[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 646 Introduced in Senate (IS)]
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117th CONGRESS
1st Session
S. 646
To amend titles XIX and XXI of the Social Security Act to provide for
12-month continuous enrollment under Medicaid and the Children's Health
Insurance Program, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 9, 2021
Mr. Brown (for himself, Ms. Baldwin, Ms. Warren, and Mr. Whitehouse)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To amend titles XIX and XXI of the Social Security Act to provide for
12-month continuous enrollment under Medicaid and the Children's Health
Insurance Program, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Stabilize Medicaid and CHIP Coverage
Act of 2021''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Every year millions of people are enrolled in Medicaid
and the Children's Health Insurance Program (in this section
referred to as ``CHIP''), but subsequently lose their coverage,
despite still being eligible, because of inefficient and
cumbersome paperwork and logistical requirements.
(2) Data show that the typical enrollee receives Medicaid
coverage for about \3/4\ of the year and that coverage periods
are lower for non-elderly, non-disabled adults than for those
with disabilities, seniors, and children.
(3) Medicaid enrollees with coverage disruption are more
likely to be hospitalized for illnesses, like asthma, diabetes,
or cardiovascular disease, that can be effectively managed
through ongoing primary medical care and medication, are less
likely to be screened for breast cancer, and may have poorer
cancer outcomes.
(4) Children enrolled in CHIP also experience disruptions
in health coverage and care. For example, during just a 1-year
period, over \1/3\ of CHIP enrollees were also enrolled in a
State's Medicaid program. Transitions between Medicaid and CHIP
can cause disruptions in care because the health care coverage
and participating providers vary between the two programs.
(5) Interruptions in coverage can impair the receipt of
effective primary care and lead to expensive hospitalizations
or emergency room visits.
(6) Unnecessary enrollment, disenrollment, and reenrollment
in Medicaid and CHIP result in higher administrative expenses
for reenrollment and result in more people uninsured at any
given time.
(7) Stable coverage under Medicaid and CHIP lowers average
monthly medical costs. Continuous enrollment also permits
better prevention and disease management, leading to fewer
serious illnesses and hospitalizations.
(8) Children with stable coverage are less likely to have
unmet medical needs, allowing children to receive the
preventive care that is necessary to help them grow into
healthy adults.
SEC. 3. 12-MONTH CONTINUOUS ENROLLMENT.
(a) Requirement of 12-Month Continuous Enrollment Under Medicaid.--
(1) In general.--Section 1902(e)(12) of the Social Security
Act (42 U.S.C. 1396a(e)), is amended to read as follows:
``(12) 12-month continuous enrollment.--
``(A) In general.--Notwithstanding any other
provision of this title, a State plan approved under
this title or under any waiver of such plan approved
pursuant to section 1115 or section 1915, shall provide
that an individual who is determined to be eligible for
benefits under such plan (or waiver) shall be
considered to meet the eligibility requirements met on
the date of application and shall remain eligible and
enrolled for such benefits through the end of the month
in which the 12-month period (beginning on the date of
determination of eligibility) ends.
``(B) Promoting retention of eligible and enrolled
persons beyond 12 months.--The Secretary shall--
``(i) identify methods that promote the
retention of individuals who are enrolled under
the State plan or under a waiver of such plan
and who remain eligible for medical assistance
beyond the 12-month period described in
subparagraph (A); and
``(ii) actively promote the adoption of
such enrollment retention methods by States,
which shall include, but not be limited to,
issuing guidance and developing resources on
State best practices.
``(C) Enrollment and retention reporting.--
``(i) In general.--Not later than 1 year
after the date of enactment of the Stabilize
Medicaid and CHIP Coverage Act of 2021, the
Secretary shall publish the procedures that
States are expected to use to provide annual
enrollment and retention reports beginning not
later than 2 years after the date of enactment
of such Act.
``(ii) State reporting requirements.--At a
minimum, the reporting procedures published
under clause (i) shall include a description of
State eligibility criteria and enrollment
procedures under this title and data regarding
enrollment and retention using standardized
reporting formats determined by the Secretary.
``(iii) Secretary report and publication.--
``(I) In general.--The Secretary
annually shall publish enrollment and
retention performance results for all
States not later than 6 months after
the deadline for each annual State
enrollment and retention reporting
period.
``(II) Estimated enrollment
continuity ratios.--Each annual report
published by the Secretary under
subclause (I) shall include estimates
of Medicaid enrollment continuity
ratios for each State in accordance
with the requirements of subclause
(III).
``(III) Requirements.--The
Secretary shall develop both overall
enrollment continuity ratios for all
enrollees and separate enrollment
continuity ratios for each of the
following categories:
``(aa) Children.
``(bb) Individuals whose
eligibility category is related
to having attained age 65.
``(cc) Individuals whose
eligibility category is related
to disability or blindness.
``(dd) Individuals whose
eligibility category is related
to their status as parents and
caretaker relatives of children
under 19 or who are otherwise
not elderly, blind or disabled
adults.''.
(b) Requirement of 12-Month Continuous Enrollment Under CHIP.--
(1) In general.--Section 2102(b) of the Social Security Act
(42 U.S.C. 1397bb(b)) is amended by adding at the end the
following new paragraph:
``(6) Requirement for 12-month continuous enrollment.--
Notwithstanding any other provision of this title, a State
child health plan that provides child health assistance under
this title through a means other than that described in section
2101(a)(2), shall provide that an individual who is determined
to be eligible for benefits under such plan shall be considered
to meet the eligibility requirements met on the date of
application and shall remain eligible and enrolled for such
benefits through the end of the month in which the 12-month
period (beginning on the date of determination of eligibility)
ends.''.
(2) Conforming amendments.--
(A) Enrollment and retention provisions.--Section
2105(a)(4)(A) of the Social Security Act (42 U.S.C.
1397ee(a)(4)(A)) is amended--
(i) by striking ``has elected the option
of'' and inserting ``is in compliance with the
requirement for''; and
(ii) by striking ``applying such policy
under its State child health plan under this
title'' and inserting ``in compliance with
section 2102(b)''.
(B) Application of medicaid retention and reporting
requirements.--Section 2107(e)(1) of the Social
Security Act (42 U.S.C. 1397gg(e)(1)) is amended--
(i) by redesignating subparagraphs (H)
through (S) as subparagraphs (I) through (T),
respectively; and
(ii) by inserting after subparagraph (G),
the following:
``(H) Subparagraphs (B) and (C) of section
1902(e)(12) (relating to promotion of enrollment beyond
12 months and reporting requirements)(without regard to
items (bb), (cc), and (dd) of subparagraph
(C)(iii)(III) of that section).''.
(c) Effective Date.--
(1) In general.--Except as provided in paragraph (2) or
(3), the amendments made by subsections (a) and (b) shall apply
to determinations (and redeterminations) of eligibility made on
or after the date that is 18 months after the date of the
enactment of this Act.
(2) Extension of effective date for state law amendment.--
In the case of a State plan under title XIX or State child
health plan under title XXI of the Social Security Act (42
U.S.C. 1396 et seq.; 42 U.S.C. 1397aa et seq.) which the
Secretary of Health and Human Services determines requires
State legislation (other than legislation appropriating funds)
in order for the respective plan to meet the additional
requirements imposed by the amendments made by subsections (a)
or (b), respectively, the respective plan shall not be regarded
as failing to comply with the requirements of such title solely
on the basis of its failure to meet such applicable additional
requirements before the first day of the first calendar quarter
beginning after the close of the first regular session of the
State legislature that begins after the date of enactment of
this Act. For purposes of the previous sentence, in the case of
a State that has a 2-year legislative session, each year of the
session is considered to be a separate regular session of the
State legislature.
(3) Option to implement 12-month continuous eligibility
prior to effective date.--A State may elect through a State
plan amendment under title XIX or XXI of the Social Security
Act (42 U.S.C. 1396 et seq.; 42 U.S.C. 1397aa et seq.) to apply
the amendments made by subsection (a) or (b), respectively, on
any date prior to the 18-month date specified in paragraph (1),
but not sooner than the date of the enactment of this Act.
SEC. 4. PREVENTING THE APPLICATION UNDER CHIP OF COVERAGE WAITING
PERIODS.
(a) In General.--Section 2102(b)(1)(B) of the Social Security Act
(42 U.S.C. 1397bb(b)(1)(B)) is amended--
(1) in clause (iii)--
(A) by striking ``in the case of'' and inserting
``in the case of a targeted low-income child (including
a child provided dental-only supplemental coverage
under section 2110(b)(5)) or in the case of''; and
(B) by adding ``and'' after the semicolon;
(2) by striking clause (iv); and
(3) by redesignating clause (v) as clause (iv).
(b) Conforming Amendments.--Section 2105(c)(10) of the Social
Security Act (42 U.S.C. 1397ee(c)(10)) is amended by striking
subparagraph (F) and redesignating subparagraphs (G) through (M) as
subparagraphs (F) through (L), respectively.
(c) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act.
SEC. 5. MEDICAID PERFORMANCE BONUSES FOR ENROLLMENT AND RETENTION
IMPROVEMENTS FOR CERTAIN INDIVIDUALS.
Section 1903 of the Social Security Act (42 U.S.C. 1396b) is
amended by adding at the end the following new subsection:
``(cc) Performance Bonuses for Enrollment and Retention of Low-
Income Individuals.--
``(1) In general.--A State may qualify for performance
bonuses related to the enrollment and retention of individuals
(including children) described in section
1902(e)(12)(C)(iii)(III). For purposes of this paragraph, a
State meets the condition of this paragraph for such
individuals if, for each category of individuals specified in
section 1902(e)(12)(C)(iii)(III), the State is implementing at
least 3 of the following enrollment and retention provisions
(treating each subparagraph as a separate enrollment and
retention provision) throughout the entire fiscal year:
``(A) Aligning treatment of income under medicaid
with that of other insurance affordability programs.--
The State implements policies, including prorating
income over annual periods, so as to align its
treatment of income for purposes of a determination of
eligibility for medical assistance with that of other
affordability insurance programs with the goal of
eliminating inconsistent determinations among these
programs.
``(B) Maintaining coverage for individuals during
periods of transition.--The State implements the
following policies:
``(i) In general.--Upon determination that
an individual is no longer eligible for medical
assistance, the State implements policies to
maintain eligibility for medical assistance,
including enrollment in the managed care
organization in which the individual was
enrolled at the time of the determination of
ineligibility, during the period of time in
which--
``(I) eligibility-related
information is transmitted to the other
insurance affordability programs;
``(II) a determination is made as
to for which other insurance
affordability program the individual is
eligible, if any; and
``(III) coverage in such program
and any related managed care
organization becomes effective.
``(ii) Managed care organization
continuity.--The State implements policies to
enroll the individual in the managed care
organization in which the individual was a
member prior to the loss of medical assistance
eligibility, if such managed care organization
participates in the other insurance
affordability program, unless the individual
voluntarily selects a separate managed care
organization.
``(C) Enhanced data-sharing between the state and
an american health benefit exchange and agencies.--The
State utilizes findings from an American Health Benefit
Exchange, an Express Lane Agency (as identified by the
State and as described in section 1902(e)(13)(F)), the
Social Security Administration, or other agencies
administering employment, educational, or social
services programs as identified by the State, to
document income, residency, age, or other relevant
information in determining or renewing eligibility.
``(D) Eligibility based on pending status.--The
State maintains eligibility for enrollees whose renewal
status has not yet been determined and for whom
eligibility based on alternative eligibility criteria
has not yet been ruled out.
``(E) Default reenrollment in managed care
organization.--In the case of individuals who are
determined to be eligible for medical assistance under
this title after the loss of eligibility for fewer than
6 months, and who previously had been members of a
managed care organization, the State re-enrolls the
individual in the managed care organization in which
the individual was a member prior to the loss of
eligibility, unless the individual voluntarily selects
a separate managed care organization.
``(2) Performance bonus payment to support 12-month
continuous enrollment for medicaid enrollees.--
``(A) Authority to make bonus payments.--
``(i) In general.--The Secretary shall make
a bonus payment for fiscal years beginning with
the first fiscal year that begins on or after
the date that is 3 years after the date of
enactment of the Stabilize Medicaid and CHIP
Coverage Act of 2021, and annually thereafter
to the extent there are funds available under
paragraph (3)(A), to each State that satisfies
the requirements of subparagraph (B).
``(ii) Regulations.--Payments to States
under this subsection for a fiscal year shall
be allocated annually among eligible States in
accordance with regulations promulgated by the
Secretary not later than the date that is 6
months prior to October 1 of the first fiscal
year for which payments are made under this
paragraph.
``(iii) Timing.--A payment to a State under
this subsection for a fiscal year shall be made
as a single payment not later than the last day
of the first calendar quarter of the succeeding
fiscal year.
``(B) State eligibility for bonus payments.--A
State shall be eligible for bonus payments under this
subsection if--
``(i) the State has adopted at least 3 of
the 5 policies described in subparagraphs (A)
through (E) of paragraph (1) for each category
of individuals specified in section
1902(e)(12)(C)(iii)(III); and
``(ii) the State is able to demonstrate
improvement in the continuity of enrollment by
child, aged, blind, and disabled, and adult
populations, compared to the State's baseline
performance with respect to continuity of
enrollment for such populations in fiscal year
2021 or such later year as the Secretary, by
regulation, shall specify.
``(3) Amounts available for payments.--
``(A) In general.--The total amount of bonus
payments made under this subsection for all fiscal
years shall be equal to $500,000,000, to be available
until expended.
``(B) Budget authority.--This paragraph constitutes
budget authority in advance of appropriations Acts and
represents the obligation of the Secretary to provide
for the payment of amounts provided under this
paragraph.
``(4) Uses of enrollment and retention performance
bonuses.--Nothing in this subsection shall prohibit a State
from establishing criteria which would permit the State to
distribute a portion of the proceeds of any bonus payments
received pursuant to this subsection to financially support
providers and managed care entities participating under the
State plan or under a waiver of such plan who have contributed
to improved enrollment and retention activities.''.
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