,,ii  #aad? ,,congress  #a/ ,session    
,s4 #ebb  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,febru>y #ab1 #bjae    
,mr4 ,br[n 7= himself1 ,ms4 ,/ab5[1 ,mr4
 ,wyd51 ,mr4 ,casey1 ,mr4 ,reid1 ,mr4   
,durb91 ,ms4 ,baldw91 ,mr4 ,b5net1 ,mr4 
,blum5?al1 ,mr4 ,book]1 ,mrs4 ,box]1    
,ms4 ,cantwell1 ,mr4 ,c>d91 ,mr4 ,c>p]1 
,mr4 ,coons1 ,mr4 ,donnelly1 ,mr4       
,frank51 ,mrs4 ,gillibr&1 ,mr4 ,he9ri*1 
,ms4 ,heitkamp1 ,ms4 ,hirono1 ,mr4      
,ka9e1 ,mr4 ,k+1 ,ms4 ,klobu*>1 ,mr4    
,leahy1 ,mr4 ,m>key1 ,mr4 ,man*91 ,mrs4 
,mc,caskill1 ,mr4 ,m55dez1 ,mr4 ,m]kley1
 ,ms4 ,mikulski1 ,mr4 ,murphy1 ,mrs4    
,murray1 ,mr4 ,nelson1 ,mr4 ,pet]s1 ,mr4
 ,re$1 ,mr4 ,s&]s1 ,mr4 ,s*atz1 ,mr4    
,s*um]1 ,mrs4 ,%ahe51 ,mr4 ,te/]1 ,mr4  
,udall1 ,mr4 ,w>n]1 ,ms4 ,w>r51 ,mr4    
,:iteh\se1 & ,mrs4 ,fe9/e97 introduc$ ! 
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,f9ance  ,a ,,bill   
,to am5d title ,,xxi ( ! ,social        
,security ,act to ext5d ! ,*ildr5's     
,heal? ,insurance ,program1 & = o!r     

purposes4  #a4 ,%ort title  ,?is ,act   
may be cit$ z ! ,protect+ ,& ,reta9+    
,our ,*ildr5's ,heal? ,insurance        
,program ,act ( #bjae4  #b4 #d-ye>      
ext5sion ( ,,*ip fund+  7a7 ,fund+  7#a7
 ,9 g5]al ,section #bajd7;a7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acig;dd7a77 is am5d$-- 7,a7 9 p>agraph 
7#ag71 by /rik+ & at ! end2 &  7,b7 by  
/rik+ p>agraph 7#ah7 & ins]t+ ! foll[+  
new p>agraphs3  7#ah7 = fiscal ye>      
#bjae1 #ba1jfa1jjj1jjj2  7#ai7 = fiscal 
ye> #bjaf1 #ai1cjj1jjj1jjj2  7#bj7 =    
fiscal ye> #bjag1 #bj1cjj1jjj1jjj2      
7#ba7 = fiscal ye> #bjah1               
#ba1cjj1jjj1jjj2 &  7#bb7 = fiscal ye>  
#bjai1 = purposes ( mak+ #b semi-annual 
allotm5ts--  7,a7 #b1hej1jjj1jjj = !    
p]iod beg9n+ on ,octob] #a1 #bjah1 &    
end+ on ,m>* #ca1 #bjai2 &  7,b7        
#b1hej1jjj1jjj = ! p]iod beg9n+ on      
,april #a1 #bjai1 & end+ on ,septemb]   
#cj1 #bjai4  4  7#b7 ,prev5tion (       
duplicate appropriations = fiscal ye>   
#bjae ,not)/&+ any o!r provision ( law1 

ins(> z funds h be5 appropriat$ "u      
subsection 7a77#ah7 or 7m7 ( section    
#bajd ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acig;dd71 or "u section #ajh 
( ! ,*ildr5's ,heal? ,insurance ,program
 ,reau?orization ,act ( #bjji 7,public  
,law #aaa-c71 z su* subsections &       
section are 9 effect on ! day be=e !    
date ( ! enactm5t ( ?is ,act1 to provide
 allotm5ts to ,/ates "u ! ,/ate         
,*ildr5's ,heal? ,insurance ,program    
e/abli%$ "u title ,,xxi ( ! ,social     
,security ,act 7#db ,u4,s4,c4 #acig;aa  
et seq47 7:e!r implem5t$ "u title ,,xix1
 ,,xxi1 or bo?1 ( ! ,social ,security   
,act7 = fiscal ye> #bjae--  7,a7 any    
am\nts t are s appropriat$ t are n s    
allott$ & obligat$ be=e ! date ( !      
enactm5t ( ?is ,act1 are resc9d$2 &     
7,b7 any am\nt provid$ = ,,*ip allotm5ts
 to a ,/ate "u ?is section 7& ! am5dm5ts
 made by ?is section7 = su* fiscal ye>  
%all be r$uc$ by ! am\nt ( su*          
appropriations s allott$ & obligat$ be=e
 su* date4  7b7 ,allotm5ts  7#a7 ,9     

g5]al ,section #bajd7m7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acig;dd7m77 is am5d$-- 7,a7 9 !        
subsection head+1 by /rik+ ,?r\gh #bjae 
& ins]t+ & ,!reaft]2  7,b7 9 p>agraph   
7#b7-- 7i7 9 ! p>agraph head+1 by /rik+ 
#bjad & ins]t+ #bjah2 &  7ii7 by /rik+  
subp>agraph 7,b7 & ins]t+ ! foll[+ new  
subp>agraph3  7,b7 ,fiscal ye> #bjac    
?r\gh #bjah ,subject to p>agraphs 7#d7 &
 7#f71 f ! am\nt made available "u      
p>agraphs 7#af7 ?r\gh 7#ba7 ( subsection
 7a7 = ea* ( fiscal ye>s #bjac ?r\gh    
#bjah1 respectively1 ! ,secret>y %all   
compute a ,/ate allotm5t = ea* ,/ate    
7includ+ ! ,di/rict ( ,columbia & ea*   
commonweal? & t]ritory7 = ea* su* fiscal
 ye> z foll[s3  7i7 ,rebas+ 9 fiscal ye>
 #bjac & ea* succe$+ odd-numb]$ fiscal  
ye> ,= fiscal ye> #bjac & ea* succe$+   
odd-numb]$ fiscal ye>1 ! allotm5t ( !   
,/ate is equal to ! ,f$]al paym5ts to ! 
,/ate t are attributable to 7& c\ntable 
t[>d7 ! total am\nt ( allotm5ts         
available "u ?is section to ! ,/ate 9 ! 

prec$+ fiscal ye> 7includ+ paym5ts made 
to ! ,/ate "u subsection 7n7 = su*      
prec$+ fiscal ye> z well z am\nts       
r$i/ribut$ to ! ,/ate 9 su* prec$+      
fiscal ye>71 multipli$ by ! allotm5t    
increase factor "u p>agraph 7#e7 = su*  
odd-numb]$ fiscal ye>4  7ii7 ,gr[?      
factor update = fiscal ye> #bjad & ea*  
succe$+ ev5-numb]$ fiscal ye> ,except z 
provid$ 9 clause 7iii71 = fiscal ye>    
#bjad & ea* succe$+ ev5-numb]$ fiscal   
ye>1 ! allotm5t ( ! ,/ate is equal to ! 
sum (--  7,i7 ! am\nt ( ! ,/ate allotm5t
 "u clause 7i7 = ! prec$+ fiscal ye>2 & 
7,,ii7 ! am\nt ( any paym5ts made to !  
,/ate "u subsection 7n7 = su* prec$+    
fiscal ye>1  multipli$ by ! allotm5t    
increase factor "u p>agraph 7#e7 = su*  
ev5-numb]$ fiscal ye>4  7iii7 ,special  
rule = fiscal ye> #bjaf ,= fiscal ye>   
#bjaf1 ! allotm5t ( ! ,/ate is equal to 
! ,f$]al paym5ts to ! ,/ate t are       
attributable to 7& c\ntable t[>d7 !     
total am\nt ( allotm5ts available "u ?is
 section to ! ,/ate 9 ! prec$+ fiscal   

ye> 7includ+ paym5ts made to ! ,/ate "u 
subsection 7n7 = su* prec$+ fiscal ye> z
 well z am\nts r$i/ribut$ to ! ,/ate 9  
su* prec$+ fiscal ye>71 b det]m9$ z if !
 la/ two s5t5ces ( section #baje7;b7 7 9
 effect 9 su* prec$+ fiscal ye> & !n    
multiply+ ! result by ! allotm5t        
increase factor "u p>agraph 7#e7 =      
fiscal ye> #bjaf4  2  7,c7 9 p>agraph   
7#c7-- 7i7 9 ! head+1 by /rik+ #bjae;&  
ins]t+ #bjai2  7ii7 9 subp>agraph 7,a7--
 7,i7 by /rik+ p>agraph 7#ah7 & ins]t+  
p>agraph 7#bb72 &  7,,ii7 by /rik+      
section #ajh ( ! ,*ildr5's ,heal?       
,insurance ,program ,reau?orization ,act
 ( #bjji & ins]t+ section #b7;b77#b7 ( !
 ,protect+ ,& ,reta9+ ,our ,*ildr5's    
,heal? ,insurance ,program ,act ( #bjae2
  7iii7 9 subp>agraph 7,b71 by /rik+    
p>agraph 7#ah7 & ins]t+ p>agraph 7#bb72 
7iv7 9 subp>agraph 7,c7-- 7,i7 by /rik+ 
#bjad ea* place x appe>s & ins]t+ #bjah2
 &  7,,ii7 by /rik+ #bjae & ins]t+      
#bjai2 &  7v7 9 subp>agraph 7,d7--  7,i7
 9 clause 7i7-- 7aa7 9 subclause 7,i71  

by /rik+ subsection 7a77#ah77;,a7 &     
ins]t+ subsection 7a77#bb77;,a72 &  7bb7
 9 subclause 7,,ii71 by /rik+ section   
#ajh ( ! ,*ildr5's ,heal? ,insurance    
,program ,reau?orization ,act ( #bjji & 
ins]t+ section #b7;b77#b7 ( ! ,protect+ 
,& ,reta9+ ,our ,*ildr5's ,heal?        
,insurance ,program ,act ( #bjae2 &     
7,,ii7 9 clause 7ii77,,ii71 by /rik+    
subsection 7a77#ah77;,b7 & ins]t+       
subsection 7a77#bb77;,b72  7,d7 9       
p>agraph 7#d71 by /rik+ #bjae & ins]t+  
#bjai2  7,e7 9 p>agraph 7#f7--  7i7 9   
subp>agraph 7,a71 by /rik+ #bjae &      
ins]t+ #bjai2 &  7ii7 9 ! second s5t5ce1
 by /rik+ or fiscal ye> #bjad & ins]t+  
fiscal ye> #bjad1 fiscal ye> #bjaf1 or  
fiscal ye> #bjah2 &  7,f7 9 p>agraph    
7#h7-- 7i7 9 ! p>agraph head+1 by /rik+ 
#bjae & ins]t+ #bjai2 &  7ii7 by /rik+ =
 a p]iod 9 fiscal ye> #bjae & ins]t+ = a
 p]iod 9 fiscal ye> #bjai4  7#b7 ,"o-"t 
appropriation = fiscal ye> #bjai ,!re is
 appropriat$ to ! ,secret>y ( ,heal? &  
,human ,s]vices1 out ( any money 9 !    

,treasury n o!rwise appropriat$1        
#af1gjj1jjj1jjj to accompany ! allotm5t 
made = ! p]iod beg9n+ on ,octob] #a1    
#bjah1 & end+ on ,m>* #ca1 #bjai1 "u    
section #bajd7;a77#bb77;,a7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acig;dd7a77#bb77;,a77 7z add$ by       
subsection 7a77#a771 to rema9 available 
until exp5d$4 ,su* am\nt %all be us$ to 
provide allotm5ts to ,/ates "u p>agraph 
7#c7 ( section #bajd7m7 ( su* ,act 7#db 
,u4,s4,c4 #acig;dd7m77 7z am5d$ by      
p>agraph 7#a77;,c77 = ! fir/ #f mon?s ( 
fiscal ye> #bjai 9 ! same mann] z       
allotm5ts are provid$ "u subsection     
7a77#bb77;,a7 ( su* section #bajd &     
subject to ! same t]ms & conditions z   
apply to ! allotm5ts provid$ f su*      
subsection 7a77#bb77;,a74  7c7 ,*ild    
enrollm5t cont+5cy fund  7#a7 ,9 g5]al  
,section #bajd7n7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acig;dd7n77 is     
am5d$-- 7,a7 9 p>agraph 7#b7--  7i7 9   
subp>agraph 7,a7-- 7,i7 9 ! matt] prec$+
 clause 7i71 by /rik+ & 7,d7 & ins]t+ 1 

7,d71 & 7,e72 &  7,,ii7 by /rik+ clause 
7ii7 & ins]t+ ! foll[+3  7ii7 = ea* (-- 
7,i7 fiscal ye>s #bjaj ?r\gh #bjad1 su* 
sums z are necess>y = mak+ paym5ts to   
eligible ,/ates = su* fiscal ye>1 b n 9 
excess ( ! aggregate cap describ$ 9     
subp>agraph 7,b72 &  7,,ii7 fiscal ye>s 
#bjae ?r\gh #bjah 7& = ea* ( !          
semi-annual allotm5t p]iods = fiscal ye>
 #bjai71 su* sums z are necess>y = mak+ 
paym5ts to eligible ,/ates = su* fiscal 
ye> or p]iod4  2 &  7ii7 by /rik+       
subp>agraph 7,b7 & ins]t+ ! foll[+3     
7,b7 ,aggregate cap ,! total am\nt      
available = paym5t f ! ,fund = ea* (    
fiscal ye>s #bjaj ?r\gh #bjad1 tak+ into
 acc\nt deposits made "u subp>agraph    
7,c71 %all n exce$ #bj p]c5t ( ! am\nt  
made available "u subsection 7a7 = !    
fiscal ye>4 ,9 ! case ( fiscal ye>s     
#bjae ?r\gh #bjah 7& = ea* ( !          
semi-annual allotm5t p]iods = fiscal ye>
 #bjai71 !re %all be no limit on ! am\nt
 available = paym5t f ! ,fund4  2  7iii7
 9 subp>agraph 7,d7-- 7,i7 by ins]t+    

be=e fiscal ye> #bjae aft] fiscal ye> or
 p]iod2 &  7,,ii7 by /rik+ = any succe$+
 fiscal ye>2 &  7iv7 by add+ at ! end ! 
foll[+ subp>agraph3  7,e7 ,transf]s     
,not)/&+ any o!r provision ( ?is title1 
! foll[+ am\nts %all also be available1 
)\t fiscal ye> limitation1 = mak+       
paym5ts f ! ,fund3  7i7 ,unobligat$     
national allotm5t = fiscal ye>s beg9n+ )
 fiscal ye> #bjad  7,i7 ,fiscal ye>     
#bjad allotm5t ,z ( ,decemb] #ca (      
fiscal ye> #bjae1 ! portion1 if any1 ( !
 am\nt appropriat$ "u subsection 7a7 =  
fiscal ye> #bjad t is unobligat$ =      
allotm5t to a ,/ate "u subsection 7m7 = 
su* fiscal ye>4  7,,ii7 ,succe$+ fiscal 
ye> allotm5ts ,z ( ,decemb] #ca ( fiscal
 ye> #bjaf1 & ea* succe$+ fiscal ye>1 ! 
portion1 if any1 ( ! am\nt appropriat$  
"u subsection 7a7 = ! prec$+ fiscal ye> 
t is unobligat$ = allotm5t to a ,/ate "u
 subsection 7m7 = su* prec$+ fiscal ye>4
  7ii7 ,unexp5d$ allotm5ts n us$ =      
r$i/ribution ,z ( ,decemb] #ca ( fiscal 
ye> #bjae1 & z ( ,novemb] #ae ( ea*     

succe$+ fiscal ye>1 ! total am\nt (     
allotm5ts made to ,/ates "u subsection  
7a7 = ! second prec$+ fiscal ye> t is n 
exp5d$ or r$i/ribut$ "u subsection 7f7  
dur+ ! p]iod 9 :i* su* allotm5ts are    
available = obligation4  7iii7 ,unexp5d$
 p]=mance inc5tive funds ,z ( ,janu>y   
#a1 #bjaf1 & z ( ,janu>y #a ( ea*       
succe$+ cal5d> ye>1 ! portion1 if any1 (
 ! am\nt appropriat$ "u section         
#baje7;a77#c77;,e77iii7 = ! prec$+      
fiscal ye> t is n exp5d$ or obligat$ "u 
su* section4  2 &  7,b7 9 p>agraph      
7#c7-- 7i7 9 subp>agraph 7,a7--  7,i7 by
 r$esignat+ clauses 7i7 & 7ii7 z        
subclauses 7,i7 & 7,,ii71 respectively1 
& realign+ ! left m>g9s accord+ly2      
7,,ii7 by /rik+ ,if a ,/ate's & all t   
foll[s ?r\gh #bjae1 & ins]t+ ! foll[+3  
7i7 ,= fiscal ye>s #bjji ?r\gh #bjad ,if
 a ,/ate's exp5ditures "u ?is title 9   
fiscal ye> #bjji1 fiscal ye> #bjaj1     
fiscal ye> #bjaa1 fiscal ye> #bjab1     
fiscal ye> #bjac1 or fiscal ye> #bjad  2
  7,,iii7 by /rik+ or p]iod ea* place x 

appe>s2  7,,iv7 9 subclause 7,,ii7 7z s 
r$esignat$71 by /rik+ 7or 9 :i* ! p]iod 
occurs72 &  7,v7 by add+ at ! end !     
foll[+ clause3  7ii7 ,= fiscal ye>s aft]
 #bjad  7,i7 ,9 g5]al ,= ea* ( fiscal   
ye>s #bjae ?r\gh #bjah 7& = ea* ( !     
semi-annual allotm5t p]iods = fiscal ye>
 #bjai71 if ! ,secret>y det]m9es t a    
,/ate is a %ortfall ,/ate describ$ 9    
subclause 7,,ii7 = t fiscal ye> or      
p]iod1 ! ,secret>y %all pay to ! ,/ate f
 ! ,fund1 9 addition to any o!r paym5ts 
made to ! ,/ate "u ?is title = ! fiscal 
ye> or p]iod1 an am\nt equal to ! am\nt 
describ$ 9 subclause 7,,iii74  7,,ii7   
,%ortfall ,/ates describ$ ,= purposes ( 
?is clause1 ) respect to a fiscal ye> or
 semi-annual allotm5t p]iod1 a %ortfall 
,/ate is a ,/ate = :i* ! ,secret>y      
e/imates1 on ! basis ( ! mo/ rec5t data 
available to ! ,secret>y1 t ! project$  
exp5ditures = ! ,/ate & fiscal ye> or   
p]iod "u ?is title 7includ+ 9 ! =m (    
cov]age describ$ 9 p>agraph 7#a7 or 7#b7
 ( section #baja1 or bo?7 w exce$ ! sum 

(--  7aa7 ! am\nt ( ! ,/ate's allotm5ts 
= any prec$+ fiscal ye> t rema9s        
available = exp5diture & t w n be exp5d$
 by ! end ( ! imm$iately prec$+ fiscal  
ye>2  7bb7 ! am\nt 7if any7 t w be      
r$i/ribut$ to ! ,/ate "u subsection 7f7 
= ! fiscal ye> or p]iod2  7cc7 ! am\nt  
7if any7 to be paid to ! ,/ate 9 ! fir/ 
qu>t] ( ! fiscal ye> "u section         
#baje7;a77#c72 &  7dd7 ! am\nt ( !      
,/ate's allotm5t = ! fiscal ye> or      
p]iod4  7,,iii7 ,am\nt describ$ ,)      
respect to a ,/ate & fiscal ye> or      
p]iod1 ! am\nt describ$ 9 ?is subclause 
is equal to ! am\nt by :i* ! project$   
exp5ditures = ! ,/ate "u ?is title = !  
fiscal ye> or p]iod 7e/imat$ by !       
,secret>y on ! basis ( ! mo/ rec5t data 
available to ! ,secret>y7 exce$ ! sum   
det]m9$ "u subclause 7,,ii7 = ! ,/ate & 
fiscal ye> or p]iod4  7,,iv7            
,retrospective adju/m5t ,! ,secret>y may
 adju/ ! det]m9ations made "u ?is clause
 ) respect to a ,/ate & fiscal ye> or   
p]iod z necess>y on ! basis ( ! am\nts  

report$ by ,/ates n lat] ?an ,novemb]   
#cj ( ! succe$+ fiscal ye>1 z approv$ by
 ! ,secret>y4  2  7ii7 9 subp>agraph    
7,b77ii71 by /rik+ 7or semi-annual p]iod
 occurr+ 9 a fiscal ye>72  7iii7 9      
subp>agraph 7,c7--  7,i7 9 ! matt]      
prec$+ clause 7i71 by /rik+ subp>agraph 
7,a77ii7 & ins]t+ subp>agraph           
7,a77i77,,ii72 &  7,,ii7 9 clause 7ii71 
by /rik+ 7or semi-annual p]iod occurr+ 9
 a fiscal ye>72 &  7iv7 9 subp>agraph   
7,g71 by ins]t+ ! exp5ditures "u ! ,/ate
 *ild heal? plan & aft] reg>d+4  7#b7   
,con=m+ am5dm5t ,section                
#bajd7;f77#b77;,a77ii7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acieg;dd7f77#b77;,a77ii77 is am5d$ by  
ins]t+ only 9 ! case ( a fiscal ye> be=e
 fiscal ye> #bjae1 be=e ! am\nt4  7d7   
,ext5sion & update ( p]=mance inc5tive  
paym5ts  7#a7 ,ext5sion ?r\gh fiscal ye>
 #bjai ,section #baje7;a77#c7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acig;ee7a77#c77 is am5d$-- 7,a7 9      
subp>agraph 7,a7--  7i7 by /rik+ #bjac &

 ins]t+ #bjai2 &  7ii7 9 ! second       
s5t5ce1 by ins]t+ 1 except t paym5t "u  
?is p>agraph may be made to a ,/ate =   
fiscal ye> #bjad z a s+le paym5t n lat] 
?an ,decemb] #ca1 #bjae be=e ! p]iod2   
7,b7 9 subp>agraph 7,e7-- 7i7 9 clause  
7ii7--  7,i7 by /rik+ subclause 7,i7 &  
ins]t+ ! foll[+3  7,i7 ,unobligat$      
national allotm5t = fiscal ye>s #bjji   
?r\gh #bjac ,z ( ,decemb] #ca ( fiscal  
ye> #bjji1 & z ( ,decemb] #ca ( ea*     
succe$+ fiscal ye> ?r\gh fiscal ye>     
#bjac1 ! portion1 if any1 ( ! am\nt     
appropriat$ "u section #bajd7;a7 = su*  
fiscal ye> t is unobligat$ = allotm5t to
 a ,/ate "u section #bajd7m7 = su*      
fiscal ye> or set aside "u subsection   
7a77#c7 or 7b77#b7 ( section #baaa = su*
 fiscal ye>4  2  7,,ii7 9 subclause     
7,,iii71 by /rik+ #bjac & ins]t+ #bjad2 
7ii7 by r$esignat+ clause 7iii7 z clause
 7iv72 &  7iii7 by ins]t+ aft] clause   
7ii7 ! foll[+ new clause3  7iii7        
,appropriation = fiscal ye>s #bjae ?r\gh
 #bjai ,out ( any money 9 ! ,treasury n 

o!rwise appropriat$1 !re are appropriat$
 #ejj1jjj1jjj = ea* ( fiscal ye>s #bjae 
?r\gh #bjai = mak+ paym5ts "u ?is       
p>agraph4 ,am\nts appropriat$ = a fiscal
 ye> "u ?is clause %all rema9 available 
= mak+ paym5ts "u ?is p>agraph until    
,janu>y #a ( ! foll[+ fiscal ye>4 ,any  
am\nts ( su* appropriations t rema9     
unexp5d$ or unobligat$ z ( su* date %all
 be transf]r$ & made available = mak+   
paym5ts "u section #bajd7n74  2 &  7,c7 
9 subp>agraph 7,f77iii71 by /rik+ #bjac 
& ins]t+ #bjai4  7#b7 ,updat$ p]=mance  
inc5tive crit]ia = fiscal ye>s #bjae    
?r\gh #bjai ,section #baje7;a7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acig;ee7a77 is am5d$--  7,a7 9 p>agraph
 7#c77;,a71 by ins]t+ or 7#e7 aft]      
p>agraph 7#d72  7,b7 9 p>agraph 7#d7--  
7i7 9 ! head+1 by ins]t+ fiscal ye>s    
#bjji ?r\gh #bjad aft] = *ildr52 &  7ii7
 9 ! matt] prec$+ subp>agraph 7,a71 by  
/rik+ = a fiscal ye> if & ins]t+ =      
fiscal ye>s #bjji ?r\gh #bjad if2 &     
7,c7 by add+ at ! end ! foll[+ new      

p>agraph3  7#e7 ,enrollm5t & ret5tion   
provisions = *ildr5 = fiscal ye> #bjae &
 succe$+ fiscal ye>s  7,a7 ,9 g5]al ,=  
purposes ( p>agraph 7#c77;,a71 a ,/ate  
meets ! condition ( ?is p>agraph =      
fiscal ye> #bjae & any succe$+ fiscal   
ye> if x is implem5t+ at lea/ #d ( !    
enrollm5t & ret5tion provisions specifi$
 9 subp>agraph 7,b7 7treat+ ea* clause z
 a sep>ate enrollm5t & ret5tion         
provision7 ?r\gh\t ! entire fiscal ye>4 
7,b7 ,enrollm5t & ret5tion provisions ,!
 enrollm5t & ret5tion provisions        
specifi$ 9 ?is subp>agraph are ! foll[+3
 7i7 ,cont9u\s eligibility ,! ,/ate has 
elect$ ! option ( cont9u\s eligibility =
 a full #ab mon?s = all *ildr5 describ$ 
9 section #aijb7;e77#ab7 "u title ,,xix 
"u #ai ye>s ( age1 z well z apply+ su*  
policy "u its ,/ate *ild heal? plan "u  
?is title4  7ii7 ,express ,lane         
eligibility ,! ,/ate is implem5t+ !     
option describ$ 9 section #aijb7;e77#ac7
 "u title ,,xix z well z1 pursuant to   
section #bajg7;e77#a71 "u ?is title4    

7iii7 ,presumptive eligibility ,! ,/ate 
provides m$ical assi/ance to *ildr5 dur+
 a presumptive eligibility p]iod by     
implem5t+ section #aibj;,a "u title     
,,xix z well z1 pursuant to section     
#bajg7;e77#a71 "u ?is title1 & ensures t
 su* p]iod beg9s ) ! det]m9ation by any 
qualifi$ entity t ! family income ( !   
*ild does n exce$ ! applicable level (  
income eligibility "u ! ,/ate plan4 ,a  
,/ate %all n satisfy ?is provision if ! 
only type ( entity recogniz$ by ! ,/ate 
z a qualifi$ entity is a hospital t has 
elect$ to be a qualifi$ entity "u       
section #aijb7;a77#dg77;,b74  7iv7      
,premium assi/ance = employ]-sponsor$   
plans ,! ,/ate has opt$ to (f] a premium
 assi/ance subsidy = qualifi$           
employ]-sponsor$ cov]age by implem5t+   
section #aijf;,a "u title ,,xix or !    
option describ$ 9 section #baje7;c77#aj7
 "u ?is title4  7v7 ,elim9ation ( wait+ 
p]iods ,! ,/ate does n impose a wait+   
p]iod = cov]age ( any individual "u !   
,/ate *ild heal? plan & ensures t no    

wait+ p]iod applies 9 ! case ( cov]age  
provid$ to any individual eligible =    
cov]age "u ! ,/ate *ild heal? plan ?r\gh
 cov]age pur*as$ by ! ,/ate "u section  
#baje7;c77#c7 or employ]-sponsor$       
cov]age subsidiz$ by ! ,/ate "u section 
#aijf;,a ( title ,,xix or section       
#baje7;c77#aj7 ( ?is title4  7vi7       
,automat$ track+ ( co/ %>+ or l[] cap on
 co/ %>+ ,9 ! case ( a ,/ate *ild heal? 
plan t imposes premiums1 d$uctibles1 co/
 %>+1 or simil> *>ges t c\ld 7z det]m9$ 
by ! ,secret>y7 cause families t include
 an individual receiv+ assi/ance "u !   
plan to h out-(-pocket exp5ses t exce$ !
 limit impos$ "u section                
#bajc7;e77#c77;,b71 ! ,/ate has ei!r--  
7,i7 e/abli%$1 or1 9 ! case ( a ,/ate   
*ild heal? plan t provides *ild heal?   
assi/ance ?r\gh manag$ c>e entities or  
organizations1 requir$ su* entities or  
organizations to coord9ate ) ! ,/ate    
ag5cy responsible = implem5t+ ! ,/ate   
*ild heal? plan "u ?is title 9          
e/abli%+--  7aa7 an electronic process =

 track+ su* exp5ses t does n rely on    
docum5tation provid$ by ! individual or 
! family2 &  7bb7 a sy/em = notify+ ea* 
su* family ( ! aggregate mon?ly or      
qu>t]ly limits on out-(-pocket exp5ses  
applicable to ! family "u section       
#bajc7;e77#c77;,b7 & expla9+ to ea* su* 
family t no su* exp5ses %all be impos$  
on any individual 9 ! family = ! rema9d]
 ( any mon? or qu>t] ) respect to :i* ! 
family has rea*$ ! applicable aggregate 
mon?ly or qu>t]ly family limit impos$ "u
 su* section2 or  7,,ii7 elect$ to      
elim9ate d$uctibles1 copaym5ts1         
co9surance1 or o!r =ms ( co/-%>+ 7o!r   
?an premiums7 impos$ "u ?is title )     
respect to any individual receiv+       
cov]age "u ! ,/ate *ild heal? plan4     
7vii7 ,real-"t eligibility det]m9ations 
?r\gh ! use ( enhanc$ data s\rces ,)    
respect to applications & r5ewals =     
m$ical assi/ance "u title ,,xix or *ild 
heal? assi/ance "u ?is title = a fiscal 
ye>1 ! ,/ate meets ! foll[+ crit]ia =   
all income det]m9ations made us+ modifi$

 adju/$ gross income "u section         
#aijb7;e77#ad77;,a73  7,i7 ,! ,/ate     
relies on enhanc$ data s\rces 7:i* may  
include1 b %all n be limit$ to1 ! data  
s\rces available "u section #aacg or !  
f$]al ,data ,s]vices ,hub7 to make !    
det]m9ations4  7,,ii7 ,9 ! case (       
initial applications1 ! ,/ate makes at  
lea/ #ej p]c5t ( ! det]m9ations )9 #bd  
h\rs ( receiv+ ! application4 ,if a     
,/ate successfully makes ! requir$      
m9imum p]c5tage ( timely det]m9ations = 
a fiscal ye>1 su* ,/ate %all n receive  
cr$it = meet+ ?is provision 9 any       
subsequ5t fiscal ye> unless ! ,/ate     
makes a p]c5tage ( timely income        
det]m9ations t is at lea/ #e p]c5tage   
po9ts high] 7or1 if at lea/ #ge p]c5t ( 
! ,/ate's det]m9ations 9 a previ\s      
fiscal ye> 7 timely1 #a p]c5tage po9t   
high]7 ?an ! p]c5tage t ! ,/ate a*iev$ 9
 ! la/ fiscal ye> 9 :i* ! ,/ate receiv$ 
cr$it = meet+ ?is provision4  7,,iii7 ,9
 ! case ( r5ewals1 ! ,/ate makes at lea/
 #ej p]c5t ( ! det]m9ations )9 #bd h\rs 

( receiv+ ! r5ewal4 ,if a ,/ate         
successfully makes ! requir$ m9imum     
p]c5tage ( timely det]m9ations = a      
fiscal ye>1 su* ,/ate %all n receive    
cr$it = meet+ ?is provision 9 any       
subsequ5t fiscal ye> unless ! ,/ate     
makes a p]c5tage ( timely income        
det]m9ations t is at lea/ #e p]c5tage   
po9ts high] 7or1 if at lea/ #ge p]c5t ( 
! ,/ate's det]m9ations 9 a previ\s      
fiscal ye> 7 timely1 #a p]c5tage po9t   
high]7 ?an ! p]c5tage t ! ,/ate a*iev$ 9
 ! la/ fiscal ye> 9 :i* ! ,/ate receiv$ 
cr$it = meet+ ?is provision4  7viii7    
,elim9ation ( premiums or retroactive   
re9/atem5t ^u premium paym5t ,! ,/ate   
has elect$ to ei!r-- 7,i7 impose no     
premiums = cov]age "u ! ,/ate *ild heal?
 plan2 or  7,,ii7 9 ! case ( an         
individual ^: cov]age "u ! ,/ate *ild   
heal? plan has be5 t]m9at$ = failure to 
make premium paym5ts1 provide assi/ance 
to su* individual = purposes ( imm$iate 
re5rollm5t ( ! individual ^u paym5t (   
out/&+ premiums1 ) cov]age retroactive  

to ! beg9n+ ( ! mo/ rec5t mon? = :i* an 
out/&+ premium has be5 paid1 & %all n   
impose any wait+ p]iod or fee z a       
condition ( su* re5rollm5t4  4  7e7     
,ext5sion ( qualify+ /ates option       
,section #baje7;g77#d7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acig;ee7g77#d77 is am5d$-- 7#a7 9 !    
p>agraph head+1 by /rik+ #bjae & ins]t+ 
#bjai2 &  7#b7 9 subp>agraph 7,a71 by   
/rik+ #bjae & ins]t+ #bjai4  7f7        
,ext5sion ( c]ta9 programs &            
demon/ration projects  7#a7 ,quality c>e
 = *ildr5 demon/ration project ,section 
#aaci;,a7d77#a7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acbj;b-#i;a7d77#a77
 is am5d$ 9 ! matt] be=e subp>agraph    
7,a7 by ins]t+ 1 & dur+ ! p]iod ( fiscal
 ye>s #bjaf ?r\gh #bjai1 ! ,secret>y    
%all aw>d n m ?an #aj grants1 be=e to   
,/ates4  7#b7 ,*ildhood obesity         
demon/ration project ,section           
#aaci;,a7e77#h7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acbj;b-#i;a7e77#h77
 is am5d$ by ins]t+ 1 & #be1jjj1jjj = ! 

p]iod ( fiscal ye>s #bjae ?\gh #bjai    
aft] #bjad4  7#c7 ,p$iatric quality     
measures program ,section #aaci;,a7i7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#acbj;b-#i;a7i77 is am5d$ 9 ! fir/      
s5t5ce by ins]t+ be=e ! p]iod at ! end !
 foll[+3 1 & !re is appropriat$ = ea* ( 
fiscal ye>s #bjaf ?r\gh #bjai1          
#de1jjj1jjj = ! purpose ( c>ry+ out ?is 
section 7o!r ?an subsections 7e71 7f71 &
 7g7744  7#d7 ,outrea* & enrollm5t      
grants2 national campaign ,section #baac
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acigmm7 is am5d$-- 7,a7 9    
subsection 7a77#a71 by /rik+ #bjae &    
ins]t+ #bjai2 &  7,b7 9 subsection 7g71 
by ins]t+ 1 & #hj1jjj1jjj = ! p]iod (   
fiscal ye>s #bjaf ?r\gh #bjai1 to rema9 
available until exp5d$1 aft] #bjae4  7g7
 ,express lane eligibility ,section     
#aijb7;e77#ac77;,i7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#acif;a7e77#ac77;,i77 is am5d$ by /rik+ 
,septemb] #cj1 #bjae & ins]t+ ,septemb] 
#cj1 #bjai4  7h7 ,au?ority ,to use      

income det]m9ation made "u c]ta9        
programs ,section #aijb7;e77#ad7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7e77#ad77 is am5d$-- 7#a7 9      
subp>agraph 7,a71 9 ! fir/ s5t5ce1 by   
/rik+ subp>agraph 7,d7 & ins]t+         
subp>agraphs 7,d7 & 7,j72 &  7#b7 by    
add+ at ! end ! foll[+ new subp>agraph3 
7,j7 ,use ( income det]m9ation made "u  
c]ta9 o!r programs  7i7 ,9 g5]al ,=     
purposes ( det]m9+ income eligibility = 
m$ical assi/ance "u ! ,/ate plan or "u  
any waiv] ( su* plan1 a ,/ate may use a 
det]m9ation ( income made by--  7,i7 !  
,/ate program fund$ "u "p ,a ( title    
,,iv2 or  7,,ii7 ! supplem5tal nutrition
 assi/ance program e/abli%$ "u ! ,food &
 ,nutrition ,act ( #bjjh4  7ii7 ,sunset 
,clause 7i7 %all n apply aft] ,septemb] 
#cj1 #bjai4  4