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108th CONGRESS
  1st Session
                                S. 1843

 To amend titles XIX and XXI of the Social Security Act to provide for 
  FamilyCare coverage for parents of enrolled children, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           November 10, 2003

Ms. Snowe (for herself and Mr. Kennedy) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend titles XIX and XXI of the Social Security Act to provide for 
  FamilyCare coverage for parents of enrolled children, 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 OF TITLE; TABLE OF CONTENTS.

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

Sec. 1. Short title of title; table of contents.
Sec. 2. Renaming of title XXI program.
Sec. 3. FamilyCare coverage of parents and pregnant women under the 
                            medicaid program and title XXI.
Sec. 4. Automatic enrollment of children born to title XXI parents.
Sec. 5. Optional coverage of legal immigrants under the medicaid 
                            program and title XXI.
Sec. 6. Optional coverage of children through age 20 under the medicaid 
                            program and title XXI.
Sec. 7. Application of simplified title XXI procedures under the 
                            medicaid program.
Sec. 8. Elimination of 100 hour rule and other AFDC-related eligibility 
                            restrictions.
Sec. 9. State grant program for market innovation.
Sec. 10. Limitations on conflicts of interest.
Sec. 11. Title XXI funding.
Sec. 12. Demonstration programs to improve medicaid and title XXI 
                            outreach to homeless individuals and 
                            families.
Sec. 13. Additional title XXI revisions.
Sec. 14. Effective date.

SEC. 2. RENAMING OF TITLE XXI PROGRAM.

    (a) In General.--The heading of title XXI of the Social Security 
Act (42 U.S.C. 1397aa et seq.) is amended to read as follows:

                   ``TITLE XXI--FAMILYCARE PROGRAM''.

    (b) Program References.--Any reference in any provision of Federal 
law or regulation to ``SCHIP'' or ``State children's health insurance 
program'' under title XXI of the Social Security Act shall be deemed a 
reference to the FamilyCare program under such title.

SEC. 3. FAMILYCARE COVERAGE OF PARENTS AND PREGNANT WOMEN UNDER THE 
              MEDICAID PROGRAM AND TITLE XXI.

    (a) Incentives To Implement FamilyCare Coverage.--
            (1) Under medicaid.--
                    (A) Establishment of new optional eligibility 
                category.--Section 1902(a)(10)(A)(ii) of the Social 
                Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is 
                amended--
                            (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:
                                    ``(XIX) who are individuals 
                                described in subsection (k)(1) 
                                (relating to parents of categorically 
                                eligible children);''.
                    (B) Parents described.--Section 1902 of the Social 
                Security Act is further amended by inserting after 
                subsection (j) the following:
    ``(k)(1)(A) Individuals described in this paragraph are 
individuals--
            ``(i) who are the parents of an individual who is under 19 
        years of age (or such higher age as the State may have elected 
        under section 1902(l)(1)(D) and who is eligible for medical 
        assistance under subsection (a)(10)(A);
            ``(ii) who are not otherwise eligible for medical 
        assistance under such subsection or under a waiver approved 
        under section 1115 or otherwise (except under section 1931 or 
        under subsection (a)(10)(A)(ii)(XIX)); and
            ``(iii) whose family income exceeds the effective income 
        level or resource level applicable under the State plan under 
        part A of title IV as in effect as of July 16, 1996, but does 
        not exceed the highest effective income level applicable to a 
        child in the family under this title.
    ``(B) In establishing an income eligibility level for individuals 
described in this paragraph, a State may apply to such individuals the 
highest effective income level applicable to a child in the family 
under this title in order to ensure that such individuals are enrolled 
in the same program as their children.
    ``(C) An individual may not be treated as being described in this 
paragraph unless, at the time of the individual's enrollment under this 
title, the child referred to in subparagraph (A)(i) of the individual 
is also enrolled under this title.
    ``(D) In this subsection, the term `parent' has the meaning given 
the term `caretaker relative' for purposes of carrying out section 
1931.
    ``(2) In the case of a parent described in paragraph (1) who is 
also the parent of a child who is eligible for child health assistance 
under title XXI, the State may elect (on a uniform basis) to enroll all 
such parents under this title or under title XXI.''.
                    (C) Enhanced matching funds available if certain 
                conditions met.--Section 1905 of the Social Security 
                Act (42 U.S.C. 1396d) is amended--
                            (i) in the fourth sentence of subsection 
                        (b), by striking ``or subsection (u)(3)'' and 
                        inserting ``, (u)(3), or (u)(4)''; and
                            (ii) in subsection (u)--
                                    (I) by redesignating paragraph (4) 
                                as paragraph (6), and
                                    (II) by inserting after paragraph 
                                (3) the following:
    ``(4) For purposes of subsection (b):
            ``(A) FamilyCare parents.--The expenditures described in 
        this subparagraph are the expenditures described in the 
        following clauses (i) and (ii):
                    ``(i) Parents.--If the conditions described in 
                clause (iii) are met, expenditures for medical 
                assistance for--
                                    ``(I) parents described in section 
                                1902(k)(1);
                                    ``(II) parents who would be 
                                described in section 1902(k)(1) but for 
                                the fact that they are eligible for 
                                medical assistance under section 1931 
                                or under a waiver approved under 
                                section 1115 and whose family income 
                                exceeds the effective income level 
                                applicable under section 1931 or under 
                                a waiver approved under section 1115 to 
                                a family of the size involved as of 
                                January 1, 2004; and
                                    ``(III) in the case of a State 
                                that, as of January 1, 2004, has an 
                                effective income level under section 
                                1931 or under a waiver approved under 
                                section 1115 for parents described in 
                                section 1902(k)(1)(A)(i) that exceeds 
                                100 percent of the poverty line, 
                                parents described in such section whose 
                                family income exceeds 100 percent of 
                                the poverty line.
                    ``(ii) Certain pregnant women.--If the conditions 
                described in clause (iv) are met, expenditures for 
                medical assistance for pregnant women described in 
                subsection (n) or under section 1902(l)(1)(A) in a 
                family the income of which exceeds the effective income 
                level applicable under subsection (a)(10)(A)(i)(III) or 
                (l)(2)(A) of section 1902 to a family of the size 
                involved as of January 1, 2004.
                    ``(iii) Conditions for expenditures for parents.--
                The conditions described in this clause are the 
                following:
                            ``(I) The State has a State child health 
                        plan under title XXI which (whether implemented 
                        under such title or under this title) has an 
                        effective income level for children that is at 
                        least 200 percent of the poverty line.
                            ``(II) Subject to the availability of the 
                        State's allotments under title XXI, the State 
                        child health plan under that title does not 
                        limit the acceptance of applications, does not 
                        use a waiting list for children who meet 
                        eligibility standards to qualify for 
                        assistance, and provides benefits to all 
                        children in the State who apply for and meet 
                        eligibility standards.
                            ``(III) The State plans under this title 
                        and title XXI do not provide coverage for 
                        parents with higher family income without 
                        covering parents with a lower family income.
                            ``(IV) The State does not apply an income 
                        level for parents that is lower than the 
                        effective income level (expressed as a percent 
                        of the poverty line) that has been specified 
                        under the State plan under title XIX (including 
                        under a waiver authorized by the Secretary or 
                        under section 1902(r)(2)), as of January 1, 
                        2004, to be eligible for medical assistance as 
                        a parent under this title.
                    ``(iv) Conditions for expenditures for certain 
                pregnant women.--The conditions described in this 
                clause are the following:
                            ``(I) The State has established an 
                        effective income eligibility level for pregnant 
                        women under subsection (a)(10)(A)(i)(III) or 
                        (l)(2)(A) of section 1902 that is at least 185 
                        percent of the poverty line.
                            ``(II) The State plans under this title and 
                        title XXI do not provide coverage for pregnant 
                        women described in subparagraph (A)(ii) with 
                        higher family income without covering such 
                        pregnant women with a lower family income.
                            ``(III) The State does not apply an income 
                        level for pregnant women that is lower than the 
                        effective income level (expressed as a percent 
                        of the poverty line and considering applicable 
                        income disregards) that has been specified 
                        under the State plan under subsection 
                        (a)(10)(A)(i)(III) or (l)(2)(A) of section 
                        1902, as of January 1, 2004, to be eligible for 
                        medical assistance as a pregnant woman.
                            ``(IV) The State satisfies the conditions 
                        described in subclauses (I) and (II) of clause 
                        (iii).
                    ``(v) Definitions.--For purposes of this 
                subsection:
                            ``(I) The term `parent' has the meaning 
                        given such term for purposes of section 
                        1902(k)(1).
                            ``(II) The term `poverty line' has the 
                        meaning given such term in section 
                        2110(c)(5).''.
                    (D) Payment from title xxi allotment for medicaid 
                expansion costs; elimination of counting medicaid child 
                presumptive eligibility costs against title xxi 
                allotment.--Section 2105(a)(1) of the Social Security 
                Act (42 U.S.C. 1397ee(a)(1)) is amended--
                            (i) in the matter preceding subparagraph 
                        (A), by striking ``(or, in the case of 
                        expenditures described in subparagraph (B), the 
                        Federal medical assistance percentage (as 
                        defined in the first sentence of section 
                        1905(b)))''; and
                            (ii) by striking subparagraph (B) and 
                        inserting the following:
                    ``(B) for the provision of medical assistance that 
                is attributable to expenditures described in section 
                1905(u)(4)(A);''.
            (2) Under title xxi.--
                    (A) FamilyCare coverage.--Title XXI of the Social 
                Security Act (42 U.S.C. 1397aa et seq.) is amended by 
                adding at the end the following:

``SEC. 2111. OPTIONAL FAMILYCARE COVERAGE OF PARENTS OF TARGETED LOW-
              INCOME CHILDREN OR TARGETED LOW-INCOME PREGNANT WOMEN.

    ``(a) Optional Coverage.--Notwithstanding any other provision of 
this title, a State may provide for coverage, through an amendment to 
its State child health plan under section 2102, of parent health 
assistance for targeted low-income parents, pregnancy-related 
assistance for targeted low-income pregnant women, or both, in 
accordance with this section, but only if--
            ``(1) with respect to the provision of parent health 
        assistance, the State meets the conditions described in clause 
        (iii) of section 1905(u)(4)(A);
            ``(2) with respect to the provision of pregnancy-related 
        assistance, the State meets the conditions described in clause 
        (iv) of section 1905(u)(4)(A); and
            ``(3) in the case of parent health assistance for targeted 
        low-income parents, the State elects to provide medical 
        assistance under section 1902(a)(10)(A)(ii)(XIX), under section 
        1931, or under a waiver under section 1115 to individuals 
        described in section 1902(k)(1)(A)(i) and elects an effective 
        income level that, consistent with paragraphs (1)(B) and (2) of 
        section 1902(k), ensures that such individuals are enrolled in 
        the same program as their children if their children are 
        eligible for coverage under title XIX (including under a waiver 
        authorized by the Secretary or under section 1902(r)(2)).''.
    ``(b) Definitions.--For purposes of this title:
            ``(1) Parent health assistance.--The term `parent health 
        assistance' has the meaning given the term child health 
        assistance in section 2110(a) as if any reference to targeted 
        low-income children were a reference to targeted low-income 
        parents.
            ``(2) Parent.--The term `parent' has the meaning given the 
        term `caretaker relative' for purposes of carrying out section 
        1931.
            ``(3) Pregnancy-related assistance.--The term `pregnancy-

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