42 USC 1397kk - Phase-out of coverage for nonpregnant childless adults; conditions for coverage of parents

the Secretary shall not on or after February 4, 2009, 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)

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 January 1, 2010, 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

(B)

Extension upon State request

(C)

Application of enhanced FMAP

(3)

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

(A)

In general

(B)

Deadline for approval

(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

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

(i)

(ii)

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 October 1, 2011, 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

(C)

Application of enhanced FMAP

(2)

Rules for fiscal years 2012 through 2013

(A)

Payments for coverage limited to block grant funded from State allotment

(B)

Terms and conditions

(i)

Block grant set aside from State allotment

(ii)

Payments from block grant

(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)

the enhanced FMAP determined under section 1397ee(b) of this title 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)

the Federal medical assistance percentage (as determined under section 1396d(b) of this title 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

(vi)

No increase in income eligibility level for parents

(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)

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

(ii)

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

(iii)

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

(B)

High-performing State

(C)

State increasing enrollment of low-income children

(4)

Rules of construction

(c)

Applicable existing waiver

For purposes of this section—

(1)

In general

The term “applicable existing waiver” means a waiver, experimental, pilot, or demonstration project under section 1315 of this title, 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

(B)

Nonpregnant childless adult

(Aug. 14, 1935, ch. 531, title XXI, § 2111, as added Pub. L. 111–3, title I, § 112(a)(1), Feb. 4, 2009, 123 Stat. 29; amended Pub. L. 114–10, title III, § 301(b)(2)(D), Apr. 16, 2015, 129 Stat. 157.)

cite as: 42 USC 1397kk

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