Title 42 — The Public Health and WelfareRelease 119-73
§1397gg Strategic objectives and performance goals; plan administration
Title 42 › Chapter CHAPTER 7— - SOCIAL SECURITY › Subchapter SUBCHAPTER XXI— - STATE CHILDREN’S HEALTH INSURANCE PROGRAM › § 1397gg
Summary
A State child health plan must say what its main goals are, what specific targets it will reach, and how it will measure success. The plan must include specific goals for getting more low-income children covered. For each goal the state must explain how it will measure progress using objective, verifiable data and how it will compare results to the goals. The plan must promise to collect and keep the needed data, send regular reports to the Secretary in the required format and at required times, allow the Secretary to review records, describe its annual assessments and evaluations under section 1397hh, explain how the public was and will be involved, and provide a budget that shows how money will be used and where the non‑Federal money will come from, including any cost-sharing by families. Many Medicaid and program rules also apply to these plans, such as rules about conflicts of interest, third‑party liability, provider enrollment and payments (including payments to FQHCs and rural clinics), provider screening and oversight, eligibility rules (including 1‑year continuous eligibility and presumptive eligibility), limits on provider taxes, certain immigrant coverage choices, and other administrative, disclosure, penalty, and waiver rules. The Secretary cannot approve a waiver that uses these funds to give coverage to a nonpregnant childless adult or a parent who is not pregnant. After February 4, 2009, the Secretary may not let a state waive or change the requirements in section 1397kk. A state may treat children in a qualified CHIP look‑alike program and children in its CHIP plan as part of one risk pool. A qualified CHIP look‑alike program is a state program that lets children under 19 who are not eligible for Medicaid or CHIP buy coverage with benefits like CHIP and that is paid for only with state and premium funds.
Full Legal Text
Title 42, §1397gg
The Public Health and Welfare — Source: USLM XML via OLRC
(a)(1)A State child health plan shall include a description of—
(A)the strategic objectives,
(B)the performance goals, and
(C)the performance measures,
(2)Such plan shall identify specific strategic objectives relating to increasing the extent of creditable health coverage among targeted low-income children and other low-income children.
(3)Such plan shall specify one or more performance goals for each such strategic objective so identified.
(4)Such plan shall describe how performance under the plan will be—
(A)measured through objective, independently verifiable means, and
(B)compared against performance goals, in order to determine the State’s performance under this subchapter.
(b)(1)A State child health plan shall include an assurance that the State will collect the data, maintain the records, and furnish the reports to the Secretary, at the times and in the standardized format the Secretary may require in order to enable the Secretary to monitor State program administration and compliance and to evaluate and compare the effectiveness of State plans under this subchapter.
(2)A State child health plan shall include a description of the State’s plan for the annual assessments and reports under section 1397hh(a) of this title and the evaluation required by section 1397hh(b) of this title.
(3)A State child health plan shall include an assurance that the State will afford the Secretary access to any records or information relating to the plan for the purposes of review or audit.
(c)A State child health plan shall include a description of the process used to involve the public in the design and implementation of the plan and the method for ensuring ongoing public involvement.
(d)A State child health plan shall include a description of the budget for the plan. The description shall be updated periodically as necessary and shall include details on the planned use of funds and the sources of the non-Federal share of plan expenditures, including any requirements for cost-sharing by beneficiaries.
(e)The following sections of this chapter shall apply to States under this subchapter in the same manner as they apply to a State under subchapter XIX:
(B)section 1396a(a)(25) of this title (relating to third party liability).
(C)section 1396a(a)(39) of this title (relating to termination of participation of certain providers).
(D)section 1396a(a)(78) of this title (relating to enrollment of providers participating in State plans providing medical assistance on a fee-for-service basis).
(E)section 1396a(a)(72) of this title (relating to limiting FQHC contracting for provision of dental services).
(F)section 1396a(a)(73) of this title (relating to requiring certain States to seek advice from designees of Indian Health Programs and Urban Indian Organizations).
(G)Subsections (a)(77) and (kk) of section 1396a of this title (relating to provider and supplier screening, oversight, and reporting requirements) and subsection (a)(83) of section 1396a of this title (relating to searchable directories of the providers described in subsection (mm) of such section).
(H)section 1396a(a)(88) of this title (relating to address information for enrollees and prevention of simultaneous enrollments).
(I)section 1396a(e)(13) of this title (relating to the State option to rely on findings from an Express Lane agency to help evaluate a child’s eligibility for medical assistance).
(J)section 1396a(e)(14) of this title (relating to income determined using modified adjusted gross income and household income).
(K)Paragraphs (5) and (16) of section 1396a(e) of this title (relating to the State option to provide medical assistance consisting of full benefits during pregnancy and throughout the 12-month postpartum period under subchapter XIX),11 So in original. There are two closing parentheses for the opening parenthesis preceding “relating”. if the State provides child health assistance for targeted low-income children who are pregnant or to targeted low-income pregnant women and the State has elected to apply such paragraph (16) with respect to pregnant women under subchapter XIX, the provision of assistance under the State child health plan or waiver for targeted low-income children or targeted low-income pregnant women during pregnancy and the 12-month postpartum period shall be required and not at the option of the State and shall include coverage of all items or services provided to a targeted low-income child or targeted low-income pregnant woman (as applicable) under the State child health plan or waiver).1
(L)section 1396a(e)(12) of this title (relating to 1 year of continuous eligibility for children), except that a targeted low-income child enrolled under the State child health plan or waiver may be transferred to the Medicaid program under subchapter XIX for the remaining duration of the 12-month continuous eligibility period, if the child becomes eligible for full benefits under subchapter XIX during such period.
(M)section 1396a(bb) of this title (relating to payment for services provided by Federally-qualified health centers and rural health clinics).
(N)section 1396a(ff) of this title (relating to disregard of certain property for purposes of making eligibility determinations).
(O)Paragraphs (2), (16), and (17) of section 1396b(i) of this title (relating to limitations on payment).
(P)section 1396b(m)(3) of this title (relating to limitation on payment with respect to managed care).
(Q)Paragraph (4) of section 1396b(v) of this title (relating to optional coverage of categories of lawfully residing immigrant children or pregnant women), but only if the State has elected to apply such paragraph with respect to such category of children or pregnant women under subchapter XIX.
(R)section 1396b(v)(5) of this title (relating to payments for medical assistance furnished to aliens), except in relation to payments for services provided under section 1397ee(a)(1)(D)(ii) of this title.
(S)section 1396b(w) of this title (relating to limitations on provider taxes and donations).
(T)section 1396r–1a of this title (relating to presumptive eligibility for children).
(U)Subsections (a)(2)(C) (relating to Indian enrollment), (d)(5) (relating to contract requirement for managed care entities), (d)(6) (relating to enrollment of providers participating with a managed care entity), and (h) (relating to special rules with respect to Indian enrollees, Indian health care providers, and Indian managed care entities) of section 1396u–2 of this title.
(V)section 1396w–2 of this title (relating to authorization to receive data directly relevant to eligibility determinations).
(W)section 1396w–3(b) of this title (relating to coordination with State Exchanges and the State Medicaid agency).
(B)section 1316 of this title (relating to administrative and judicial review), but only insofar as consistent with this subchapter.
(C)section 1320a–3 of this title (relating to disclosure of ownership and related information).
(D)section 1320a–5 of this title (relating to disclosure of information about certain convicted individuals).
(E)section 1320a–7a of this title (relating to civil monetary penalties).
(F)section 1320a–7b(d) of this title (relating to criminal penalties for certain additional charges).
(G)section 1320b–2 of this title (relating to periods within which claims must be filed).
(f)Notwithstanding subsection (e)(2)(A) and section 1315(a) of this title:
(1)The Secretary may not approve a waiver, experimental, pilot, or demonstration project that would allow funds made available under this subchapter to be used to provide child health assistance or other health benefits coverage to a nonpregnant childless adult or a parent (as defined in section 1397kk(c)(2)(A) of this title), who is not pregnant, of a targeted low-income child.
(2)The Secretary may not approve, extend, renew, or amend a waiver, experimental, pilot, or demonstration project with respect to a State after February 4, 2009, that would waive or modify the requirements of section 1397kk of this title.
(g)(1)Nothing in this subchapter (or any other provision of Federal law) shall be construed as preventing a State from considering children enrolled in a qualified CHIP look-alike program and children enrolled in a State child health plan under this subchapter (or a waiver of such plan) as members of a single risk pool.
(2)In this subsection, the term “qualified CHIP look-alike program” means a State program—
(A)under which children who are under the age of 19 and are not eligible to receive medical assistance under subchapter XIX or child health assistance under this subchapter may purchase coverage through the State that provides benefits that are at least identical to the benefits provided under the State child health plan under this subchapter (or a waiver of such plan); and
(B)that is funded exclusively through non-Federal funds, including funds received by the State in the form of premiums for the purchase of such coverage.
Legislative History
Notes & Related Subsidiaries
Editorial Notes
Codification Amendment by section 501(d)(2) of Pub. L. 111–3 executed after amendment by section 214(b) of Pub. L. 111–3 to reflect the probable intent of Congress, notwithstanding section 501(d)(3) of Pub. L. 111–3, set out as an
Effective Date
of 2009 Amendment note under section 1396a of this title.
Amendments
2025—Subsec. (e)(1)(H) to (Q). Pub. L. 119–21, § 71103(b)(1), added subpar. (H) and redesignated former subpars. (H) to (P) as (I) to (Q), respectively. Former subpar. (Q) redesignated (R), then (S). Subsec. (e)(1)(R) to (W). Pub. L. 119–21, §§ 71103(b)(1)(A), 71109(b), added subpar. (R) and redesignated former subpars. (Q) to (U) as (R) to (V), respectively, then (S) to (W), respectively. 2022—Subsec. (e)(1)(G). Pub. L. 117–328, § 5123(c), inserted “and subsection (a)(83) of section 1396a of this title (relating to searchable directories of the providers described in subsection (mm) of such section)” before period at end. Subsec. (e)(1)(K) to (U). Pub. L. 117–328, § 5112(b), added subpar. (K) and redesignated former subpars. (K) to (T) as (L) to (U), respectively. 2021—Subsec. (e)(1)(J) to (T). Pub. L. 117–2 added subpar. (J) and redesignated former subpars. (J) to (S) as (K) to (T), respectively. 2018—Subsec. (e)(1)(B) to (S). Pub. L. 115–123 added subpar. (B) and redesignated former subpars. (B) to (R) as (C) to (S), respectively. Subsec. (g). Pub. L. 115–120 added subsec. (g). 2016—Subsec. (e)(1)(B) to (R). Pub. L. 114–255 added subpars. (B), (C), and (L), redesignated former subpars. (B) to (I) as (D) to (K) and (J) to (O) as (M) to (R), respectively, and in subpar. (P), as so redesignated, substituted “(a)(2)(C) (relating to Indian enrollment), (d)(5) (relating to contract requirement for managed care entities), (d)(6) (relating to enrollment of providers participating with a managed care entity), and (h) (relating to special rules with respect to Indian enrollees, Indian health care providers, and Indian managed care entities)” for “(a)(2)(C) and (h)”. 2010—Subsec. (e)(1)(D). Pub. L. 111–309, § 205(f)(2)(A), substituted “(kk)” for “(ii)”. Pub. L. 111–148, § 6401(c)(2), added subpar. (D). Former subpar. (D) redesignated (E). Subsec. (e)(1)(E). Pub. L. 111–148, § 6401(c)(1), redesignated subpar. (D) as (E). Former subpar. (E) redesignated (F). Pub. L. 111–148, § 2101(d)(2)(B), added subpar. (E). Former subpar. (E) redesignated (F). Subsec. (e)(1)(F). Pub. L. 111–152, which directed the substitution of “modified adjusted gross income” for “modified gross income” in subpar. (E), as added by section 2101(d)(2) of Pub. L. 111–148, was executed to subpar. (F) to reflect the probable intent of Congress and the redesignation of subpar. (E) as (F) by Pub. L. 111–148, § 6401(c)(1). See below. Pub. L. 111–148, § 6401(c)(1), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G). Pub. L. 111–148, § 2101(d)(2)(A), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G). Subsec. (e)(1)(G) to (M). Pub. L. 111–148, § 6401(c)(1), redesignated subpars. (F) to (L) as (G) to (M), respectively. Former subpar. (M) redesignated (N). Pub. L. 111–148, § 2101(d)(2)(A), redesignated subpars. (F) to (L) as (G) to (M), respectively. Subsec. (e)(1)(N). Pub. L. 111–309 redesignated subpar. (N) relating to section 1396w–3 of this title as (O). Pub. L. 111–148, § 6401(c)(1), redesignated subpar. (M), relating to section 1396w–2 of this title, as (N). Pub. L. 111–148, § 2101(e), added subpar. (N) relating to section 1396w–3(b) of this title. Subsec. (e)(1)(O). Pub. L. 111–309 redesignated subpar. (N) relating to section 1396w–3 of this title as (O). 2009—Subsec. (e)(1). Pub. L. 111–5, § 5006(e)(2)(B)(ii), rearranged subpars. into alphabetical order. Subsec. (e)(1)(B). Pub. L. 111–5, § 5006(e)(2)(B)(i), redesignated subpar. (D) as (B). Former subpar. (B) redesignated (D). Pub. L. 111–3, § 203(a)(2), added subpar. (B). Former subpar. (B) redesignated (C). Subsec. (e)(1)(C). Pub. L. 111–5, § 5006(e)(2)(B)(iii), added subpar. (C). Former subpar. (C) redesignated (F). Pub. L. 111–5, § 5006(b)(2)(B), added subpar. (C). Former subpar. (C) redesignated (D). Pub. L. 111–3, § 501(d)(2), added subpar. (C). Former subpar. (C) redesignated (D). Pub. L. 111–3, § 203(a)(2), redesignated subpar. (B) as (C). Former subpar. (C) redesignated (D). Subsec. (e)(1)(D). Pub. L. 111–5, § 5006(e)(2)(B)(i), redesignated subpar. (B) as (D). Former subpar. (D) redesignated (B). Pub. L. 111–5, § 5006(b)(2)(A), redesignated subpar. (C) as (D). Former subpar. (D) redesignated (E). Pub. L. 111–3, § 503(a)(1), added subpar. (D). Former subpar. (D) redesignated (E). Pub. L. 111–3, § 501(d)(2), redesignated subpar. (C) as (D). Former subpar. (D) redesignated (E). Pub. L. 111–3, § 203(a)(2), redesignated subpar. (C) as (D). Former subpar. (D) redesignated (E). Subsec. (e)(1)(E). Pub. L. 111–5, § 5006(b)(2)(A), redesignated subpar. (D) as (E). Former subpar. (E) redesignated (F). Pub. L. 111–3, § 503(a)(1), redesignated subpar. (D) as (E). Former subpar. (E) redesignated (F). Pub. L. 111–3, § 501(d)(2), redesignated subpar. (D) as (E). Former subpar. (E) redesignated (F). Pub. L. 111–3, § 214(b), added subpar. (E). Former subpar. (E) redesignated (F). Pub. L. 111–3, § 203(a)(2), redesignated subpar. (D) as (E). Subsec. (e)(1)(F). Pub. L. 111–5, § 5006(e)(2)(B)(i), redesignated subpar. (C) as (F). Former subpar. (F) redesignated (G). Pub. L. 111–5, § 5006(b)(2)(A), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G). Pub. L. 111–3, § 503(a)(1), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G). Pub. L. 111–3, § 501(d)(2), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G). Pub. L. 111–3, § 214(b), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G). Pub. L. 111–3, § 203(d)(2), added subpar. (F). Subsec. (e)(1)(G). Pub. L. 111–5, § 5006(e)(2)(B)(i), redesignated subpar. (F) as (G). Former subpar. (G) redesignated (I). Pub. L. 111–5, § 5006(b)(2)(A), redesignated subpar. (F) as (G). Former subpar. (G) redesignated (H). Pub. L. 111–3, § 503(a)(1), redesignated subpar. (F) as (G). Former subpar. (G) redesignated (H). Pub. L. 111–3, § 501(d)(2), redesignated subpar. (F) as (G). Former subpar. (G) redesignated (H). Pub. L. 111–3, § 214(b), redesignated subpar. (F) as (G). Subsec. (e)(1)(H). Pub. L. 111–5, § 5006(b)(2)(A), redesignated subpar. (G) as (H). Former subpar. (H) redesignated (I). Pub. L. 111–3, § 503(a)(1), redesignated subpar. (G) as (H). Former subpar. (H) redesignated (I). Pub. L. 111–3, § 501(d)(2), redesignated subpar. (G) as (H). Subsec. (e)(1)(I). Pub. L. 111–5, § 5006(e)(2)(B)(i), redesignated subpar. (G) as (I). Former subpar. (I) redesignated (J). Pub. L. 111–5, § 5006(b)(2)(A), redesignated subpar. (H) as (I). Former subpar. (I) redesignated (J). Pub. L. 111–3, § 503(a)(1), redesignated subpar. (H) as (I). Subsec. (e)(1)(J). Pub. L. 111–5, § 5006(e)(2)(B)(i), redesignated subpar. (I) as (J). Former subpar. (J) redesignated (K). Pub. L. 111–5, § 5006(d)(2)(B), added subpar. (J). Pub. L. 111–5, § 5006(b)(2)(A), redesignated subpar. (I) as (J). Subsec. (e)(1)(K). Pub. L. 111–5, § 5006(e)(2)(B)(i), redesignated subpar. (J) as (K). Former subpar. (K) redesignated (L). Pub. L. 111–5, § 5006(d)(2)(A), redesignated subpar. (J) as (K). Subsec. (e)(1)(L). Pub. L. 111–5, § 5006(e)(2)(B)(i), redesignated subpar. (K) as (L). Subsec. (f). Pub. L. 111–3, § 112(a)(2)(A)(i), substituted “section 1315(a) of this title:” for “section 1315(a) of this title, the Secretary” and inserted par. (1) designation and “The Secretary” before “may not approve a waiver,”. Subsec. (f)(1). Pub. L. 111–3, § 112(a)(2)(A)(ii), (iii), inserted “or a parent (as defined in section 1397kk(c)(2)(A) of this title), who is not pregnant, of a targeted low-income child” after “nonpregnant childless adult” and struck out last sentence which read as follows: “For purposes of the preceding sentence, a caretaker relative (as such term is defined for purposes of carrying out section 1396u–1 of this title) shall not be considered a childless adult.” Subsec. (f)(2). Pub. L. 111–3, § 112(a)(2)(A)(iv), added par. (2). 2006—Subsec. (f). Pub. L. 109–171 added subsec. (f). 2000—Subsec. (e)(1)(D). Pub. L. 106–554 added subpar. (D).
Statutory Notes and Related Subsidiaries
Effective Date
of 2022 AmendmentAmendment by section 5112(b) of Pub. L. 117–328 effective on the first day of the first fiscal quarter that begins on or after the date that is 1 year after Dec. 29, 2022, see section 5112(c) of Pub. L. 117–328, set out as a note under section 1396a of this title. Amendment by section 5123(c) of Pub. L. 117–328 effective July 1, 2025, see section 5123(d) of Pub. L. 117–328, set out as a note under section 1396a of this title.
Effective Date
of 2021 Amendment Pub. L. 117–2, title IX, § 9822(b), Mar. 11, 2021, 135 Stat. 221, as amended by Pub. L. 117–328, div. FF, title V, § 5113, Dec. 29, 2022, 136 Stat. 5940, provided that: “The
Amendments
made by subsection (a) [amending this section], shall apply with respect to State elections made under paragraph (16) of section 1902(e) of the Social Security Act (42 U.S.C. 1396a(e)), as added by section 9812(a) of subtitle J of this title [subtitle J (§§ 9811–9819) of title IX of Pub. L. 117–2], beginning on the 1st day of the 1st fiscal year quarter that begins one year after the date of the enactment of this Act [Mar. 11, 2021].” [Pub. L. 117–328, div. FF, title V, § 5113, Dec. 29, 2022, 136 Stat. 5940, provided in part that the amendment made by section 5113 to section 9822(b) of Pub. L. 117–2, set out above, is effective as if included in the enactment of Pub. L. 117–2.]
Effective Date
of 2009 AmendmentAmendment by Pub. L. 111–5 effective
July 1, 2009, see section 5006(f) of Pub. L. 111–5, set out as a note under section 1396a of this title. Except as otherwise provided, amendment by Pub. L. 111–3 effective Apr. 1, 2009, and applicable to child health assistance and medical assistance provided on or after that date, see section 3 of Pub. L. 111–3, set out as a note under section 1396 of this title. Amendment by section 203(a)(2), (d)(2) of Pub. L. 111–3 effective Feb. 4, 2009, see section 203(f) of Pub. L. 111–3, set out as a note under section 1396a of this title. Amendment by section 501(d)(2) of Pub. L. 111–3 effective Jan. 1, 2009, see section 501(d)(3) of Pub. L. 111–3, set out as a note under section 1396a of this title. Pub. L. 111–3, title V, § 503(a)(2), Feb. 4, 2009, 123 Stat. 89, provided that: “The amendment made by paragraph (1) [amending this section] shall apply to services provided on or after
October 1, 2009.”
Effective Date
of 2006 Amendment Pub. L. 109–171, title VI, § 6102(d), Feb. 8, 2006, 120 Stat. 132, provided that: “This section [amending this section and section 1397ee of this title and enacting provisions set out as a note below] and the
Amendments
made by this section shall take effect as if enacted on October 1, 2005, and shall apply to any waiver, experimental, pilot, or demonstration project that is approved on or after that date.”
Construction
of 2016 AmendmentNothing in amendment by Pub. L. 114–255 to be construed as changing or limiting the appeal rights of providers or the process for appeals of States under the Social Security Act, see section 5005(d) of Pub. L. 114–255, set out as a note under section 1396a of this title.
Construction
of 2006 Amendment Pub. L. 109–171, title VI, § 6102(c), Feb. 8, 2006, 120 Stat. 131, as amended by Pub. L. 111–3, title I, § 112(a)(2)(B), Feb. 4, 2009, 123 Stat. 33, provided that: “Subject to section 2111 of the Social Security Act [42 U.S.C. 1397kk], as added by section 112 of the Children’s Health Insurance Program Reauthorization Act of 2009 [Pub. L. 111–3], nothing in this section [amending this section and section 1397ee of this title and enacting provisions set out as a note above] or the
Amendments
made by this section shall be construed to— “(1) authorize the waiver of any provision of title XIX or XXI of the Social Security Act (42 U.S.C. 1396 et seq., 1397aa et seq.) that is not otherwise authorized to be waived under such titles or under title XI of such Act (42 U.S.C. 1301 et seq.) as of the date of enactment of this Act [Feb. 8, 2006]; “(2) imply congressional approval of any waiver, experimental, pilot, or demonstration project affecting funds made available under the State children’s health insurance program under title XXI of the Social Security Act (42 U.S.C. 1397aa et. seq.) or any amendment to such a waiver or project that has been approved as of such date of enactment; or “(3) apply to any waiver, experimental, pilot, or demonstration project that would allow funds made available under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.) to be used to provide child health assistance or other health benefits coverage to a nonpregnant childless adult that is approved before the date of enactment of this Act or to any extension, renewal, or amendment of such a waiver or project that is approved on or after such date of enactment.”
Reference
Citations & Metadata
Citation
42 U.S.C. § 1397gg
Title 42 — The Public Health and Welfare
Last Updated
Apr 6, 2026
Release point: 119-73