For other versions of this document, see http://wikileaks.org/wiki/CRS-RL30703 ------------------------------------------------------------------------------ Order Code RL30703 CRS Report for Congress Received through the CRS Web Medicaid and SCHIP Provisions in H.R. 5291 and S. 3165 (the 2000 Medicare "Refinement Bills") Updated October 13, 2000 Jean Hearne Elicia Herz Specialists in Social Legislation Evelyne Baumrucker Analyst in Social Legislation Domestic Social Policy Division Congressional Research Service ~ The Library of Congress Medicaid and SCHIP Provisions in H.R. 5291 and S. 3165 (the 2000 Medicare "Refinement Bills") Summary On September 27, 2000, the House Commerce Committee ordered reported a bipartisan bill, the Beneficiary Improvement and Protection Act of 2000 (H.R. 5291). On October 5, 2000 William V. Roth, Jr., the Chairman of the Senate Finance Committee, introduced the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 2000 (S. 3165). While both bills are largely comprised of Medicare provisions, they include a number of changes to the Medicaid and the State Children's Health Insurance Program (SCHIP). Among the major changes included in the Medicaid provisions of both bills are changes to the disproportionate share hospital allotments for states, changes to reimbursement methods for Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs), and new options for states to cover certain legal immigrants who are pregnant women and children. Major SCHIP provisions include extending the availability of unused funds from FY1998 and FY1999 and redistributing these unused funds among both states that spend and that do not spend their full original allotments, and giving states the option to cover certain legal immigrant children. Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Recent Legislative Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Medicaid and SCHIP Provisions in H.R. 5291 and S. 3165 (the 2000 Medicare "Refinement Bills") . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Disproportionate Share Hospital Payments . . . . . . . . . . . . . . . . . . . . . . . . . 5 New Prospective Payment System for FQHCs and RHCs . . . . . . . . . . . . . . 8 Optional Coverage of Certain Legal Immigrants . . . . . . . . . . . . . . . . . . . . . 9 Presumptive Eligibility for Pregnant Women and Children . . . . . . . . . . . . 10 Improving Welfare-To-Work Transition under Medicaid . . . . . . . . . . . . . 12 Medicaid County-Organized Health Systems . . . . . . . . . . . . . . . . . . . . . . 13 Medicaid Recognition for Services of Physician Assistants . . . . . . . . . . . . 13 Extension of Payments for Certain Qualified Medicare Beneficiaries . . . . . 14 Streamlined Approval of Continued State-Wide 1115 Medicaid Waivers . 15 Alaska Federal Matching Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 State Children's Health Insurance Program . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Continued Availability and Redistribution of Unused SCHIP Allotments . 17 Optional Coverage of Certain Legal Immigrants Under SCHIP . . . . . . . . 18 Authority to Pay for Medicaid Expansion SCHIP Costs From Title XXI Appropriation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Other Provisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Juvenile Diabetes Research Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Indian Diabetes Grant Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Medicaid and SCHIP Provisions in H.R. 5291 and S. 3165 (the 2000 Medicare "Refinement Bills") Introduction Medicaid is a joint federal-state entitlement program that pays for medical assistance primarily for low-income persons who are aged, blind, disabled, members of families with dependent children, and certain other pregnant women and children. Within broad federal guidelines, each state designs and administers its own program. Total program outlays in FY1999 were $180.9 billion. Federal outlays were $102.5 billion and state outlays were approximately $78.4 billion. The federal government shares in a state's Medicaid costs by means of a statutory formula designed to provide a higher federal matching rate to states with lower per capita incomes. In FY1999, federal matching rates ranged from 50% to 76% of a state's expenditures for Medicaid items and services. Overall, the federal government finances about 57% of all Medicaid costs. The State Children's Health Insurance Program (SCHIP), enacted in the Balanced Budget Act of 1997 (BBA 97, P.L. 105-33) is targeted at uninsured children who live in families with income below twice the federal poverty level and who would not otherwise be eligible for Medicaid. States may use SCHIP funds to provide coverage through health insurance that meets specific standards for benefits and cost-sharing (known as separate state programs), or through expansions of eligibility under Medicaid, or through a combination of both options. SCHIP entitles states with approved SCHIP plans to pre-determined, annual federal allotments based on a distribution formula set in law. Each state has flexibility to define the group of targeted, low-income children who are eligible for its SCHIP. Eligibility criteria may include, for example, geography, age, income and resources, residency, disability status, access to other health insurance, and duration of eligibility for SCHIP. As of October 4, 2000, all 50 states, the District of Columbia and all five territories had approved SCHIP plans. Among these, 23 are Medicaid expansions, 15 are new or expanded separate state programs, and 18 will use both a Medicaid expansion and a separate state program. The 105th Congress made important changes to the Medicaid program through the BBA 97.1 That legislation included provisions to achieve net Medicaid savings of about $13 billion between FY1998 and FY2002, largely from reductions in 1 For a detailed description of the changes to Medicaid under BBA 97, see CRS Report 98- 132, Medicaid: 105th Congress, by Melvina Ford and Richard Price. CRS-2 supplemental payments to hospitals that serve a disproportionate share of Medicaid and low-income patients. BBA 97 also significantly increased the flexibility that states have to manage their Medicaid programs. In particular, it gave states the option of requiring most beneficiaries to enroll in managed care plans without seeking a federal waiver, and replaced federal reimbursement requirements imposed by the Boren amendments with a public notice process for setting payment rates for institutional services. The Act also required that the previously existing cost-based reimbursement system for Federally Qualified Health Centers and Rural Health Clinics be phased out over a 6-year period. Spending items in the Act included Medicaid coverage for additional children, and increased assistance for low-income individuals to pay Medicare Part B premiums. BBA 97 also included the provisions establishing SCHIP under a new Title XXI of the Social Security Act. SCHIP represents the largest federal effort to provide health insurance coverage to uninsured, low-income children since the enactment of Medicaid in 1965. The program began in October 1997 with total federal funding of $39.7 billion for the period FY1998 through FY2007. The 106th Congress revisited Medicaid and SCHIP in 1999. On November 29 of that year, the President signed the Consolidated Appropriations Act for FY2000 (P.L. 106-113). Included in that bill by reference was the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA 99), a bill largely comprised of Medicare provisions, but which also included a number of changes to the Medicaid and the State Children's Health Insurance Program (SCHIP). In addition to technical amendments to BBA 97, BBRA 99 included provisions allowing for increased Medicaid disproportionate share payments to hospitals for certain states and the District of Columbia, and for extended access to a special $500 million fund to pay for Medicaid eligibility determinations resulting from welfare reform for a longer period of time than allowed under previous law. BBRA 99 also modified the schedule for phasing out cost-based reimbursement for Federally Qualified Health Centers and Rural Health Clinics that had been included in the BBA 97. Changes to SCHIP in BBRA 99 included provisions to improve state-level data collection; to evaluate the SCHIP (and Medicaid) programs with respect to outreach and enrollment practices; and to create a clearinghouse to coordinate and consolidate federal databases and reports on children's health. In addition, BBRA 99 included a number of changes to the formula used to distribute federal SCHIP funds among the states, increased the amounts available for U.S. territories, and minor technical changes.2 2 For a detailed description of changes to Medicaid and SCHIP under BBRA 99, see CRS Report RL30400, Medicaid and the State Children's Health Insurance Program (SCHIP): Provisions in the Consolidated Appropriations Act for FY2000, by Jean Hearne and Elicia Herz. CRS-3 Recent Legislative Activity Committees with jurisdiction over Medicaid and SCHIP, the House Committee on Commerce and the Senate Committee on Finance, are considering legislation that would affect these programs. On September 27, 2000, the House Commerce Committee ordered reported a bipartisan bill, the Beneficiary Improvement and Protection Act of 2000 (H.R. 5291). On October 5, 2000 William V. Roth Jr., the Senate Finance Committee Chairman, introduced the Medicare, Medicaid and SCHIP Balanced Budget Refinement Act of 2000 (S. 3165). While both the House and Senate bills are largely comprised of Medicare provisions, they include a number of changes to Medicaid and SCHIP. Several such provisions appear in both the House and Senate bills. Both would freeze Medicaid disproportionate share hospital (DSH) allotments, but for different fiscal years. H.R. 5291 contains other changes to DSH, including setting a higher rate of increase in such allotments for extremely low DSH states, making other adjustments specific to the District of Columbia and Tennessee, and clarifying that Medicaid beneficiaries enrolled in managed care arrangements must be included in calculations related to DSH payments. In addition, both bills include provisions to replace the current cost-based reimbursement arrangements for Federally Qualified Health Centers and Rural Health Clinics with a new Medicaid prospective payment system. Both bills also clarify states' authority to conduct presumptive eligibility determinations, as defined in Medicaid law, under separate (non-Medicaid) SCHIP programs. Both the House and Senate bills have nearly identical provisions regarding the availability and redistribution of unused FY1998 and FY1999 SCHIP allotments. Following specific formulas, these unspent funds are redistributed to both states that have and have not fully exhausted their original allotments within required time frames. Finally, both bills increase appropriated amounts for diabetes grants under SCHIP, but the amount of the increases differ. Other Medicaid and SCHIP provisions in H.R. 5291 only include: (1) optional coverage of certain legal immigrants who are pregnant women and children, (2) addition of new entities to the list of those qualified to make presumptive eligibility determinations for low-income pregnant women and children, (3) a 1-year extension of transitional medical assistance (TMA) for low-income working families under Medicaid, simplification of TMA reporting and notification requirements, and making TMA optional for states meeting certain income eligibility requirements, (4) continuation of the current exemption from Medicaid health maintenance organization (HMO) reporting requirements for certain county-organized health systems, and (5) addition of the services of physician assistants to the list of optional Medicaid benefits. Other Medicaid and SCHIP provisions in S. 3165 only include: (1) permanent extension of Medicaid payments for Medicare Part B premiums on behalf of qualified Medicare beneficiaries with income up to 135% of the federal poverty level (FPL), (2) streamlined approval of continued statewide 1115 Medicaid waivers, (3) adjustment to the federal medical assistance percentage (FMAP) for Alaska, and (4) authority to pay Medicaid expansion costs under SCHIP out of the SCHIP appropriation, and codification of the Administration's policy regarding the order of payments for specified benefit and administrative costs from state-specific SCHIP allotments. CRS-4 The Congressional Budget Office has released a preliminary cost estimate for H.R. 5291. Changes to Medicaid in the Beneficiary Health Improvement Act as ordered reported on September 27, were estimated to increase federal outlays by $5.7 billion over the 5-year period 2001 to 2005 and $15.1 billion over 10 years (2001- 2010). Provisions affecting SCHIP are estimated to increase federal outlays by $0.2 billion for 2001 through 2005 and $0.3 billion for 2001 through 2010. Cost estimates are not yet available for S. 3165. The following side-by-side comparison provides a description of current law and a more detailed explanation of the proposed changes to Medicaid and SCHIP included in H.R. 5291 and in S. 3165. CRS-5 Medicaid and SCHIP Provisions in H.R. 5291 and S. 3165 (the 2000 Medicare "Refinement Bills") Medicaid Disproportionate Share Hospital Payments S. 3165 H.R. 5291 Medicare, Medicaid and SCHIP Beneficiary Improvement and Balanced Budget Refinement Act of Current Law Protection Act of 2000 2000 Continuation of Medicaid The federal share of Medicaid Freezes state-specific DSH allotments for Freezes Medicaid DSH payments for DSH allotments disproportionate share hospital (DSH) FY2001 and FY2002 at the FY2000 levels. FY2001 at FY2000 levels. payments, payments for hospitals that treat For FY2001 and beyond, each state's DSH a disproportionate share of uninsured and allotment would be equal to its allotment for Effective October 1, 2000. Medicaid enrollees, is capped at specified the previous year increased by the amounts for each state for FY1998 through percentage change in the consumer price FY2002. States' allotments for years after index for the previous year, subject to a 2002 will be equal to its allotment for the ceiling equal to 12% of that state's total previous year increased by the percentage medical assistance payments in that year. change in the consumer price index for the previous year. Each state's DSH payments Effective January 1, 2001. for FY2003 and beyond are limited to no more than 12% of spending for medical assistance for that year. CRS-6 S. 3165 H.R. 5291 Medicare, Medicaid and SCHIP Beneficiary Improvement and Balanced Budget Refinement Act of Current Law Protection Act of 2000 2000 Higher rate of increase in No provision. Creates a higher rate of increase in No provision. Medicaid DSH allotment Medicaid DSH allotments for extremely low for extremely low DSH DSH states. states For states where total FY1999 federal and state DSH spending is less than 1% of the state's total medical assistance expenditures for that fiscal year, the DSH allotment for FY2001 shall be increased to 1% of the state's total amount of expenditures under their plan for such assistance during that fiscal year. Effective January 1, 2001. Allotment for the District The DSH allotment for the District of For the purpose of calculating the FY2001 No provision. of Columbia Columbia is set at $32 million for FY2000 allotment, the FY2000 DSH allotment for and FY2001 . the District of Columbia is increased to $49 million. Effective January 1, 2001. Contingent allotment for Renewable waivers, authorized under If Tennessee's statewide section 1115 No provision. Tennessee section 1915(b), 1915(c), or section 1115 of Medicaid waiver program is revoked or Medicaid law, allow states to waive certain terminated, Tennessee's FY2001 DSH federal requirements in order to operate allotment would be equal to $286,442,437. special programs or projects. Effective January 1, 2001. CRS-7 S. 3165 H.R. 5291 Medicare, Medicaid and SCHIP Beneficiary Improvement and Balanced Budget Refinement Act of Current Law Protection Act of 2000 2000 Assuring identification of States are required to provide Clarifies that Medicaid enrollees of No provision. Medicaid managed care disproportionate share payments to those managed care organizations and primary patients hospitals whose Medicaid inpatient care case management organizations are to utilization rate is at least one standard be included for the purposes of calculating deviation above the mean Medicaid the Medicaid inpatient utilization rate and inpatient utilization rate for all hospitals the low-income utilization rate. The state receiving Medicaid payments in the State, must include in their MCO contracts and those with a low-income utilization rate information that allows the state to above 25%. The Medicaid inpatient determine which hospital services are utilization rate includes the number of provided to Medicaid beneficiaries through inpatient days attributable to Medicaid managed care. Also requires states to beneficiaries. The low-income utilization include a sponsorship code for the managed rate includes the total revenues paid on care entity on the Medicaid beneficiary's behalf of Medicaid beneficiaries. identification card. Effective January 1, 2001. CRS-8 New Prospective Payment System for FQHCs and RHCs S. 3165 H.R. 5291 Medicare, Medicaid and SCHIP Beneficiary Improvement and Balanced Budget Refinement Act of Current Law Protection Act of 2000 2000 New prospective payment States are required to pay FQHCs and Creates a prospective payment system for Same as House bill. system for Federally RHCs amounts that are at least a FQHCs and RHCs. Beginning in FY2001, Qualified Health Centers percentage of the facilities' reasonable costs FQHCs and RHCs would be paid per visit (FQHCs) and Rural for providing services - 100% of costs for payments equal to 100% of reasonable costs Health Centers (RHCs) services during FY1998 and FY1999; 95% incurred during 1999 and 2000 adjusted for for FY2000, FY2001 and FY2002; 90% for any increase or decrease in the scope of FY2003; 85% for FY2004. Cost-based services furnished. Per visit payments for reimbursement expires in 2005. In the case entities first qualifying as FQHCs or RHCs of a contract between an FQHC or RHC after 2000 will begin in the first year that and a managed care organization (MCO), the center or clinic attains such qualification the MCO must pay the FQHC or RHC at and would be 100% of the costs incurred least as much as it would pay any other during that year based on the rates provider for similar services. States are established for similar centers or clinics. required to make supplemental payments to For subsequent years payment for all clinics the FQHCs and RHCs, equal to the would be equal to amounts for the preceding difference between the contracted amounts fiscal year increased by the percentage and the cost-based amounts. increase in the Medicare Economic Index for primary care services, adjusted for any increase or decrease in the scope of services furnished. CRS-9 Optional Coverage of Certain Legal Immigrants S. 3165 H.R. 5291 Medicare, Medicaid and SCHIP Beneficiary Improvement and Balanced Budget Refinement Act of Current Law Protection Act of 2000 2000 Optional coverage for Non-qualified aliens are not eligible for Amends Title XIX to allow states the option No provision. certain sub-groups of federal medical assistance under Title XIX of extending Medicaid coverage to certain qualified aliens except in the case of medical emergency. subgroups of qualified aliens who have lawfully resided in the United States for 2 States are required to cover certain years. They include pregnant women categories of qualified aliens provided they (during pregnancy and for 60 days meet the state's financial and other following birth) and children including eligibility criteria. Other qualified aliens optional targeted low-income children may become eligible for Medicaid at state covered by Medicaid. option, subject to their state's financial and other criteria. For states that elect to provide medical assistance to a sub-category of aliens, Qualified aliens entering with sponsors after action may not be brought under an December 19, 1997 are subject to the affidavit of support against the sponsor of "deeming rule", under which the sponsors' such an alien on the basis of the medical income and resources are deemed to be care received. available to the immigrant in determining the immigrant's financial eligibility for Effective October 1, 2000. benefits until the immigrant becomes a citizen or meets the 10-year work requirement. CRS-10 Presumptive Eligibility for Pregnant Women and Children S. 3165 H.R. 5291 Medicare, Medicaid and SCHIP Beneficiary Improvement and Balanced Budget Refinement Act of Current Law Protection Act of 2000 2000 Entities that qualify to Presumptive eligibility allows pregnant Adds several new entities to the list of those No provision. determine presumptive women and children in families with income qualified to make Medicaid presumptive eligibility for low-income that appears to be below a state's Medicaid eligibility determinations for children and pregnant women and income standards to enroll temporarily in pregnant women. These include agencies children Medicaid, until a final formal determination that determine eligibility for Medicaid or the of eligibility is made. For children, entities State Children's Health Insurance Program qualified to make presumptive eligibility (SCHIP); certain elementary and secondary determinations include Medicaid providers, schools; state or tribal child support and agencies that determine eligibility for enforcement agencies; child care resource Head Start, subsidized child care, or the and referral agencies; certain organizations Special Supplemental Food Program for providing emergency food and shelter to the Women, Infants and Children (WIC). For homeless; entities involved in enrollment pregnant women, qualified entities include under Medicaid, Temporary Assistance for Medicaid providers of outpatient hospital Needy Families (TANF), SCHIP, or that and clinic services receiving certain federal determine eligibility for federally funded grants, providers of certain food and housing assistance; or any other entity nutritional supplement services, state deemed by a state, as approved by the perinatal program providers, or providers of Secretary of Health and Human Services certain health services for Indians. (HHS). Effective October 1, 2000. CRS-11 S. 3165 H.R. 5291 Medicare, Medicaid and SCHIP Beneficiary Improvement and Balanced Budget Refinement Act of Current Law Protection Act of 2000 2000 Application of There is no express provision for Clarifies states' authority to conduct Clarifies states' authority to conduct presumptive eligibility presumptive eligibility under separate (non- presumptive eligibility, as defined in presumptive eligibility as defined in provisions to State Medicaid) SCHIP programs. However, the Medicaid law (and amended by the previous Medicaid law under separate (non- Children's Health Secretary of HHS permits states to develop, provision), under separate (non-Medicaid) Medicaid) SCHIP programs. Insurance Program for separate (non-Medicaid) SCHIP SCHIP programs. (SCHIP) programs, procedures that are similar to Effective October 1, 2000 and applies to those permitted under Medicaid . Effective October 1, 2000. SCHIP allotments for fiscal year 2001 forward. CRS-12 Improving Welfare-To-Work Transition under Medicaid S. 3165 H.R. 5291 Medicare, Medicaid and SCHIP Beneficiary Improvement and Balanced Budget Refinement Act of Current Law Protection Act of 2000 2000 Extension and In 1996, Temporary Assistance for Needy Extends the sunset on TMA by one year to No provision. simplification options Families (TANF) replaced Aid to Families FY2002. with Dependent Children (AFDC). Medicaid entitlement was retained for Allows states to waive reporting individuals who meet the requirements of requirements for families qualifying for up the former AFDC program in effect on July to 12 months of TMA (and the 16, 1996, even if they do not qualify for corresponding obligation of states to notify TANF. For Medicaid purposes, states may families of these reporting requirements). modify their former AFDC income and resource standards within specified Makes TMA an option, rather than a parameters. States are required to continue requirement, for the subset of states that: Medicaid coverage for a period of 6 to 12 (1) use income and resource methodologies months for individuals described above who that are less restrictive than those applicable meet specified prior enrollment under their former AFDC programs on July requirements and who then lose Medicaid 16, 1996 for individuals who meet the other coverage because of employment or requirements for this group, and (2) cover, earnings rules applicable to this eligibility at a minimum, such individuals in families group. This transitional medical assistance with gross income up to 185% FPL. States (TMA) will sunset at the end of FY2001. in this subset are further deemed to meet States must adhere to certain beneficiary Medicaid state plan requirements specified notification requirements for TMA. in other sections of current law. Families who qualify for the full 12 months of TMA must report gross earnings and Effective October 1, 2000. employment-related child care costs for each of months 1 through 9. CRS-13 Medicaid County-Organized Health Systems S. 3165 H.R. 5291 Medicare, Medicaid and SCHIP Beneficiary Improvement and Balanced Budget Refinement Act of Current Law Protection Act of 2000 2000 Medicaid county- Health insuring organizations (HIOs) are Allows the current exemption from No provision. organized health systems county-sponsored health maintenance Medicaid HMO contracting requirements to organizations. Up to three HIOs designated continue to apply as long as no more than by the state of California are exempt from 14% of all Medicaid beneficiaries in certain federal statutory requirements for California are enrolled in those HIOs. Medicaid HMO contracts. The exemption only applies if the HIOs enroll no more than Effective as if included in the Consolidated 10 percent of all Medicaid beneficiaries in Omnibus Budget Reconciliation Act of California (not counting qualified Medicare 1985. beneficiaries.) Medicaid Recognition for Services of Physician Assistants S. 3165 H.R. 5291 Medicare, Medicaid and SCHIP Beneficiary Improvement and Balanced Budget Refinement Act of Current Law Protection Act of 2000 2000 Optional Medicaid Federal statute lists services that qualify as Includes services provided by physician No provision. coverage of physician Medicaid benefits. Federal matching assistants as Medicaid recognized benefits assistants payments are available toward the cost of as long as the services are provided under items on the list, if covered by State the supervision of a physician and are Medicaid programs. States are required to authorized under State law. The services of cover certain of those listed items and may physician assistants would be an optional choose to cover other items on the list. Medicaid benefit. Effective upon enactment. CRS-14 Extension of Payments for Certain Qualified Medicare Beneficiaries S. 3165 H.R. 5291 Medicare, Medicaid and SCHIP Beneficiary Improvement and Balanced Budget Refinement Act of Current Law Protection Act of 2000 2000 Extension of authorization Medicaid covers the costs of certain No provision. The Committee's provision would remove for certain Medicare Medicare financial obligations for qualified the sunset date of December 2002, but only qualified individuals Medicare beneficiaries (QMBs), specified for QI-1 eligibility status. It also would low income Medicare beneficiaries create an allotment for FY2003 and beyond (SLMBs) and two groups of "qualified that is equal to the allotment for the individuals" referred to as QI-1s and QI-2s. previous fiscal year increased by the QMBs are aged or disabled persons with percentage increase in the medical care incomes at or below the federal poverty line component of the Consumer Price Index for and assets below twice the SSI level. The urban consumers. eligibility pathways for QI-1 and QI-2 are authorized only between January of 1998 Effective as if included in BBA97. and December 2002 when QI-1 and QI-2. Federal amounts available for covering the costs of Medicaid benefits for QI-1s and QI-2s are capped for each of the fiscal years 1998-2002. States are allocated a portion of each year's allotment based on a formula that compares the number of individuals estimated to be in the two groups in each state relative to the national total of individuals in the two groups. CRS-15 Streamlined Approval of Continued State-Wide 1115 Medicaid Waivers S. 3165 H.R. 5291 Medicare, Medicaid and SCHIP Beneficiary Improvement and Balanced Budget Refinement Act of Current Law Protection Act of 2000 2000 Extension of waivers Under Section 1115 of the Social Security No provision. Creates a process for submitting requests under Section 1115 of the Act, states may obtain waivers of for and receiving extensions of waiver Social Security Act compliance with a broad range of Medicaid projects that have already received an initial requirements to conduct experimental, pilot, 3-year extension. Requires states to submit or demonstration projects. Waivers are applications to extend those projects at least approved for a period of 5 years. States 120 days before the expiration date of the wishing to obtain approval for periods existing waiver. The Secretary would be beyond 5 years may submit, during the 6- required to notify the State if she intends to month period ending 1 year before the date review the terms and conditions of the the waiver would otherwise expire, a written project and inform the State of proposed request for an extension of up to 3 years. changes no later than 45 days after receipt. If the Secretary fails to provide such notification, the request is deemed approved. No more than 120 days after submission (or a later date if agreed to by the state), the request would be either approved subject to new terms and conditions or, in the absence of an agreement on those terms, new terms and conditions determined by the Secretary to be reasonably consistent with the overall objective of the waiver. CRS-16 Alaska Federal Matching Rate S. 3165 H.R. 5291 Medicare, Medicaid and SCHIP Beneficiary Improvement and Balanced Budget Refinement Act of Current Law Protection Act of 2000 2000 Alaska FMAP The federal share of the cost of Medicaid No provision. Changes the formula for calculating the services is equal to the federal medical FMAP for Alaska for fiscal years 2001 assistance percentage (FMAP) of those through 2005. The state percentage for costs. It is determined annually according Alaska would be calculated by using an to a statutory formula designed to pay a adjusted per capita income instead of the higher federal matching percentage to states per capita income generally used. The with lower per capita incomes relative to the adjusted per capita income for Alaska national average. would be calculated as the three year average per capita income for the state BBA 97 included a provision that set the divided by 1.05. FMAP for Alaska at 59.8% for FY1998 through FY2000. Applies to fiscal years 2001 through 2005. CRS-17 State Children's Health Insurance Program Continued Availability and Redistribution of Unused SCHIP Allotments S. 3165 H.R. 5291 Medicare, Medicaid and SCHIP Beneficiary Improvement and Balanced Budget Refinement Act of Current Law Protection Act of 2000 2000 Continued availability Funds for the SCHIP Program are Establishes new methods for distributing Identical to the House reported bill with two and redistribution of authorized and appropriated for FY1998 unspent FY1998 and FY1999 allotments. exceptions. First, specifies that reallocated unused FY1998 and through FY2007. From each year's States that use all their SCHIP allotments funds remain available through the end of FY1999 SCHIP allotments appropriation, a state is allotted an amount (for each of those years) would receive an FY2002 for both states that spend and those as determined by a formula set in law. amount equal to estimated spending in that do not spend all their original Federal funds not drawn down from a excess of their original exhausted allotment. allotments within the specified timeframes. state's allotment by the end of each fiscal Second, the effective date of the Senate year continue to be available to that state amendment is as if included in the for 2 additional fiscal years. Allotments not Each territory that spends its original enactment of BBA 97 (August 5, 1997). spent at the end of 3 years will be allotment would receive an amount that redistributed by the Secretary of Health and bears the same ratio to 1.05% of the total Human Services (HHS) to states that have amount available for redistribution as the fully spent their original allotments for that ratio of its original allotment to the total year. Redistributed funds not spent by the allotment for all territories. end of the fiscal year in which they are reallocated officially expire. All States that do not use all their SCHIP administrative expenses including outreach allotment would receive an amount equal to activities are subject to an overall limit of the total amount of unspent funds, less 10% of total program spending per fiscal amounts distributed to states that fully year. exhausted their original allotments, multiplied by the ratio of a state's unspent original allotment to the total amount of unspent funds. Redistributed funds would remain available through the end of FY2002. States may use up to 10% of the retained FY1998 funds for outreach activities. Effective upon enactment. CRS-18 Optional Coverage of Certain Legal Immigrants Under SCHIP S. 3165 H.R. 5291 Medicare, Medicaid and SCHIP Beneficiary Improvement and Balanced Budget Refinement Act of Current Law Protection Act of 2000 2000 Allows for state option of For states that provide SCHIP coverage Adds a new provision that gives states the No provision. SCHIP coverage to through a Medicaid expansion, legal option of expanding health insurance certain subgroups of immigrant children are subject to the same coverage to permanent resident alien qualified aliens Medicaid restrictions as other legal children who are otherwise eligible for immigrants. States that operate a separate SCHIP and who have been lawfully residing state SCHIP program must cover those in the United States for 2 years. The legal immigrant children who meet the coverage expansion would only be available Federal definition of qualified alien and who to states that have expanded coverage to are otherwise eligible. These states may this category of children under their also cover battered immigrants. Medicaid state plan. For qualified alien children entering with Effective October 1, 2000. sponsors after December 19, 1997, SCHIP coverage is subject to the "deeming rule." CRS-19 Authority to Pay for Medicaid Expansion SCHIP Costs From Title XXI Appropriation S. 3165 H.R. 5291 Medicare, Medicaid and SCHIP Beneficiary Improvement and Balanced Budget Refinement Act of Current Law Protection Act of 200 2000 Authority to pay for States' allotments under SCHIP pay only No provision. Authorizes the payment of the costs of Medicaid expansion the federal share of costs associated with SCHIP Medicaid expansions from the SCHIP costs from Title separate (non-Medicaid) SCHIP programs. SCHIP appropriation. As a conforming XXI appropriation The federal share of costs associated with amendment, eliminates the requirement that SCHIP Medicaid expansions are paid for state SCHIP allotments be reduced by under Medicaid. State SCHIP allotments amounts paid under Medicaid for SCHIP are reduced by the amounts paid under Medicaid expansion costs and presumptive Medicaid for SCHIP Medicaid expansion eligibility costs. Also codifies proposed costs, and presumptive eligibility costs. rules regarding the order of payments for benefits and administrative costs from state- specific SCHIP allotments. For fiscal years 1998 through 2000 only, authorizes the transfer of unexpended SCHIP appropriations to the Medicaid appropriation account for the purpose of reimbursing payments associated with SCHIP Medicaid expansion programs. Effective as if included in the enactment of the Balanced Budget Act of 1997 (August 5, 1997). CRS-20 Other Provisions Juvenile Diabetes Research Program S. 3165 H.R. 5291 Medicare, Medicaid and SCHIP Beneficiary Improvement and Balanced Budget Refinement Act of Current Law Protection Act of 2000 2000 Juvenile Diabetes The Balanced Budget Act of 1997 amended Extends the authority for grants to be made Increases the appropriated funds available Research Title III of the Public Health Service Act to for Juvenile Diabetes Research and for diabetes grants, bringing the total to create a grant program under which the increases funding to $50 million each for $100 million each for FY2001 and FY2002. Secretary could make grants to support FY2003 and FY2007. The funds will prevention and treatment services of, and remain available until expended. The funds research relating to, type I diabetes in may not be derived or deducted from the children. Congress committed $150 million, State Children's Health Insurance Program. ($30 million each year over 5 years FY1998 through FY2002), for this program, with the funds being transferred from Title XXI of the Social Security Act (State Children's Health Insurance Program) for these grants. This commitment was in addition to the annual appropriations for NIH. CRS-21 Indian Diabetes Grant Program S. 3165 H.R. 5291 Medicare, Medicaid and SCHIP Beneficiary Improvement and Balanced Budget Refinement Act of Current Law Protection Act of 2000 2000 Indian Diabetes Grants The Balanced Budget Act of 1997 amended Extends the authority for grants to be made Increases the appropriated funds available Title III of the Public Health Service Act to for diabetes prevention and treatment for diabetes prevention and treatment create a grant program under which the programs for Indians, and increases funding programs for Indians, bringing the total to Secretary could make grants to support to $50 million each for FY2003 and $100 million each for FY2001 and FY2002. prevention and treatment services of FY2007. The funds will remain available diabetes in Indians. These grants were to until expended. The funds may not be purchase services provided through one or derived or deducted from the State more of the following entities: the Indian Children's Health Insurance Program. Health Service, a tribal Indian health program, and an urban Indian health program. Congress committed $150 million, ($30 million each year over 5 years FY1998 through FY2002), for this program, with the funds being transferred from Title XXI of the Social Security Act (State Children's Health Insurance Program) for these grants. ------------------------------------------------------------------------------ For other versions of this document, see http://wikileaks.org/wiki/CRS-RL30703