Sec. 403. Improving beneficiary choice in SCHIP
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Section 2102 of the Social Security Act ( 42 U.S.C. 1397b ), as amended by sections 401(a) and 402(a), is amended— in subsection (a)— in paragraph (8), by striking and at the end; in paragraph (9), by striking the period at the end and inserting ; and ; and by adding at the end the following new paragraph: effective for plan years beginning on or after October 1, 2014, how the plan will provide for child health assistance with respect to targeted low-income children through alternative coverage options in accordance with subsection (e). ; and by adding at the end the following new subsection:
Effective October 1, 2014, a State child health plan shall provide for the offering of any qualified alternative coverage that a qualified entity seeks to offer to targeted low-income children through the plan in the State. With respect to all qualified alternative coverage offered in a State, the State child health plan shall establish a uniform dollar limitation on the per capita monthly amount that will be paid by the State to the qualified entity with respect to such coverage provided to a targeted low-income child.
Such limitation may not be less than 90 percent of the per capita monthly payment made for coverage offered under the State child health plan that is not in the form of an alternative coverage option. Nothing in this paragraph shall be construed— as requiring a State to provide for the full payment of premiums for qualified alternative coverage; as preventing a State from charging additional premiums to cover the difference between the cost of qualified alternative coverage and the amount of such payment limitation; or as preventing a State from using its own funds to provide a dollar limitation that exceeds the Federal financial participation as limited under section 2105(c)(10).
Except as provided in subparagraph (B), if the uniform dollar limitation under paragraph
(2)exceeds the premium for qualified alternative coverage for an enrollee, then such excess shall be refunded to the Federal and State governments in the same proportion as is otherwise applicable to recovered funds under this title. In the case of coverage under a high-deductible health plan, the excess described in subparagraph
(A)shall be deposited into a health savings account established with respect to such plan. A State is not subject to the requirement of paragraph
(1)if the State child health plan provides, as of the date of the enactment of this subsection, for a cash out or health savings account type option for those enrolled under the plan. In this section, the term qualified alternative coverage means health insurance coverage that— meets the coverage requirements of section 2103 (other than cost-sharing requirements of such section); and is offered by a qualified insurer, and not directly by the State. In this section, the term qualified insurer means, with respect to a State, an entity that is licensed to offer health insurance coverage in the State. . Section 2105 of the Social Security Act ( 42 U.S.C. 1397d ) is amended— in subsection (a)(1)(C), as amended by section 402(b), by inserting before the semicolon at the end the following: and, subject to paragraph (13)(C), in the form of payment of the premiums for coverage for qualified alternative coverage ; and in subsection (c), as amended by section 401(b) by adding at the end the following new paragraph: Payment may be made to a State under subsection (a)(1)(C), subject to the provisions of this paragraph, for the purchase of qualified alternative coverage. With respect to coverage described in subparagraph (A), no limitation on beneficiary cost-sharing otherwise applicable under this title or title XIX shall apply. The amount of the payment under paragraph (1)(C) for coverage described in subparagraph
(A)during a fiscal year in the aggregate for all such coverage in the State may not exceed the product of— the national per capita expenditure under this title (taking into account both Federal and State expenditures) for the previous fiscal year (as determined by the Secretary using the best available data); the enhanced FMAP for the State and fiscal year involved; and the number of targeted low-income children for whom such coverage is provided. A State child health plan— may not require a targeted low-income child to enroll in coverage described in subparagraph
(A)in order to obtain child health assistance under this title; before providing such child health assistance for such coverage of a child, shall make available (which may be through an Internet Web site or other means) to the parent or guardian of the child information on the coverage available under this title, including benefits and cost-sharing; and shall provide at least one opportunity per fiscal year for beneficiaries to switch coverage under this title from coverage described in subparagraph
(A)to the coverage that is otherwise made available under this title. A State child health plan shall— describe how the State will notify potential beneficiaries of coverage described in subparagraph (A); provide such notification in writing at least during the initial application for enrollment under this title and during redeterminations of eligibility if the individual was enrolled before October 1, 2014; and post a description of these coverage options on any official Web site that may be established by the State in connection with the plan. Nothing in this section is to be construed to prohibit a State from— establishing limits on beneficiary cost-sharing under such alternative coverage; paying all or part of a beneficiary’s cost-sharing requirements under such coverage; paying less than the full cost of a child’s share of the premium under such coverage, insofar as the premium for such coverage exceeds the limitation established by the State under subparagraph (C); using State funds to pay for benefits above the Federal upper limit established under subparagraph (C); or providing any guidance or information it deems appropriate in order to help beneficiaries make an informed decision regarding the option to enroll in coverage described in subparagraph (A). . The Secretary of Health and Human Services shall provide for the application of the amendments made by subsections
(a)and
(b)under the Medicaid program under title XIX of the Social Security Act in the same manner as such amendments apply to SCHIP under title XXI of such Act.
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