---
kind: "section"
citation: "42 U.S.C. § 1397mm"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1397mm"
heading: "Grants to improve outreach and enrollment"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1397mm"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XXI — State Children’s Health Insurance Program"
---

# §1397mm. Grants to improve outreach and enrollment

- (a) **Outreach and enrollment grants; national campaign—**
  - (1) **In general—** From the amounts appropriated under [subsection (g)](#g), subject to paragraphs [(2)](#a-2) and [(3)](#a-3), the [Secretary](/usc/42/1301.md?p=a-6) shall award [grants](/usc/42/1397j.md?p=10) to [eligible entities](/usc/42/1397j.md?p=7) during the period of [fiscal years](/usc/42/619.md?p=3) 2009 through 2029 to conduct outreach and enrollment efforts that are designed to increase the enrollment and participation of eligible children under this subchapter and subchapter XIX.
  - (2) **Ten percent set aside for national enrollment campaign—** An amount equal to 10 percent of such amounts shall be used by the [Secretary](/usc/42/1301.md?p=a-6) for expenditures during such period to carry out a national enrollment campaign in accordance with [subsection (h)](#h).
  - (3) **Ten percent set aside for evaluating and providing technical assistance to grantees—** For the period of [fiscal years](/usc/42/619.md?p=3) 2024 through 2029, an amount equal to 10 percent of such amounts shall be used by the [Secretary](/usc/42/1301.md?p=a-6) for the purpose of evaluating and providing technical assistance to [eligible entities](/usc/42/1397j.md?p=7) awarded [grants](/usc/42/1397j.md?p=10) under this section.
- (b) **Priority for award of grants—**
  - (1) **In general—** In awarding [grants](/usc/42/1397j.md?p=10) under [subsection (a)](#a), the [Secretary](/usc/42/1301.md?p=a-6) shall give priority to [eligible entities](/usc/42/1397j.md?p=7) that—
    - (A) propose to target geographic areas with high rates of—
      - (i) eligible but unenrolled children, [including](/usc/42/1301.md?p=b) such children who reside in rural areas; or
      - (ii) racial and ethnic minorities and health disparity populations, [including](/usc/42/1301.md?p=b) those proposals that address cultural and linguistic barriers to enrollment; and
    - (B) submit the most demonstrable evidence required under paragraphs [(1)](#c-1) and [(2)](#c-2) of subsection (c).
  - (2) **Ten percent set aside for outreach to Indian children—** An amount equal to 10 percent of the funds appropriated under [subsection (g)](#g) shall be used by the [Secretary](/usc/42/1301.md?p=a-6) to award [grants](/usc/42/1397j.md?p=10) to [Indian](/usc/42/619.md?p=4-A) Health Service providers and urban [Indian](/usc/42/619.md?p=4-A) organizations receiving funds under title V of the [Indian](/usc/42/619.md?p=4-A) Health Care Improvement Act ([25 U.S.C. 1651](/usc/25/1651.md) et seq.) for outreach to, and enrollment of, children who are [Indians](/usc/42/619.md?p=4-A).
- (c) **Application—** An [eligible entity](/usc/42/1397j.md?p=7) that desires to receive a [grant](/usc/42/1397j.md?p=10) under [subsection (a)](#a) shall submit an application to the [Secretary](/usc/42/1301.md?p=a-6) in such form and manner, and containing such information, as the [Secretary](/usc/42/1301.md?p=a-6) may decide. Such application shall include—
  - (1) evidence demonstrating that the entity [includes](/usc/42/1301.md?p=b) members who have access to, and credibility with, ethnic or low-income populations in the communities in which activities funded under the [grant](/usc/42/1397j.md?p=10) are to be conducted;
  - (2) evidence demonstrating that the entity has the ability to address barriers to enrollment, such as lack of awareness of eligibility, stigma concerns and punitive fears associated with receipt of benefits, and other cultural barriers to applying for and receiving [child health assistance](/usc/42/1397jj.md?p=a) or medical assistance;
  - (3) specific quality or outcomes performance measures to evaluate the effectiveness of activities funded by a [grant](/usc/42/1397j.md?p=10) awarded under this section; and
  - (4) an assurance that the [eligible entity](/usc/42/1397j.md?p=7) shall—
    - (A) conduct an assessment of the effectiveness of such activities against the performance measures;
    - (B) cooperate with the collection and reporting of enrollment data and other information in order for the [Secretary](/usc/42/1301.md?p=a-6) to conduct such assessments; and
    - (C) in the case of an [eligible entity](/usc/42/1397j.md?p=7) that is not the [State](/usc/42/619.md?p=5), provide the [State](/usc/42/619.md?p=5) with enrollment data and other information as necessary for the [State](/usc/42/619.md?p=5) to make necessary projections of eligible children and pregnant women.
- (d) **Dissemination of enrollment data and information determined from effectiveness assessments; annual report—** The [Secretary](/usc/42/1301.md?p=a-6) shall—
  - (1) make publicly available the enrollment data and information collected and reported in accordance with [subsection (c)(4)(B)](#c-4-B); and
  - (2) submit an annual report to Congress on the outreach and enrollment activities conducted with funds appropriated under this section.
- (e) **Maintenance of effort for States awarded grants; no match required for any eligible entity awarded a grant—**
  - (1) **State maintenance of effort—** In the case of a [State](/usc/42/619.md?p=5) that is awarded a [grant](/usc/42/1397j.md?p=10) under this section, the [State](/usc/42/619.md?p=5) share of funds expended for outreach and enrollment activities under the [State child health plan](/usc/42/1397jj.md?p=c-7) shall not be less than the [State](/usc/42/619.md?p=5) share of such funds expended in the [fiscal year](/usc/42/619.md?p=3) preceding the first [fiscal year](/usc/42/619.md?p=3) for which the [grant](/usc/42/1397j.md?p=10) is awarded.
  - (2) **No matching requirement—** No [eligible entity](/usc/42/1397j.md?p=7) awarded a [grant](/usc/42/1397j.md?p=10) under [subsection (a)](#a) shall be required to provide any matching funds as a condition for receiving the [grant](/usc/42/1397j.md?p=10).
- (f) **Definitions—** In this section:
  - (1) **Eligible entity—** The term “[eligible entity](/usc/42/1397j.md?p=7)” means any of the following:
    - (A) A [State](/usc/42/619.md?p=5) with an approved [child](/usc/42/1382c.md?p=c) [health plan](/usc/42/1320d.md?p=5) under this subchapter.
    - (B) A local government.
    - (C) An [Indian tribe](/usc/42/619.md?p=4-A) or tribal [consortium](/usc/42/17061.md?p=4), a [tribal organization](/usc/42/619.md?p=4-A), an urban [Indian](/usc/42/619.md?p=4-A) organization receiving funds under title V of the [Indian](/usc/42/619.md?p=4-A) Health Care Improvement Act ([25 U.S.C. 1651](/usc/25/1651.md) et seq.), or an [Indian](/usc/42/619.md?p=4-A) Health Service provider.
    - (D) A Federal health safety net organization.
    - (E) A national, [State](/usc/42/619.md?p=5), local, or community-based public or [nonprofit](/usc/42/300s–3.md?p=3) private organization, [including](/usc/42/1301.md?p=b) organizations that use community health workers, community-based doula programs, or parent mentors.
    - (F) A faith-based organization or consortia, to the extent that a [grant](/usc/42/1397j.md?p=10) awarded to such an entity is consistent with the requirements of [section 300x–65 of this title](/usc/42/300x–65.md) relating to a [grant](/usc/42/1397j.md?p=10) award to nongovernmental entities.
    - (G) An elementary or secondary school.
  - (2) **Federal health safety net organization—** The term “Federal health safety net organization” means—
    - (A) a Federally-qualified health center (as defined in [section 1396d(l)(2)(B)](/usc/42/1396d.md?p=l-2-B) of this title);
    - (B) a [hospital](/usc/42/300s–3.md?p=1) defined as a disproportionate share [hospital](/usc/42/300s–3.md?p=1) for purposes of [section 1396r–4 of this title](/usc/42/1396r–4.md);
    - (C) a covered entity described in [section 256b(a)(4) of this title](/usc/42/256b.md?p=a-4); and
    - (D) any other entity or [consortium](/usc/42/17061.md?p=4) that serves children under a federally funded program, [including](/usc/42/1301.md?p=b) the special supplemental nutrition program for women, infants, and children (WIC) established under [section 1786 of this title](/usc/42/1786.md), the Head Start and Early Head Start programs under the Head Start Act ([42 U.S.C. 9801](/usc/42/9801.md) et seq.),[^1] the school lunch program established under the Richard B. Russell National School Lunch Act [[42 U.S.C. 1751](/usc/42/1751.md) et seq.], and an elementary or secondary school.
  - (3) **Indians; Indian tribe; tribal organization; urban Indian organization—** The terms “[Indian](/usc/42/619.md?p=4-A)”, “[Indian tribe](/usc/42/619.md?p=4-A)”, “[tribal organization](/usc/42/619.md?p=4-A)”, and “urban [Indian](/usc/42/619.md?p=4-A) organization” have the meanings given such terms in section 4 of the [Indian](/usc/42/619.md?p=4-A) Health Care Improvement Act ([25 U.S.C. 1603](/usc/25/1603.md)).
  - (4) **Community health worker—** The term “community health worker” means an individual who promotes health or nutrition within the community in which the individual resides—
    - (A) by serving as a liaison between communities and health care [agencies](/usc/42/1397n–12.md?p=1);
    - (B) by providing guidance and [social](/usc/42/1397j.md?p=20) assistance to community residents;
    - (C) by enhancing community residents’ ability to effectively communicate with [health care providers](/usc/42/1320d.md?p=3);
    - (D) by providing culturally and linguistically appropriate health or nutrition education;
    - (E) by advocating for individual and community health or nutrition needs; and
    - (F) by providing referral and followup services.
  - (5) **Parent mentor—** The term “parent mentor” means an individual who—
    - (A) is a parent or guardian of at least one [child](/usc/42/1382c.md?p=c) who is an eligible [child](/usc/42/1382c.md?p=c) under this subchapter or subchapter XIX; and
    - (B) is trained to assist families with children who have no [health insurance coverage](/usc/42/1397jj.md?p=c-3) with respect to improving the [social](/usc/42/1397j.md?p=20) determinants of the health of such children, [including](/usc/42/1301.md?p=b) by providing—
      - (i) education about [health insurance coverage](/usc/42/1397jj.md?p=c-3), [including](/usc/42/1301.md?p=b), with respect to obtaining such coverage, eligibility criteria and application and renewal processes;
      - (ii) assistance with completing and submitting applications for [health insurance coverage](/usc/42/1397jj.md?p=c-3);
      - (iii) a liaison between families and representatives of [State](/usc/42/619.md?p=5) plans under subchapter XIX or [State child health plans](/usc/42/1397jj.md?p=c-7) under this subchapter;
      - (iv) guidance on identifying medical and dental homes and community pharmacies for children; and
      - (v) assistance and referrals to successfully address [social](/usc/42/1397j.md?p=20) determinants of children’s health, [including](/usc/42/1301.md?p=b) poverty, food insufficiency, and housing.
- (g) **Appropriation—** There is appropriated, out of any money in the Treasury not otherwise appropriated, $140,000,000 for the period of [fiscal years](/usc/42/619.md?p=3) 2009 through 2015, $40,000,000 for the period of [fiscal years](/usc/42/619.md?p=3) 2016 and 2017, $120,000,000 for the period of [fiscal years](/usc/42/619.md?p=3) 2018 through 2023, $48,000,000 for the period of [fiscal years](/usc/42/619.md?p=3) 2024 through 2027, and $40,000,000 for the period of [fiscal years](/usc/42/619.md?p=3) 2028 and 2029, for the purpose of awarding [grants](/usc/42/1397j.md?p=10) under this section. Amounts appropriated and paid under the authority of this section shall be in addition to amounts appropriated under [section 1397dd of this title](/usc/42/1397dd.md) and paid to [States](/usc/42/619.md?p=5) in accordance with [section 1397ee of this title](/usc/42/1397ee.md), [including](/usc/42/1301.md?p=b) with respect to expenditures for outreach activities in accordance with subsections [(a)(1)(D)(iii)](/usc/42/1397ee.md?p=a-1-D-iii) and [(c)(2)(C)](/usc/42/1397ee.md?p=c-2-C) of that section.
- (h) **National enrollment campaign—** From the amounts made available under [subsection (a)(2)](#a-2), the [Secretary](/usc/42/1301.md?p=a-6) shall develop and implement a national enrollment campaign to improve the enrollment of underserved [child](/usc/42/1382c.md?p=c) populations in the programs established under this subchapter and subchapter XIX. Such campaign may include—
  - (1) the establishment of partnerships with the [Secretary](/usc/42/1301.md?p=a-6) of Education and the [Secretary](/usc/42/1301.md?p=a-6) of Agriculture to develop national campaigns to link the eligibility and enrollment systems for the assistance programs each [Secretary](/usc/42/1301.md?p=a-6) administers that often serve the same children;
  - (2) the integration of information about the programs established under this subchapter and subchapter XIX in public health awareness campaigns administered by the [Secretary](/usc/42/1301.md?p=a-6);
  - (3) increased financial and technical support for enrollment hotlines maintained by the [Secretary](/usc/42/1301.md?p=a-6) to ensure that all [States](/usc/42/619.md?p=5) participate in such hotlines;
  - (4) the establishment of joint public awareness outreach initiatives with the [Secretary](/usc/42/1301.md?p=a-6) of Education and the [Secretary](/usc/42/1301.md?p=a-6) of Labor regarding the importance of health insurance to building strong communities and the economy;
  - (5) the development of special outreach materials for Native Americans or for individuals with limited English proficiency;
  - (6) the development of materials and toolkits and the provision of technical assistance to [States](/usc/42/619.md?p=5) regarding enrollment and retention strategies for eligible children under this subchapter and subchapter XIX; and
  - (7) such other outreach initiatives as the [Secretary](/usc/42/1301.md?p=a-6) determines would increase public awareness of the programs under this subchapter and subchapter XIX.

## Footnotes

[^1]: See References in Text note below.

## Source credit

(Aug. 14, 1935, ch. 531, title XXI, § 2113, as added Pub. L. 111–3, title II, § 201(a), Feb. 4, 2009, 123 Stat. 35; amended Pub. L. 111–148, title X, § 10203(d)(2)(E), Mar. 23, 2010, 124 Stat. 931; Pub. L. 114–10, title III, § 303, Apr. 16, 2015, 129 Stat. 158; Pub. L. 115–120, div. C, § 3004(a), (b), Jan. 22, 2018, 132 Stat. 36; Pub. L. 115–123, div. E, title I, § 50103, Feb. 9, 2018, 132 Stat. 176; Pub. L. 117–328, div. FF, title V, § 5111(c)(4), Dec. 29, 2022, 136 Stat. 5939.)

## Notes

### Editorial Notes

### References in Text

The Indian Health Care Improvement Act, referred to in subsecs. (b)(2) and (f)(1)(C), is Pub. L. 94–437, Sept. 30, 1976, 90 Stat. 1400. Title V of the Act is classified generally to subchapter IV (§ 1651 et seq.) of chapter 18 of Title 25, Indians. For complete classification of this Act to the Code, see Short Title note set out under section 1601 of Title 25 and Tables.

The Head Start Act, referred to in subsec. (f)(2)(D), is subchapter B (§ 635 et seq.) of chapter 8 of subtitle A of title VI of Pub. L. 97–35, Aug. 13, 1981, 95 Stat. 499, which is classified generally to subchapter II (§ 9831 et seq.) of chapter 105 of this title. For complete classification of this Act to the Code, see Short Title note set out under section 9801 of this title and Tables.

The Richard B. Russell National School Lunch Act, referred to in subsec. (f)(2)(D), is act June 4, 1946, ch. 281, 60 Stat. 230, which is classified generally to chapter 13 (§ 1751 et seq.) of this title. For complete classification of this Act to the Code, see Short Title note set out under section 1751 of this title and Tables.

### Amendments

2022—Subsec. (a)(1). Pub. L. 117–328, § 5111(c)(4)(A)(i), substituted “through 2029” for “through 2027”.

Subsec. (a)(3). Pub. L. 117–328, § 5111(c)(4)(A)(ii), substituted “through 2029” for “through 2027”.

Subsec. (g). Pub. L. 117–328, § 5111(c)(4)(B), substituted “2017,” for “2017,,” and “$48,000,000” for “and $48,000,000” and inserted “, and $40,000,000 for the period of fiscal years 2028 and 2029” after “through 2027”.

2018—Subsec. (a)(1). Pub. L. 115–123, § 50103(a)(1), (b)(1), substituted “paragraphs (2) and (3)” for “paragraph (2)” and “2027” for “2023”.

Pub. L. 115–120, § 3004(a)(1), substituted “2023” for “2017”.

Subsec. (a)(3). Pub. L. 115–123, § 50103(b)(2), added par. (3).

Subsec. (f)(1)(E). Pub. L. 115–120, § 3004(b)(1), substituted “, community-based doula programs, or parent mentors” for “or community-based doula programs”.

Subsec. (f)(5). Pub. L. 115–120, § 3004(b)(2), added par. (5).

Subsec. (g). Pub. L. 115–123, § 50103(a)(2), substituted “, $120,000,000” for “and $120,000,000” and inserted “, and $48,000,000 for the period of fiscal years 2024 through 2027” after “2023”.

Pub. L. 115–120, § 3004(a)(2), substituted “, $40,000,000” for “and $40,000,000” and inserted “, and $120,000,000 for the period of fiscal years 2018 through 2023” after “2017”.

Subsec. (h)(6), (7). Pub. L. 115–123, § 50103(c), added par. (6) and redesignated former par. (6) as (7).

2015—Subsec. (a)(1). Pub. L. 114–10, § 303(1), substituted “2017” for “2015”.

Subsec. (g). Pub. L. 114–10, § 303(2), inserted “and $40,000,000 for the period of fiscal years 2016 and 2017” after “2015”.

2010—Subsec. (a)(1). Pub. L. 111–148, § 10203(d)(2)(E)(i), substituted “2015” for “2013”.

Subsec. (g). Pub. L. 111–148, § 10203(d)(2)(E)(ii), substituted “$140,000,000 for the period of fiscal years 2009 through 2015” for “$100,000,000 for the period of fiscal years 2009 through 2013”.

### 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.