42 U.S.C. § 1397kk | Phase-out of coverage for nonpregnant childless adults; conditions for coverage of parents

(a)

Termination of coverage for nonpregnant childless adults

(1)

No new CHIP waivers; automatic extensions at State option through 2009

section 1315 of this titleNotwithstanding or any other provision of this subchapter, except as provided in this subsection—

(A)

February 4, 2009 the Secretary shall not on or after , approve or renew a waiver, experimental, pilot, or demonstration project that would allow funds made available under this subchapter to be used to provide child health assistance or other health benefits coverage to a nonpregnant childless adult; and

(B)

January 1, 2010 notwithstanding the terms and conditions of an applicable existing waiver, the provisions of paragraph (2) shall apply for purposes of any period beginning on or after , in determining the period to which the waiver applies, the individuals eligible to be covered by the waiver, and the amount of the Federal payment under this subchapter.

(2)

Termination of CHIP coverage under applicable existing waivers at the end of 2009

(A)

In general

December 31, 2009No funds shall be available under this subchapter for child health assistance or other health benefits coverage that is provided to a nonpregnant childless adult under an applicable existing waiver after .

(B)

Extension upon State request

January 1, 2010section 1315 of this titleSeptember 30, 2009December 31, 2009If an applicable existing waiver described in subparagraph (A) would otherwise expire before , notwithstanding the requirements of subsections (e) and (f) of , a State may submit, not later than , a request to the Secretary for an extension of the waiver. The Secretary shall approve a request for an extension of an applicable existing waiver submitted pursuant to this subparagraph, but only through .

(C)

Application of enhanced FMAP

section 1397ee(b) of this titleFebruary 4, 2009December 31, 2009The enhanced FMAP determined under shall apply to expenditures under an applicable existing waiver for the provision of child health assistance or other health benefits coverage to a nonpregnant childless adult during the period beginning on , and ending on .

(3)

State option to apply for Medicaid waiver to continue coverage for nonpregnant childless adults

(A)

In general

September 30, 2009section 1315 of this titleEach State for which coverage under an applicable existing waiver is terminated under paragraph (2)(A) may submit, not later than , an application to the Secretary for a waiver under of the State plan under subchapter XIX to provide medical assistance to a nonpregnant childless adult whose coverage is so terminated (in this subsection referred to as a “Medicaid nonpregnant childless adults waiver”).

(B)

Deadline for approval

December 31, 2009September 30, 2009The Secretary shall make a decision to approve or deny an application for a Medicaid nonpregnant childless adults waiver submitted under subparagraph (A) within 90 days of the date of the submission of the application. If no decision has been made by the Secretary as of , on the application of a State for a Medicaid nonpregnant childless adults waiver that was submitted to the Secretary by , the application shall be deemed approved.

(C)

Standard for budget neutrality

The budget neutrality requirement applicable with respect to expenditures for medical assistance under a Medicaid nonpregnant childless adults waiver shall—

(i)

in the case of fiscal year 2010, allow expenditures for medical assistance under subchapter XIX for all such adults to not exceed the total amount of payments made to the State under paragraph (2)(B) for fiscal year 2009, increased by the percentage increase (if any) in the projected nominal per capita amount of National Health Expenditures for 2010 over 2009, as most recently published by the Secretary; and

(ii)

in the case of any succeeding fiscal year, allow such expenditures to not exceed the amount in effect under this subparagraph for the preceding fiscal year, increased by the percentage increase (if any) in the projected nominal per capita amount of National Health Expenditures for the calendar year that begins during the year involved over the preceding calendar year, as most recently published by the Secretary.

(b)

Rules and conditions for coverage of parents of targeted low-income children

(1)

Two-year period; automatic extension at State option through fiscal year 2011

(A)

No new CHIP waivers

section 1315 of this titleNotwithstanding or any other provision of this subchapter, except as provided in this subsection—

(i)

(ii)

October 1, 2011 notwithstanding the terms and conditions of an applicable existing waiver, the provisions of paragraphs (2) and (3) shall apply for purposes of any fiscal year beginning on or after , in determining the period to which the waiver applies, the individuals eligible to be covered by the waiver, and the amount of the Federal payment under this subchapter.

(B)

Extension upon State request

October 1, 2011September 30, 2011If an applicable existing waiver described in subparagraph (A) would otherwise expire before , and the State requests an extension of such waiver, the Secretary shall grant such an extension, but only, subject to paragraph (2)(A), through .

(C)

Application of enhanced FMAP

section 1397ee(b) of this titleThe enhanced FMAP determined under shall apply to expenditures under an applicable existing waiver for the provision of child health assistance or other health benefits coverage to a parent of a targeted low-income child during the third and fourth quarters of fiscal year 2009 and during fiscal years 2010 and 2011.

(2)

Rules for fiscal years 2012 through 2013

(A)

Payments for coverage limited to block grant funded from State allotment

Any State that provides child health assistance or health benefits coverage under an applicable existing waiver for a parent of a targeted low-income child may elect to continue to provide such assistance or coverage through fiscal year 2012 or 2013, subject to the same terms and conditions that applied under the applicable existing waiver, unless otherwise modified in subparagraph (B).

(B)

Terms and conditions

(i)

Block grant set aside from State allotment

section 1397dd(a)(16) of this title section 1397dd(m)(5) of this titleIf the State makes an election under subparagraph (A), the Secretary shall set aside for the State for each such fiscal year an amount equal to the Federal share of 110 percent of the State’s projected expenditures under the applicable existing waiver for providing child health assistance or health benefits coverage to all parents of targeted low-income children enrolled under such waiver for the fiscal year (as certified by the State and submitted to the Secretary by not later than August 31 of the preceding fiscal year). In the case of fiscal year 2013, the set aside for any State shall be computed separately for each period described in subparagraphs (A) and (B) of and any reduction in the allotment for either such period under shall be allocated on a pro rata basis to such set aside.

(ii)

Payments from block grant

The Secretary shall pay the State from the amount set aside under clause (i) for the fiscal year, an amount for each quarter of such fiscal year equal to the applicable percentage determined under clause (iii) or (iv) for expenditures in the quarter for providing child health assistance or other health benefits coverage to a parent of a targeted low-income child.

(iii)

Enhanced FMAP only in fiscal year 2012 for States with significant child outreach or that achieve child coverage benchmarks; FMAP for any other States

For purposes of clause (ii), the applicable percentage for any quarter of fiscal year 2012 is equal to—

(I)

section 1397ee(b) of this title the enhanced FMAP determined under in the case of a State that meets the outreach or coverage benchmarks described in any of subparagraph (A), (B), or (C) of paragraph (3) for fiscal year 2011; or

(II)

section 1396d(b) of this title the Federal medical assistance percentage (as determined under without regard to clause (4) of such section) in the case of any other State.

(iv)

Amount of Federal matching payment in 2013

For purposes of clause (ii), the applicable percentage for any quarter of fiscal year 2013 is equal to—

(I)

the REMAP percentage if—

(aa)

the applicable percentage for the State under clause (iii) was the enhanced FMAP for fiscal year 2012; and

(bb)

the State met either of the coverage benchmarks described in subparagraph (B) or (C) of paragraph (3) for fiscal year 2012; or

(II)

the Federal medical assistance percentage (as so determined) in the case of any State to which subclause (I) does not apply.

For purposes of subclause (I), the REMAP percentage is the percentage which is the sum of such Federal medical assistance percentage and a number of percentage points equal to one-half of the difference between such Federal medical assistance percentage and such enhanced FMAP.

(v)

No Federal payments other than from block grant set aside

No payments shall be made to a State for expenditures described in clause (ii) after the total amount set aside under clause (i) for a fiscal year has been paid to the State.

(vi)

No increase in income eligibility level for parents

February 4, 2009No payments shall be made to a State from the amount set aside under clause (i) for a fiscal year for expenditures for providing child health assistance or health benefits coverage to a parent of a targeted low-income child whose family income exceeds the income eligibility level applied under the applicable existing waiver to parents of targeted low-income children on .

(3)

Outreach or coverage benchmarks

For purposes of paragraph (2), the outreach or coverage benchmarks described in this paragraph are as follows:

(A)

Significant child outreach campaign

The State—

(i)

section 1397mm of this title was awarded a grant under for fiscal year 2011;

(ii)

section 1397ee(a)(4) of this title implemented 1 or more of the enrollment and retention provisions described in for such fiscal year; or

(iii)

has submitted a specific plan for outreach for such fiscal year.

(B)

High-performing State

The State, on the basis of the most timely and accurate published estimates of the Bureau of the Census, ranks in the lowest ⅓ of States in terms of the State’s percentage of low-income children without health insurance.

(C)

State increasing enrollment of low-income children

section 1397ee(a)(3)(B) of this titleThe State qualified for a performance bonus payment under for the most recent fiscal year applicable under such section.

(4)

Rules of construction

section 1315 of this titleNothing in this subsection shall be construed as prohibiting a State from submitting an application to the Secretary for a waiver under of the State plan under subchapter XIX to provide medical assistance to a parent of a targeted low-income child that was provided child health assistance or health benefits coverage under an applicable existing waiver.

(c)

Applicable existing waiver

For purposes of this section—

(1)

In general

section 1315 of this titleThe term “applicable existing waiver” means a waiver, experimental, pilot, or demonstration project under , grandfathered under section 6102(c)(3) of the Deficit Reduction Act of 2005, or otherwise conducted under authority that—

(A)

would allow funds made available under this subchapter to be used to provide child health assistance or other health benefits coverage to—

(i)

a parent of a targeted low-income child;

(ii)

a nonpregnant childless adult; or

(iii)

individuals described in both clauses (i) and (ii); and

(B)

was in effect during fiscal year 2009.

(2)

Definitions

(A)

Parent

section 1396u–1 of this titleThe term “parent” includes a caretaker relative (as such term is used in carrying out ) and a legal guardian.

(B)

Nonpregnant childless adult

section 1397gg(f) of this titleThe term “nonpregnant childless adult” has the meaning given such term by .

Aug. 14, 1935, ch. 531 Pub. L. 111–3, title I, § 112(a)(1)Feb. 4, 2009123 Stat. 29 Pub. L. 114–10, title III, § 301(b)(2)(D)Apr. 16, 2015129 Stat. 157 (, title XXI, § 2111, as added , , ; amended , , .)

Editorial Notes

References in Text

section 6102(c)(3) of Pub. L. 109–171 section 1397gg of this titleSection 6102(c)(3) of the Deficit Reduction Act of 2005, referred to in subsec. (c)(1), is , which is set out as a note under .

Amendments

Pub. L. 114–102015—Subsec. (b)(2)(B)(i). substituted “section 1397dd(m)(5)” for “section 1397dd(m)(4)”.

Statutory Notes and Related Subsidiaries

Effective Date

Apr. 1, 2009section 3 of Pub. L. 111–3 section 1396 of this titleSection effective , and applicable to child health assistance and medical assistance provided on or after that date, with certain exceptions, see , set out as a note under .