A State child health plan shall include a description, consistent with the requirements of this subchapter, of-
The plan shall include a description of the standards used to determine the eligibility of targeted low-income children for child health assistance under the plan. Such standards may include (to the extent consistent with this subchapter) those relating to the geographic areas to be served by the plan, age, income and resources (including any standards relating to spenddowns and disposition of resources), residency, disability status (so long as any standard relating to such status does not restrict eligibility), access to or coverage under other health coverage, and duration of eligibility. Such standards may not discriminate on the basis of diagnosis.
Such eligibility standards-
The plan shall include a description of methods of establishing and continuing eligibility and enrollment.
The plan shall include a description of procedures to be used to ensure-
Subject to subparagraph (B), the plan shall include a description of the procedures used to reduce administrative barriers to the enrollment of children and pregnant women who are eligible for medical assistance under subchapter XIX or for child health assistance or health benefits coverage under this subchapter. Such procedures shall be established and revised as often as the State determines appropriate to take into account the most recent information available to the State identifying such barriers.
A State shall be deemed to comply with subparagraph (A) if the State's application and renewal forms and supplemental forms (if any) and information verification process is the same for purposes of establishing and renewing eligibility for children and pregnant women for medical assistance under subchapter XIX and child health assistance under this subchapter, and such process does not require an application to be made in person or a face-to-face interview.
Nothing in this subchapter shall be construed as providing an individual with an entitlement to child health assistance under a State child health plan.
A State child health plan shall include a description of the procedures to be used by the State to accomplish the following:
Outreach (through community health workers and others) to families of children likely to be eligible for child health assistance under the plan or under other public or private health coverage programs to inform these families of the availability of, and to assist them in enrolling their children in, such a program.
Coordination of the administration of the State program under this subchapter with other public and private health insurance programs.
In the case of a State that provides for premium assistance subsidies under the State child health plan in accordance with paragraph (2)(B), (3), or (10) of section 1397ee(c) of this title, or a waiver approved under section 1315 of this title, outreach, education, and enrollment assistance for families of children likely to be eligible for such subsidies, to inform such families of the availability of, and to assist them in enrolling their children in, such subsidies, and for employers likely to provide coverage that is eligible for such subsidies, including the specific, significant resources the State intends to apply to educate employers about the availability of premium assistance subsidies under the State child health plan.
The State child health plan shall provide that-
A State child health plan shall provide that, in the case of a targeted low-income child who is within 30 days of the date on which such child is scheduled to be released from a public institution following adjudication, the State shall have in place a plan for providing, and shall provide in accordance with such plan, screenings, diagnostic services, referrals, and case management services otherwise covered under the State child health plan (or waiver of such plan) in the same manner as described in section 1396a(a)(84)(D) of this title.
1See References in Text note below.
42 U.S.C. § 1397bb
Applicability of Amendment Amendment of section by section 205(b)(1) of title I of div. G of Pub. L. 118-42 applicable beginning Jan. 1, 2026. See 2024 Amendment notes below. Amendment of section by section 5121(c)(1) of Pub. L. 117-328 applicable beginning on the first day of the first calendar quarter that begins on or after the date that is 24 months after Dec. 29, 2022. See 2022 Amendment note below.
EDITORIAL NOTES
REFERENCES IN TEXTThe Internal Revenue Code of 1986, referred to in subsec. (b)(1)(B)(v), is classified generally to Title 26, Internal Revenue Code.Section 1603(c) of title 25, referred to in subsec. (b)(3)(D), was redesignated section 1603(13) of title 25 by Pub. L. 111-148, title X, §10221(a), Mar. 23, 2010, 124 Stat. 935.
AMENDMENTS2024-Subsec. (d)(1)(A). Pub. L. 118-42, §205(b)(1)(B)-(D), inserted "or targeted low-income pregnant woman" after "targeted low-income child", "or pregnant woman" after "because the child", and "or pregnant woman" after "during the period the child". Pub. L. 118-42, §205(b)(1)(A), which directed insertion of "or pregnancy-related" after "child health", was executed by making the insertion before "assistance under the State child health plan" to reflect the probable intent of Congress. 2022-Subsec. (d). Pub. L. 117-328 added subsec. (d).2018-Subsec. (a)(7)(B). Pub. L. 115-271 substituted "paragraphs (5) and (6) of section 1397cc(c)" for "section 1397cc(c)(5)".2016-Subsec. (a)(7)(C). Pub. L. 114-198 added subpar. (C).2010-Subsec. (b)(1)(B)(v). Pub. L. 111-152 substituted "modified adjusted gross income" for "modified gross income". Pub. L. 111-148 added cl. (v).2009-Subsec. (a)(7)(B). Pub. L. 111-3, §501(a)(2), inserted "and services described in section 1397cc(c)(5) of this title" after "emergency services".Subsec. (b)(1)(B)(iii), (iv). Pub. L. 111-3, §§111(b)(2), 501, added cls. (iii) and (iv).Subsec. (b)(4), (5). Pub. L. 111-3, §212, added par. (4) and redesignated former par. (4) as (5). Subsec. (c)(1). Pub. L. 111-3, §201(b)(2)(B)(i), inserted "(through community health workers and others)" after "Outreach". Subsec. (c)(3). Pub. L. 111-3, §302(a), added par. (3).
STATUTORY NOTES AND RELATED SUBSIDIARIES
EFFECTIVE DATE OF 2024 AMENDMENT Pub. L. 118-42, div. G, title I, §205(b)(2), Mar. 9, 2024, 138 Stat. 406, provided that: "The amendments made by paragraph (1) [amending this section] shall apply beginning January 1, 2026."
EFFECTIVE DATE OF 2022 AMENDMENT Amendment by Pub. L. 117-328 applicable beginning on the first day of the first calendar quarter that begins on or after the date that is 24 months after Dec. 29, 2022, see section 5121(d) of Pub. L. 117-328 set out as a note under section 1396a of this title.
EFFECTIVE DATE OF 2018 AMENDMENT Pub. L. 115-271, title V, §5022(e), Oct. 24, 2018, 132 Stat. 3965, provided that:"(1) IN GENERAL.-Subject to paragraph (2), the amendments made by this section [amending this section and sections 1397cc and 1397jj of this title] shall take effect with respect to child health assistance provided on or after the date that is 1 year after the date of the enactment of this Act [Oct. 24, 2018]."(2) EXCEPTION FOR STATE LEGISLATION.-In the case of a State child health plan under title XXI of the Social Security Act [42 U.S.C. 1397aa et seq.] (or a waiver of such plan), which the Secretary of Health and Human Services determines requires State legislation in order for the respective plan (or waiver) to meet any requirement imposed by the amendments made by this section, the respective plan (or waiver) shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement 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 section [Oct. 24, 2018]. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature."
EFFECTIVE DATE OF 2009 AMENDMENT Amendment by sections 111(b)(2), 201(b)(2)(B)(i), 212, 302(a), and 501(b)(2) of Pub. L. 111-3 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 an Effective Date note under section 1396 of this title. Pub. L. 111-3, title V, §501(a)(3), Feb. 4, 2009, 123 Stat. 85, provided that: "The amendments made by paragraphs (1) and (2) [amending this section and section 1397cc of this title] shall apply to coverage of items and services furnished on or after October 1, 2009."
- Secretary
- The term "Secretary" means the Secretary of Housing and Urban Development.1See References in Text note below.
- person
- The term "person" means an individual, a trust or estate, a partnership, or a corporation.