For purposes of this subchapter, the term "child health assistance" means payment for part or all of the cost of health benefits coverage for targeted low-income children that includes any of the following (and includes, in the case described in section 1397ee(a)(1)(D)(i) of this title, payment for part or all of the cost of providing any of the following), as specified under the State plan:
For purposes of this subchapter-
Subject to paragraph (2), the term "targeted low-income child" means a child-
Such term does not include-
A child shall not be considered to be described in paragraph (1)(C) notwithstanding that the child is covered under a health insurance coverage program that has been in operation since before July 1, 1997, and that is offered by a State which receives no Federal funds for the program's operation.
The term "medicaid applicable income level" means, with respect to a child, the effective income level (expressed as a percent of the poverty line) that has been specified under the State plan under subchapter XIX (including under a waiver authorized by the Secretary or under section 1396a(r)(2) of this title), as of March 31, 1997, for the child to be eligible for medical assistance under section 1396a(l)(2) or 1396d(n)(2) of this title (as selected by a State) for the age of such child.
Subject to subparagraphs (B) and (C), in the case of any child who is enrolled in a group health plan or health insurance coverage offered through an employer who would, but for the application of paragraph (1)(C), satisfy the requirements for being a targeted low-income child under a State child health plan that is implemented under this subchapter, a State may waive the application of such paragraph to the child in order to provide-
A State may limit the application of a waiver of paragraph (1)(C) to children whose family income does not exceed a level specified by the State, so long as the level so specified does not exceed the maximum income level otherwise established for other children under the State child health plan.
A State may not offer dental-only supplemental coverage under this paragraph unless the State satisfies the following conditions:
The State child health plan under this subchapter-
The State child health plan may not provide more favorable dental coverage or cost-sharing protection for dental coverage to children provided dental-only supplemental coverage under this paragraph than the dental coverage and cost-sharing protection for dental coverage provided to targeted low-income children who are eligible for the full range of child health assistance provided under the State child health plan.
A child shall not be considered to be described in paragraph (2)(B) if-
For purposes of subparagraph (A)(i), a public agency satisfies this subparagraph if the amount of annual agency expenditures made on behalf of employees enrolled in health coverage paid for by the agency that includes dependent coverage for the most recent State fiscal year is not less than the amount of such expenditures made by the agency for the 1997 State fiscal year, increased by the percentage increase in the medical care expenditure category of the Consumer Price Index for All-Urban Consumers (all items: U.S. City Average) for such preceding fiscal year.
For purposes of subparagraph (A)(ii), this subparagraph applies to a child if the State determines that the annual aggregate amount of premiums and cost-sharing imposed for coverage of the family of the child would exceed 5 percent of such family's income for the year involved.
In the case of a child who is an inmate of a public institution, during the 30 days prior to the release of the child from such institution the child shall not be considered to be described in paragraph (2)(A) with respect to the screenings, diagnostic services, referrals, and case management services otherwise covered under the State child health plan (or waiver of such plan) that the State is required to provide under section 1397bb(d)(2) of this title.
For purposes of this subchapter:
The term "child" means an individual under 19 years of age.
The term "creditable health coverage" has the meaning given the term "creditable coverage" under section 2701(c)2 of the Public Health Service Act (42 U.S.C. 300gg(c)) and includes coverage that meets the requirements of section 1397cc of this title provided to a targeted low-income child under this subchapter or under a waiver approved under section 1397ee(c)(2)(B) of this title (relating to a direct service waiver).
The terms "group health plan", "group health insurance coverage", and "health insurance coverage" have the meanings given such terms in section 300gg-91 of this title.
The term "low-income child" means a child whose family income is at or below 200 percent of the poverty line for a family of the size involved.
The term "poverty line" has the meaning given such term in section 9902(2) of this title, including any revision required by such section.
The term "preexisting condition exclusion" has the meaning given such term in section 2701(b)(1)(A)2 of the Public Health Service Act (42 U.S.C. 300gg(b)(1)(A)).
Unless the context otherwise requires, the terms "State child health plan" and "plan" mean a State child health plan approved under section 1397ff of this title.
The term "uncovered child" means a child that does not have creditable health coverage.
The term "school-based health center" means a health clinic that-
For purposes of subparagraph (A)(iii), the term "sponsoring facility" includes any of the following:
1So in original. A closing parenthesis probably should precede the period.
2See References in Text note below.
42 U.S.C. § 1397jj
Applicability of Amendment Amendment of section by section 5121(c)(2) 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 notes below.
Amendment of Subsection (b)(7) Pub. L. 117-328 div. FF, title V, §5122(b), (c), Dec. 29, 2022, 136 Stat. 5944, provided that, effective on the first day of the first calendar quarter that begins after the date that is 24 months after Dec. 29, 2022 and applicable to items and services furnished for periods beginning on or after such date, subsection (b)(7) of this section is amended as follows: (1) in the heading, by striking "Exception" and inserting "Exceptions"; and(2) by adding at the end the following new sentence: "At the option of the State, a child who is an inmate of a public institution shall not be considered to be described in paragraph (2)(A) during the period that the child is an inmate of such institution pending disposition of charges."See 2022 Amendment note below.
EDITORIAL NOTES
REFERENCES IN TEXTSection 2701 of the Public Health Service Act, referred to in subsec. (c)(2), (6), is section 2701 of act July 1, 1944, which was classified to section 300gg of this title, was renumbered section 2704, effective for plan years beginning on or after Jan. 1, 2014, with certain exceptions, and amended, by Pub. L. 111-148, title I, §§1201(2), 1563, formerly §1562(c)(1), title X, §10107(b)(1), Mar. 23, 2010, 124 Stat. 154, 264, 911, and was transferred to section 300gg-3 of this title. A new section 2701 of act July 1, 1944, related to fair health insurance premiums, was added, effective for plan years beginning on or after Jan. 1, 2014, and amended, by Pub. L. 111-148, title I, §1201(4), title X, §10103(a), Mar. 23, 2010, 124 Stat. 155, 892, and is classified to section 300gg of this title.
AMENDMENTS2022-Subsec. (b)(2)(A). Pub. L. 117-328, §5121(c)(2)(A), inserted "except as provided in paragraph (7)," before "a child who is an inmate of a public institution".Subsec. (b)(7). Pub. L. 117-328, §5122(b), substituted "Exceptions" for "Exception" in heading and inserted in text at end "At the option of the State, a child who is an inmate of a public institution shall not be considered to be described in paragraph (2)(A) during the period that the child is an inmate of such institution pending disposition of charges." Pub. L. 117-328, §5121(c)(2)(B), added par. (7).2018-Subsec. (a)(18). Pub. L. 115-271, §5022(b)(2)(B)(i), substituted "substance use" for "substance abuse" in two places.Subsec. (a)(19). Pub. L. 115-271, §5022(b)(2)(B)(ii), substituted "substance use" for "substance abuse".Subsec. (b)(5)(A)(i). Pub. L. 115-271, §5022(b)(2)(C), substituted "subsection (c)(6)" for "subsection (c)(5)".2015-Subsec. (c)(9)(B)(v). Pub. L. 114-95 made technical amendment to reference in original act which appears in text as reference to section 7801 of title 20. 2010-Subsec. (a)(23). Pub. L. 111-148, §2302(b), which directed insertion of "(concurrent, in the case of an individual who is a child, with care related to the treatment of the child's condition with respect to which a diagnosis of terminal illness has been made" after "hospice care", was executed by making the insertion after "Hospice care", to reflect the probable intent of Congress.Subsec. (b)(2)(B). Pub. L. 111-148, §10203(d)(2)(D)(i), inserted "except as provided in paragraph (6)," before "a child".Subsec. (b)(6). Pub. L. 111-148, §10203(d)(2)(D)(ii), added par. (6).Subsec. (b)(6)(B). Pub. L. 111-309, §205(d)(1), struck out "per person" before "agency contribution" in heading and substituted "employees" for "each employee". Subsec. (b)(6)(C). Pub. L. 111-309, §205(d)(2), struck out ",on a case-by-case basis," after "determines".Subsec. (c)(9)(B)(v). Pub. L. 111-148, §2102(a)(7), substituted "local educational agency (as defined under section 7801 of title 20" for "school or school system". 2009-Subsec. (b)(1)(C). Pub. L. 111-3, §501(b)(1)(A), inserted ",subject to paragraph (5)," after "subchapter XIX or".Subsec. (b)(5). Pub. L. 111-3, §501(b)(1)(B), added par. (5).Subsec. (c)(9). Pub. L. 111-3, §505(b), added par. (9). 2000-Subsec. (a). Pub. L. 106-554 substituted "section 1397ee(a)(1)(D)(i)" for "section 1397ee(a)(2)(A)" in introductory provisions.1997-Subsec. (b)(1)(B)(ii). Pub. L. 105-100, §162(3)(A), amended cl. (ii) generally. Prior to amendment, cl. (ii) read as follows: "is a child whose family income (as determined under the State child health plan) exceeds the medicaid applicable income level (as defined in paragraph (4)), but does not exceed 50 percentage points above the medicaid applicable income level; and". Subsec. (b)(4). Pub. L. 105-100, §162(3)(B), substituted "March 31, 1997" for "June 1, 1997" and "1396a(l)(2) or 1396d(n)(2) of this title (as selected by a State)" for "1396a(l)(2) of this title". Subsec. (c)(3). Pub. L. 105-100, §162(9), made technical amendment to reference in original act which appears in text as reference to section 300gg-91 of this title.
STATUTORY NOTES AND RELATED SUBSIDIARIES
EFFECTIVE DATE OF 2022 AMENDMENT Amendment by section 5121(c)(2) 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 section 5121(d) of Pub. L. 117-328 set out as a note under section 1396a of this title. Amendment by section 5122(b) of Pub. L. 117-328 effective on the first day of the first calendar quarter that begins after the date that is 24 months after Dec. 29, 2022 and applicable to items and services furnished for periods beginning on or after such date, see section 5122(c) of Pub. L. 117-328 set out as a note under section 1396a of this title.
EFFECTIVE DATE OF 2018 AMENDMENT Amendment by Pub. L. 115-271 effective with respect to child health assistance provided on or after the date that is 1 year after Oct. 24, 2018, with exception if State legislation required, see section 5022(e) of Pub. L. 115-271 set out as a note under section 1397bb of this title.
EFFECTIVE DATE OF 2015 AMENDMENT Amendment by Pub. L. 114-95 effective Dec. 10, 2015, except with respect to certain noncompetitive programs and competitive programs, see section 5 of Pub. L. 114-95 set out as a note under section 6301 of Title 20, Education.
EFFECTIVE DATE OF 2010 AMENDMENT Pub. L. 111-148, title II, §2102(a), Mar. 23, 2010, 124 Stat. 288, provided that the amendment made by section 2102(a)(7) of Pub. L. 111-148 is effective as if included in the enactment of the Children's Health Insurance Program Reauthorization Act of 2009 (Pub. L. 111-3).
EFFECTIVE DATE OF 2009 AMENDMENT Amendment by 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.
EFFECTIVE DATE OF 2000 AMENDMENT Amendment by Pub. L. 106-554 effective as if included in the enactment of section 4901 of Pub. L. 105-33 see section 1(a)(6) [title VIII, §802(f)] of Pub. L. 106-554 set out as a note under section 1396d of this title.
EFFECTIVE DATE OF 1997 AMENDMENT Pub. L. 105-100, title I, §162, Nov. 19, 1997, 111 Stat. 2188, provided in part that the amendment made by that section is effective as if included in the enactment of subtitle J (§§4901-4923) of title IV of the Balanced Budget Act of 1997, Pub. L. 105-33.
CHIP ELIGIBILITY FOR CHILDREN INELIGIBLE FOR MEDICAID AS A RESULT OF ELIMINATION OF DISREGARDS Pub. L. 111-148, title II, §2101(f), Mar. 23, 2010, 124 Stat. 287, provided that: "Notwithstanding any other provision of law, a State shall treat any child who is determined to be ineligible for medical assistance under the State Medicaid plan or under a waiver of the plan as a result of the elimination of the application of an income disregard based on expense or type of income, as required under section 1902(e)(14) of the Social Security Act [42 U.S.C. 1396a(e)(14)] (as added by this Act), as a targeted low-income child under section 2110(b) [42 U.S.C. 1397jj(b)] (unless the child is excluded under paragraph (2) of that section) and shall provide child health assistance to the child under the State child health plan (whether implemented under title XIX or XXI, or both, of the Social Security Act [42 U.S.C. 1396 et seq., 1397aa et seq.])."
- 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.