SEC. 3001. Short Title.
This division may be cited as the “Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act” or the “HEALTHY KIDS Act”.
Division C — Healthy Kids Act
DIVISION C Healthy Kids Act
SEC. 3002. Six-Year Funding Extension of the Children’s Health Insurance Program.
Funding.—
In general.— Section 2104(a) of the Social Security Act (42 U.S.C. 1397dd(a)), as amended by section 3201(a) of the CHIP and Public Health Funding Extension Act (division C of Public Law 115–96), is amended—
in paragraph (20)(B), by striking “ ; and” and inserting a semicolon;
by striking paragraph (21) and inserting the following new paragraphs:
“(21) for fiscal year 2018, $21,500,000,000;
“(22) for fiscal year 2019, $22,600,000,000;
“(23) for fiscal year 2020, $23,700,000,000;
“(24) for fiscal year 2021, $24,800,000,000;
“(25) for fiscal year 2022, $25,900,000,000; and
“(26) for fiscal year 2023, for purposes of making two semi-annual allotments—
“(A) $2,850,000,000 for the period beginning on October 1, 2022, and ending on March 31, 2023; and
“(B) $2,850,000,000 for the period beginning on April 1, 2023, and ending on September 30, 2023.”
Prevention of duplicate appropriations for fiscal year 2018.— Notwithstanding any other provision of law, insofar as funds have been appropriated under subsection (a)(21) of section 2104 of the Social Security Act (42 U.S.C. 1397dd), as such subsection is in effect on the day before the date of the enactment of this Act, to provide allotments to States under the State Children’s Health Insurance Program established under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.) (whether implemented under title XIX, XXI, or both, of the Social Security Act) for fiscal year 2018—
any amounts that are so appropriated that are not so allotted and obligated before the date of the enactment of this Act, are rescinded; and
any amount provided for CHIP allotments to a State under this section (and the amendments made by this section) for such fiscal year shall be reduced by the amount of such appropriations so allotted and obligated before such date.
Allotments.—
In general.— Section 2104(m) of the Social Security Act (42 U.S.C. 1397dd(m)), as amended by section 3201(b) of the CHIP and Public Health Funding Extension Act (division C of Public Law 115–96), is amended—
in paragraph (2)(B)—
in the matter preceding clause (i), by striking “ (19)” and inserting “ (25)”;
in clause (i), by striking “ and 2017” and inserting “ , 2017, and 2023”; and
in clause (ii)—
in the matter preceding subclause (I), by striking “ and paragraph (10)”; and
in subclause (I), by inserting “ (or, in the case of fiscal year 2018, under paragraph (4))” after “ clause (i)”;
in paragraph (5), by striking “ 2018” and inserting “ 2023”;
in paragraph (7)—
in subparagraph (A), by striking “ 2017” and inserting “ 2023”;
in subparagraph (B), in the matter preceding clause (i), by inserting “ (or, in the case of fiscal year 2018, by not later than the date that is 60 days after the date of the enactment of the HEALTHY KIDS Act)” after “ before the August 31 preceding the beginning of the fiscal year”; and
in the matter following subparagraph (B), by striking “ or fiscal year 2016” and inserting “ fiscal year 2016, fiscal year 2018, fiscal year 2020, or fiscal year 2022”;
in paragraph (9), by striking “ 2018” and inserting “ 2023”; and
by amending paragraph (10) to read as follows:
“(10) For fiscal year 2023.—
“(A) First half.—Subject to paragraphs (5) and (7), from the amount made available under subparagraph (A) of paragraph (26) of subsection (a) for the semi-annual period described in such subparagraph, increased by the amount of the appropriation for such period under section 3002(b)(2) of the HEALTHY KIDS Act, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the first half ratio (described in subparagraph (D)) of the amount described in subparagraph (C).
“(B) Second half.—Subject to paragraphs (5) and (7), from the amount made available under subparagraph (B) of paragraph (26) of subsection (a) for the semi-annual period described in such subparagraph, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the amount made available under such subparagraph, multiplied by the ratio of—
“(i) the amount of the allotment to such State under subparagraph (A); to
“(ii) the total of the amount of all of the allotments made available under such subparagraph.
“(C) Full year amount based on rebased amount.—The amount described in this subparagraph for a State is equal to the Federal payments to the State that are attributable to (and countable towards) the total amount of allotments available under this section to the State in fiscal year 2022 (including payments made to the State under subsection (n) for fiscal year 2022 as well as amounts redistributed to the State in fiscal year 2022), multiplied by the allotment increase factor under paragraph (6) for fiscal year 2023.
“(D) First half ratio.—The first half ratio described in this subparagraph is the ratio of—
“(i) the sum of—
“(I) the amount made available under subsection (a)(26)(A); and
“(II) the amount of the appropriation for such period under section 3002(b)(2) of the HEALTHY KIDS Act; to
“(ii) the sum of—
“(I) the amount described in clause (i); and
“(II) the amount made available under subsection (a)(26)(B).”
One-time appropriation for fiscal year 2023.— There is appropriated to the Secretary of Health and Human Services, out of any money in the Treasury not otherwise appropriated, $20,200,000,000 to accompany the allotment made for the period beginning on October 1, 2022, and ending on March 31, 2023, under paragraph (26)(A) of section 2104(a) of the Social Security Act (42 U.S.C. 1397dd(a)) (as added by subsection (a)), to remain available until expended. Such amount shall be used to provide allotments to States under paragraph (10) of section 2104(m) of such Act (as added by paragraph (1)) for the first 6 months of fiscal year 2023 in the same manner as allotments are provided under subsection (a)(26)(A) of such section 2104 and subject to the same terms and conditions as apply to the allotments provided from such subsection (a)(26)(A).
Extension of the Child Enrollment Contingency Fund.— Section 2104(n) of the Social Security Act (42 U.S.C. 1397dd(n)) is amended—
in paragraph (2)—
in subparagraph (A)(ii)—
by striking “ 2010, 2011, 2012, 2013, 2014, and 2016” and inserting “ 2010 through 2014, 2016, and 2018 through 2022”; and
by striking “ fiscal year 2015 and fiscal year 2017” and inserting “ fiscal years 2015, 2017, and 2023”; and
in subparagraph (B)—
by striking “ 2010, 2011, 2012, 2013, 2014, and 2016” and inserting “ 2010 through 2014, 2016, and 2018 through 2022”; and
by striking “ fiscal year 2015 and fiscal year 2017” and inserting “ fiscal years 2015, 2017, and 2023”; and
in paragraph (3)(A), in the matter preceding clause (i), by striking “ or a semi-annual allotment period for fiscal year 2015 or 2017” and inserting “ or in any of fiscal years 2018 through 2022 (or a semi-annual allotment period for fiscal year 2015, 2017, or 2023)”.
Extension of Qualifying States Option.—
in the heading, by striking “ through 2017” and inserting “ through 2023”; and
in subparagraph (A), by striking “ 2017” and inserting “ 2023”.
Technical amendments.— Section 2104(f)(2)(B)(ii) of the Social Security Act (42 U.S.C. 1397dd(f)(2)(B)(ii)), as amended by section 3201(c) of the CHIP and Public Health Funding Extension Act (division C of Public Law 115–96), is amended—
in subclause (I), by striking “ for the month (as defined in subclause (II))” and inserting “ (as defined in subclause (II)) for the month”;
in subclause (II), by inserting “ , as in effect on the day before the date of the enactment of the HEALTHY KIDS Act,” after “ section 2105(g)(4)(A)”; and
in subclause (VI)—
by inserting “ , as in effect on the day before the date of the enactment of the HEALTHY KIDS Act” after “ , section 2105(g)(4)”; and
by inserting “ , as so in effect” after “ under section 2105(g)(4)”.
Extension of Express Lane Eligibility Option.— Section 1902(e)(13)(I) of the Social Security Act (42 U.S.C. 1396a(e)(13)(I)) is amended by striking “ 2017” and inserting “ 2023”.
Assurance of Affordability Standard for Children and Families.—
in the paragraph heading, by striking “ until october 1, 2019” and inserting “ through september 30, 2023”; and
in subparagraph (A), in the matter preceding clause (i)—
by striking “ 2019” and inserting “ 2023”; and
by striking “ The preceding sentence shall not be construed as preventing a State during such period” and inserting “ During the period that begins on October 1, 2019, and ends on September 30, 2023, the preceding sentence shall only apply with respect to children in families whose income does not exceed 300 percent of the poverty line (as defined in section 2110(c)(5)) applicable to a family of the size involved. The preceding sentences shall not be construed as preventing a State during any such periods”.
Conforming amendments.— Section 1902(gg)(2) of the Social Security Act (42 U.S.C. 1396a(gg)(2)) is amended—
in the paragraph heading, by striking “ until october 1, 2019” and inserting “ through september 30, 2023”; and
by striking “ September 30, 2019,” and inserting “ September 30, 2023 (but during the period that begins on October 1, 2019, and ends on September 30, 2023, only with respect to children in families whose income does not exceed 300 percent of the poverty line (as defined in section 2110(c)(5)) applicable to a family of the size involved)”.
CHIP Look-Alike Plans.—
Blending risk pools.— Section 2107 of the Social Security Act (42 U.S.C. 1397gg) is amended by adding at the end the following:
“(g) Use of Blended Risk Pools.—
“(1) In general.—Nothing in this title (or any other provision of Federal law) shall be construed as preventing a State from considering children enrolled in a qualified CHIP look-alike program and children enrolled in a State child health plan under this title (or a waiver of such plan) as members of a single risk pool.
“(2) Qualified chip look-alike program.—In this subsection, the term ‘qualified CHIP look-alike program’ means a State program—
“(A) under which children who are under the age of 19 and are not eligible to receive medical assistance under title XIX or child health assistance under this title may purchase coverage through the State that provides benefits that are at least identical to the benefits provided under the State child health plan under this title (or a waiver of such plan); and
“(B) that is funded exclusively through non-Federal funds, including funds received by the State in the form of premiums for the purchase of such coverage.”
Coverage rule.—
In general.— Section 5000A(f)(1) of the Internal Revenue Code of 1986 is amended in subparagraph (A)(iii), by inserting “ or under a qualified CHIP look-alike program (as defined in section 2107(g) of the Social Security Act)” before the comma at the end.
Effective date.— The amendment made by subparagraph (A) shall apply with respect to taxable years beginning after December 31, 2017.
Availability of Unused Fiscal Year 2018 Redistribution Amounts.— Any amounts that have been redistributed to States under subsection (f) of section 2104 of the Social Security Act (42 U.S.C. 1397dd) for fiscal year 2018 that are not, or will not be, expended by the end of that fiscal year shall be—
adjusted by the Secretary before the end of fiscal year 2018 to reflect an updated estimate of shortfalls under subsection (f)(2)(A) of such section; and
available for redistribution under subsection (f) of such section for subsequent fiscal years.
SEC. 3003. Extension of Certain Programs and Demonstration Projects.
Childhood Obesity Demonstration Project.— Section 1139A(e)(8) of the Social Security Act (42 U.S.C. 1320b–9a(e)(8)) is amended—
by striking “ and $10,000,000” and inserting “ , $10,000,000”; and
by inserting after “ 2017” the following: “ , and $30,000,000 for the period of fiscal years 2018 through 2023”.
Pediatric Quality Measures Program.— Section 1139A(i) of the Social Security Act (42 U.S.C. 1320b–9a(i)) is amended—
by striking “ Out of any” and inserting the following:
“(1) In general.—Out of any”
by striking “ there is appropriated for each” and inserting
“(A) for each”
by striking “ , and there is appropriated for the period” and inserting
“(B) for the period”
by striking “ . Funds appropriated under this subsection shall remain available until expended.” and inserting “ ; and”; and
by adding at the end the following:
“(C) for the period of fiscal years 2018 through 2023, $90,000,000 for the purpose of carrying out this section (other than subsections (e), (f), and (g)).
“(2) Availability.—Funds appropriated under this subsection shall remain available until expended.”
SEC. 3004. Extension of Outreach and Enrollment Program.
in subsection (a)(1), by striking “ 2017” and inserting “ 2023”; and
in subsection (g)—
by striking “ and $40,000,000” and inserting “ , $40,000,000”; and
by inserting after “ 2017” the following: “ , and $120,000,000 for the period of fiscal years 2018 through 2023”.
Making Organizations That Use Parent Mentors Eligible To Receive Grants.— Section 2113(f) of the Social Security Act (42 U.S.C. 1397mm(f)) is amended—
in paragraph (1)(E), by striking “ or community-based doula programs” and inserting “ , community-based doula programs, or parent mentors”; and
by adding at the end the following new paragraph:
“(5) Parent mentor.—The term ‘parent mentor’ means an individual who—
“(A) is a parent or guardian of at least one child who is an eligible child under this title or title XIX; and
“(B) is trained to assist families with children who have no health insurance coverage with respect to improving the social determinants of the health of such children, including by providing—
“(i) education about health insurance coverage, including, with respect to obtaining such coverage, eligibility criteria and application and renewal processes;
“(ii) assistance with completing and submitting applications for health insurance coverage;
“(iii) a liaison between families and representatives of State plans under title XIX or State child health plans under this title;
“(iv) guidance on identifying medical and dental homes and community pharmacies for children; and
“(v) assistance and referrals to successfully address social determinants of children’s health, including poverty, food insufficiency, and housing.”
Exclusion From Modified Adjusted Gross Income.— Section 1902(e) of the Social Security Act (42 U.S.C. 1396a(e)) is amended—
in the first paragraph (14), relating to income determined using modified adjusted gross income, by adding at the end the following new subparagraph:
“(J) Exclusion of parent mentor compensation from income determination.—Any nominal amount received by an individual as compensation, including a stipend, for participation as a parent mentor (as defined in paragraph (5) of section 2113(f)) in an activity or program funded through a grant under such section shall be disregarded for purposes of determining the income eligibility of such individual for medical assistance under the State plan or any waiver of such plan.”
; and
by striking “ (14) Exclusion” and inserting “ (15) Exclusion”.
SEC. 3005. Extension and Reduction of Additional Federal Financial Participation for Chip.
Section 2105(b) of the Social Security Act (42 U.S.C. 1397ee(b)) is amended in the second sentence by inserting “ and during the period that begins on October 1, 2019, and ends on September 30, 2020, the enhanced FMAP determined for a State for a fiscal year (or for any portion of a fiscal year occurring during such period) shall be increased by 11.5 percentage points” after “ 23 percentage points,”.
SEC. 3006. Medicaid Improvement Fund.
Section 1941 of the Social Security Act (42 U.S.C. 1396w–1) is amended—
in subsection (a), in the first sentence, by inserting before the period at the end the following: “ , and, in accordance with subsection (b)(3), for the purposes of subparagraph (B) of such subsection”; and
in subsection (b)—
in paragraph (2)—
in the first sentence, by inserting “ pursuant to paragraph (1)” after “ in the Fund”;
by inserting after the first sentence the following sentence: “ Amounts in the Fund pursuant to paragraph (3) shall be available in advance of appropriations but only if the total amount obligated from the Fund does not exceed the amount available to the Fund under such paragraph (3).”; and
in the last sentence, by striking “ sentence” and inserting “ sentences”; and
by adding at the end the following new paragraph:
“(3) Additional funding for state activities relating to mechanized claims systems.—
“(A) In general.—In addition to the amount made available under paragraph (1), there shall be available to the Fund, for expenditures from the Fund in accordance with subparagraph (B), for fiscal year 2023 and thereafter, $980,000,000, to remain available until expended.
“(B) Purposes.—The Secretary shall use amounts made available to the Fund under subparagraph (A) to pay to each State which has a plan approved under this title, for each quarter beginning during or after fiscal year 2023 an amount equal to—
“(i) 100 percent minus the percent specified in clause (i) of section 1903(a)(3)(A) of so much of the sums expended by the State during such quarter as are attributable to the activities described in such clause;
“(ii) 100 percent minus the Federal medical assistance percentage applied under clause (iii) of such section of so much of the sums expended during such quarter (as found necessary by the Secretary under such clause) by the State as are attributable to the activities described in such clause; and
“(iii) 100 percent minus the percent specified in section 1903(a)(3)(B) of so much of the sums expended by the State during such quarter as are attributable to the activities described in such section.”