42 USC 1397ll - Optional coverage of targeted low-income pregnant women through a State plan amendment

U.S Code last checked for updates: Nov 22, 2024

§ 1397ll.

Optional coverage of targeted low-income pregnant women through a State plan amendment

(a)

In general

(b)

Conditions

A State may only elect the option under subsection (a) if the following conditions are satisfied:

(1)

Minimum income eligibility levels for pregnant women and children

The State has established an income eligibility level—

(A)

for pregnant women under subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) of section 1396a of this title that is at least 185 percent (or such higher percent as the State has in effect with regard to pregnant women under this subchapter) of the poverty line applicable to a family of the size involved, but in no case lower than the percent in effect under any such subsection as of July 1, 2008; and

(B)

for children under 19 years of age under this subchapter (or subchapter XIX) that is at least 200 percent of the poverty line applicable to a family of the size involved.

(2)

No CHIP income eligibility level for pregnant women lower than the State’s Medicaid level

(3)

No coverage for higher income pregnant women without covering lower income pregnant women

(4)

Application of requirements for coverage of targeted low-income children

(5)

No preexisting condition exclusion or waiting period

(6)

Application of cost-sharing protection

(7)

No waiting list for children

(c)

Option to provide presumptive eligibility

(d)

Definitions

For purposes of this section:

(1)

Pregnancy-related assistance

(2)

Targeted low-income pregnant woman

The term “targeted low-income pregnant woman” means an individual—

(A)

during pregnancy and through the end of the month in which the 60-day period, or, in the case that subparagraph (A) of section 1396a(e)(16) of this title applies to the State child health plan (or waiver of such plan), pursuant to section 1397gg(e)(1) of this title, the 12-month period,1

 So in original. The comma probably should not appear.

(beginning on the last day of her pregnancy) ends;

(B)

whose family income exceeds 185 percent (or, if higher, the percent applied under subsection (b)(1)(A)) of the poverty line applicable to a family of the size involved, but does not exceed the income eligibility level established under the State child health plan under this subchapter for a targeted low-income child; and

(C)

who satisfies the requirements of paragraphs (1)(A), (1)(C), (2), and (3) of section 1397jj(b) of this title in the same manner as a child applying for child health assistance would have to satisfy such requirements.

(e)

Automatic enrollment for children born to women receiving pregnancy-related assistance

(f)

States providing assistance through other options

(1)

Continuation of other options for providing assistance

The option to provide assistance in accordance with the preceding subsections of this section shall not limit any other option for a State to provide—

(A)

child health assistance through the application of sections 457.10, 457.350(b)(2), 457.622(c)(5), and 457.626(a)(3) of title 42, Code of Federal Regulations (as in effect after the final rule adopted by the Secretary and set forth at 67 Fed. Reg. 61956–61974 (October 2, 2002)), or

(B)

pregnancy-related services through the application of any waiver authority (as in effect on June 1, 2008).

(2)

Clarification of authority to provide postpartum services

(3)

No inference

Nothing in this subsection shall be construed—

(A)

to infer congressional intent regarding the legality or illegality of the content of the sections specified in paragraph (1)(A); or

(B)

to modify the authority to provide pregnancy-related services under a waiver specified in paragraph (1)(B).

(Aug. 14, 1935, ch. 531, title XXI, § 2112, as added Pub. L. 111–3, title I, § 111(a), Feb. 4, 2009, 123 Stat. 26; amended Pub. L. 116–127, div. F, § 6004(b)(2), Mar. 18, 2020, 134 Stat. 206; Pub. L. 117–2, title IX, § 9822(a)(2), Mar. 11, 2021, 135 Stat. 221.)

cite as: 42 USC 1397ll