§1397kk — Title 42 The Public Health and Welfare | U.S. Code

Summary

The law stops federal approval of new waivers or experiments that use these federal child‑health funds to cover nonpregnant adults without children on or after February 4, 2009. It also ends federal money for that coverage under any existing waiver after December 31, 2009. A State could ask by September 30, 2009, to extend an existing waiver only through December 31, 2009. The higher federal matching rate called the “enhanced FMAP” applies to such waiver spending from February 4, 2009, through December 31, 2009. States whose coverage is cut off can apply by September 30, 2009, for a Medicaid waiver to cover those adults; the Secretary must decide within 90 days or the application is treated as approved by December 31, 2009. For fiscal year 2010 and later years, spending under such Medicaid waivers is capped using the State’s 2009 payments grown by the projected percentage increase in national per‑person health spending. The law also bars new waivers that use these funds to cover parents of targeted low‑income children on or after February 4, 2009, and sets rules for waivers in fiscal years starting October 1, 2011, and later. If an existing parent waiver would end before October 1, 2011, the Secretary can extend it only through September 30, 2011. The enhanced FMAP applies in late 2009 and in fiscal years 2010 and 2011. A State may choose to keep parent coverage through fiscal year 2012 or 2013. If it does, the Secretary will set aside an amount equal to the federal share of 110% of the State’s projected waiver costs (certified by the State by August 31 before the year) and pay quarters using either the enhanced FMAP, a special REMAP, or the regular federal rate depending on whether the State meets certain outreach or coverage benchmarks. Payments stop when the set‑aside is used up, and no federal payments may go to parents with family income above the level used under the waiver on February 4, 2009. Definitions: “applicable existing waiver” = a waiver in effect in fiscal year 2009 that used these funds to cover parents or nonpregnant childless adults; “parent” = includes caretaker relatives and legal guardians; “nonpregnant childless adult” = as defined elsewhere in law.

Title 42, §1397kk

The Public Health and Welfare — Source: USLM XML via OLRC

(a)(1)Notwithstanding section 1315 of this title or any other provision of this subchapter, except as provided in this subsection—

(A)the Secretary shall not on or after February 4, 2009, approve or renew 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; and

(B)notwithstanding the terms and conditions of an applicable existing waiver, the provisions of paragraph (2) shall apply for purposes of any period beginning on or after January 1, 2010, in determining the period to which the waiver applies, the individuals eligible to be covered by the waiver, and the amount of the Federal payment under this subchapter.

(2)(A)No funds shall be available under this subchapter for child health assistance or other health benefits coverage that is provided to a nonpregnant childless adult under an applicable existing waiver after December 31, 2009.

(B)If an applicable existing waiver described in subparagraph (A) would otherwise expire before January 1, 2010, notwithstanding the requirements of subsections (e) and (f) of section 1315 of this title, a State may submit, not later than September 30, 2009, a request to the Secretary for an extension of the waiver. The Secretary shall approve a request for an extension of an applicable existing waiver submitted pursuant to this subparagraph, but only through December 31, 2009.

(C)The enhanced FMAP determined under section 1397ee(b) of this title shall apply to expenditures under an applicable existing waiver for the provision of child health assistance or other health benefits coverage to a nonpregnant childless adult during the period beginning on February 4, 2009, and ending on December 31, 2009.

(3)(A)Each State for which coverage under an applicable existing waiver is terminated under paragraph (2)(A) may submit, not later than September 30, 2009, an application to the Secretary for a waiver under section 1315 of this title of the State plan under subchapter XIX to provide medical assistance to a nonpregnant childless adult whose coverage is so terminated (in this subsection referred to as a “Medicaid nonpregnant childless adults waiver”).

(B)The Secretary shall make a decision to approve or deny an application for a Medicaid nonpregnant childless adults waiver submitted under subparagraph (A) within 90 days of the date of the submission of the application. If no decision has been made by the Secretary as of December 31, 2009, on the application of a State for a Medicaid nonpregnant childless adults waiver that was submitted to the Secretary by September 30, 2009, the application shall be deemed approved.

(C)The budget neutrality requirement applicable with respect to expenditures for medical assistance under a Medicaid nonpregnant childless adults waiver shall—

(i)in the case of fiscal year 2010, allow expenditures for medical assistance under subchapter XIX for all such adults to not exceed the total amount of payments made to the State under paragraph (2)(B) for fiscal year 2009, increased by the percentage increase (if any) in the projected nominal per capita amount of National Health Expenditures for 2010 over 2009, as most recently published by the Secretary; and

(ii)in the case of any succeeding fiscal year, allow such expenditures to not exceed the amount in effect under this subparagraph for the preceding fiscal year, increased by the percentage increase (if any) in the projected nominal per capita amount of National Health Expenditures for the calendar year that begins during the year involved over the preceding calendar year, as most recently published by the Secretary.

(b)(1)(A)Notwithstanding section 1315 of this title or any other provision of this subchapter, except as provided in this subsection—

(i)the Secretary shall not on or after February 4, 2009, approve or renew 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 parent of a targeted low-income child; and

(ii)notwithstanding the terms and conditions of an applicable existing waiver, the provisions of paragraphs (2) and (3) shall apply for purposes of any fiscal year beginning on or after October 1, 2011, in determining the period to which the waiver applies, the individuals eligible to be covered by the waiver, and the amount of the Federal payment under this subchapter.

(B)If an applicable existing waiver described in subparagraph (A) would otherwise expire before October 1, 2011, and the State requests an extension of such waiver, the Secretary shall grant such an extension, but only, subject to paragraph (2)(A), through September 30, 2011.

(C)The enhanced FMAP determined under section 1397ee(b) of this title shall apply to expenditures under an applicable existing waiver for the provision of child health assistance or other health benefits coverage to a parent of a targeted low-income child during the third and fourth quarters of fiscal year 2009 and during fiscal years 2010 and 2011.

(2)(A)Any State that provides child health assistance or health benefits coverage under an applicable existing waiver for a parent of a targeted low-income child may elect to continue to provide such assistance or coverage through fiscal year 2012 or 2013, subject to the same terms and conditions that applied under the applicable existing waiver, unless otherwise modified in subparagraph (B).

(B)(i)If the State makes an election under subparagraph (A), the Secretary shall set aside for the State for each such fiscal year an amount equal to the Federal share of 110 percent of the State’s projected expenditures under the applicable existing waiver for providing child health assistance or health benefits coverage to all parents of targeted low-income children enrolled under such waiver for the fiscal year (as certified by the State and submitted to the Secretary by not later than August 31 of the preceding fiscal year). In the case of fiscal year 2013, the set aside for any State shall be computed separately for each period described in subparagraphs (A) and (B) of section 1397dd(a)(16) of this title and any reduction in the allotment for either such period under section 1397dd(m)(5) of this title shall be allocated on a pro rata basis to such set aside.

(ii)The Secretary shall pay the State from the amount set aside under clause (i) for the fiscal year, an amount for each quarter of such fiscal year equal to the applicable percentage determined under clause (iii) or (iv) for expenditures in the quarter for providing child health assistance or other health benefits coverage to a parent of a targeted low-income child.

(iii)For purposes of clause (ii), the applicable percentage for any quarter of fiscal year 2012 is equal to—

(I)the enhanced FMAP determined under section 1397ee(b) of this title in the case of a State that meets the outreach or coverage benchmarks described in any of subparagraph (A), (B), or (C) of paragraph (3) for fiscal year 2011; or

(II)the Federal medical assistance percentage (as determined under section 1396d(b) of this title without regard to clause (4) of such section) in the case of any other State.

(iv)For purposes of clause (ii), the applicable percentage for any quarter of fiscal year 2013 is equal to—

(I)the REMAP percentage if—

(aa)the applicable percentage for the State under clause (iii) was the enhanced FMAP for fiscal year 2012; and

(bb)the State met either of the coverage benchmarks described in subparagraph (B) or (C) of paragraph (3) for fiscal year 2012; or

(II)the Federal medical assistance percentage (as so determined) in the case of any State to which subclause (I) does not apply.

(v)No payments shall be made to a State for expenditures described in clause (ii) after the total amount set aside under clause (i) for a fiscal year has been paid to the State.

(vi)No payments shall be made to a State from the amount set aside under clause (i) for a fiscal year for expenditures for providing child health assistance or health benefits coverage to a parent of a targeted low-income child whose family income exceeds the income eligibility level applied under the applicable existing waiver to parents of targeted low-income children on February 4, 2009.

(3)For purposes of paragraph (2), the outreach or coverage benchmarks described in this paragraph are as follows:

(A)The State—

(i)was awarded a grant under section 1397mm of this title for fiscal year 2011;

(ii)implemented 1 or more of the enrollment and retention provisions described in section 1397ee(a)(4) of this title for such fiscal year; or

(iii)has submitted a specific plan for outreach for such fiscal year.

(B)The State, on the basis of the most timely and accurate published estimates of the Bureau of the Census, ranks in the lowest ⅓ of States in terms of the State’s percentage of low-income children without health insurance.

(C)The State qualified for a performance bonus payment under section 1397ee(a)(3)(B) of this title for the most recent fiscal year applicable under such section.

(4)Nothing in this subsection shall be construed as prohibiting a State from submitting an application to the Secretary for a waiver under section 1315 of this title of the State plan under subchapter XIX to provide medical assistance to a parent of a targeted low-income child that was provided child health assistance or health benefits coverage under an applicable existing waiver.

(c)For purposes of this section—

(1)The term “applicable existing waiver” means a waiver, experimental, pilot, or demonstration project under section 1315 of this title, grandfathered under section 6102(c)(3) of the Deficit Reduction Act of 2005, or otherwise conducted under authority that—

(A)would allow funds made available under this subchapter to be used to provide child health assistance or other health benefits coverage to—

(i)a parent of a targeted low-income child;

(ii)a nonpregnant childless adult; or

(iii)individuals described in both clauses (i) and (ii); and

(B)was in effect during fiscal year 2009.

(2)(A)The term “parent” includes a caretaker relative (as such term is used in carrying out section 1396u–1 of this title) and a legal guardian.

(B)The term “nonpregnant childless adult” has the meaning given such term by section 1397gg(f) of this title.

Notes & Related Subsidiaries

Editorial Notes

References in Text

section 6102(c)(3) of the Deficit Reduction Act of 2005, referred to in subsec. (c)(1), is section 6102(c)(3) of Pub. L. 109–171, which is set out as a note under section 1397gg of this title.

Amendments

2015—Subsec. (b)(2)(B)(i). Pub. L. 114–10 substituted “section 1397dd(m)(5)” for “section 1397dd(m)(4)”.

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.

§1397kk Phase-out of Coverage for Nonpregnant Childless Adults; Conditions for Coverage of Parents