Stabilize Medicaid and CHIP Coverage Act of 2019

II 116TH CONGRESS 1ST SESSION S. 873 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 26, 2019 Mr. BROWN (for himself, Ms. BALDWIN, Ms. WARREN, and Mr. WHITE- HOUSE) 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 Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Stabilize Medicaid and 4 CHIP Coverage Act of 2019’’. 5 SEC. 2. FINDINGS. 6 Congress finds the following: 7 VerDate Sep 11 2014 05:21 Mar 30, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S873.IS S873 kjohnson on DSK79L0C42 with BILLS 2 •S 873 IS (1) Every year millions of people are enrolled in 1 Medicaid and the Children’s Health Insurance Pro- 2 gram (in this section referred to as ‘‘CHIP’’), but 3 subsequently lose their coverage, despite still being 4 eligible, because of inefficient and cumbersome pa- 5 perwork and logistical requirements. 6 (2) Data show that the typical enrollee receives 7 Medicaid coverage for about 3⁄4 of the year and that 8 coverage periods are lower for non-elderly, non-dis- 9 abled adults than for those with disabilities, seniors, 10 and children. 11 (3) Medicaid enrollees with coverage disruption 12 are more likely to be hospitalized for illnesses, like 13 asthma, diabetes, or cardiovascular disease, that can 14 be effectively managed through ongoing primary 15 medical care and medication, are less likely to be 16 screened for breast cancer, and may have poorer 17 cancer outcomes. 18 (4) Children enrolled in CHIP also experience 19 disruptions in health coverage and care. For exam- 20 ple, during just a 1-year period, over 1⁄3 of CHIP 21 enrollees were also enrolled in a State’s Medicaid 22 program. Transitions between Medicaid and CHIP 23 can cause disruptions in care because the health care 24 VerDate Sep 11 2014 05:21 Mar 30, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S873.IS S873 kjohnson on DSK79L0C42 with BILLS 3 •S 873 IS coverage and participating providers vary between 1 the two programs. 2 (5) Interruptions in coverage can impair the re- 3 ceipt of effective primary care and lead to expensive 4 hospitalizations or emergency room visits. 5 (6) Unnecessary enrollment, disenrollment, and 6 reenrollment in Medicaid and CHIP result in higher 7 administrative expenses for reenrollment and result 8 in more people uninsured at any given time. 9 (7) Stable coverage under Medicaid and CHIP 10 lowers average monthly medical costs. Continuous 11 enrollment also permits better prevention and dis- 12 ease management, leading to fewer serious illnesses 13 and hospitalizations. 14 (8) Children with stable coverage are less likely 15 to have unmet medical needs, allowing children to 16 receive the preventive care that is necessary to help 17 them grow into healthy adults. 18 SEC. 3. 12-MONTH CONTINUOUS ENROLLMENT. 19 (a) REQUIREMENT OF 12-MONTH CONTINUOUS EN- 20 ROLLMENT UNDER MEDICAID.— 21 (1) IN GENERAL.—Section 1902(e)(12) of the 22 Social Security Act (42 U.S.C. 1396a(e)), is amend- 23 ed to read as follows: 24 ‘‘(12) 12-MONTH CONTINUOUS ENROLLMENT.— 25 VerDate Sep 11 2014 05:21 Mar 30, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S873.IS S873 kjohnson on DSK79L0C42 with BILLS 4 •S 873 IS ‘‘(A) IN GENERAL.—Notwithstanding any 1 other provision of this title, a State plan ap- 2 proved under this title or under any waiver of 3 such plan approved pursuant to section 1115 or 4 section 1915, shall provide that an individual 5 who is determined to be eligible for benefits 6 under such plan (or waiver) shall be considered 7 to meet the eligibility requirements met on the 8 date of application and shall remain eligible and 9 enrolled for such benefits through the end of 10 the month in which the 12-month period (begin- 11 ning on the date of determination of eligibility) 12 ends. 13 ‘‘(B) PROMOTING RETENTION OF ELIGI- 14 BLE AND ENROLLED PERSONS BEYOND 12 15 MONTHS.—The Secretary shall— 16 ‘‘(i) identify methods that promote the 17 retention of individuals who are enrolled 18 under the State plan or under a waiver of 19 such plan and who remain eligible for med- 20 ical assistance beyond the 12-month period 21 described in subparagraph (A); and 22 ‘‘(ii) actively promote the adoption of 23 such enrollment retention methods by 24 States, which shall include, but not be lim- 25 VerDate Sep 11 2014 05:21 Mar 30, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S873.IS S873 kjohnson on DSK79L0C42 with BILLS 5 •S 873 IS ited to, issuing guidance and developing re- 1 sources on State best practices. 2 ‘‘(C) ENROLLMENT AND RETENTION RE- 3 PORTING.— 4 ‘‘(i) IN GENERAL.—Not later than 1 5 year after the date of enactment of the 6 Stabilize Medicaid and CHIP Coverage Act 7 of 2019, the Secretary shall publish the 8 procedures that States are expected to use 9 to provide annual enrollment and retention 10 reports beginning not later than 2 years 11 after the date of enactment of such Act. 12 ‘‘(ii) STATE REPORTING REQUIRE- 13 MENTS.—At a minimum, the reporting 14 procedures published under clause (i) shall 15 include a description of State eligibility cri- 16 teria and enrollment procedures under this 17 title and data regarding enrollment and re- 18 tention using standardized reporting for- 19 mats determined by the Secretary. 20 ‘‘(iii) SECRETARY REPORT AND PUB- 21 LICATION.— 22 ‘‘(I) IN GENERAL.—The Sec- 23 retary annually shall publish enroll- 24 ment and retention performance re- 25 VerDate Sep 11 2014 05:21 Mar 30, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S873.IS S873 kjohnson on DSK79L0C42 with BILLS 6 •S 873 IS sults for all States not later than 6 1 months after the deadline for each an- 2 nual State enrollment and retention 3 reporting period. 4 ‘‘(II) ESTIMATED ENROLLMENT 5 CONTINUITY RATIOS.—Each annual 6 report published by the Secretary 7 under subclause (I) shall include esti- 8 mates of Medicaid enrollment con- 9 tinuity ratios for each State in accord- 10 ance with the requirements of sub- 11 clause (III). 12 ‘‘(III) REQUIREMENTS.—The 13 Secretary shall develop both overall 14 enrollment continuity ratios for all en- 15 rollees and separate enrollment con- 16 tinuity ratios for each of the following 17 categories: 18 ‘‘(aa) Children. 19 ‘‘(bb) Individuals whose eli- 20 gibility category is related to hav- 21 ing attained age 65. 22 ‘‘(cc) Individuals whose eli- 23 gibility category is related to dis- 24 ability or blindness. 25 VerDate Sep 11 2014 05:21 Mar 30, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S873.IS S873 kjohnson on DSK79L0C42 with BILLS 7 •S 873 IS ‘‘(dd) Individuals whose eli- 1 gibility category is related to 2 their status as parents and care- 3 taker relatives of children under 4 19 or who are otherwise not el- 5 derly, blind or disabled adults.’’. 6 (b) REQUIREMENT OF 12-MONTH CONTINUOUS EN- 7 ROLLMENT UNDER CHIP.— 8 (1) IN GENERAL.—Section 2102(b) of the So- 9 cial Security Act (42 U.S.C. 1397bb(b)) is amended 10 by adding at the end the following new paragraph: 11 ‘‘(6) REQUIREMENT FOR 12-MONTH CONTIN- 12 UOUS ENROLLMENT.—Notwithstanding any other 13 provision of this title, a State child health plan that 14 provides child health assistance under this title 15 through a means other than that described in sec- 16 tion 2101(a)(2), shall provide that an individual who 17 is determined to be eligible for benefits under such 18 plan shall be considered to meet the eligibility re- 19 quirements met on the date of application and shall 20 remain eligible and enrolled for such benefits 21 through the end of the month in which the 12-month 22 period (beginning on the date of determination of 23 eligibility) ends.’’. 24 (2) CONFORMING AMENDMENTS.— 25 VerDate Sep 11 2014 05:21 Mar 30, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S873.IS S873 kjohnson on DSK79L0C42 with BILLS 8 •S 873 IS (A) ENROLLMENT AND RETENTION PROVI- 1 SIONS.—Section 2105(a)(4)(A) of the Social Se- 2 curity Act (42 U.S.C. 1397ee(a)(4)(A)) is 3 amended— 4 (i) by striking ‘‘has elected the option 5 of’’ and inserting ‘‘is in compliance with 6 the requirement for’’; and 7 (ii) by striking ‘‘applying such policy 8 under its State child health plan under this 9 title’’ and inserting ‘‘in compliance with 10 section 2102(b)’’. 11 (B) APPLICATION OF MEDICAID RETEN- 12 TION AND REPORTING REQUIREMENTS.—Sec- 13 tion 2107(e)(1) of the Social Security Act (42 14 U.S.C. 1397gg(e)(1)) is amended— 15 (i) by redesignating subparagraphs 16 (G) through (S) as subparagraphs (H) 17 through (T), respectively; and 18 (ii) by inserting after subparagraph 19 (F), the following: 20 ‘‘(G) Subparagraphs (B) and (C) of sec- 21 tion 1902(e)(12) (relating to promotion of en- 22 rollment beyond 12 months and reporting re- 23 quirements)(without regard to items (bb), (cc), 24 VerDate Sep 11 2014 05:21 Mar 30, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S873.IS S873 kjohnson on DSK79L0C42 with BILLS 9 •S 873 IS and (dd) of subparagraph (C)(iii)(III) of that 1 section).’’. 2 (c) EFFECTIVE DATE.— 3 (1) IN GENERAL.—Except as provided in para- 4 graph (2) or (3), the amendments made by sub- 5 sections (a) and (b) shall apply to determinations 6 (and redeterminations) of eligibility made on or after 7 the date that is 18 months after the date of the en- 8 actment of this Act. 9 (2) EXTENSION OF EFFECTIVE DATE FOR 10 STATE LAW AMENDMENT.—In the case of a State 11 plan under title XIX or State child health plan 12 under title XXI of the Social Security Act (42 13 U.S.C. 1396 et seq.; 42 U.S.C. 1397aa et seq.) 14 which the Secretary of Health and Human Services 15 determines requires State legislation (other than leg- 16 islation appropriating funds) in order for the respec- 17 tive plan to meet the additional requirements im- 18 posed by the amendments made by subsections (a) 19 or (b), respectively, the respective plan shall not be 20 regarded as failing to comply with the requirements 21 of such title solely on the basis of its failure to meet 22 such applicable additional requirements before the 23 first day of the first calendar quarter beginning 24 after the close of the first regular session of the 25 VerDate Sep 11 2014 05:21 Mar 30, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S873.IS S873 kjohnson on DSK79L0C42 with BILLS 10 •S 873 IS State legislature that begins after the date of enact- 1 ment of this Act. For purposes of the previous sen- 2 tence, in the case of a State that has a 2-year legis- 3 lative session, each year of the session is considered 4 to be a separate regular session of the State legisla- 5 ture. 6 (3) OPTION TO IMPLEMENT 12-MONTH CONTIN- 7 UOUS ELIGIBILITY PRIOR TO EFFECTIVE DATE.—A 8 State may elect through a State plan amendment 9 under title XIX or XXI of the Social Security Act 10 (42 U.S.C. 1396 et seq.; 42 U.S.C. 1397aa et seq.) 11 to apply the amendments made by subsection (a) or 12 (b), respectively, on any date prior to the 18-month 13 date specified in paragraph (1), but not sooner than 14 the date of the enactment of this Act. 15 SEC. 4. PREVENTING THE APPLICATION UNDER CHIP OF 16 COVERAGE WAITING PERIODS. 17 (a) IN GENERAL.—Section 2102(b)(1)(B) of the So- 18 cial Security Act (42 U.S.C. 1397bb(b)(1)(B)) is amend- 19 ed— 20 (1) in clause (iii)— 21 (A) by striking ‘‘in the case of’’ and insert- 22 ing ‘‘in the case of a targeted low-income child 23 (including a child provided dental-only supple- 24 VerDate Sep 11 2014 05:21 Mar 30, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S873.IS S873 kjohnson on DSK79L0C42 with BILLS 11 •S 873 IS mental coverage under section 2110(b)(5)) or in 1 the case of’’; and 2 (B) by adding ‘‘and’’ after the semicolon; 3 (2) by striking clause (iv); and 4 (3) by redesignating clause (v) as clause (iv). 5 (b) CONFORMING AMENDMENTS.—Section 6 2105(c)(10) of the Social Security Act (42 U.S.C. 7 1397ee(c)(10)) is amended by striking subparagraph (F) 8 and redesignating subparagraphs (G) through (M) as sub- 9 paragraphs (F) through (L), respectively. 10 (c) EFFECTIVE DATE.—The amendments made by 11 this section shall take effect on the date of enactment of 12 this Act. 13 SEC. 5. MEDICAID PERFORMANCE BONUSES FOR ENROLL- 14 MENT AND RETENTION IMPROVEMENTS FOR 15 CERTAIN INDIVIDUALS. 16 Section 1903 of the Social Security Act (42 U.S.C. 17 1396b) is amended by adding at the end the following new 18 subsection: 19 ‘‘(bb) PERFORMANCE BONUSES FOR ENROLLMENT 20 AND RETENTION OF LOW-INCOME INDIVIDUALS.— 21 ‘‘(1) IN GENERAL.—A State may qualify for 22 performance bonuses related to the enrollment and 23 retention of individuals (including children) de- 24 scribed in section 1902(e)(12)(C)(iii)(III). For pur- 25 VerDate Sep 11 2014 05:21 Mar 30, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S873.IS S873 kjohnson on DSK79L0C42 with BILLS 12 •S 873 IS poses of this paragraph, a State meets the condition 1 of this paragraph for such individuals if, for each 2 category of individuals specified in section 3 1902(e)(12)(C)(iii)(III), the State is implementing 4 at least 3 of the following enrollment and retention 5 provisions (treating each subparagraph as a separate 6 enrollment and retention provision) throughout the 7 entire fiscal year: 8 ‘‘(A) ALIGNING TREATMENT OF INCOME 9 UNDER MEDICAID WITH THAT OF OTHER IN- 10 SURANCE AFFORDABILITY PROGRAMS.—The 11 State implements policies, including prorating 12 income over annual periods, so as to align its 13 treatment of income for purposes of a deter- 14 mination of eligibility for medical assistance 15 with that of other affordability insurance pro- 16 grams with the goal of eliminating inconsistent 17 determinations among these programs. 18 ‘‘(B) MAINTAINING COVERAGE FOR INDI- 19 VIDUALS DURING PERIODS OF TRANSITION.— 20 The State implements the following policies: 21 ‘‘(i) IN GENERAL.—Upon determina- 22 tion that an individual is no longer eligible 23 for medical assistance, the State imple- 24 ments policies to maintain eligibility for 25 VerDate Sep 11 2014 05:21 Mar 30, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S873.IS S873 kjohnson on DSK79L0C42 with BILLS 13 •S 873 IS medical assistance, i [Text truncated for display. 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