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H.R. 3963 would amend title XXI of the Social Security Act to extend and improve the Children's Health Insurance Program.
Detailed Summary
<b>(This measure has not been amended since it was passed by the House on October 25, 2007. The summary of that version is repeated here.)</b>
Children's Health Insurance Program Reauthorization Act of 2007 - Makes the amendments made by this Act effective on October 1, 2007, regardless of whether final regulations have been promulgated to carry them out.
Allows certain state plans under titles XIX (Medicaid) or XXI (State Children's Health Insurance Program) (CHIP) (also known as SCHIP) of the Social Security Act (SSA) that require state legislation to meet additional requirements imposed by this Act additional time to make required plan changes.
Sets forth a contingent effective date for CHIP funding for FY2008.
<b>Title I: Financing - Subtitle A: Funding </b>- (Sec. 101) Amends SSA title XXI to reauthorize the CHIP program through FY2012 at increased levels.
(Sec. 102) Provides for the determination of allotments for the 50 states, the District of Columbia, and the commonwealths and territories for FY2008-FY2012.
(Sec. 103) Establishes in the Treasury the Child Enrollment Contingency Fund for payments to a state to eliminate its shortfall (the amount by which its available federal CHIP allotments are not adequate to cover its CHIP expenditures.)
(Sec. 104) Directs the Secretary of Health and Human Services to make a performance bonus payment to states to offset additional Medicaid and CHIP child enrollment costs resulting from enrollment and retention efforts. Limits the sole use of such payments to reducing the number of low-income children who do not have health insurance coverage in the State. Makes appropriations for FY2008 for such payments. Requires certain funds transfers to cover FY2009-FY2012.
(Sec. 105) Reduces the availability of allotments for FY2008 and each ensuing fiscal year from three to two years.
(Sec. 106) Amends Public Law 110-92 to make permanent the redistribution of unused FY2005 allotments to states with estimated funding shortfalls for FY2008. Extends authority for qualifying states to use certain funds for Medicaid expenditures only through the date of enactment of this Act.
Amends SSA title XXI to provide for redistribution of unused allotments for fiscal years after FY2005.
(Sec. 107) Provides qualifying states the option to receive the enhanced portion of the CHIP matching rate for Medicaid (SSA title XIX) coverage of certain children.
(Sec. 108) Makes a one-time appropriation of additional funds to the Secretary of Health and Human Services for FY2012.
(Sec. 109) Revises funding requirements for the territories under CHIP and SSA title XIX (Medicaid) for FY2008-FY2012.
Removes federal matching payments for data reporting systems from the overall limit on payments to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.
Directs the Comptroller General to report to the appropriate congressional committees on federal funding under Medicaid and CHIP for such territories.
<b>Subtitle B: Focus on Low-Income Children and Pregnant Women </b>- (Sec. 111) Gives states the option to cover targeted low-income pregnant women under CHIP through a state plan amendment if certain conditions are met, including that the state has established an income eligibility level of at least 185% of the federal poverty line for pregnant women under Medicaid. Sets the minimum income eligibility level for children under age 19 at 200% of the poverty line applicable to a family of the size involved. Provides for automatic enrollment for children born to women receiving pregnancy-related assistance.
(Sec. 112) Provides for phase-out of CHIP coverage for nonpregnant childless adults, leaving states an option to apply for a Medicaid waiver to continue coverage for such adults. Prescribes terms and conditions for coverage of parents of targeted low-income children.
Directs the Comptroller General to study and report to Congress on whether: (1) the coverage of a parent, a caretaker relative, or a legal guardian of a targeted low-income child under a state CHIP health plan increases the enrollment of, or the quality of care for, children; and (2) such parents, relatives, and legal guardians who enroll in such a plan are more likely to enroll their children in such a plan or in a state Medicaid plan.
(Sec. 113) Eliminates counting Medicaid child presumptive eligibility costs against CHIP allotment.
(Sec. 114) Denies payments to states for new CHIP coverage of children with effective family income that exceeds 300% of the federal poverty line. Exempts from this denial (grandfathers) any state that already has an approved state plan amendment or waiver to provide such expenditures.
(Sec. 115) Allows a state to cover: (1) certain individuals and thereby receive federal financial participation for medical assistance for them under Medicaid; or (2) receive such federal financial participation for children made eligible as a result of an income or resource eligibility level expansion.
(Sec. 116) Directs the Comptroller General to report to the appropriate congressional committees and the Secretary on the best practices by states in addressing the issue of CHIP crowd-out (the substitution for a child of CHIP health benefits coverage for coverage other than under CHIP or Medicaid).
Directs the Secretary to arrange with the Institute of Medicine for a report to the appropriate congressional committees on: (1) the most accurate, reliable, and timely way to measure, on a state-by-state basis, the rate of public and private health benefits coverage among low-income children with family income that does not exceed 200% of the poverty line, and CHIP crowd-out; and (2) the least burdensome way to gather the necessary data to conduct such measurements. Makes appropriations for such report.
Directs the Secretary to publish in the Federal Register, and post on the public Department of Health and Human Services (HHS) website: (1) recommendations regarding best practices for states to use to address CHIP crowd-out; and (2) uniform standards for data collection by states to measure and report health benefits coverage for children with family income below 200% of the poverty line, and on CHIP crowd-out, including for children with family income that exceeds 200% of the poverty line.
Requires each state that submits a plan amendment (or waiver request) to provide for CHIP eligibility for higher income children (with effective family income exceeding 300% of the poverty line) to include with such plan amendment or request a description of how the state will: (1) address CHIP crowd-out; and (2) incorporate recommended best practices.
Requires the Secretary to review each state plan amendment or waiver request submitted and determine whether: (1) it incorporates recommended best practices; and (2) the state meets the required enrollment targets, and, if a higher income state, meets the target rate for low-income children.
Prohibits payments for higher income children to any state failing to meet the coverage target rate for low-income children.
Authorizes a state to elect to limit CHIP eligibility to a targeted low-income child on the basis of the existence of a valid medical support order on the child's behalf, but only if the state does not deny such eligibility on that basis if the child asserts that the order is not being complied with for any one of specified reasons (unless none of them applies).
Specifies such reasons for noncompliance with a medical support order as: (1) failure of the noncustodial parent to comply with the order; (2) failure of an employer, group health plan, or health insurance issuer to comply with such order; or (3) residence of the child in a geographic area in which CHIP benefits are generally unavailable.
<b>Title II: Outreach and Enrollment - Subtitle A: Outreach and Enrollment Activities </b>- (Sec. 201) Amends SSA title XXI to direct the Secretary to award grants during FY2008-FY2012 for outreach and enrollment efforts to increase the enrollment and participation of eligible children under CHIP and Medicaid.
Makes necessary appropriations.
Directs the Secretary to develop and implement a national enrollment campaign to improve the enrollment of underserved child populations in CHIP and Medicaid programs.
Allows payments under CHIP and Medicaid for translation or interpretation services in connection with the enrollment of, retention of, and use of services by, individuals for whom English is not their primary language.
(Sec. 202) Amends SSA title XI to provide for increased outreach and enrollment of Indians in CHIP and Medicaid.
Waives the 10% cap on CHIP payments for outreach with respect to any expenditures for outreach activities to families of Indian children likely to be eligible for child health assistance under the state Medicaid plan or related waivers.
(Sec. 203) Authorizes a state plan under the Medicaid and CHIP programs to rely on findings from an Express Lane agency to conduct simplified eligibility determinations.
Amends SSA title XIX to authorize a federal or state agency or private entity in possession of the sources of data directly relevant for Medicaid eligibility determination (including eligibi
