 U.S.C. 1 397 ee(c)(2)) is amended by adding at the end the following ‘‘(C) NONAPPLICATION TO CERTAIN EXPENDITURES.—The limitation under subparagraph (A) shall not apply with respect to the following e x penditures: ‘‘(i) EXPENDITURES TO INCREASE OUTREACH TO, AND THE ENROLLMENT OF, INDIAN CHILDREN UNDER THIS TITLE AND TITLE xix.—Expenditures for outreach activi- ties to families of Indian children likely to be eligible for child health assistance under the plan or medical assistance under the State plan under title XIX (or under a waiver of such plan), to inform such families of the availability of, and to assist them in enrolling their children in, such plans, including such activities conducted under grants, contracts, or agreements entered into under section 1139(a).’’. SEC.203 .S TA TE OP T I O N TO R E LY ON F IN D IN G S FRO M ANE X PRESS LANE AGENCY TO COND U CT SIMPLIFIED ELIGI B ILITY DETERMINATIONS. (a) APPLICATION UNDER MEDICAID AND CHIP PROGRAMS.— (1) MEDICAID.—Section 1902(e) (42 U.S.C. 139 6 a(e)) is amended by adding at the end the following: ‘‘(13) EXPRESS LANE OPTION.— ‘‘(A) IN GENERAL.— ‘‘(i) OPTION TO USE A FINDING FROM AN EXPRESS LANE AGENC Y .—At the option of the State, the State plan may provide that in determining eligibility under this title for a child (as defined in subparagraph ( G )), the State may rely on a finding made within a reasonable period (as determined by the State) from an Express Lane agency


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 123STA T .4 1 PUBLIC LA W 111 – 3 —FE B.4 , 2 0 0 9(asdefin edins ubp a r a g rap h ( F) ) w hen i t deter m ines whether a c hi l d satisfies o ne or more components of eligi - bilit y for medical assistance under this title .T he S tate may rely on a finding from an Ex press L ane agency not- withstanding sections 1902 (a)( 46 )( B )and11 37 (d) or any differences in budget unit , disregard, deeming or other methodology, if the following re q uirements are met

‘( I ) PROHIB I T IO N ON DE TER M ININ GC HI L DREN INELI- GIBLE F OR CO V ER A GE. — If a finding from an Express Lane agency would result in a determination that a child does not satisfy an eligibility requirement for medical assistance under this title and for child health assistance under title X XI, the State shall determine eligibility for assistance using its regular procedures. ‘‘(II) N OTICE RE QU IREMENT.—For any child who is found eligible for medical assistance under the State plan under this title or child health assistance under title XXI and who is sub j ect to premiums based on an Express Lane agency ’ s finding of such child’s income le v el, the State shall provide notice that the child may qualify for lower premium payments if evaluated by the State using its regular policies and of the proce- dures for requesting such an evaluation. ‘‘(III) C OM P LIANCE W ITH S CREEN AND ENROLL REQUIREMENT.—The State shall satisfy the require- ments under subparagraphs ( A ) and (B) of section 2102(b)(3) (relating to screen and enroll) before enrolling a child in child health assistance under title XXI. At its option, the State may fulfill such require- ments in accordance with either option provided under subparagraph (C) of this paragraph. ‘‘(I V ) VERIFICATION OF CITI Z ENSHIP OR NATIONALIT Y STATUS.—The State shall satisfy the requirements of section 1902(a)(46)(B) or 210 5 (c)(9), as applicable for verifications of citi z enship or nationality status. ‘‘(V) CODING.—The State meets the requirements of subparagraph (E). ‘‘(ii) O PTION TO APPLY TO RENEWALS AND REDETERMINA- TIONS.—The State may apply the provisions of this para- graph when conducting initial determinations of eligibility, redeterminations of eligibility, or both, as described in the State plan. ‘‘(B) R ULES OF CONSTRUCTION.—Nothing in this paragraph shall be construed— ‘‘(i) to limit or prohibit a State from ta k ing any actions otherwise permitted under this title or title XXI in deter- mining eligibility for or enrolling children into medical assistance under this title or child health assistance under title XXI or ‘‘(ii) to modify the limitations in section 1902(a)(5) con- cerning the agencies that may make a determination of eligibility for medical assistance under this title. ‘‘(C) OPTIONS FOR SATISFYING THE SCREEN AND ENROLL REQUIREMENT.— ‘‘(i) IN GENERAL.— W ith respect to a child whose eligi- bility for medical assistance under this title or for child health assistance under title XXI has been evaluated by


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 123STA T .4 2 PUBLIC LA W 111 – 3 —FE B.4 , 2 0 0 9aSt at e a g e ncyusi ng an inc om e f in d ing f r om an Exp ress L ane agency , a State may carry out its duties under su b- paragrap h s (A) and ( B ) of section 210 2(b)( 3 ) (re l ating to screen and enroll) in accordance w ith either clause (ii) or clause (iii) .‘ ‘(ii) E STABLI S H I NG AS CRE ENING THRESH O L D . — ‘‘( I ) IN GENERAL.— U nder this clause, the State establishes a screening threshold set as a percentage of the F ederal po v erty level that exceeds the highest income threshold applicable under this title to the child by a minimum of 30 percentage points or, at State option, a higher number of percentage points that reflects the value (as determined by the State and described in the State plan) of any differences between income methodologies used by the program administered by the Express Lane agency and the methodologies used by the State in determining eligi- bility for medical assistance under this title. ‘‘(II) C HILDREN W ITH INCO M E NOT ABO V E THRESHOLD.—If the income of a child does not exceed the screening threshold, the child is deemed to satisfy the income eligibility criteria for medical assistance under this title regardless of whether such child would otherwise satisfy such criteria. ‘‘(III) CHILDREN WITH INCOME ABOVE THRESHOLD.— If the income of a child exceeds the screening threshold, the child shall be considered to have an income above the M edicaid applicable income level described in sec- tion 2110(b)( 4 ) and to satisfy the re q uirement under section 2110(b)(1)(C) (relating to the requirement that C H I P matching funds be used only for children not eligible for Medicaid). If such a child is enrolled in child health assistance under title X XI, the State shall provide the parent, guardian, or custodial relative with the following ‘‘(aa) N otice that the child may be eligible to receive medical assistance under the State plan under this title if evaluated for such assistance under the State ’ s regular procedures and notice of the process through which a parent, guardian, or custodial relative can request that the State evaluate the child’s eligibility for medical assist- ance under this title using such regular proce- dures. ‘‘(bb) A description of differences between the medical assistance provided under this title and child health assistance under title XXI, including differences in cost-sharing requirements and cov- ered benefits. ‘‘(iii) T EM P ORAR Y ENROLLMENT IN CHIP PENDING SCREEN AND ENROLL.— ‘‘(I) IN GENERAL.—Under this clause, a State enrolls a child in child health assistance under title XXI for a temporary period if the child appears eligible for such assistance based on an income finding by an Express Lane agency.


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 123STA T .4 3 PUBLIC LA W 111 – 3 —FE B.4 , 2 0 0 9‘ ‘ (I I )DET E RMINA TI O NO F E L I G I B ILIT Y.— D urings u chtempo r a r y enro l lment perio d, the S tate shall determine the child ’ s eligi b ility f or child health assistance under title X XI or for medical assistance under this title in accordance w ith this clause. ‘‘(III) P ROM P T FOLLO WU P.—In ma k ing such a determination, the State shall take prompt action to determine whether the child should be enrolled in med - ical assistance under this title or child health assist- ance under title XXI pursuant to subparagraphs ( A ) and ( B ) of section 210 2(b)( 3 ) (relating to screen and enroll). ‘‘(I V ) R E Q UIREMENT FOR S IMPLIFIE D DETERMINA- TION.—In making such a determination, the State shall use procedures that, to the ma x imum feasible extent, reduce the burden imposed on the indi v idual of such determination. Such procedures may not re q uire the child’s parent, guardian, or custodial relative to provide or verify information that already has been provided to the State agency by an E xpress L ane agency or another source of information unless the State agency has reason to believe the information is erroneous. ‘‘(V) A V AILABILITY OF CH IP MATCHING FUNDS DURING TEMPORARY ENROLLMENT PERIOD.— M edical assistance for items and services that are provided to a child enrolled in title XXI during a temporary enrollment period under this clause shall be treated as child health assistance under such title. ‘‘(D) O PTION FOR AUTOMATIC ENROLLMENT.— ‘‘(i) IN GENERAL.— T he State may initiate and deter- mine eligibility for medical assistance under the State Med- icaid plan or for child health assistance under the State CH IP plan without a program application from, or on behalf of, the child based on data obtained from sources other than the child (or the child’s family), but a child can only be automatically enrolled in the State Medicaid plan or the State CHIP plan if the child or the family affirmatively consents to being enrolled through affirmation in writing, by telephone, orally, through electronic signature, or through any other means specified by the Secretary or by signature on an Express Lane agency application, if the requirement of clause (ii) is met. ‘‘(ii) INFORMATION REQUIREMENT.—The requirement of this clause is that the State informs the parent, guardian, or custodial relative of the child of the services that will be covered, appropriate methods for using such services, premium or other cost sharing charges (if any) that apply, medical support obligations (under section 1 9 12(a)) created by enrollment (if applicable), and the actions the parent, guardian, or relative must take to maintain enrollment and renew coverage. ‘‘(E) CODING APPLICATION TO ENROLLMENT ERROR RATES.— ‘‘(i) IN GENERAL.— F or purposes of subparagraph (A)(iv), the requirement of this subparagraph for a State is that the State agrees to— ‘‘(I) assign such codes as the Secretary shall require to the children who are enrolled in the State Procedu re s.


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 123STA T .4 4 PUBLIC LA W 111 – 3 —FE B.4 , 2 0 0 9Medica id pl a north e S tate CHIP plan thro ug h reliance ona f inding m ade by an Ex pre s s L ane agency for the duration of the State ’ s election under this para - graph ‘ ( II ) annually pro v ide the Secretary w ith a statis- tically valid sample (that is approved by Secretary) of the children enrolled in such plans through reliance on such a finding by conducting a full Medicaid eligi- bility review of the children identified for such sample for purposes of determining an eligibility error rate (as described in clause (iv)) with respect to the enroll- ment of such children (and shall not include such chil- dren in any data or samples used for purposes of complying with a Medicaid Eligibility Q uality Control (MEQC) review or a payment error rate measurement (PE R M) re q uirement); ‘‘(III) submit the error rate determined under sub- clause (II) to the Secretary; ‘‘(I V ) if such error rate exceeds 3 percent for either of the first 2 fiscal years in which the State elects to apply this paragraph , demonstrate to the satisfac- tion of the Secretary the specific corrective actions implemented by the State to improve upon such error rate; and ‘‘(V) if such error rate exceeds 3 percent for any fiscal year in which the State elects to apply this paragraph, a reduction in the amount otherwise pay- able to the State under section 190 3(a) for quarters for that fiscal year, equal to the total amount of erro- neous excess payments determined for the fiscal year only with respect to the children included in the sample for the fiscal year that are in excess of a 3 percent error rate with respect to such children . ‘‘(ii) NOPUNIT I VEAC TION B A S E D ONE R ROR RATE. —T he Secretary shall not apply the error rate derived from the sample under clause (i) to the entire population of children enrolled in the State Medicaid plan or the State CHIP plan through reliance on a finding made by an Express Lane agency, or to the population of children enrolled in such plans on the basis of the State’s regular procedures for determining eligibility, or penali z e the State on the basis of such error rate in any manner other than the reduction of payments provided for under clause (i)(V). ‘‘(iii) RU L EO F CONSTRUCTION.—Nothing in this para- graph shall be construed as relieving a State that elects to apply this paragraph from being sub j ect to a penalty under section 1903(u), for payments made under the State Medicaid plan with respect to ineligible individuals and families that are determined to exceed the error rate per- mitted under that section (as determined without regard to the error rate determined under clause (i)(II)). ‘‘(iv) ERROR RATE DEFINED.—In this subparagraph, the term ‘error rate’ means the rate of erroneous excess pay- ments for medical assistance (as defined in section 1903(u)(1)( D )) for the period involved, except that such payments shall be limited to individuals for which eligi- bility determinations are made under this paragraph and Submis si on.Deadl ine. S t atisti c s.