,,ii #aafth ,,congress #ast ,session ,s4 #hgc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #bf1 #bjai,mr4 ,brown 7for himself1 ,ms4 ,baldwin1 ,ms4 ,warren1 and ,mr4 ,whitehouse7 introduced the following bill2 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 #ab-month continuous enrollment under ,medicaid and the ,children's ,health ,insurance ,program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,stabilize ,medicaid and ,,chip ,coverage ,act of #bjai4 #b4 ,findings ,congress finds the following3 7#a7 ,every year millions of people are enrolled in ,medicaid and the ,children's ,health ,insurance ,program 7in this section referred to as ,,chip71 but subsequently lose their coverage1 despite still being eligible1 because of inefficient and cumbersome paperwork and logistical requirements4 7#b7 ,data show that the typical enrollee receives ,medicaid coverage for about #c_/d of the year and that coverage periods are lower for non-elderly1 non-disabled adults than for those with disabilities1 seniors1 and children4 7#c7 ,medicaid enrollees with coverage disruption are more likely to be hospitalized for illnesses1 like asthma1 diabetes1 or cardiovascular disease1 that can be effectively managed through ongoing primary medical care and medication1 are less likely to be screened for breast cancer1 and may have poorer cancer outcomes4 7#d7 ,children enrolled in ,,chip also experience disruptions in health coverage and care4 ,for example1 during just a #a-year period1 over #a_/c of ,,chip enrollees were also enrolled in a ,state's ,medicaid program4 ,transitions between ,medicaid and ,,chip can cause disruptions in care because the health care coverage and participating providers vary between the two programs4 7#e7 ,interruptions in coverage can impair the receipt of effective primary care and lead to expensive hospitalizations or emergency room visits4 7#f7 ,unnecessary enrollment1 disenrollment1 and reenrollment in ,medicaid and ,,chip result in higher administrative expenses for reenrollment and result in more people uninsured at any given time4 7#g7 ,stable coverage under ,medicaid and ,,chip lowers average monthly medical costs4 ,continuous enrollment also permits better prevention and disease management1 leading to fewer serious illnesses and hospitalizations4 7#h7 ,children with stable coverage are less likely to have unmet medical needs1 allowing children to receive the preventive care that is necessary to help them grow into healthy adults4 #c4 #ab-month continuous enrollment 7a7 ,requirement of #ab-,month continuous enrollment under medicaid 7#a7 ,in general ,section #aijb7;e77#ab7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e771 is amended to read as follows3 7#ab7 #ab-month continuous enrollment 7,a7 ,in general ,notwithstanding any other provision of this title1 a ,state plan approved under this title or under any waiver of such plan approved pursuant to section #aaae or section #aiae1 shall provide that an individual who is determined to be eligible for benefits under such plan 7or waiver7 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 #ab-month period 7beginning on the date of determination of eligibility7 ends4 7,b7 ,promoting retention of eligible and enrolled persons beyond #ab months ,the ,secretary shall-- 7i7 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 #ab-month period described in subparagraph 7,a72 and 7ii7 actively promote the adoption of such enrollment retention methods by ,states1 which shall include1 but not be limited to1 issuing guidance and developing resources on ,state best practices4 7,c7 ,enrollment and retention reporting 7i7 ,in general ,not later than #a year after the date of enactment of the ,stabilize ,medicaid and ,,chip ,coverage ,act of #bjai1 the ,secretary shall publish the procedures that ,states are expected to use to provide annual enrollment and retention reports beginning not later than #b years after the date of enactment of such ,act4 7ii7 ,state reporting requirements ,at a minimum1 the reporting procedures published under clause 7i7 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 ,secretary4 7iii7 ,secretary report and publication 7,i7 ,in general ,the ,secretary annually shall publish enrollment and retention performance results for all ,states not later than #f months after the deadline for each annual ,state enrollment and retention reporting period4 7,,ii7 ,estimated enrollment continuity ratios ,each annual report published by the ,secretary under subclause 7,i7 shall include estimates of ,medicaid enrollment continuity ratios for each ,state in accordance with the requirements of subclause 7,,iii74 7,,iii7 ,requirements ,the ,secretary shall develop both overall enrollment continuity ratios for all enrollees and separate enrollment continuity ratios for each of the following categories3 7aa7 ,children4 7bb7 ,individuals whose eligibility category is related to having attained age #fe4 7cc7 ,individuals whose eligibility category is related to disability or blindness4 7dd7 ,individuals whose eligibility category is related to their status as parents and caretaker relatives of children under #ai or who are otherwise not elderly1 blind or disabled adults4 4 7b7 ,requirement of #ab-,month continuous enrollment under ,,chip 7#a7 ,in general ,section #bajb7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;bb7b77 is amended by adding at the end the following new paragraph3 7#f7 ,requirement for #ab-month continuous enrollment ,notwithstanding any other provision of this title1 a ,state child health plan that provides child health assistance under this title through a means other than that described in section #baja7;a77#b71 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 #ab-month period 7beginning on the date of determination of eligibility7 ends4 4 7#b7 ,conforming amendments 7,a7 ,enrollment and retention provisions ,section #baje7;a77#d77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7a77#d77;,a77 is amended-- 7i7 by striking has elected the option of and inserting is in compliance with the requirement for2 and 7ii7 by striking applying such policy under its ,state child health plan under this title and inserting in compliance with section #bajb7;b74 7,b7 ,application of medicaid retention and reporting requirements ,section #bajg7;e77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77 is amended-- 7i7 by redesignating subparagraphs 7,g7 through 7,s7 as subparagraphs 7,h7 through 7,t71 respectively2 and 7ii7 by inserting after subparagraph 7,f71 the following3 7,g7 ,subparagraphs 7,b7 and 7,c7 of section #aijb7;e77#ab7 7relating to promotion of enrollment beyond #ab months and reporting requirements77without regard to items 7bb71 7cc71 and 7dd7 of subparagraph 7,c77iii77,,iii7 of that section74 4 7c7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b7 or 7#c71 the amendments made by subsections 7a7 and 7b7 shall apply to determinations 7and redeterminations7 of eligibility made on or after the date that is #ah months after the date of the enactment of this ,act4 7#b7 ,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 7#db ,u4,s4,c4 #acif et seq42 #db ,u4,s4,c4 #acig;aa et seq47 which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the respective plan to meet the additional requirements imposed by the amendments made by subsections 7a7 or 7b71 respectively1 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 ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session is considered to be a separate regular session of the ,state legislature4 7#c7 ,option to implement #ab-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 7#db ,u4,s4,c4 #acif et seq42 #db ,u4,s4,c4 #acig;aa et seq47 to apply the amendments made by subsection 7a7 or 7b71 respectively1 on any date prior to the #ah-month date specified in paragraph 7#a71 but not sooner than the date of the enactment of this ,act4 #d4 ,preventing the application under chip of coverage waiting periods 7a7 ,in general ,section #bajb7;b77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;bb7b77#a77;,b77 is amended-- 7#a7 in clause 7iii7-- 7,a7 by striking in the case of and inserting in the case of a targeted low-income child 7including a child provided dental-only supplemental coverage under section #baaj7;b77#e77 or in the case of 2 and 7,b7 by adding and after the semicolon2 7#b7 by striking clause 7iv72 and 7#c7 by redesignating clause 7v7 as clause 7iv74 7b7 ,conforming amendments ,section #baje7;c77#aj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7c77#aj77 is amended by striking subparagraph 7,f7 and redesignating subparagraphs 7,g7 through 7,m7 as subparagraphs 7,f7 through 7,l71 respectively4 7c7 ,effective date ,the amendments made by this section shall take effect on the date of enactment of this ,act4 #e4 ,medicaid performance bonuses for enrollment and retention improvements for certain individuals ,section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 is amended by adding at the end the following new subsection3 7bb7 ,performance bonuses for enrollment and retention of low-,income individuals 7#a7 ,in general ,a ,state may qualify for performance bonuses related to the enrollment and retention of individuals 7including children7 described in section #aijb7;e77#ab77;,c77iii77,,iii74 ,for purposes of this paragraph1 a ,state meets the condition of this paragraph for such individuals if1 for each category of individuals specified in section #aijb7;e77#ab77;,c77iii77,,iii71 the ,state is implementing at least #c of the following enrollment and retention provisions 7treating each subparagraph as a separate enrollment and retention provision7 throughout the entire fiscal year3 7,a7 ,aligning treatment of income under medicaid with that of other insurance affordability programs ,the ,state implements policies1 including prorating income over annual periods1 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 programs4 7,b7 ,maintaining coverage for individuals during periods of transition ,the ,state implements the following policies3 7i7 ,in general ,upon determination that an individual is no longer eligible for medical assistance1 the ,state implements policies to maintain eligibility for medical assistance1 including enrollment in the managed care organization in which the individual was enrolled at the time of the determination of ineligibility1 during the period of time in which-- 7,i7 eligibility-related information is transmitted to the other insurance affordability programs2 7,,ii7 a determination is made as to for which other insurance affordability program the individual is eligible1 if any2 and 7,,iii7 coverage in such program and any related managed care organization becomes effective4 7ii7 ,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 eligibility1 if such managed care organization participates in the other insurance affordability program1 unless the individual voluntarily selects a separate managed care organization4 7,c7 ,enhanced data-sharing between the state and an american health benefit exchange and agencies ,the ,state utilizes findings from an ,american ,health ,benefit ,exchange1 an ,express ,lane ,agency 7as identified by the ,state and as described in section #aijb7;e77#ac77;,f771 the ,social ,security ,administration1 or other agencies administering employment1 educational1 or social services programs as identified by the ,state1 to document income1 residency1 age1 or other relevant information in determining or renewing eligibility4 7,d7 ,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 out4 7,e7 ,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 #f months1 and who previously had been members of a managed care organization1 the ,state re-enrolls the individual in the managed care organization in which the individual was a member prior to the loss of eligibility1 unless the individual voluntarily selects a separate managed care organization4 7#b7 ,performance bonus payment to support #ab-month continuous enrollment for medicaid enrollees 7,a7 ,authority to make bonus payments 7i7 ,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 #c years after the date of enactment of the ,stabilize ,medicaid and ,,chip ,coverage ,act of #bjai1 and annually thereafter to the extent there are funds available under paragraph 7#c77;,a71 to each ,state that satisfies the requirements of subparagraph 7,b74 7ii7 ,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 #f months prior to ,october #a of the first fiscal year for which payments are made under this paragraph4 7iii7 ,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 year4 7,b7 ,state eligibility for bonus payments ,a ,state shall be eligible for bonus payments under this subsection if-- 7i7 the ,state has adopted at least #c of the #e policies described in subparagraphs 7,a7 through 7,e7 of paragraph 7#a7 for each category of individuals specified in section #aijb7;e77#ab77;,c77iii77,,iii72 and 7ii7 the ,state is able to demonstrate improvement in the continuity of enrollment by child1 aged1 blind1 and disabled1 and adult populations1 compared to the ,state's baseline performance with respect to continuity of enrollment for such populations in fiscal year #bjai or1 such later year as the ,secretary1 by regulation1 shall specify4 7#c7 ,amounts available for payments 7,a7 ,in general ,the total amount of bonus payments made under this subsection for all fiscal years shall be equal to #ejj1jjj1jjj1 to be available until expended4 7,b7 ,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 paragraph4 7#d7 ,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 activities4 4