text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Start Healthy, Stay Healthy Act of 
  2005''.
  
  SEC. 2. STATE OPTION TO EXPAND OR ADD COVERAGE OF CERTAIN PREGNANT 
                WOMEN UNDER MEDICAID AND SCHIP.
  
      (a) Medicaid.--
              (1) Authority to expand coverage.--Section 1902(l)(2)(A)(i) 
          of the Social Security Act (42 U.S.C. 1396a(l)(2)(A)(i)) is 
          amended by inserting ``(or such higher percent as the State may 
          elect for purposes of expenditures for medical assistance for 
          pregnant women described in section 1905(u)(4)(A))'' after 
          ``185 percent''.
              (2) Enhanced matching funds available if certain conditions 
          met.--Section 1905 of the Social Security Act (42 U.S.C. 1396d) 
          is amended--
                      (A) in the fourth sentence of subsection (b), by 
                  striking ``or subsection (u)(3)'' and inserting ``, 
                  (u)(3), or (u)(4)''; and
                      (B) in subsection (u)--
                              (i) by redesignating paragraph (4) as 
                          paragraph (5); and
                              (ii) by inserting after paragraph (3) the 
                          following:
      ``(4) For purposes of the fourth sentence of subsection (b) and 
  section 2105(a), the expenditures described in this paragraph are the 
  following:
              ``(A) Certain pregnant women.--If the conditions described 
          in subparagraph (B) are met, expenditures for medical 
          assistance for pregnant women described in subsection (n) or 
          under section 1902(l)(1)(A) in a family the income of which 
          exceeds the effective income level (expressed as a percent of 
          the poverty line and considering applicable income disregards) 
          that has been specified under subsection (a)(10)(A)(i)(III) or 
          (l)(2)(A) of section 1902, as of January 1, 2005, but does not 
          exceed the income eligibility level established under title XXI 
          for a targeted low-income child.
              ``(B) Conditions.--The conditions described in this 
          subparagraph are the following:
                      ``(i) The State plans under this title and title 
                  XXI do not provide coverage for pregnant women 
                  described in subparagraph (A) with higher family income 
                  without covering such pregnant women with a lower 
                  family income.
                      ``(ii) The State does not apply an effective income 
                  level for pregnant women that is lower than the 
                  effective income level (expressed as a percent of the 
                  poverty line and considering applicable income 
                  disregards) that has been specified under the State 
                  plan under subsection (a)(10)(A)(i)(III) or (l)(2)(A) 
                  of section 1902, as of January 1, 2005, to be eligible 
                  for medical assistance as a pregnant woman.
              ``(C) Definition of poverty line.--In this subsection, the 
          term `poverty line' has the meaning given such term in section 
          2110(c)(5).''.
              (3) Payment from title xxi allotment for medicaid expansion 
          costs; elimination of counting medicaid child presumptive 
          eligibility costs against title xxi allotment.--Section 
          2105(a)(1) of the Social Security Act (42 U.S.C. 1397ee(a)(1)) 
          is amended--
                      (A) in the matter preceding subparagraph (A), by 
                  striking ``(or, in the case of expenditures described 
                  in subparagraph (B), the Federal medical assistance 
                  percentage (as defined in the first sentence of section 
                  1905(b)))''; and
                      (B) by striking subparagraph (B) and inserting the 
                  following:
                      ``(B) for the provision of medical assistance that 
                  is attributable to expenditures described in section 
                  1905(u)(4)(A);''.
              (4) Additional amendments to medicaid.--
                      (A) Eligibility of a newborn.--Section 1902(e)(4) 
                  of the Social Security Act (42 U.S.C. 1396a(e)(4)) is 
                  amended in the first sentence by striking ``so long as 
                  the child is a member of the woman's household and the 
                  woman remains (or would remain if pregnant) eligible 
                  for such assistance''.
                      (B) Application of qualified entities to 
                  presumptive eligibility for pregnant women under 
                  medicaid.--Section 1920(b) of the Social Security Act 
                  (42 U.S.C. 1396r-1(b)) is amended by adding at the end 
                  after and below paragraph (2) the following flush 
                  sentence:
  ``The term `qualified provider' includes a qualified entity as defined 
  in section 1920A(b)(3).''.
      (b) SCHIP.--
              (1) Coverage.--Title XXI of the Social Security Act (42 
          U.S.C. 1397aa et seq.) is amended by adding at the end the 
          following:
  
  ``SEC. 2111. OPTIONAL COVERAGE OF TARGETED LOW-INCOME PREGNANT WOMEN.
  
      ``(a) Optional Coverage.--Notwithstanding any other provision of 
  this title, a State may provide for coverage, through an amendment to 
  its State child health plan under section 2102, of pregnancy-related 
  assistance for targeted low-income pregnant women in accordance with 
  this section, but only if the State meets the conditions described in 
  section 1905(u)(4)(B).
      ``(b) Definitions.--For purposes of this title:
              ``(1) Pregnancy-related assistance.--The term `pregnancy-
          related assistance' has the meaning given the term child health 
          assistance in section 2110(a) as if any reference to targeted 
          low-income children were a reference to targeted low-income 
          pregnant women, except that the assistance shall be limited to 
          services related to pregnancy (which include prenatal, 
          delivery, and postpartum services and services described in 
          section 1905(a)(4)(C)) and to other conditions that may 
          complicate pregnancy.
              ``(2) Targeted low-income pregnant woman.--The term 
          `targeted low-income pregnant woman' means a woman--
                      ``(A) during pregnancy and through the end of the 
                  month in which the 60-day period (beginning on the last 
                  day of her pregnancy) ends;
                      ``(B) whose family income exceeds the effective 
                  income level (expressed as a percent of the poverty 
                  line and considering applicable income disregards) that 
                  has been specified under subsection (a)(10)(A)(i)(III) 
                  or (l)(2)(A) of section 1902, as of January 1, 2005, to 
                  be eligible for medical assistance as a pregnant woman 
                  under title XIX but does not exceed the income 
                  eligibility level established under the State child 
                  health plan under this title for a targeted low-income 
                  child; and
                      ``(C) who satisfies the requirements of paragraphs 
                  (1)(A), (1)(C), (2), and (3) of section 2110(b).
      ``(c) References to Terms and Special Rules.--In the case of, and 
  with respect to, a State providing for coverage of pregnancy-related 
  assistance to targeted low-income pregnant women under subsection (a), 
  the following special rules apply:
              ``(1) Any reference in this title (other than in subsection 
          (b)) to a targeted low-income child is deemed to include a 
          reference to a targeted low-income pregnant woman.
              ``(2) Any such reference to child health assistance with 
          respect to such women is deemed a reference to pregnancy-
          related assistance.
              ``(3) Any such reference to a child is deemed a reference 
          to a woman during pregnancy and the period described in 
          subsection (b)(2)(A).
              ``(4) In applying section 2102(b)(3)(B), any reference to 
          children found through screening to be eligible for medical 
          assistance under the State medicaid plan under title XIX is 
          deemed a reference to pregnant women.
              ``(5) There shall be no exclusion of benefits for services 
          described in subsection (b)(1) based on any preexisting 
          condition and no waiting period (including any waiting period 
          imposed to carry out section 2102(b)(3)(C)) shall apply.
              ``(6) Subsection (a) of section 2103 (relating to required 
          scope of health insurance coverage) shall not apply insofar as 
          a State limits coverage to services described in subsection 
          (b)(1) and the reference to such section in section 
          2105(a)(1)(C) is deemed not to require, in such case, 
          compliance with the requirements of section 2103(a).
              ``(7) In applying section 2103(e)(3)(B) in the case of a 
          pregnant woman provided coverage under this section, the 
          limitation on total annual aggregate cost-sharing shall be 
          applied to the entire family of such pregnant woman.
      ``(d) Automatic Enrollment for Children Born to Women Receiving 
  Pregnancy-Related Assistance.--If a child is born to a targeted low-
  income pregnant woman who was receiving pregnancy-related assistance 
  under this section on the date of the child's birth, the child shall be 
  deemed to have applied for child health assistance under the State 
  child health plan and to have been found eligible for such assistance 
  under such plan or to have applied for medical assistance under title 
  XIX and to have been found eligible for such assistance under such 
  title, as appropriate, on the date of such birth and to remain eligible 
  for such assistance until the child attains 1 year of age. During the 
  period in which a child is deemed under the preceding sentence to be 
  eligible for child health or medical assistance, the child health or 
  medical assistance eligibility identification number of the mother 
  shall also serve as the identification number of the child, and all 
  claims shall be submitted and paid under such number (unless the State 
  issues a separate identification number for the child before such 
  period expires).''.
              (2) Additional allotments for providing coverage of 
          pregnant women.--
                      (A) In general.--Section 2104 of the Social 
                  Security Act (42 U.S.C. 1397dd) is amended by inserting 
                  after subsection (c) the following:
      ``(d) Additional Allotments for Providing Coverage of Pregnant 
  Women.--
              ``(1) Appropriation; total allotment.--For the purpose of 
          providing additional allotments to States under this title, 
          there is appropriated, out of any money in the Treasury not 
          otherwise appropriated, for each of fiscal years 2006 and 2007, 
          $200,000,000.
              ``(2) State and territorial allotments.--In addition to the 
          allotments provided under subsections (b) and (c), subject to 
          paragraphs (3) and (4), of the amount available for the 
          additional allotments under paragraph (1) for a fiscal year, 
          the Secretary shall allot to each State with a State child 
          health plan approved under this title--
                      ``(A) in the case of such a State other than a 
                  commonwealth or territory described in subparagraph 
                  (B), the same proportion as the proportion of the 
                  State's allotment under subsection (b) (determined 
                  without regard to subsection (f)) to the total amount 
                  of the allotments under subsection (b) for such States 
                  eligible for an allotment under this paragraph for such 
                  fiscal year; and
                      ``(B) in the case of a commonwealth or territory 
                  described in subsection (c)(3), the same proportion as 
                  the proportion of the commonwealth's or territory's 
                  allotment under subsection (c) (determined without 
                  regard to subsection (f)) to the total amount of the 
                  allotments under subsection (c) for commonwealths and 
                  territories eligible for an allotment under this 
                  paragraph for such fiscal year.
              ``(3) Use of additional allotment.--Additional allotments 
          provided under this subsection are not available for amounts 
          expended before October 1, 2005. Such amounts are available for 
          amounts expended on or after such date for child health 
          assistance for targeted low-income children, as well as for 
          pregnancy-related assistance for targeted low-income pregnant 
          women.
              ``(4) No payments unless election to expand coverage of 
          pregnant women.--No payments may be made to a State under this 
          title from an allotment provided under this subsection unless 
          the State provides pregnancy-related assistance for targeted 
          low-income pregnant women under this title, or provides medical 
          assistance for pregnant women under title XIX, whose family 
          income exceeds the effective income level applicable under 
          subsection (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902 to a 
          family of the size involved as of January 1, 2005.''.
                      (B) Conforming amendments.--Section 2104 of the 
                  Social Security Act (42 U.S.C. 1397dd) is amended--
                              (i) in subsection (a), in the matter 
                          preceding paragraph (1), by inserting ``subject 
                          to subsection (d),'' after ``under this 
                          section,'';
                              (ii) in subsection (b)(1), by inserting 
                          ``and subsection (d)'' after ``Subject to 
                          paragraph (4)''; and
                              (iii) in subsection (c)(1), by inserting 
                          ``subject to subsection (d),'' after ``for a 
                          fiscal year,''.
              (3) Presumptive eligibility under title xxi.--
                      (A) Application to pregnant women.--Section 
                  2107(e)(1)(D) of the Social Security Act (42 U.S.C. 
                  1397gg(e)(1)) is amended to read as follows:
                      ``(D) Sections 1920 and 1920A (relating to 
                  presumptive eligibility).''.
                      (B) Exception from limitation on administrative 
                  expenses.--Section 2105(c)(2) of the Social Security 
                  Act (42 U.S.C. 1397ee(c)(2)) is amended by adding at 
                  the end the following new subparagraph:
                      ``(C) Exception for presumptive eligibility 
                  expenditures.--The limitation under subparagraph (A) on 
                  expenditures shall not apply to expenditures 
                  attributable to the application of section 1920 or 
                  1920A (pursuant to section 2107(e)(1)(D)), regardless 
                  of whether the child or pregnant woman is determined to 
                  be ineligible for the program under this title or title 
                  XIX.''.
              (4) Additional amendments to title xxi.--
                      (A) No cost-sharing for pregnancy-related 
                  services.--Section 2103(e)(2) of the Social Security 
                  Act (42 U.S.C. 1397cc(e)(2)) is amended--
                              (i) in the heading, by inserting ``or 
                          pregnancy-related services'' after ``Preventive 
                          services''; and
                              (ii) by inserting before the period at the 
                          end the following: ``or for pregnancy-related 
                          services''.
                      (B) No waiting period.--Section 2102(b)(1)(B) of 
                  the Social Security Act (42 U.S.C. 1397bb(b)(1)(B)) is 
                  amended--
                              (i) by striking ``, and'' at the end of 
                          clause (i) and inserting a semicolon;
                              (ii) by striking the period at the end of 
                          clause (ii) and inserting ``; and''; and
                              (iii) by adding at the end the following:
                              ``(iii) may not apply a waiting period 
                          (including a waiting period to carry out 
                          paragraph (3)(C)) in the case of a targeted 
                          low-income pregnant woman.''.
      (c) Effective Date.--The amendments made by this section apply to 
  items and services furnished on or after October 1, 2005, without 
  regard to whether regulations implementing such amendments have been 
  promulgated.
  
  SEC. 3. COORDINATION WITH THE MATERNAL AND CHILD HEALTH PROGRAM.
  
      (a) In General.--Section 2102(b)(3) of the Social Security Act (42 
  U.S.C. 1397bb(b)(3)) is amended--
              (1) in subparagraph (D), by striking ``and'' at the end;
              (2) in subparagraph (E), by striking the period and 
          inserting ``; and''; and
              (3) by adding at the end the following new subparagraph:
                      ``(F) that operations and activities under this 
                  title are developed and implemented in consultation and 
                  coordination with the program operated by the State 
                  under title V in areas including outreach and 
                  enrollment, benefits and services, service delivery 
                  standards, public health and social service agency 
                  relationships, and quality assurance and data 
                  reporting.''.
      (b) Conforming Medicaid Amendment.--Section 1902(a)(11) of such Act 
  (42 U.S.C. 1396a(a)(11)) is amended--
              (1) by striking ``and'' before ``(C)''; and
              (2) by inserting before the semicolon at the end the 
          following: ``, and (D) provide that operations and activities 
          under this title are developed and implemented in consultation 
          and coordination with the program operated by the State under 
          title V in areas including outreach and enrollment, benefits 
          and services, service delivery standards, public health and 
          social service agency relationships, and quality assurance and 
          data reporting''.
      (c) Effective Date.--The amendments made by this section take 
  effect on January 1, 2006.
  
  SEC. 4. INCREASE IN SCHIP INCOME ELIGIBILITY.
  
      (a) Definition of Low-Income Child.--Section 2110(c)(4) of the 
  Social Security Act (42 U.S.C. 42 U.S.C. 1397jj(c)(4)) is amended by 
  striking ``200'' and inserting ``250''.
      (b) Effective Date.--The amendment made by subsection (a) applies 
  to child health assistance provided, and allotments determined under 
  section 2104 of the Social Security Act (42 U.S.C. 1397dd) for fiscal 
  years beginning with fiscal year 2006.
target: Start Healthy, Stay Healthy Act of 2005- Amends titles XIX (Medicaid) and XXI (State Children's Health Insurance Program) (SCHIP) of the Social Security Act (SSA) to give States new options to: (1) cover low-income pregnant women; and (2) provide for coordination of SCHIP with the Maternal and Child Health Program under SSA title V.
  
  Provides for an increase in SCHIP income eligibility.
feat_title: A bill to amend title XIX and XXI of the Social Security Act to expand or add coverage of pregnant women under the medicaid and State children's health insurance program, and for other purposes.