Sec. 401. Requiring outreach and coverage before expansion of eligibility
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Section 2102(a) of the Social Security Act ( 42 U.S.C. 1397bb(a) ) is amended— in paragraph (6), by striking and at the end; in paragraph (7), by striking the period at the end and inserting ; and ; and by adding at the end the following new paragraph: how the eligibility and benefits provided for under the plan for each fiscal year (beginning with fiscal year 2015) will allow for the State’s annual funding allotment to cover at least 90 percent of the eligible targeted low-income children in the State. . The amendments made by paragraph
(1)shall apply to State child health plans for fiscal years beginning with fiscal year 2015. Section 2105(c) of the Social Security Act ( 42 U.S.C. 1397dd(c) ) is amended by adding at the end the following new paragraph: For child health assistance furnished in a fiscal year beginning with fiscal year 2015: Payment shall not be made under this section for child health assistance for a targeted low-income child in a family the income of which exceeds 300 percent of the poverty line applicable to a family of the size involved. In the case of child health assistance for a targeted low-income child in a family the income of which exceeds 200 percent (but does not exceed 300 percent) of the poverty line applicable to a family of the size involved no payment shall be made under this section for such assistance unless the State demonstrates to the satisfaction of the Secretary that— the State has met the 90 percent retrospective coverage test specified in subparagraph (B)(i) for the previous fiscal year; and the State will meet the 90 percent prospective coverage test specified in subparagraph (B)(ii) for the fiscal year. The 90 percent retrospective coverage test specified in this clause is, for a State for a fiscal year, that on average during the fiscal year, the State has enrolled under this title or title XIX at least 90 percent of the individuals residing in the State who— are children under 19 years of age (or are pregnant women) and are eligible for medical assistance under title XIX; or are targeted low-income children whose family income does not exceed 200 percent of the poverty line and who are eligible for child health assistance under this title. The 90 percent prospective test specified in this clause is, for a State for a fiscal year, that on average during the fiscal year, the State will enroll under this title or title XIX at least 90 percent of the individuals residing in the State who— are children under 19 years of age (or are pregnant women) and are eligible for medical assistance under title XIX; or are targeted low-income children whose family income does not exceed such percent of the poverty line (in excess of 200 percent) as the State elects consistent with this paragraph and who are eligible for child health assistance under this title. Clauses
(i)and
(ii)of subparagraph
(A)shall not apply to the provision of child health assistance— to a targeted low-income child who is enrolled for child health assistance under this title as of September 30, 2012; to a pregnant woman who is enrolled for assistance under this title as of September 30, 2013, through the completion of the post-partum period following completion of her pregnancy; and for items and services furnished before October 1, 2014, to an individual who is not a targeted low-income child and who is enrolled for assistance under this title as of September 30, 2013. In this paragraph and sections 2102(a)(8) and 2104(a)(2), the term targeted low-income child includes an individual under age 19, including the period from conception to birth, who is eligible for child health assistance under this title by virtue of the definition of the term child under section 457.10 of title 42, Code of Federal Regulations. . Section 2110 of the Social Security Act ( 42 U.S.C. 1397jj ) is amended by adding at the end the following new subsection: In determining family income under this title (including in the case of a State child health plan that provides health benefits coverage in the manner described in section 2101(a)(2)), a State shall base such determination on gross income (including amounts that would be included in gross income if they were not exempt from income taxation) and may only take into consideration such income disregards as the Secretary shall develop. . Subject to subparagraph (B), the amendment made by paragraph
(1)shall apply to determinations (and redeterminations) of income made on or after April 1, 2012. In the case of a State child health plan under title XXI of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendment made by paragraph (1), the State child health plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.
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Sec. 401
Requiring outreach and coverage before expansion of eligibility
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