C2-07-i3 I 7E00 Soca:ih/ Blvd. I I i^Ssltitn&rs, S^-r^r/iend 21244 110th congress H. 3888 R. 1st Session To provide for a 5-year SCHIP reauthorization for coverage of low-income children, an expansion of child health care insurance coverage through tax fairness, and a health care Federalism initiative, and for other purposes. IN THE HOUSE OF REPRESENTATIVES October 18, 2007 Mrs. MUSGRAVE (for herself, Mr. Price of Georgia, Mr. Feeney, Mr. Walberg, Mr. BoEHNER, Mr. Blunt, Mr. Cantor, Mr. Putnam, Mr. Keller of Florida, Mr. Terry, Mr. Rosi^am, Mr. Thornberry, Mr. Sessions, Mr. Chabot, Mr. David Davis of Tennessee, Mr. Heller of Nevada, Mr. Kline of Minnesota, Mr. Pence, Mr. Carter, Mr. GOHMERT, Mr. Weldon of Florida, Mr. WESTMORELAND, Mr. PiTTS, Mr. Bishop of Utah, Mrs. Blackburn, Mr. Issa, Mr. Bartlett of Maryland, Mr. Smith of Nebraska, Mr. Hoekstra, Mrs. Schmidt, Mr. Brow of South Carolina, Mr. Coble, Mr. Miller of Florida, Mr. Burton of Indiana, Mr. Gingrey, Mr. Boozman, Mr. Smith of Texas, Mr. Gary G. Miller of Cahfornia, Mr. Crenshaw, Mr. Wajvip, Mrs. CUBIN, and Mr. Franks of Arizona) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means and Rules, for a period to be sub- sequently determined by the Speaker, in each case for consideration of such provisions as fall \\dthin the jurisdiction of the committee concerned A BILL To provide for a 5-year SCHIP reauthorization for coverage of lov^-income children, an exjoansion of child health care insurance coverage through tax fairness, and a health care Federalism initiative, and for other purposes. 2 1 Be it enacted hy the Senate and House ofRepresenta- 2 tives ofthe United States ofAmerica in Congress assembled, 3 SECTION SHORT TITLE; TABLE OF CONTENTS. 1. — 4 (a) Short Title. This Act may be cited as the 5 "More Children, More Choices Act of 2007". — 6 (b) Table op Contents. The table of contents of 7 this Act is as follows: See. 1. Short title; table of contents. TITLE I—SCHIP REAUTHORIZATION Sec. 101. Requiring outreach and coverage before expansion of eligibLlity. Sec. 102. Application of citizenship documentation requirements; increased Federal matching rate for citizenship documentation enforce- ment under Medicaid and SCHIP. Sec. 103. Limitations on eligibility based on substantial net assets. Sec. 104. Clarification of State authorities. Sec. 105. Easing administrative barriers to State cooperation wdth employer- sponsored insurance coverage. Sec. 106. Improving beneficiary choice in SCHIP. Sec. 107. Allotment distribution formula. Sec. 108. Five-year reauthorization. Sec. 109. Enhancing the programmatic focus on children and pregnant women. Sec. 110. Grants for outreach and enrollment. TITLE n—CHILD HEALTH INSURANCE COVERAGE THROUGH TAX FAIRNESS Sec. 201. Expansion of child health care insurance coverage through tax fair- ness. TITLE III—STATE HEALTH REFORM PROJECTS Sec. 301. State health reform projects. a TITLE IV—SENSE OF THE HOUSE OF REPRESENTATR^S Sec. 401. Medicare and Medicaid reform and savings. •HR 3888 IH 3 TITLE I—SCHIP 1 REAUTHORIZATION 2 3 SEC. 101. REQUIRING OUTREACH AND COVERAGE BEFORE 4 EXPANSION OF ELIGIBILITY. How 5 (a) State Plan Required To Specify It 6 Will Achieve Coverage for 90 Percent of Tar- — 7 GETED Low-Income Children. — 8 (1) In general. Section 2102(a) of the So- 9 cial Security Act (42 U.S.C. 1397bb(a)) is amend- ed— 10 11 (A) in paragraph (6), by striking ''and" at 12 the end; 13 (B) in paragraph (7), by striking the pe- 14 riod at the end and inserting and"; and 15 (C) by adding at the end the folloAving new 16 paragraph: 17 "(8) how the eligibility and benefits prowded 18 for under the plan for each fiscal year (beginning 19 with fiscal year 2009) will allow for the State's an- 20 nual funding allotment to cover at least 90 percent 21 of the eligible targeted low-income children in the 22 State.". — 23 Effective date. The amendments made (2) 24 by paragraph (1) shall apply to State child health •HR 3888 IH 4 1 plans for fiscal years beginning with fiscal year 2 2009. 3 (b) Limitation on Program Expansions Until — 4 Lowest Income Eligible Individuals Enrolled. 5 Section 2105(c) of such Act (42 U.S.C. 1397dd(c)) is 6 amended by adding at the end the following new para- 7 graph: 8 "(8) Limitation on increased coverage of — 9 HIGHER INCOME CHILDREN. For child health as- 10 sistance furnished in a fiscal year beginning with fis- 11 cal year 2008: 12 "(A) No PAYMENT FOR CHILDREN WITH 13 FAJVIILY INCOME ABOVE 250 PERCENT OF POV- — 14 ERTY LINE. Payment shall not be made under 15 this section for child health assistance for a tar- 16 geted low-income child in a family the income 17 of which exceeds 250 percent of the poverty line 18 applicable to a family of the size involved. 19 "(B) Special rules for payment for 20 CHILDREN WITH FAMILY INCOME ABOVE 200 — 21 PERCENT OF POVERTY LINE. In the case of 22 child health assistance for a targeted low^-in- 23 come child in a family the income of which ex- 24 ceeds 200 percent (but does not exceed 250 25 percent) of the poverty line applicable to a fam- >HR 3888 IH — — — 5 1 ily of the size involved no payment shall be 2 made under this section for such assistance un- 3 less the State demonstrates to the satisfaction 4 of the Secretary that 5 ''(i) the State has met the 90 percent 6 retrospective coverage test specified in sub- 7 paragraph (C)(i) for the previous fiscal 8 year; and 9 "(ii) the State will meet the 90 per- 10 cent prospective coverage test specified in 11 subparagraph (C)(ii) for the fiscal year. 12 "(C) 90 PERCENT COVERAGE TESTS. — 13 "(i) Retrospective test. The 90 14 percent retrospective coverage test speci- 15 fied in this clause is, for a State for a fis- 16 cal year, that on average during the fiscal 17 year, the State has enrolled under this title XIX 18 or title at least 90 percent of the indi- 19 viduals residing in the State who 20 "(I) are children under 19 years 21 of age (or are pregnant women) and 22 are eligible for medical assistance 23 under title XIX; or 24 "(11) are targeted low-income 25 children whose family income does not •HR 3888 IH — — 6 1 exceed 200 percent of the poverty line 2 and who are ehgible for child health 3 assistance nnder this title. — 4 "(ii) Prospective test. The 90 5 percent prospective test specified in this 6 clause is, for a State for a fiscal year, that 7 on average during the fiscal year, the State XIX 8 will enroll under this title or title at 9 least 90 percent of the individuals residing 10 in the State who 11 "(I) are children under 19 years 12 of age (or are pregnant women) and 13 are eligible for medical assistance 14 under title XIX; or 15 "(II) are targeted low-income 16 children whose family income does not 17 exceed such percent of the poverty 18 line (in excess of 200 percent) as the 19 State elects consistent with this para- 20 graph and who are eligible for child 21 health assistance under this title. — 22 "(D) Grandfather. Subparagraphs (A) 23 and (B) shall not apply to the provision of child 24 health assistance •HR 3888 IH t — 7 1 "(i) to a targeted low-income child 2 who is enrolled for child health assistance 3 under this title as of September 30, 2007; 4 "(ii) to a pregnant woman who is en- 5 rolled for assistance nnder this title as of 6 September 30, 2007, through the comple- 7 tion of the post-partum period following 8 completion of her pregnancy; and 9 "(iii) for items and services furnished 10 before October 2008, to an individual 1, 11 who is not a targeted low-income child and 12 who is enrolled for assistance under this 13 title as of September 30, 2007. 14 "(E) Treatment of pregnant — 15 WOMEN. In this paragraph and sections 16 2102(a)(8) and 2104(a)(2), the term 'targeted 17 low-income child' includes an individual under 18 age 19, including the period from conception to 19 birth, who is eligible for child health assistance 20 under this title by virtue of the definition of the 21 term 'child' under section 457.10 of title 42, 22 Code of Federal Regulations.". 23 Standardization of Income Determina- (c) 24 TIONS. HR 3888 IH 8 — 1 (1) In general. Section 2110(d) of such Act 2 (42 U.S.C. 1397jj) is amended by adding at the end 3 the following new subsection: 4 "(d) Standardization of Income Determina- — 5 TIONS. In determining family income under this title (in- 6 eluding in the case of a State child health plan that pro- 7 vides health benefits coverage in the manner described in 8 section 2101(a)(2)), a State shall base such determination 9 on gross income (including amounts that would be in- 10 eluded in gross income if they were not exempt from in- 1 1 come taxation) and may only take into consideration such 12 income disregards as the Secretary shall develop.". — 13 (2) Effective date. (A) Subject to subpara- 14 graph (B), the amendment made by paragraph (1) 15 shall apply to determinations (and redeterminations) 16 of income made on or after April 1, 2008. 17 (B) In the case of a State child health plan 18 under title XXI of the Social Security Act which the 19 Secretary of Health and Human Services determines 20 requires State legislation (other than legislation ap- 21 propriating funds) in order for the plan to meet the 22 additional requirement imposed by the amendment 23 made by paragraph (1), the State child health plan 24 shall not be regarded as failing to comply with the 25 requirements of such title solely on the basis of its •HR 3888 IH — 9 1 failure to meet this additional requirement before 2 the first day of the first calendar quarter beginning 3 after the close of the first regular session of the 4 State legislature that begins after the date of the en- 5 actment of this Act. For purposes of the previous 6 sentence, in the case of a State that has a 2-year 7 legislative session, each year of such session shall be 8 deemed to be a separate regular session of the State 9 legislature. 10 SEC. 102. APPLICATION OF CITIZENSHIP DOCUMENTATION 11 REQUIREMENTS; INCREASED FEDERAL 12 MATCHING RATE FOR CITIZENSHIP DOCU- 13 MENTATION ENFORCEMENT UNDER MED- 14 ICAID AND SCHIP. — 15 (a) Application of Requirements. — 16 (1) In general. Section 2105(c) of the So- 17 cial Security Act (42 U.S.C. 1397dd(c)), as amended 18 by section 101(b), is amended by adding at the end 19 the following new paragraph: 20 "(9) Application op citizenship docu- '21 mentation requirements. — 22 "(A) In gener^\l. Subject to subpara- 23 graph (B), no payment may be made under this 24 section to a State with respect to amounts ex- 25 pended for child health assistance for an indi- •HR 3888 IH Hr3888ih D- 2 10 1 vidual who declares under section 2 1137(d)(1)(A) to be a citizen or national of the 3 United States for purposes of establishing eligi- 4 bility for benefits under this title, unless the re- 5 quirement of section 1903(x) is met. 6 "(B) Treatment of pregnant — 7 WOMEN. For purposes of applying subpara- 8 graph (A) in the case of a pregnant woman who 9 qualifies for child health assistance by virtue of 10 the application of section 457.10 of title 42, 11 Code of Federal Regulations, the requirement 12 of such section shall be deemed to be satisfied 13 by the presentation of documentation of per- 14 sonal identity described in section 15 274A(b)(l)(D) of the Immigration and Nation- 16 ality Act or any other documentation of per- 17 sonal identity of such other type as the Sec- 18 retary finds, by regiilation, provides a reliable 19 means of identification.". — 20 Effective date. The amendment made (2) 21 by paragraph (1) shall apply to eligibilit}^ determina- 22 tions and redeterminations made on or after April 1, 23 2008. •HR 3888 IH