---
kind: "section"
citation: "42 U.S.C. § 1397ff"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1397ff"
heading: "Process for submission, approval, and amendment of State child health plans"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1397ff"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XXI — State Children’s Health Insurance Program"
---

# §1397ff. Process for submission, approval, and amendment of State child health plans

- (a) **Initial plan—**
  - (1) **In general—** As a condition of receiving payment under subsection (a) or (g) of [section 1397ee of this title](/usc/42/1397ee.md), a [State](/usc/42/619.md?p=5) shall submit to the [Secretary](/usc/42/1301.md?p=a-6) a [State child health plan](/usc/42/1397jj.md?p=c-7) that meets the applicable requirements of this subchapter.
  - (2) **Approval—** Except as the [Secretary](/usc/42/1301.md?p=a-6) may provide under [subsection (e)](#e), a [State](/usc/42/619.md?p=5) plan submitted under [paragraph (1)](#a-1)—
    - (A) shall be approved for purposes of this subchapter, and
    - (B) shall be effective beginning with a calendar quarter that is specified in the plan, but in no case earlier than October 1, 1997.
- (b) **Plan amendments—**
  - (1) **In general—** A [State](/usc/42/619.md?p=5) may amend, in whole or in part, its [State child health plan](/usc/42/1397jj.md?p=c-7) at any time through transmittal of a plan amendment.
  - (2) **Approval—** Except as the [Secretary](/usc/42/1301.md?p=a-6) may provide under [subsection (e)](#e), an amendment to a [State](/usc/42/619.md?p=5) plan submitted under [paragraph (1)](#b-1)—
    - (A) shall be approved for purposes of this subchapter, and
    - (B) shall be effective as provided in [paragraph (3)](#b-3).
  - (3) **Effective dates for amendments—**
    - (A) **In general—** Subject to the succeeding provisions of this paragraph, an amendment to a [State](/usc/42/619.md?p=5) plan shall take effect on one or more effective dates specified in the amendment.
    - (B) **Amendments relating to eligibility or benefits—**
      - (i) **Notice requirement—** Any plan amendment that eliminates or restricts eligibility or benefits under the plan may not take effect unless the [State](/usc/42/619.md?p=5) certifies that it has provided prior public notice of the change, in a form and manner provided under applicable [State](/usc/42/619.md?p=5) law.
      - (ii) **Timely transmittal—** Any plan amendment that eliminates or restricts eligibility or benefits under the plan shall not be effective for longer than a 60-day period unless the amendment has been transmitted to the [Secretary](/usc/42/1301.md?p=a-6) before the end of such period.
    - (C) **Other amendments—** Any plan amendment that is not described in [subparagraph (B)](#b-3-B) and that becomes effective in a [State](/usc/42/619.md?p=5) [fiscal year](/usc/42/619.md?p=3) may not remain in effect after the end of such [fiscal year](/usc/42/619.md?p=3) (or, if later, the end of the 90-day period on which it becomes effective) unless the amendment has been transmitted to the [Secretary](/usc/42/1301.md?p=a-6).
- (c) **Disapproval of plans and plan amendments—**
  - (1) **Prompt review of plan submittals—** The [Secretary](/usc/42/1301.md?p=a-6) shall promptly review [State](/usc/42/619.md?p=5) plans and plan amendments submitted under this section to determine if they substantially comply with the requirements of this subchapter.
  - (2) **90-day approval deadlines—** A [State](/usc/42/619.md?p=5) plan or plan amendment is considered approved unless the [Secretary](/usc/42/1301.md?p=a-6) notifies the [State](/usc/42/619.md?p=5) in writing, within 90 days after receipt of the plan or amendment, that the plan or amendment is disapproved (and the reasons for disapproval) or that specified additional information is needed.
  - (3) **Correction—** In the case of a disapproval of a plan or plan amendment, the [Secretary](/usc/42/1301.md?p=a-6) shall provide a [State](/usc/42/619.md?p=5) with a reasonable opportunity for correction before taking financial sanctions against the [State](/usc/42/619.md?p=5) on the basis of such disapproval.
- (d) **Program operation—**
  - (1) **In general—** The [State](/usc/42/619.md?p=5) shall conduct the program in accordance with the plan (and any amendments) approved under [subsection (c)](#c) and with the requirements of this subchapter.
  - (2) **Violations—** The [Secretary](/usc/42/1301.md?p=a-6) shall establish a process for enforcing requirements under this subchapter. Such process shall provide for the withholding of funds in the case of substantial noncompliance with such requirements. In the case of an enforcement action against a [State](/usc/42/619.md?p=5) under this paragraph, the [Secretary](/usc/42/1301.md?p=a-6) shall provide a [State](/usc/42/619.md?p=5) with a reasonable opportunity for correction before taking financial sanctions against the [State](/usc/42/619.md?p=5) on the basis of such an action.
- (e) **Continued approval—** An approved [State child health plan](/usc/42/1397jj.md?p=c-7) shall continue in effect unless and until the [State](/usc/42/619.md?p=5) amends the plan under [subsection (b)](#b) or the [Secretary](/usc/42/1301.md?p=a-6) finds, under [subsection (d)](#d), substantial noncompliance of the plan with the requirements of this subchapter.

## Source credit

(Aug. 14, 1935, ch. 531, title XXI, § 2106, as added Pub. L. 105–33, title IV, § 4901(a), Aug. 5, 1997, 111 Stat. 563; amended Pub. L. 119–21, title VII, § 71401(b)(3), July 4, 2025, 139 Stat. 332.)

## Notes

### Editorial Notes

### Amendments

2025—Subsec. (a)(1). Pub. L. 119–21 inserted “subsection (a) or (g) of” before “section 1397ee of this title”.