---
kind: "section"
citation: "42 U.S.C. § 1397ll"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1397ll"
heading: "Optional coverage of targeted low-income pregnant women through a State plan amendment"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1397ll"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XXI — State Children’s Health Insurance Program"
---

# §1397ll. Optional coverage of targeted low-income pregnant women through a State plan amendment

- (a) **In general—** Subject to the succeeding provisions of this section, a [State](/usc/42/619.md?p=5) may elect through an amendment to its [State child health plan](/usc/42/1397jj.md?p=c-7) under [section 1397bb of this title](/usc/42/1397bb.md) to provide pregnancy-related assistance under such plan for targeted low-income pregnant women.
- (b) **Conditions—** A [State](/usc/42/619.md?p=5) may only elect the option under [subsection (a)](#a) if the following conditions are satisfied:
  - (1) **Minimum income eligibility levels for pregnant women and children—** The [State](/usc/42/619.md?p=5) 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](/usc/42/1396a.md) that is at least 185 percent (or such higher percent as the [State](/usc/42/619.md?p=5) has in effect with regard to pregnant women under this subchapter) of the [poverty line](/usc/42/1397jj.md?p=c-5) 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](/usc/42/1397jj.md?p=c-5) applicable to a family of the size involved.
  - (2) **No CHIP income eligibility level for pregnant women lower than the State’s Medicaid level—** The [State](/usc/42/619.md?p=5) does not apply an effective income level for pregnant women under the [State](/usc/42/619.md?p=5) plan amendment that is lower than the effective income level (expressed as a percent of the [poverty line](/usc/42/1397jj.md?p=c-5) and considering applicable income disregards) specified under subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) of [section 1396a of this title](/usc/42/1396a.md), on February 4, 2009, to be eligible for medical assistance as a pregnant woman.
  - (3) **No coverage for higher income pregnant women without covering lower income pregnant women—** The [State](/usc/42/619.md?p=5) does not provide coverage for pregnant women with higher family income without covering pregnant women with a lower family income.
  - (4) **Application of requirements for coverage of targeted low-income children—** The [State](/usc/42/619.md?p=5) provides pregnancy-related assistance for targeted low-income pregnant women in the same manner, and subject to the same requirements under [section 1397cc(c) of this title](/usc/42/1397cc.md?p=c), as the [State](/usc/42/619.md?p=5) provides [child health assistance](/usc/42/1397jj.md?p=a) for targeted low-income children under the [State child health plan](/usc/42/1397jj.md?p=c-7), and in addition to providing [child health assistance](/usc/42/1397jj.md?p=a) for such women.
  - (5) **No preexisting condition exclusion or waiting period—** The [State](/usc/42/619.md?p=5) does not apply any exclusion of benefits for pregnancy-related assistance based on any preexisting condition or any waiting period ([including](/usc/42/1301.md?p=b) any waiting period imposed to carry out [section 1397bb(b)(3)(C) of this title](/usc/42/1397bb.md?p=b-3-C)) for receipt of such assistance.
  - (6) **Application of cost-sharing protection—** The [State](/usc/42/619.md?p=5) provides pregnancy-related assistance to a targeted low-income woman consistent with the cost-sharing protections under [section 1397cc(e) of this title](/usc/42/1397cc.md?p=e) and applies the limitation on total annual aggregate cost sharing imposed under [paragraph (3)(B)](/usc/42/1397cc.md?p=e-3-B) of such section to the family of such a woman.
  - (7) **No waiting list for children—** The [State](/usc/42/619.md?p=5) does not impose, with respect to the enrollment under the [State child health plan](/usc/42/1397jj.md?p=c-7) of targeted low-income children during the quarter, any enrollment cap or other numerical limitation on enrollment, any waiting list, any procedures designed to delay the consideration of applications for enrollment, or similar limitation with respect to enrollment.
- (c) **Option to provide presumptive eligibility—** A [State](/usc/42/619.md?p=5) that elects the option under [subsection (a)](#a) and satisfies the conditions described in [subsection (b)](#b) may elect to apply [section 1396r–1 of this title](/usc/42/1396r–1.md) (relating to presumptive eligibility for pregnant women) to the [State child health plan](/usc/42/1397jj.md?p=c-7) in the same manner as such section applies to the [State](/usc/42/619.md?p=5) plan under subchapter XIX.
- (d) **Definitions—** For purposes of this section:
  - (1) **Pregnancy-related assistance—** The term “pregnancy-related assistance” has the meaning given the term “[child health assistance](/usc/42/1397jj.md?p=a)” in [section 1397jj(a) of this title](/usc/42/1397jj.md?p=a) with respect to an individual during the period described in [paragraph (2)(A)](#d-2-A).
  - (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](/usc/42/1396a.md?p=e-16) applies to the [State child health plan](/usc/42/1397jj.md?p=c-7) (or waiver of such plan), pursuant to [section 1397gg(e)(1) of this title](/usc/42/1397gg.md?p=e-1), the 12-month period,[^1] (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)](#b-1-A)) of the [poverty line](/usc/42/1397jj.md?p=c-5) applicable to a family of the size involved, but does not exceed the income eligibility level established under the [State child health plan](/usc/42/1397jj.md?p=c-7) under this subchapter for a [targeted low-income child](/usc/42/1397jj.md?p=b-1); and
    - (C) who satisfies the requirements of paragraphs (1)(A), (1)(C), (2), and (3) of [section 1397jj(b) of this title](/usc/42/1397jj.md?p=b) in the same manner as a [child](/usc/42/1382c.md?p=c) applying for [child health assistance](/usc/42/1397jj.md?p=a) would have to satisfy such requirements.
- (e) **Automatic enrollment for children born to women receiving pregnancy-related assistance—** If a [child](/usc/42/1382c.md?p=c) is born to a targeted low-income pregnant woman who was receiving pregnancy-related assistance under this section on the date of the [child](/usc/42/1382c.md?p=c)’s birth, the [child](/usc/42/1382c.md?p=c) shall be deemed to have applied for [child health assistance](/usc/42/1397jj.md?p=a) under the [State child health plan](/usc/42/1397jj.md?p=c-7) and to have been found eligible for such assistance under such plan or to have applied for medical assistance under subchapter XIX and to have been found eligible for such assistance under such subchapter, as appropriate, on the date of such birth and to remain eligible for such assistance until the [child](/usc/42/1382c.md?p=c) attains 1 year of age. During the period in which a [child](/usc/42/1382c.md?p=c) is deemed under the preceding sentence to be eligible for [child](/usc/42/1382c.md?p=c) health or medical assistance, the [child](/usc/42/1382c.md?p=c) health or medical assistance eligibility identification number of the mother shall also serve as the identification number of the [child](/usc/42/1382c.md?p=c), and all claims shall be submitted and paid under such number (unless the [State](/usc/42/619.md?p=5) issues a separate identification number for the [child](/usc/42/1382c.md?p=c) before such period expires).
- (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](/usc/42/619.md?p=5) to provide—
    - (A) [child health assistance](/usc/42/1397jj.md?p=a) 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](/usc/42/1301.md?p=a-6) 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—** Any [State](/usc/42/619.md?p=5) that provides [child health assistance](/usc/42/1397jj.md?p=a) under any authority described in [paragraph (1)](#f-1) may continue to provide such assistance, as well as postpartum services, through the end of the month in which the 60-day period (beginning on the last day of the pregnancy) ends, in the same manner as such assistance and postpartum services would be provided if provided under the [State](/usc/42/619.md?p=5) plan under subchapter XIX, but only if the mother would otherwise satisfy the eligibility requirements that apply under the [State child health plan](/usc/42/1397jj.md?p=c-7) (other than with respect to age) during such period.
  - (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)](#f-1-A); or
    - (B) to modify the authority to provide pregnancy-related services under a waiver specified in [paragraph (1)(B)](#f-1-B).

## Footnotes

[^1]: So in original. The comma probably should not appear.

## Source credit

(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.)

## Notes

### Editorial Notes

### Amendments

2021—Subsec. (d)(2)(A). Pub. L. 117–2 inserted “, 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,” after “60-day period”.

2020—Subsec. (b)(4). Pub. L. 116–127 inserted “under section 1397cc(c) of this title” after “same requirements”.

### Statutory Notes and Related Subsidiaries

### Effective Date

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