SOS Act of 2003

        [Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1012 Introduced in Senate (IS)]

108th CONGRESS
1st Session
S. 1012

To amend title XIX of the Social Security Act to provide fiscal relief
and program simplification to States, to improve coverage and services
to medicaid beneficiaries, and for other purposes.

_______________________________________________________________________

IN THE SENATE OF THE UNITED STATES

May 7, 2003

Mr. Bingaman (for himself, Mr. Corzine, Mrs. Clinton, Mr. Kerry, Mr.
Lautenberg, Mr. Dayton, and Mr. Johnson) introduced the following bill;
which was read twice and referred to the Committee on Finance

_______________________________________________________________________

A BILL

To amend title XIX of the Social Security Act to provide fiscal relief
and program simplification to States, to improve coverage and services
to medicaid beneficiaries, and for other purposes.

Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title.--This Act may be cited as the ``Strengthening Our
States Act of 2003'' or the ``SOS Act of 2003''.
(b) Table of Contents.--The table of contents of this Act is as
follows:

Sec. 1. Short title; table of contents.
TITLE I--STRENGTHENING FEDERAL RESPONSIBILITY FOR MEDICARE
BENEFICIARIES

Sec. 101. Assuming Federal responsibility for all medicare cost-
sharing.
Sec. 102. Expanded protections for low income medicare beneficiaries.
TITLE II--PROVIDING STATES FISCAL RELIEF

Sec. 201. Temporary increase of medicaid FMAP.
Sec. 202. Temporary grants for State fiscal relief.
Sec. 203. Increasing medicaid DSH allotments.
Sec. 204. Increased State access to unspent SCHIP funds.
Sec. 205. Federal responsibility for emergency care for illegal
immigrants.
Sec. 206. Increased Federal responsibility for translation services.
Sec. 207. Increased Federal matching rates for certain services.
TITLE III--HELPING STATES WITH COMMITMENT TO ELDERLY AND DISABLED;
FAMILY OPPORTUNITY ACT

Subtitle A--Elderly and Persons With Disabilities

Sec. 301. Full accounting of savings in determining cost-effectiveness.
Sec. 302. Extension of medicaid coverage under the ticket to work
program to cover spouses.
Sec. 303. Encouraging transition to home and community care.
Sec. 304. Enhanced matching rate for disabled individuals awaiting
medicare eligibility.
Sec. 305. Providing initial term of 5 years for section 1915 waivers.
Sec. 306. Optional coverage of community-based attendant services and
supports under the medicaid program.
Subtitle B--Family Opportunity Act

Sec. 311. Short title.
Sec. 312. Opportunity for families of disabled children to purchase
medicaid coverage for such children.
Sec. 313. Treatment of inpatient psychiatric hospital services for
individuals under age 21 in home or
community-based services waivers.
Sec. 314. Demonstration of coverage under the medicaid program of
children with potentially severe
disabilities.
Sec. 315. Development and support of family-to-family health
information centers.
Sec. 316. Restoration of medicaid eligibility for certain SSI
beneficiaries.
TITLE IV--FACILITATING PROGRAM ADMINISTRATION AND PRESERVING COVERAGE

Sec. 401. Allowing uniform coverage of all low income Americans.
Sec. 402. Facilitating coverage of families.
Sec. 403. Assistance with coverage of legal immigrants under the
medicaid program and SCHIP.
Sec. 404. Flexibility in eligibility determinations.

TITLE I--STRENGTHENING FEDERAL RESPONSIBILITY FOR MEDICARE
BENEFICIARIES

SEC. 101. ASSUMING FEDERAL RESPONSIBILITY FOR ALL MEDICARE COST-
SHARING.

(a) In General.--Section 1905(b) of the Social Security Act (42
U.S.C. 1396d(b)) is amended--
(1) by striking ``and'' before ``(4)''; and
(2) by inserting before the period the following: ``, and
(5) the Federal medical assistance percentage shall be 100
percent with respect to medical assistance provided with costs
described in section 1905(p)(3)''.
(b) Conforming Amendment.--Section 1902 of such Act (42 U.S.C.
1396a) is amended by striking subsection (n).
(c) Effective Date.--The amendments made by this section shall
apply to medical assistance for medicare cost-sharing for months
beginning with July 2003.

SEC. 102. EXPANDED PROTECTIONS FOR LOW INCOME MEDICARE BENEFICIARIES.

(a) In General.--Section 1902(a)(10)(E) of the Social Security Act
(42 U.S.C. 1396a(a)(10)(E)) is amended--
(1) by adding ``and'' at the end of clause (ii);
(2) in clause (iii), by striking ``110 percent in 1993 and
1994, and 120 percent in 1995 and years'' and inserting ``135
percent''; and
(3) by striking clause (iv).
(b) Conforming Amendment.--Section 1933 of such Act (42 U.S.C.
1396v) is repealed.
(c) Effective Date.--The amendments made by subsection (a), and the
repeal made by subsection (b), shall apply to months after September
2003.

TITLE II--PROVIDING STATES FISCAL RELIEF

SEC. 201. TEMPORARY INCREASE OF MEDICAID FMAP.

(a) Permitting Maintenance of Fiscal Year 2002 FMAP for Last 2
Calendar Quarters of Fiscal Year 2003.--Notwithstanding any other
provision of law, but subject to subsection (e), if the FMAP determined
without regard to this section for a State for fiscal year 2003 is less
than the FMAP as so determined for fiscal year 2002, the FMAP for the
State for fiscal year 2002 shall be substituted for the State's FMAP
for the third and fourth calendar quarters of fiscal year 2003, before
the application of this section.
(b) Permitting Maintenance of Fiscal Year 2003 FMAP for Fiscal Year
2004.--Notwithstanding any other provision of law, but subject to
subsection (e), if the FMAP determined without regard to this section
for a State for fiscal year 2004 is less than the FMAP as so determined
for fiscal year 2003, the FMAP for the State for fiscal year 2003 shall
be substituted for the State's FMAP for each calendar quarter of fiscal
year 2004, before the application of this section.
(c) General 3.73 Percentage Points Increase for Last 2 Calendar
Quarters of Fiscal Year 2003 and Fiscal Year 2004.--Notwithstanding any
other provision of law, but subject to subsections (e) and (f), for
each State for the third and fourth calendar quarters of fiscal year
2003 and each calendar quarter of fiscal year 2004, the FMAP (taking
into account the application of subsections (a) and (b)) shall be
increased by 3.73 percentage points.
(d) Increase in Cap on Medicaid Payments to Territories.--
Notwithstanding any other provision of law, but subject to subsection
(f), with respect to the third and fourth calendar quarters of fiscal
year 2003 and each calendar quarter of fiscal year 2004, the amounts
otherwise determined for Puerto Rico, the Virgin Islands, Guam, the
Northern Mariana Islands, and American Samoa under subsections (f) and
(g) of section 1108 of the Social Security Act (42 U.S.C. 1308) shall
each be increased by an amount equal to 7.46 percent of such amounts.
(e) Scope of Application.--The increases in the FMAP for a State
under this section shall apply only for purposes of title XIX of the
Social Security Act and shall not apply with respect to--
(1) disproportionate share hospital payments described in
section 1923 of such Act (42 U.S.C. 1396r-4); or
(2) payments under title IV or XXI of such Act (42 U.S.C.
601 et seq. and 1397aa et seq.).
(f) State Eligibility.--
(1) In general.--Subject to paragraph (2), a State is
eligible for an increase in its FMAP under subsection (c) or an
increase in a cap amount under subsection (d) only if the
eligibility under its State plan under title XIX of the Social
Security Act (including any waiver under such title or under
section 1115 of such Act (42 U.S.C. 1315)) is no more
restrictive than the eligibility under such plan (or waiver) as
in effect on September 2, 2003.
(2) State reinstatement of eligibility permitted.--A State
that has restricted eligibility under its State plan under
title XIX of the Social Security Act (including any waiver
under such title or under section 1115 of such Act (42 U.S.C.
1315)) after September 2, 2003, but prior to the date of
enactment of this Act is eligible for an increase in its FMAP
under subsection (c) or an increase in a cap amount under
subsection (d) in the first calendar quarter (and subsequent
calendar quarters) in which the State has reinstated
eligibility that is no more restrictive than the eligibility
under such plan (or waiver) as in effect on September 2, 2003.
(3) Rule of construction.--Nothing in paragraph (1) or (2)
shall be construed as affecting a State's flexibility with
respect to benefits offered under the State medicaid program
under title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.) (including any waiver under such title or under section
1115 of such Act (42 U.S.C. 1315)).
(g) Definitions.--In this section:
(1) FMAP.--The term ``FMAP'' means the Federal medical
assistance percentage, as defined in section 1905(b) of the
Social Security Act (42 U.S.C. 1396d(b)).
(2) State.--The term ``State'' has the meaning given such
term for purposes of title XIX of the Social Security Act (42
U.S.C. 1396 et seq.).
(h) Repeal.--Effective as of October 1, 2004, this section is
repealed.

SEC. 202. TEMPORARY GRANTS FOR STATE FISCAL RELIEF.

(a) In General.--Title XX of the Social Security Act (42 U.S.C.
1397-1397f) is amended by adding at the end the following:

``SEC. 2008. ADDITIONAL TEMPORARY GRANTS FOR STATE FISCAL RELIEF.

``(a) In General.--For the purpose of providing State fiscal relief
allotments to States under this section, there are hereby appropriated,
out of any funds in the Treasury not otherwise appropriated,
$15,000,000,000. Such funds shall be available for obligation by the
State through June 30, 2005, and for expenditure by the State through
September 30, 2005. This section constitutes budget authority in
advance of appropriations Acts and represents the obligation of the
Federal Government to provide for the payment to States of amounts
provided under this section.
``(b) Allotment.--Funds appropriated under subsection (a) shall be
allotted by the Secretary among the States in accordance with the
following table:

------------------------------------------------------------------------
``State                       Allotment (in dollars)
------------------------------------------------------------------------
Alabama                                $170,940,139
Alaska                                 $42,076,374
Amer. Samoa                            $414,007
Arizona                                $261,264,449
Arkansas                               $133,398,723
California                             $1,583,851,051
Colorado                               $143,030,332
Connecticut                            $207,204,156
Delaware                               $38,537,434
District of Columbia                   $65,034,813
Florida                                $624,655,953
Georgia                                $368,582,068
Guam                                   $669,845
Hawaii                                 $46,337,939
Idaho                                  $48,659,904
Illinois                               $543,631,283
Indiana                                $271,629,605
Iowa                                   $130,309,854
Kansas                                 $94,370,028
Kentucky                               $212,122,967
Louisiana                              $239,827,085
Maine                                  $92,781,591
Maryland                               $236,000,265
Massachusetts                          $472,765,757
Michigan                               $435,451,207
Minnesota                              $302,429,550
Mississippi                            $176,956,163
Missouri                               $302,534,081
Montana                                $36,437,168
Nebraska                               $79,550,313
Nevada                                 $52,331,624
New Hampshire                          $54,101,351
New Jersey                             $411,954,920
New Mexico                             $112,850,197
New York                               $2,383,327,447
North Carolina                         $439,742,488
North Dakota                           $27,253,781
N. Mariana Islands                     $233,880
Ohio                                   $616,448,513
Oklahoma                               $146,240,811
Oregon                                 $167,002,460
Pennsylvania                           $745,862,667
Puerto Rico                            $18,916,230
Rhode Island                           $80,098,624
South Carolina                         $184,217,430
South Dakota                           $30,302,145
Tennessee                              $350,273,887
Texas                                  $814,722,031
Utah                                   $63,422,131
Vermont                                $40,549,714
Virgin Islands                         $624,499
Virginia                               $215,155,129
Washington                             $298,697,312
West Virginia                          $95,818,709
Wisconsin                              $270,901,128
Wyoming                                $17,496,788
------------------------------------------------------------------------
Total                                  $15,000,000,000
------------------------------------------------------------------------

``(c) Use of Funds.--Funds appropriated under this section may be
used by a State for services directed at the goals set forth in section
2001, subject to the requirements of this title.
``(d) Payment to States.--Not later than 30 days after amounts are
appropriated under subsection (a), in addition to any payment made
under section 2002 or 2007, the Secretary shall make a lump sum payment
to a State of the total amount of the allotment for the State as
specified in subsection (b).
``(e) Definition.--For purposes of this section, the term `State'
means the 50 States, the District of Columbia, and the territories
contained in the list under subsection (b).''.
(b) Repeal.--Effective as of October 1, 2005, section 2008 of the
Social Security Act, as added by subsection (a), is repealed.
(c) GAO Study and Report.--
(1) Study.--The Comptroller General of the United States
shall conduct a study to determine an appropriate index that
could be used to temporarily adjust the Federal medical
assistance percentage for purposes of programs authorized under
the Social Security Act either with respect to all States
during a period of national recession or with respect to a
specific State when the State's economy takes a significant
turn for the worse.
(2) Report.--Not later than 1 year after the date of the
enactment of this Act, the Comptroller General of the United
States shall submit a report to Congress on the study conducted
under paragraph (1).

SEC. 203. INCREASING MEDICAID DSH ALLOTMENTS.

(a) Continuation of Medicaid DSH Allotment Adjustments Under BIPA
2000.--
(1) In general.--Section 1923(f) of the Social Security Act
(42 U.S.C. 1396r-4(f))--
(A) in paragraph (2)--
(i) in the heading, by striking ``through
2002'' and inserting ``through 2000'';
(ii) by striking ``ending with fiscal year
2002'' and inserting ``ending with fiscal year
2000''; and
(iii) in the table in such paragraph, by
striking the columns labeled ``FY 01'' and
``FY02'';
(B) in paragraph (3)(A), by striking ``paragraph
(2)'' and inserting ``paragraph (4)''; and
(C) in paragraph (4), as added by section 701(a)(1)
of the Medicare, Medicaid, and SCHIP Benefits
Improvement and Protection Act of 2000 (as enacted into
law by section 1(a)(6) of Public Law 106-554)--
(i) by striking ``for fiscal years 2001 and
2002'' in the heading;
(ii) in subparagraph (A), by striking
``Notwithstanding paragraph (2), the'' and
inserting ``The'';
(iii) in subparagraph (C)--
(I) by striking ``No application''
and inserting ``Application''; and
(II) by striking ``without regard
to'' and inserting ``taking into
account''.
(2) Increase in medicaid dsh allotment for the district of
columbia.--
(A) In general.--Effective for DSH allotments
beginning with fiscal year 2003, the item in the table
contained in section 1923(f)(2) of the Social Security
Act (42 U.S.C. 1396r-4(f)(2)) for the District of
Columbia for the DSH allotment for FY 00 (fiscal year
2000) is amended by striking ``32'' and inserting
``49''.
(B) Construction.--Nothing in subparagraph (A)
shall be construed as preventing the application of
section 1923(f)(4) of the Social Security Act (as
amended by subsection (a)) to the District of Columbia
for fiscal year 2003 and subsequent fiscal years.
(3) Effective date.--The amendments made by this subsection
shall apply to DSH allotments for fiscal years beginning with
fiscal year 2003.
(b) Increase in Floor for Treatment as an Extremely Low DSH State
to 3 Percent in Fiscal Year 2003.--
(1) Increase in dsh floor.--Section 1923(f)(5) of the
Social Security Act (42 U.S.C. 1396r-4(f)(5)) is amended--
(A) by striking ``fiscal year 1999'' and inserting
``fiscal year 2001'';
(B) by striking ``August 31, 2000'' and inserting
``August 31, 2002'';
(C) by striking ``1 percent'' each place it appears
and inserting ``3 percent''; and
(D) by striking ``fiscal year 2001'' and inserting
``fiscal year 2003''.
(2) Effective date.--The amendments made by paragraph (1)
take effect as if enacted on October 1, 2002, and apply to DSH
allotments under title XIX of the Social Security Act for
fiscal year 2003 and each fiscal year thereafter.

SEC. 204. INCREASED STATE ACCESS TO UNSPENT SCHIP FUNDS.

(a) Retained and Redistributed Allotments for Fiscal Years 1998 and
1999.--Paragraphs (2)(A)(i) and (2)(A)(ii) of section 2104(g) of the
Social Security Act (42 U.S.C. 1397dd(g)) are each amended by striking
``fiscal year 2002'' and inserting ``fiscal year 2004''.
(b) Extension and Revision of Retained and Redistributed Allotments
for Fiscal Year 2000.--
(1) Permitting and extending retention of portion of fiscal
year 2000 allotment.--Paragraph (2) of such section 2104(g) is
amended--
(A) in the heading, by striking ``and 1999'' and
inserting ``through 2000''; and
(B) by adding at the end of subparagraph (A) the
following:
``(iii) Fiscal year 2000 allotment.--Of the
amounts allotted to a State pursuant to this
section for fiscal year 2000 that were not
expended by the State by the end of fiscal year
2002, 50 percent of that amount shall remain
available for expenditure by the State through
the end of fiscal year 2004.''.
(2) Redistributed allotments.--Paragraph (1) of such
section 2104(g) is amended--
(A) in subparagraph (A), by inserting ``or for
fiscal year 2000 by the end of fiscal year 2002,''
after ``fiscal year 2001,'';
(B) in subparagraph (A), by striking ``1998 or
1999'' and inserting ``1998, 1999, or 2000'';
(C) in subparagraph (A)(i)--
(i) by striking ``or'' at the end of
subclause (I),
(ii) by striking the period at the end of
subclause (II) and inserting ``; or''; and
(iii) by adding at the end the following
new subclause:
``(III) the fiscal year 2000
allotment, the amount specified in
subparagraph (C)(i) (less the total of
the amounts under clause (ii) for such
fiscal year), multiplied by the ratio
of the amount specified in subparagraph
(C)(ii) for the State to the amount
specified in subparagraph (C)(iii).'';
(D) in subparagraph (A)(ii), by striking ``or
1999'' and inserting ``, 1999, or 2000'';
(E) in subparagraph (B), by striking ``with respect
to fiscal year 1998 or 1999'';
(F) in subparagraph (B)(ii)--
(i) by inserting ``with respect to fiscal
year 1998, 1999, or 2000,'' after ``subsection
(e),''; and
(ii) by striking ``2002'' and inserting
``2004''; and
(G) by adding at the end the following new
subparagraph:
``(C) Amounts used in computing redistributions for
fiscal year 2000.--For purposes of subparagraph
(A)(i)(III)--
``(i) the amount specified in this clause
is the amount specified in paragraph
(2)(B)(i)(I) for fiscal year 2000, less the
total amount remaining available pursuant to
paragraph (2)(A)(iii);
``(ii) the amount specified in this clause
for a State is the amount by which the State's
expenditures under this title in fiscal years
2000, 2001, and 2002 exceed the State's
allotment for fiscal year 2000 under subsection
(b); and
``(iii) the amount specified in this clause
is the sum, for all States entitled to a
redistribution under subparagraph (A) from the
allotments for fiscal year 2000, of the amounts
specified in clause (ii).''.
(3) Conforming amendments.--Such section 2104(g) is further
amended--
(A) in its heading, by striking ``and 1999'' and
inserting ``, 1999, and 2000''; and
(B) in paragraph (3)--
(i) by striking ``or fiscal year 1999'' and
inserting ``, fiscal year 1999, or fiscal year
2000''; and
(ii) by striking ``or November 30, 2001''
and inserting ``November 30, 2001, or November
30, 2002'', respectively.
(c) Extension and Revision of Retained and Redistributed Allotments
for Fiscal Year 2001.--
(1) Permitting and extending retention of portion of fiscal
year 2001 allotment.--Paragraph (2) of such section 2104(g), as
amended in subsection (b)(1)(B), is further amended--
(A) in the heading, by striking ``2000'' and
inserting ``2001''; and
(B) by adding at the end of subparagraph (A) the
following:
``(iv) Fiscal year 2001 allotment.--Of the
amounts allotted to a State pursuant to this
section for fiscal year 2001 that were not
expended by the State by the end of fiscal year
2003, 50 percent of that amount shall remain
available for expenditure by the State through
the end of fiscal year 2005.''.
(2) Redistributed allotments.--Paragraph (1) of such
section 2104(g), as amended in subsection (b)(2), is further
amended--
(A) in subparagraph (A), by inserting ``or for
fiscal year 2001 by the end of fiscal year 2003,''
after ``fiscal year 2002,'';
(B) in subparagraph (A), by striking ``1999, or
2000'' and inserting ``1999, 2000, or 2001'';
(C) in subparagraph (A)(i)--
(i) by striking ``or'' at the end of
subclause (II),
(ii) by striking the period at the end of
subclause (III) and inserting ``; or''; and
(iii) by adding at the end the following
new subclause:
``(IV) the fiscal year 2001
allotment, the amount specified in
subparagraph (D)(i) (less the total of
the amounts under clause (ii) for such
fiscal year), multiplied by the ratio
of the amount specified in subparagraph
(D)(ii) for the State to the amount
specified in subparagraph (D)(iii).'';
(D) in subparagraph (A)(ii), by striking ``or
2000'' and inserting ``2000, or 2001'';
(E) in subparagraph (B)--
(i) by striking ``and'' at the end of
clause (ii);
(ii) by redesignating clause (iii) as
clause (iv); and
(iii) by inserting after clause (ii) the
following new clause:
``(iii) notwithstanding subsection (e),
with respect to fiscal year 2001, shall remain
available for expenditure by the State through
the end of fiscal year 2005; and''; and
(F) by adding at the end the following new
subparagraph:
``(D) Amounts used in computing redistributions for
fiscal year 2001.--For purposes of subparagraph
(A)(i)(IV)--
``(i) the amount specified in this clause
is the amount specified in paragraph
(2)(B)(i)(I) for fiscal year 2001, less the
total amount remaining available pursuant to
paragraph (2)(A)(iv);
``(ii) the amount specified in this clause
for a State is the amount by which the State's
expenditures under this title in fiscal years
2001, 2002, and 2003 exceed the State's
allotment for fiscal year 2001 under subsection
(b); and
``(iii) the amount specified in this clause
is the sum, for all States entitled to a
redistribution under subparagraph (A) from the
allotments for fiscal year 2001, of the amounts
specified in clause (ii).''.
(3) Conforming amendments.--Such section 2104(g) is further
amended--
(A) in its heading, by striking ``and 2000'' and
inserting ``2000, and 2001''; and
(B) in paragraph (3)--
(i) by striking ``or fiscal year 2000'' and
inserting ``fiscal year 2000, or fiscal year
2001''; and
(ii) by striking ``or November 30, 2002,''
and inserting ``November 30, 2002, or November
30, 2003,'', respectively.
(d) Authority for Qualifying States To Use Portion of SCHIP Funds
for Medicaid Expenditures.--Section 2105 of the Social Security Act (42
U.S.C. 1397ee) is amended by adding at the end the following:
``(g) Authority for Qualifying States To Use Certain Funds for
Medicaid Expenditures.--
``(1) State option.--
``(A) In general.--Notwithstanding any other
provision of law, with respect to allotments for fiscal
years 1998, 1999, 2000, 2001, for fiscal years in which
such allotments are available under subsections (e) and
(g) of section 2104, a qualifying State (as defined in
paragraph (2)) may elect to use not more than 20
percent of such allotments (instead of for expenditures
under this title) for payments for such fiscal year
under title XIX in accordance with subparagraph (B).
``(B) Payments to states.--
``(i) In general.--In the case of a
qualifying State that has elected the option
described in subparagraph (A), subject to the
total amount of funds described with respect to
the State in subparagraph (A), the Secretary
shall pay the State an amount each quarter
equal to the additional amount that would have
been paid to the State under title XIX for
expenditures of the State for the fiscal year
described in clause (ii) if the enhanced FMAP
(as determined under subsection (b)) had been
substituted for the Federal medical assistance
percentage (as defined in section 1905(b)) of
such expenditures.
``(ii) Expenditures described.--For
purposes of clause (i), the expenditures
described in this clause are expenditures for
such fiscal years for providing medical
assistance under title XIX to individuals who
have not attained age 19 and whose family
income exceeds 150 percent of the poverty line.
``(iii) No impact on determination of
budget neutrality for waivers.--In the case of
a qualifying State that uses amounts paid under
this subsection for expenditures described in
clause (ii) that are incurred under a waiver
approved for the State, any budget neutrality
determinations with respect to such waiver
shall be determined without regard to such
amounts paid.
``(2) Qualifying state.--In this subsection, the term
`qualifying State' means a State that--
``(A) as of April 15, 1997, has an income
eligibility standard with respect to any 1 or more
categories of children (other than infants) who are
eligible for medical assistance under section
1902(a)(10)(A) or under a waiver under section 1115
implemented on January 1, 1994, that is up to 185
percent of the poverty line or above; and
``(B) satisfies the requirements described in
paragraph (3).
``(3) Requirements.--The requirements described in this
paragraph are the following:
``(A) SCHIP income eligibility.--The State has a
State child health plan that (whether implemented under
title XIX or this title)--
``(i) as of January 1, 2001, has an income
eligibility standard that is at least 200
percent of the poverty line or has an income
eligibility standard that exceeds 200 percent
of the poverty line under a waiver under
section 1115 that is based on a child's lack of
health insurance;
``(ii) subject to subparagraph (B), does
not limit the acceptance of applications for
children; and
``(iii) provides benefits to all children
in the State who apply for and meet eligibility
standards on a statewide basis.
``(B) No waiting list imposed.--With respect to
children whose family income is at or below 200 percent
of the poverty line, the State does not impose any
numerical limitation, waiting list, or similar
limitation on the eligibility of such children for
child health assistance under such State plan.
``(C) Additional requirements.--The State has
implemented at least 3 of the following policies and
procedures (relating to coverage of children under
title XIX and this title):
``(i) Uniform, simplified application
form.--With respect to children who are
eligible for medical assistance under section
1902(a)(10)(A), the State uses the same
uniform, simplified application form
(including, if applicable, permitting
application other than in person) for purposes
of establishing eligibility for benefits under
title XIX and this title.
``(ii) Elimination of asset test.--The
State does not apply any asset test for
eligibility under section 1902(l) or this title
with respect to children.
``(iii) Adoption of 12-month continuous
enrollment.--The State provides that
eligibility shall not be regularly redetermined
more often than once every year under this
title or for children described in section
1902(a)(10)(A).
``(iv) Same verification and
redetermination policies; automatic
reassessment of eligibility.--With respect to
children who are eligible for medical
assistance under section 1902(a)(10)(A), the
State provides for initial eligibility
determinations and redeterminations of
eligibility using the same verification
policies (including with respect to face-to-
face interviews), forms, and frequency as the
State uses for such purposes under this title,
and, as part of such redeterminations, provides
for the automatic reassessment of the
eligibility of such children for assistance
under title XIX and this title.
``(v) Outstationing enrollment staff.--The
State provides for the receipt and initial
processing of applications for benefits under
this title and for children under title XIX at
facilities defined as disproportionate share
hospitals under section 1923(a)(1)(A) and
Federally-qualified health centers described in
section 1905(l)(2)(B) consistent with section
1902(a)(55).''.
(e) Effective Date.--Subsections (a) through (c), and the
amendments made by such subsections, shall be effective as if this
section had been enacted on September 30, 2002, and amounts under title
XXI of the Social Security Act (42 U.S.C. 1397aa et seq.) from
allotments for fiscal years 1998 through 2000 are available for
expenditure on and after October 1, 2002, under the amendments made by
such subsections as if this section had been enacted on September 30,
2002.

SEC. 205. FEDERAL RESPONSIBILITY FOR EMERGENCY CARE FOR ILLEGAL
IMMIGRANTS.

(a) In General.--Section 1903(a)(3) of the Social Security Act (42
U.S.C. 1396b(a)(3)) is amended--
(1) in subparagraph (D), by striking ``plus'' at the end
and inserting ``and''; and
(2) by adding at the end the following:
``(E) 100 percent of the sums expended with respect
to costs incurred during such quarter as are
attributable to the provision of care and services that
are furnished to an alien described in subsection
(v)(1) that are necessary for the treatment of an
emergency medical condition, as defined in subsection
(v)(3); and''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on July 1, 2003.

SEC. 206. INCREASED FEDERAL RESPONSIBILITY FOR TRANSLATION SERVICES.

(a) In General.--Section 1903(a)(3) of the Social Security Act (42
U.S.C. 1396b(a)(3)), as amended by section 205(a), is amended by adding
at the end the following:
``(F) 90 percent of the sums expended with respect
to costs incurred during such quarter as are
attributable to the provision of language services,
including oral interpretation, translations of written
materials, and other language services, for individuals
with limited English proficiency who apply for, or
receive, medical assistance under the State plan;
and''.
(b) SCHIP.--Section 2105(A)(1) of the Social Security Act (42
U.S.C.1397ee(a)(1)) is amended--
(1) in the matter preceding subparagraph (A), by striking
``section 1905(b))'' and inserting ``section 1905(b)) or, in
the case of expenditures described in subparagraph (D)(iv), 90
percent''; and
(2) in subparagraph (D)--
(A) in clause (iii), by striking ``and'' at the
end;
(B) by redesignating clause (iv) as clause (v); and
(C) by inserting after clause (iii) the following:
``(D) for expenditures attributable to the
provision of language services, including oral
interpretation, translations of written materials, and
other language services, for individuals with limited
English proficiency who apply for, or receive, child
health assistance under the plan; and''.
(c) Effective Date.--The amendments made by this section shall take
effect on July 1, 2003.

SEC. 207. INCREASED FEDERAL MATCHING RATES FOR CERTAIN SERVICES.

(a) Outstationed Workers.--Section 1903(a)(3) of the Social
Security Act (42 U.S.C. 1396b(a)(3)), as amended by sections 205(a) and
206(a), is amended by adding at the end the following:
``(G) 90 percent of the sums expended with respect
to costs incurred during such quarter as are
attributable to providing for the receipt and initial
processing of applications of children and pregnant
women for medical assistance consistent with the
requirements of section 1902(a)(55); plus''.
(b) 100 Percent Matching Rate for Urban Indian Health Services.--
The third sentence of section 1905(b) of the Social Security Act (42
U.S.C. 1396d(b)) is amended--
(1) by inserting ``or program'' after ``facility'';
(2) by striking ``or by'' and inserting ``, by''; and
(3) by inserting ``, or by an urban Indian organization
pursuant to a grant or contract with the Indian Health Service
under title V of the Indian Health Care Improvement Act''
before the period.
(c) Effective Date.--The amendments made by this section shall take
effect on July 1, 2003.

TITLE III--STRENGTHENING STATE AND FEDERAL COMMITMENT TO THE ELDERLY
AND PERSONS WITH DISABILITIES; FAMILY OPPORTUNITY ACT

Subtitle A--Elderly and Persons With Disabilities

SEC. 301. FULL ACCOUNTING OF SAVINGS IN DETERMINING COST-EFFECTIVENESS.

(a) In General.--Section 1915(c)(2)(D) of the Social Security Act
(42 U.S.C. 1396n(c)(2)(D)) is amended by inserting ``(reduced by
average per capita reductions in spending under other Federal mandatory
spending programs resulting from operation of the waiver)'' after
``with respect to such individuals''.
(b) Effective Date.--The amendment made by subsection shall take
effect on the date of the enactment of this Act.

SEC. 302. EXTENSION OF MEDICAID COVERAGE UNDER THE TICKET TO WORK
PROGRAM TO COVER SPOUSES.

(a) In General.--Section 1902(a)(10)(A)(ii) of the Social Security
Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--
(1) in clause (i)(II), by inserting before the comma at the
end the following: ``, and at the option of a State, any
individual who is the spouse of such an individual'';
(2) in clause (ii)(XIII), by inserting before the semicolon
at the end the following: ``, and at the option of a State, any
individual who is the spouse of such an individual'';
(3) in subclause (XV), by inserting before the semicolon at
the end the following: ``, and at the option of a State, any
individual who is the spouse of such an individual''; and
(4) in subclause (XVI), by inserting before the semicolon
at the end the following: ``, and at the option of a State, any
individual who is the spouse of such an individual''.
(b) Conforming Amendment.--Section 1905(a)(xii) of such Act (42
U.S.C. 1396d(a)(xii)) is amended by inserting ``and spouses described
in clauses (i)(II), (ii)(XIII), (ii)(XV), and (ii)(XVI) of section
1902(a)(10)(A)'' after ``subsection (v))''.
(c) Effective Date.--The amendments made by this section take
effect on October 1, 2003, whether or not regulations implementing such
amendments have been issued.

SEC. 303. ENCOURAGING TRANSITION TO HOME AND COMMUNITY CARE.

(a) In General.--Section 1905(b) of the Social Security Act (42
U.S.C. 1396d(b)), as amended by section 101(a), is amended--
(1) by striking ``and'' before ``(5)''; and
(2) by inserting before the period the following: ``, and
(6) the Federal medical assistance percentage shall be equal to
the enhanced FMAP described in section 2105(b) with respect to
medical assistance provided under a waiver under section
1915(c)''.
(b) Conforming Amendment.--Section 1915(c) of such Act (42 U.S.C.
1396n(c)) is amended by adding at the end the following new paragraph:
``(11) For purposes of determining the amount of expenditures under
this section or a State plan for purposes of applying any test of cost-
effectiveness or similar test in carrying out this subsection, the
provisions of section 1905(b)(6) shall not be taken into account.''.
(c) Effective Date.--The amendments made by this section shall
apply to medical assistance for items and services furnished on or
after July 1, 2003, regardless of whether the waiver under which such
assistance is provided was approved before, on, or after the date of
the enactment of this Act.

SEC. 304. ENHANCED MATCHING RATE FOR DISABLED INDIVIDUALS AWAITING
MEDICARE ELIGIBILITY.

(a) In General.--Section 1905(b) of the Social Security Act (42
U.S.C. 1396d(b)), as amended by sections 101(a) and 303(a), is
amended--
(1) by striking ``and'' before ``(6)''; and
(2) by inserting before the period the following: ``, and
(7) the Federal medical assistance percentage shall be equal to
100 percent with respect to medical assistance provided to
individuals who are not entitled to benefits under part A of
title XVIII pursuant to section 226(b) but who would be
entitled to such benefits pursuant to such section but for the
application of a 24-month waiting period under such section''.
(b) Effective Date.--The amendments made by this section shall
apply to medical assistance for items and services furnished on or
after October 1, 2003.

SEC. 305. PROVIDING INITIAL TERM OF 5 YEARS FOR SECTION 1915 WAIVERS.

(a) In General.--Subsections (d)(3) and (e)(3) of section 1915 of
the Social Security Act (42 U.S.C. 1396n) are each amended by striking
``3 years'' and inserting ``5 years''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to waivers granted on or after the date of the enactment of this
Act.

SEC. 306. OPTIONAL COVERAGE OF COMMUNITY-BASED ATTENDANT SERVICES AND
SUPPORTS UNDER THE MEDICAID PROGRAM.

(a) Optional Coverage.--Section 1902(a)(10)(D) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(D)) is amended--
(1) by inserting ``(i)'' after ``(D)'';
(2) by adding ``and'' after the semicolon; and
(3) by adding at the end the following new clause:
``(ii) at the option of the State and subject to
section 1935, for the inclusion of community-based
attendant services and supports for any individual
who--
``(I) is eligible for medical assistance
under the State plan;
``(II) with respect to whom there has been
a determination that the individual requires
the level of care provided in a nursing
facility or an intermediate care facility for
the mentally retarded (whether or not coverage
of such intermediate care facility is provided
under the State plan); and
``(III) who chooses to receive such
services and supports;
insofar as such services are appropriate for the
individual's condition according to the individual's
plan of care;''.
(b) Community-Based Attendant Services and Supports Option.--
(1) In general.--Title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) is amended--
(A) by redesignating section 1935 as section 1936;
and
(B) by inserting after section 1934 the following:

``community-based attendant services and supports

``Sec. 1935. (a) Coverage.--
``(1) In general.--A State may provide through a plan
amendment for the inclusion of community-based attendant
services and supports (as defined in subsection (g)(1)) for
individuals described in section 1902(a)(10)(D)(ii) in
accordance with this section.
``(2) Enhanced fmap for coverage.--Notwithstanding section
1905(b), in the case of a State with an approved plan amendment
under this section during that period that also satisfies the
requirements of subsection (c) the Federal medical assistance
percentage shall be equal to the enhanced FMAP described in
section 2105(b) with respect to medical assistance in the form
of community-based attendant services and supports provided to
individuals described in section 1902(a)(10)(D)(ii) in
accordance with this section.
``(b) Development and Implementation of Benefit.--In order for a
State plan amendment to be approved under this section, a State shall
develop and implement the proposal through a public process which
includes individuals with disabilities, elderly individuals, their
representatives, and providers, and include in that proposed plan
amendment--
``(1) a State process to notify and inform individuals
(including individuals who live in nursing facilities,
individuals who live in intermediate care facilities for the
mentally retarded, and individuals who live in the community
and who have an unmet need for such services) of the
availability of such services and supports under this title,
and of other items and services that may be provided to the
individual under this title or title XVIII; and
``(2) a quality assurance program that will maximize
consumer independence and consumer control and will--
``(A) train consumers to appropriately manage their
own attendant;
``(B) provide a quality review process; and
``(C) provide for investigation and resolution of
allegations of neglect, abuse, or exploitation in
connection with the provision of such services and
supports.
``(c) No Effect on Ability To Provide Coverage Under a Waiver.--
``(1) In general.--Nothing in this section shall be
construed as affecting the ability of a State to provide
coverage under the State plan for community-based attendant
services and supports (or similar coverage) under a waiver
approved under section 1915, section 1115, or otherwise.
``(2) Eligibility for enhanced match.--In the case of a
State that provides coverage for such services and supports
under a waiver, the State shall not be eligible under section
1935 for the enhanced FMAP for the provision of such coverage
under this unless the State submits a plan amendment to the
Secretary that meets the requirements of this section.
``(d) Definitions.--In this title:
``(1) Community-based attendant services and supports.--
``(A) In general.--The term `community-based
attendant services and supports' may include one or
more of the following: attendant services and supports
furnished to an individual, as needed, to assist in
accomplishing activities of daily living, instrumental
activities of daily living, and health-related
functions through hands-on assistance, supervision, or
cueing--
``(i) under a plan of services and supports
that is based on an assessment of functional
need and that is agreed to by the individual
or, as appropriate, the individual's
representative;
``(ii) in a home or community setting,
which may include a school, workplace, or
recreation or religious facility, but does not
include a nursing facility or an intermediate
care facility for the mentally retarded;
``(iii) under an agency-provider model or
other model (as defined in paragraph (2)(C));
and
``(iv) the furnishing of which is selected,
managed, and dismissed by the individual, or,
as appropriate, with assistance from the
individual's representative.
``(B) Included services and supports.--Such term
may include one or more of the following:
``(i) Tasks necessary to assist an
individual in accomplishing activities of daily
living, instrumental activities of daily
living, and health-related functions.
``(ii) The acquisition, maintenance, and
enhancement of skills necessary for the
individual to accomplish activities of daily
living, instrumental activities of daily
living, and health-related functions.
``(iii) Backup systems or mechanisms (such
as the use of beepers), as defined by the State
according to the client's needs, to ensure
continuity of services and supports.
``(iv) Voluntary training on how to select,
manage, and dismiss attendants.
``(C) Excluded services and supports.--Subject to
subparagraph (D), such term does not include--
``(i) the provision of room and board for
the individual;
``(ii) special education and related
services provided under the Individuals with
Disabilities Education Act and vocational
rehabilitation services provided under the
Rehabilitation Act of 1973;
``(iii) assistive technology devices and
assistive technology services;
``(iv) durable medical equipment; or
``(v) home modifications.
``(D) Flexibility in transition to community-based
home setting.--Such term may include expenditures for
transitional costs required for an individual to make
the transition from a nursing facility or intermediate
care facility for the mentally retarded to a community-
based home setting where the individual resides.
``(E) Clarification of permitting payment of
relatives for providing services and supports.--Nothing
in this section shall be construed as preventing
community-based attendant services and supports from
being furnished to an individual by others who are
related to that individual and for such others being
paid for so furnishing such services and supports.
``(2) Additional definitions.--
``(A) Activities of daily living.--The term
`activities of daily living' includes eating,
toileting, grooming, dressing, bathing, and
transferring.
``(B) Consumer controlled.--The term `consumer
controlled' means a method of providing services and
supports that allow the individual, or where
appropriate, the individual's representative, maximum
control of the community-based attendant services and
supports, regardless of who acts as the employer of
record.
``(C) Delivery models.--
``(i) Agency-provider model.--The term
`agency-provider model' means, with respect to
the provision of community-based attendant
services and supports for an individual, a
method of providing consumer controlled
services and supports under which entities
contract for the provision of such services and
supports.
``(ii) Other models.--The term `other
models' means methods, other than an agency-
provider model, for the provision of consumer
controlled services and supports. Such models
may include direct cash payments or use of a
fiscal agent to assist in obtaining services.
``(D) Health-related functions.--The term `health-
related functions' means functions that can be
delegated or assigned by licensed health-care
professionals under State law to be performed by an
attendant.
``(E) Instrumental activities of daily living.--The
term `instrumental activities of daily living' includes
meal planning and preparation, managing finances,
shopping for food, clothing, and other essential items,
performing essential household chores, communicating by
phone and other media, and other activities needed to
participate in the community, as appropriate.
``(F) Individual's representative.--The term
`individual's representative' means a parent, a family
member, a guardian, an advocate, or an authorized
representative of an individual.''.
(c) Investigation by State.--Section 1903(q)(4)(A)(i) of such Act
(42 U.S.C. 1396b(q)(4)(A)(i)) is amended by inserting ``and for
investigation and resolution of allegations of neglect, abuse, or
exploitation in connection with the provision of community-based
attendant services and supports under section 1935(b)(2)(C)'' before
the semicolon.
(d) Effective Date.--The amendments made by this section take
effect on October 1, 2003, and apply to medical assistance provided for
community-based attendant services and supports described in section
1935 of the Social Security Act furnished on or after that date.

Subtitle B--Family Opportunity Act

SEC. 311. SHORT TITLE.

This subtitle may be cited as the ``Family Opportunity Act of
2003'' or the ``Dylan Lee James Act''.

SEC. 312. OPPORTUNITY FOR FAMILIES OF DISABLED CHILDREN TO PURCHASE
MEDICAID COVERAGE FOR SUCH CHILDREN.

(a) State Option To Allow Families of Disabled Children To Purchase
Medicaid Coverage for Such Children.--
(1) In general.--Section 1902 (42 U.S.C. 1396a) is
amended--
(A) in subsection (a)(10)(A)(ii)--
(i) by striking ``or'' at the end of
subclause (XVII);
(ii) by adding ``or'' at the end of
subclause (XVIII); and
(iii) by adding at the end the following
new subclause:
``(XIX) who are disabled children
described in subsection (cc)(1);''; and
(B) by adding at the end the following new
subsection:
``(cc)(1) Individuals described in this paragraph are individuals--
``(A) who have not attained 18 years of age;
``(B) who would be considered disabled under section
1614(a)(3)(C) (determined without regard to the reference to
age in that section) but for having earnings or deemed income
or resources (as determined under title XVI for children) that
exceed the requirements for receipt of supplemental security
income benefits; and
``(C) whose family income does not exceed such income level
as the State establishes and does not exceed--
``(i) 300 percent of the income official poverty
line (as defined by the Office of Management and
Budget, and revised annually in accordance with section
673(2) of the Omnibus Budget Reconciliation Act of
1981) applicable to a family of the size involved; or
``(ii) such higher percent of such poverty line as
a State may establish, except that no Federal financial
participation shall be provided under section 1903(a)
for any medical assistance provided to an individual
who would not be described in this subsection but for
this clause.''.
(2) Interaction with employer-sponsored family coverage.--
Section 1902(cc) (42 U.S.C. 1396a(cc)), as added by paragraph
(1), is amended by adding at the end the following new
paragraph:
``(2)(A) If an employer of a parent of an individual described in
paragraph (1) offers family coverage under a group health plan (as
defined in section 2791(a) of the Public Health Service Act), the State
may--
``(i) require such parent to apply for, enroll in, and pay
premiums for, such coverage as a condition of such parent's
child being or remaining eligible for medical assistance under
subsection (a)(10)(A)(ii)(XIX) if the parent is determined
eligible for such coverage and the employer contributes at
least 50 percent of the total cost of annual premiums for such
coverage; and
``(ii) if such coverage is obtained--
``(I) subject to paragraph (2) of section 1916(h),
reduce the premium imposed by the State under that
section (if any) in an amount that reasonably reflects
the premium contribution made by the parent for private
coverage on behalf of a child with a disability; and
``(II) treat such coverage as a third party
liability under subsection (a)(25).
``(B) In the case of a parent to which subparagraph (A) applies, if
the family income of such parent does not exceed 300 percent of the
income official poverty line (referred to in paragraph (1)(C)(i)), a
State may provide for payment of any portion of the annual premium for
such family coverage that the parent is required to pay. Any payments
made by the State under this subparagraph shall be considered, for
purposes of section 1903(a), to be payments for medical assistance.''.
(b) State Option To Impose Income-Related Premiums.--Section 1916
(42 U.S.C. 1396o) is amended--
(1) in subsection (a), by striking ``subsection (g)'' and
inserting ``subsections (g) and (h)''; and
(2) by adding at the end the following new subsection:
``(h)(1) With respect to disabled children provided medical
assistance under section 1902(a)(10)(A)(ii)(XIX), subject to paragraph
(2), a State may (in a uniform manner for such children) require the
families of such children to pay monthly premiums set on a sliding
scale based on family income.
``(2) A premium requirement imposed under paragraph (1) may only
apply to the extent that--
``(A) the aggregate amount of such premium and any premium
that the parent is required to pay for family coverage under
section 1902(cc)(2)(A)(i) does not exceed 5 percent of the
family's income; and
``(B) the requirement is imposed consistent with section
1902(cc)(2)(A)(ii)(I).
``(3) A State shall not require prepayment of a premium imposed
pursuant to paragraph (1) and shall not terminate eligibility of a
child under section 1902(a)(10)(A)(ii)(XIX) for medical assistance
under this title on the basis of failure to pay any such premium until
such failure continues for a period of not less than 60 days from the
date on which the premium became past due. The State may waive payment
of any such premium in any case where the State determines that
requiring such payment would create an undue hardship.''.
(c) Conforming Amendment.--Section 1903(f)(4) (42 U.S.C.
1396b(f)(4)) is amended in the matter preceding subparagraph (A) by
inserting ``1902(a)(10)(A)(ii)(XIX),'' after
``1902(a)(10)(A)(ii)(XVIII),''.
(d) Effective Date.--The amendments made by this section shall
apply to medical assistance for items and services furnished on or
after January 1, 2004.

SEC. 313. TREATMENT OF INPATIENT PSYCHIATRIC HOSPITAL SERVICES FOR
INDIVIDUALS UNDER AGE 21 IN HOME OR COMMUNITY-BASED
SERVICES WAIVERS.

(a) In General.--Section 1915(c) (42 U.S.C. 1396n(c)) is amended--
(1) in paragraph (1)--
(A) in the first sentence, by inserting ``, or
inpatient psychiatric hospital services for individuals
under age 21,'' after ``intermediate care facility for
the mentally retarded''; and
(B) in the second sentence, by inserting ``, or
inpatient psychiatric hospital services for individuals
under age 21'' before the period;
(2) in paragraph (2)(B), by striking ``or services in an
intermediate care facility for the mentally retarded'' each
place it appears and inserting ``, services in an intermediate
care facility for the mentally retarded, or inpatient psychiatric
hospital services for individuals under age 21'';
(3) by striking paragraph (2)(C) and inserting the
following:
``(C) such individuals who are determined to be likely to
require the level of care provided in a hospital, nursing
facility, or intermediate care facility for the mentally
retarded, or inpatient psychiatric hospital services for
individuals under age 21, are informed of the feasible
alternatives, if available under the waiver, at the choice of
such individuals, to the provision of inpatient hospital
services, nursing facility services, services in an
intermediate care facility for the mentally retarded, or
inpatient psychiatric hospital services for individuals under
age 21;''; and
(4) in paragraph (7)(A)--
(A) by inserting ``, or inpatient psychiatric
hospital services for individuals under age 21,'' after
``intermediate care facility for the mentally
retarded''; and
(B) by inserting ``, or who would require inpatient
psychiatric hospital services for individuals under age
21'' before the period.
(b) Effective Date.--The amendments made by subsection (a) apply
with respect to medical assistance provided on or after January 1,
2003.

SEC. 314. DEMONSTRATION OF COVERAGE UNDER THE MEDICAID PROGRAM OF
CHILDREN WITH POTENTIALLY SEVERE DISABILITIES.

(a) State Application.--A State may apply to the Secretary of
Health and Human Services (in this section referred to as the
``Secretary'') for approval of a demonstration project (in this section
referred to as a ``demonstration project'') under which up to a
specified maximum number of children with a potentially severe
disability (as defined in subsection (b)) are provided medical
assistance under the State medicaid plan under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(b) Child With a Potentially Severe Disability Defined.--
(1) In general.--In this section, the term ``child with a
potentially severe disability'' means, with respect to a
demonstration project, an individual who--
(A) has not attained 21 years of age;
(B) has a physical or mental condition, disease,
disorder (including a congenital birth defect or a
metabolic condition), injury, or developmental
disability that was incurred before the individual
attained such age; and
(C) is reasonably expected, but for the receipt of
medical assistance under the State medicaid plan, to
reach the level of disability defined under section
1614(a)(3) of the Social Security Act (42 U.S.C.
1382c(a)(3)), (determined without regard to the
reference to age in subparagraph (C) of that section).
(2) Exception.--Such term does not include an individual
who would be considered disabled under section 1614(a)(3)(C) of
the Social Security Act (42 U.S.C. 1382c(a)(3)(C)) (determined
without regard to the reference to age in that section).
(c) Approval of Demonstration Projects.--
(1) In general.--Subject to paragraph (3), the Secretary
shall approve applications under subsection (a) that meet the
requirements of paragraph (2) and such additional terms and
conditions as the Secretary may require. The Secretary may
waive the requirement of section 1902(a)(1) of the Social
Security Act (42 U.S.C. 1396a(a)(1)) to allow for sub-State
demonstrations.
(2) Terms and conditions of demonstration projects.--The
Secretary may not approve a demonstration project under this
section unless the State provides assurances satisfactory to
the Secretary that the following conditions are or will be met:
(A) Independent evaluation.--The State provides for
an independent evaluation of the project to be
conducted during fiscal year 2006.
(B) Consultation for development of criteria.--The
State consults with appropriate pediatric health
professionals in establishing the criteria for
determining whether a child has a potentially severe
disability.
(C) Annual report.--The State submits an annual
report to the Secretary (in a uniform form and manner
established by the Secretary) on the use of funds
provided under the grant that includes the following:
(i) Enrollment and financial statistics
on--
(I) the total number of children
with a potentially severe disability
enrolled in the demonstration project,
disaggregated by disability;
(II) the services provided by
category or code and the cost of each
service so categorized or coded; and
(III) the number of children
enrolled in the demonstration project
who also receive services through
private insurance.
(ii) With respect to the report submitted
for fiscal year 2006, the results of the
independent evaluation conducted under
subparagraph (A).
(iii) Such additional information as the
Secretary may require.
(3) Limitations on federal funding.--
(A) Appropriation.--
(i) In general.--Out of any funds in the
Treasury not otherwise appropriated, there is
appropriated to carry out this section--
(I) $16,666,000 for each of fiscal
years 2002 and 2003; and
(II) $16,667,000 for each of fiscal
years 2004 through 2007.
(ii) Budget authority.--Clause (i)
constitutes budget authority in advance
of appropriations Acts and represents the obligation of the Federal
Government to provide for the payment of the amounts appropriated under
clause (i).
(B) Limitation on payments.--In no case may--
(i) the aggregate amount of payments made
by the Secretary to States under this section
exceed $100,000,000;
(ii) the aggregate amount of payments made
by the Secretary to States for administrative
expenses relating to the evaluations and annual
reports required under subparagraphs (A) and
(C) of paragraph (2) exceed $2,000,000 of such
$100,000,000; or
(iii) payments be provided by the Secretary
for a fiscal year after fiscal year 2010.
(C) Funds allocated to states.--
(i) In general.--The Secretary shall
allocate funds to States based on their
applications and the availability of funds. In
making such allocations, the Secretary shall
ensure an equitable distribution of funds among
States with large populations and States with
small populations.
(ii) Availability.--Funds allocated to a
State under a grant made under this section for
a fiscal year shall remain available until
expended.
(D) Funds not allocated to states.--Funds not
allocated to States in the fiscal year for which they
are appropriated shall remain available in succeeding
fiscal years for allocation by the Secretary using the
allocation formula established under this section.
(E) Payments to states.--The Secretary shall pay to
each State with a demonstration project approved under
this section, from its allocation under subparagraph
(C), an amount for each quarter equal to the Federal
medical assistance percentage (as defined in section
1905(b) of the Social Security Act (42 U.S.C.
1395d(b))) of expenditures in the quarter for medical
assistance provided to children with a potentially
severe disability.
(d) Recommendation.--Not later than October 1, 2005, the Secretary
shall submit a recommendation to the Committee on Commerce of the House
of Representatives and the Committee on Finance of the Senate regarding
whether the demonstration project established under this section should
be continued after fiscal year 2007.
(e) State Defined.--In this section, the term ``State'' has the
meaning given such term for purposes of title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).

SEC. 315. DEVELOPMENT AND SUPPORT OF FAMILY-TO-FAMILY HEALTH
INFORMATION CENTERS.

Section 501 (42 U.S.C. 701) is amended by adding at the end the
following new subsection:
``(c)(1) In addition to amounts appropriated under subsection (a)
and retained under section 502(a)(1) for the purpose of carrying out
activities described in subsection (a)(2), there is appropriated to the
Secretary, out of any money in the Treasury not otherwise appropriated,
for the purpose of enabling the Secretary (through grants, contracts,
or otherwise) to provide for special projects of regional and national
significance for the development and support of family-to-family health
information centers described in paragraph (2), $10,000,000 for each of
fiscal years 2002 through 2007. Funds appropriated under this paragraph
shall remain available until expended.
``(2) The family-to-family health information centers described in
this paragraph are centers that--
``(A) assist families of children with disabilities or
special health care needs to make informed choices about health
care in order to promote good treatment decisions, cost-
effectiveness, and improved health outcomes for such children;
``(B) provide information regarding the health care needs
of, and resources available for, children with disabilities or
special health care needs;
``(C) identify successful health delivery models for such
children;
``(D) develop with representatives of health care
providers, managed care organizations, health care purchasers,
and appropriate State agencies a model for collaboration
between families of such children and health professionals;
``(E) provide training and guidance regarding caring for
such children;
``(F) conduct outreach activities to the families of such
children, health professionals, schools, and other appropriate
entities and individuals; and
``(G) are staffed by families of children with disabilities
or special health care needs who have expertise in Federal and
State public and private health care systems and health
professionals.
``(3) The provisions of this title that are applicable to the funds
made available to the Secretary under section 502(a)(1) apply in the
same manner to funds made available to the Secretary under paragraph
(1).''.

SEC. 316. RESTORATION OF MEDICAID ELIGIBILITY FOR CERTAIN SSI
BENEFICIARIES.

(a) In General.--Section 1902(a)(10)(A)(i)(II) (42 U.S.C.
1396a(a)(10)(A)(i)(II)) is amended--
(1) by inserting ``(aa)'' after ``(II)'';
(2) by striking ``or who are'' and inserting ``, (bb) who
are''; and
(3) by inserting before the comma at the end the following:
``, or (cc) who are under 21 years of age and with respect to
whom supplemental security income benefits would be paid under
title XVI if subparagraphs (A) and (B) of section 1611(c)(7)
were applied without regard to the phrase `the first day of the
month following'''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to medical assistance for items and services furnished on or
after the first day of the first calendar quarter that begins after the
date of enactment of this Act.

TITLE IV--FACILITATING PROGRAM ADMINISTRATION AND PRESERVING COVERAGE

SEC. 401. ALLOWING UNIFORM COVERAGE OF ALL LOW INCOME AMERICANS.

(a) In General.--Section 1902(a)(10)(A)(ii) of the Social Security
Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--
(1) by striking ``or'' at the end of subclause (XVII);
(2) by adding ``or'' at the end of subclause (XVIII); and
(3) by adding at the end the following new subclause:
``(XIX) any individual age 21
through 64 whose family income does not
exceed 200 percent of the income
official poverty line (as defined by
the Office of Management and Budget,
and revised annually in accordance with
section 673(2) of the Omnibus Budget
Reconciliation Act of 1981) applicable
to a family of the size involved;''.
(b) Conforming Amendments.--
(1) Section 1905(a) of such Act (42 U.S.C. 1396d(a)) is
amended, in the matter before paragraph (1)--
(A) by striking ``or'' at the end of clause (xii);
(B) by adding ``or'' at the end of clause (xiii);
and
(C) by inserting after clause (xiii) the following
new clause:
``(xii) individuals described in section
1902(a)(10)(A)(ii)(XIX),''.
(2) Section 1903(f)(4) of such Act (42 U.S.C. 1396b(f)(4))
is amended by inserting ``1902(a)(10)(A)(ii)(XIX),'' after
``1902(a)(10)(A)(ii)(XVIII),''.
(c) Effective Date.--The amendments made by this section shall take
effect on October 1, 2003.

SEC. 402. FACILITATING COVERAGE OF FAMILIES.

(a) In General.--Section 1905(b) of the Social Security Act (42
U.S.C. 1396d(b)), as amended by sections 101(a), 303(a), and 304(a), is
amended--
(1) by striking ``and'' before ``(7)''; and
(2) by inserting before the period the following: ``, and
(8) the Federal medical assistance percentage shall be equal to
the enhanced FMAP described in section 2105(b) with respect to
medical assistance provided for individuals who are covered
under section 1925 or section 1931 by virtue of being a parent
or other caretaker relative (as defined for purposes of such
section) of a child and whose income does not exceed the
percentage of the income official poverty line applicable under
section 1902(l)(2)(C) to children who are eligible for medical
assistance under section 1902(l)(1)(D)''.
(b) Construction.--Nothing in section 1905(b)(8) of the Social
Security Act, as added by subsection (a)(2), shall be construed as
preventing a State from providing medicaid benefits for individuals
whose income exceeds 100 percent of the Federal poverty line at the
regular FMAP.
(c) Effective Date.--The amendments made by this section shall
apply to medical assistance for items and services furnished on or
after July 1, 2003.

SEC. 403. ASSISTANCE WITH COVERAGE OF LEGAL IMMIGRANTS UNDER THE
MEDICAID PROGRAM AND SCHIP.

(a) Medicaid Program.--Section 1903(v) of the Social Security Act
(42 U.S.C. 1396b(v)) is amended--
(1) in paragraph (1), by striking ``paragraph (2)'' and
inserting ``paragraphs (2) and (4)''; and
(2) by adding at the end the following new paragraph:
``(4)(A) A State may elect (in a plan amendment under this title)
to provide medical assistance under this title, notwithstanding
sections 401(a), 402(b), 403, and 421 of the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996, for aliens who are
lawfully residing in the United States (including battered aliens
described in section 431(c) of such Act) and who are otherwise eligible
for such assistance, within either or both of the following eligibility
categories:
``(i) Pregnant women.--Women during pregnancy (and during
the 60-day period beginning on the last day of the pregnancy).
``(ii) Children.--Children (as defined under such plan),
including optional targeted low-income children described in
section 1905(u)(2)(B).
``(B) In the case of a State that has elected to provide medical
assistance to a category of aliens under subparagraph (A), no debt
shall accrue under an affidavit of support against any sponsor of such
an alien on the basis of provision of assistance to such category and
the cost of such assistance shall not be considered as an unreimbursed
cost.''.
(b) SCHIP.--Section 2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1))
is amended by redesignating subparagraphs (C) and (D) as subparagraph
(D) and (E), respectively, and by inserting after subparagraph (B) the
following new subparagraph:
``(C) Section 1903(v)(4) (relating to optional
coverage of categories of permanent resident alien
children), but only if the State has elected to apply
such section to the category of children under title
XIX.''.
(c) Effective Date.--The amendments made by this section take
effect on October 1, 2003, and apply to medical assistance and child
health assistance furnished on or after such date.

SEC. 404. FLEXIBILITY IN ELIGIBILITY DETERMINATIONS.

(a) In General.--Section 1902(e) of the Social Security Act (42
U.S.C. 1396a(e)) is amended by adding at the end the following:
``(13)(A) Subject to the requirements of this paragraph, at the
option of the State, the plan may provide that financial eligibility
requirements for medical assistance are met for an individual under 19
years of age (or such higher age as determined by the State) by using a
determination (made within a reasonable period, as found by the State,
before its use for this purpose) of the individual's family or
household income and resources, notwithstanding any differences in
budget unit, disregards, deeming, or other methodology, by a Federal or
State agency (or a public or private entity making such determination
on behalf of such agency) specified by the plan, provided that such
agency has fiscal liabilities or responsibilities affected or
potentially affected by such determinations, provided that all
information furnished by such agency pursuant to this subparagraph is
used solely for purposes of determining eligibility for medical
assistance under the State plan approved under this title or for child
health assistance under a State plan approved under title XXI.
``(B) Any State electing the option under subparagraph (A) shall--
``(i) ensure that if an individual is determined under such
subparagraph to be not eligible for medical assistance under
the State plan approved under this title or for child health
assistance under a State plan under title XXI, the State must
subsequently determine if such individual is eligible for such
assistance using the methodology that would otherwise be
applicable in determining eligibility for such an individual;
and
``(ii) ensure that any information furnished by an agency
specified in such subparagraph shall be furnished with
reasonable promptness to the agency determining eligibility for
medical assistance under the State plan approved under this
title or for child health assistance under a State plan
approved under Title XXI.
``(C) Nothing in subparagraph (A) shall be construed to restrict
the ability of an individual under 19 years of age (or such higher age
as specified by the State) to apply for medical assistance under a
State plan approved under this title or for child health assistance
under a State plan approved under title XXI under the methodology that
would otherwise be applicable in determining eligibility for such an
individual.''.
(b) Effective Date.--The amendment made by subsection (a) takes
effect on October 1, 2003.
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