42 U.S.C. § 1397jj — Definitions

Page 4501 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397jj use of American Community Survey estimates (in lieu of, or in combination with the Current Population Survey estimates, as rec- ommended), provided that any such transition is implemented in a manner that is designed to avoid adverse impacts upon States with ap- proved State child health plans under this sub- chapter. (4) Appropriation Out of any money in the Treasury of the United States not otherwise appropriated, there are appropriated $20,000,000 for fiscal year 2009 and each fiscal year thereafter for the purpose of carrying out this subsection (except that only with respect to fiscal year 2008, there are appropriated $20,000,000 for the purpose of carrying out this subsection, to re- main available until expended). (Aug. 14, 1935, ch. 531, title XXI, § 2109, as added Pub. L. 105–33, title IV, § 4901(a), Aug. 5, 1997, 111 Stat. 567; amended Pub. L. 106–113, div. B, § 1000(a)(6) [title VII, §§ 703(a), 705(c)], Nov. 29, 1999, 113 Stat. 1536, 1501A–400, 1501A–403; Pub. L. 110–173, title II, § 205, Dec. 29, 2007, 121 Stat. 2514; Pub. L. 111–3, title VI, § 602, Feb. 4, 2009, 123 Stat. 98; Pub. L. 111–148, title II, § 2102(a)(6), Mar. 23, 2010, 124 Stat. 288.) Editorial Notes REFERENCES IN TEXT The Employee Retirement Income Security Act of 1974, referred to in subsec. (a)(1), is Pub. L. 93–406, Sept. 2, 1974, 88 Stat. 832. Part 7 of subtitle B of title I of the Act is classified generally to part 7 (§ 1181 et seq.) of subtitle B of subchapter I of chapter 18 of Title 29, Labor. For complete classification of this Act to the Code, see Short Title note set out under section 1001 of Title 29 and Tables. The Public Health Service Act, referred to in subsec. (a)(1), is act July 1, 1944, ch. 373, 58 Stat. 682. Title XXVII of the Act is classified generally to subchapter XXV (§ 300gg et seq.) of chapter 6A of this title. For complete classification of this Act to the Code, see Short Title note set out under section 201 of this title and Tables. The Internal Revenue Code of 1986, referred to in sub- sec. (a)(1), is classified generally to Title 26, Internal Revenue Code. Subtitle K of such Code appears at sec- tion 9801 et seq. of Title 26. AMENDMENTS 2010—Subsec. (b)(2)(B). Pub. L. 111–148 substituted ‘‘a high-performing State under section 1397kk(b)(3)(B) of this title’’ for ‘‘the child population growth factor under section 1397dd(m)(5)(B) of this title’’. 2009—Subsec. (b)(2). Pub. L. 111–3, § 602(b)(2), added par. (2). Former par. (2) redesignated (4). Pub. L. 111–3, § 602(a), substituted ‘‘$20,000,000 for fis- cal year 2009’’ for ‘‘$10,000,000 for fiscal year 2000’’. Subsec. (b)(3), (4). Pub. L. 111–3, § 602(b), added par. (3) and redesignated former par. (2) as (4). 2007—Subsec. (b)(2). Pub. L. 110–173 inserted before pe- riod at end ‘‘(except that only with respect to fiscal year 2008, there are appropriated $20,000,000 for the pur- pose of carrying out this subsection, to remain avail- able until expended)’’. 1999—Subsec. (a)(1). Pub. L. 106–113, § 1000(a)(6) [title VII, § 705(c)(1)], substituted ‘‘title I’’ for ‘‘title II’’ be- fore ‘‘of the Employee Retirement Income Security Act of 1974,’’. Subsec. (a)(2). Pub. L. 106–113, § 1000(a)(6) [title VII, § 705(c)(2)], inserted closing parenthesis before period at end. Subsec. (b). Pub. L. 106–113, § 1000(a)(6) [title VII, § 703(a)], added subsec. (b). Statutory Notes and Related Subsidiaries 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 Pub. L. 111–148 is effective as if included in the enactment of the Children’s Health Insurance Program Reauthoriza- tion 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 as- sistance provided on or after that date, with certain ex- ceptions, see section 3 of Pub. L. 111–3, set out as an Ef- fective Date note under section 1396 of this title. § 1397jj. Definitions (a) Child health assistance For purposes of this subchapter, the term ‘‘child health assistance’’ means payment for part or all of the cost of health benefits cov- erage for targeted low-income children that in- cludes 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 pro- viding any of the following), as specified under the State plan: (1) Inpatient hospital services. (2) Outpatient hospital services. (3) Physician services. (4) Surgical services. (5) Clinic services (including health center services) and other ambulatory health care services. (6) Prescription drugs and biologicals and the administration of such drugs and biologicals, only if such drugs and biologicals are not furnished for the purpose of causing, or assisting in causing, the death, suicide, eutha- nasia, or mercy killing of a person. (7) Over-the-counter medications. (8) Laboratory and radiological services. (9) Prenatal care and prepregnancy family planning services and supplies. (10) Inpatient mental health services, other than services described in paragraph (18) but including services furnished in a State-oper- ated mental hospital and including residential or other 24-hour therapeutically planned structured services. (11) Outpatient mental health services, other than services described in paragraph (19) but including services furnished in a State-oper- ated mental hospital and including commu- nity-based services. (12) Durable medical equipment and other medically-related or remedial devices (such as prosthetic devices, implants, eyeglasses, hear- ing aids, dental devices, and adaptive devices). (13) Disposable medical supplies. (14) Home and community-based health care services and related supportive services (such as home health nursing services, home health aide services, personal care, assistance with activities of daily living, chore services, day care services, respite care services, training for family members, and minor modifications to the home). (15) Nursing care services (such as nurse practitioner services, nurse midwife services, Page 4502 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397jj 1 So in original. A closing parenthesis probably should precede the period. advanced practice nurse services, private duty nursing care, pediatric nurse services, and res- piratory care services) in a home, school, or other setting. (16) Abortion only if necessary to save the life of the mother or if the pregnancy is the re- sult of an act of rape or incest. (17) Dental services. (18) Inpatient substance use treatment serv- ices and residential substance use treatment services. (19) Outpatient substance use treatment services. (20) Case management services. (21) Care coordination services. (22) Physical therapy, occupational therapy, and services for individuals with speech, hear- ing, and language disorders. (23) Hospice care (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 ill- ness has been made.1 (24) Any other medical, diagnostic, screen- ing, preventive, restorative, remedial, thera- peutic, or rehabilitative services (whether in a facility, home, school, or other setting) if rec- ognized by State law and only if the service is— (A) prescribed by or furnished by a physi- cian or other licensed or registered practi- tioner within the scope of practice as defined by State law, (B) performed under the general super- vision or at the direction of a physician, or (C) furnished by a health care facility that is operated by a State or local government or is licensed under State law and operating within the scope of the license. (25) Premiums for private health care insur- ance coverage. (26) Medical transportation. (27) Enabling services (such as transpor- tation, translation, and outreach services) only if designed to increase the accessibility of primary and preventive health care services for eligible low-income individuals. (28) Any other health care services or items specified by the Secretary and not excluded under this section. (b) ‘‘Targeted low-income child’’ defined For purposes of this subchapter— (1) In general Subject to paragraph (2), the term ‘‘targeted low-income child’’ means a child— (A) who has been determined eligible by the State for child health assistance under the State plan; (B)(i) who is a low-income child, or (ii) is a child— (I) 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 ex- ceed 50 percentage points above the med- icaid applicable income level; (II) whose family income (as so deter- mined) does not exceed the medicaid appli- cable income level (as defined in paragraph (4) but determined as if ‘‘June 1, 1997’’ were substituted for ‘‘March 31, 1997’’); or (III) who resides in a State that does not have a medicaid applicable income level (as defined in paragraph (4)); and (C) who is not found to be eligible for med- ical assistance under subchapter XIX or, subject to paragraph (5), covered under a group health plan or under health insurance coverage (as such terms are defined in sec- tion 300gg–91 of this title). (2) Children excluded Such term does not include— (A) except as provided in paragraph (7), a child who is an inmate of a public institu- tion or a patient in an institution for mental diseases; or (B) except as provided in paragraph (6), a child who is a member of a family that is eli- gible for health benefits coverage under a State health benefits plan on the basis of a family member’s employment with a public agency in the State. (3) Special rule A child shall not be considered to be de- scribed in paragraph (1)(C) notwithstanding that the child is covered under a health insur- ance coverage program that has been in oper- ation since before July 1, 1997, and that is of- fered by a State which receives no Federal funds for the program’s operation. (4) Medicaid applicable income level The term ‘‘medicaid applicable income level’’ means, with respect to a child, the ef- fective income level (expressed as a percent of the poverty line) that has been specified under the State plan under subchapter XIX (includ- ing under a waiver authorized by the Sec- retary 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 se- lected by a State) for the age of such child. (5) Option for States with a separate CHIP pro- gram to provide dental-only supplemental coverage (A) In general Subject to subparagraphs (B) and (C), in the case of any child who is enrolled in a group health plan or health insurance cov- erage 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 ap- plication of such paragraph to the child in order to provide— (i) dental coverage consistent with the requirements of subsection (c)(6) of section 1397cc of this title; or (ii) cost-sharing protection for dental coverage consistent with such require- ments and the requirements of subsection (e)(3)(B) of such section. Page 4503 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397jj 2 See References in Text note below. (B) Limitation A State may limit the application of a waiver of paragraph (1)(C) to children whose family income does not exceed a level speci- fied by the State, so long as the level so specified does not exceed the maximum in- come level otherwise established for other children under the State child health plan. (C) Conditions A State may not offer dental-only supple- mental coverage under this paragraph unless the State satisfies the following conditions: (i) Income eligibility The State child health plan under this subchapter— (I) has the highest income eligibility standard permitted under this sub- chapter (or a waiver) as of January 1, 2009; (II) does not limit the acceptance of applications for children or impose any numerical limitation, waiting list, or similar limitation on the eligibility of such children for child health assistance under such State plan; and (III) provides benefits to all children in the State who apply for and meet eligi- bility standards. (ii) No more favorable treatment The State child health plan may not pro- vide more favorable dental coverage or cost-sharing protection for dental cov- erage to children provided dental-only sup- plemental coverage under this paragraph than the dental coverage and cost-sharing protection for dental coverage provided to targeted low-income children who are eli- gible for the full range of child health as- sistance provided under the State child health plan. (6) Exceptions to exclusion of children of em- ployees of a public agency in the State (A) In general A child shall not be considered to be de- scribed in paragraph (2)(B) if— (i) the public agency that employs a member of the child’s family to which such paragraph applies satisfies subpara- graph (B); or (ii) subparagraph (C) applies to such child. (B) Maintenance of effort with respect to agency contribution for family coverage For purposes of subparagraph (A)(i), a pub- lic 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 in- cludes dependent coverage for the most re- cent State fiscal year is not less than the amount of such expenditures made by the agency for the 1997 State fiscal year, in- creased by the percentage increase in the medical care expenditure category of the Consumer Price Index for All-Urban Con- sumers (all items: U.S. City Average) for such preceding fiscal year. (C) Hardship exception 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 im- posed for coverage of the family of the child would exceed 5 percent of such family’s in- come for the year involved. (7) Exceptions to exclusion of children who are inmates of a public institution 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 de- scribed 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 pro- vide under section 1397bb(d)(2) of this title. At the option of the State, a child who is an in- mate of a public institution shall not be con- sidered to be described in paragraph (2)(A) dur- ing the period that the child is an inmate of such institution pending disposition of charges. (c) Additional definitions For purposes of this subchapter: (1) Child The term ‘‘child’’ means an individual under 19 years of age. (2) Creditable health coverage The term ‘‘creditable health coverage’’ has the meaning given the term ‘‘creditable cov- erage’’ under section 2701(c) 2 of the Public Health Service Act (42 U.S.C. 300gg(c)) and in- cludes coverage that meets the requirements of section 1397cc of this title provided to a tar- geted 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). (3) Group health plan; health insurance cov- erage; etc. The terms ‘‘group health plan’’, ‘‘group health insurance coverage’’, and ‘‘health in- surance coverage’’ have the meanings given such terms in section 300gg–91 of this title. (4) Low-income child 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 in- volved. (5) Poverty line defined The term ‘‘poverty line’’ has the meaning given such term in section 9902(2) of this title, including any revision required by such sec- tion. (6) Preexisting condition exclusion 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)). Page 4504 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397jj (7) State child health plan; plan 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. (8) Uncovered child The term ‘‘uncovered child’’ means a child that does not have creditable health coverage. (9) School-based health center (A) In general The term ‘‘school-based health center’’ means a health clinic that— (i) is located in or near a school facility of a school district or board or of an Indian tribe or tribal organization; (ii) is organized through school, commu- nity, and health provider relationships; (iii) is administered by a sponsoring fa- cility; (iv) provides through health profes- sionals primary health services to children in accordance with State and local law, in- cluding laws relating to licensure and cer- tification; and (v) satisfies such other requirements as a State may establish for the operation of such a clinic. (B) Sponsoring facility For purposes of subparagraph (A)(iii), the term ‘‘sponsoring facility’’ includes any of the following: (i) A hospital. (ii) A public health department. (iii) A community health center. (iv) A nonprofit health care agency. (v) A local educational agency (as de- fined under section 7801 of title 20.1 (vi) A program administered by the In- dian Health Service or the Bureau of In- dian Affairs or operated by an Indian tribe or a tribal organization. (Aug. 14, 1935, ch. 531, title XXI, § 2110, as added Pub. L. 105–33, title IV, § 4901(a), Aug. 5, 1997, 111 Stat. 567; amended Pub. L. 105–100, title I, § 162(3), (9), Nov. 19, 1997, 111 Stat. 2189, 2190; Pub. L. 106–554, § 1(a)(6) [title VIII, § 802(d)(5)], Dec. 21, 2000, 114 Stat. 2763, 2763A–582; Pub. L. 111–3, title V, §§ 501(b)(1), 505(b), Feb. 4, 2009, 123 Stat. 85, 90; Pub. L. 111–148, title II, §§ 2102(a)(7), 2302(b), title X, § 10203(d)(2)(D), Mar. 23, 2010, 124 Stat. 288, 293, 930; Pub. L. 111–309, title II, § 205(d), Dec. 15, 2010, 124 Stat. 3290; Pub. L. 114–95, title IX, § 9215(qqq)(2), Dec. 10, 2015, 129 Stat. 2189; Pub. L. 115–271, title V, § 5022(b)(2)(B), (C), Oct. 24, 2018, 132 Stat. 3964; Pub. L. 117–328, div. FF, title V, §§ 5121(c)(2), 5122(b), Dec. 29, 2022, 136 Stat. 5943, 5944.) Editorial Notes REFERENCES IN TEXT Section 2701 of the Public Health Service Act, re- ferred 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 ex- ceptions, and amended, by Pub. L. 111–148, title I, §§ 1201(2), 1563(c)(1), 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 sec- tion 2701 of act July 1, 1944, related to fair health insur- ance premiums, was added, effective for plan years be- ginning 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. AMENDMENTS 2022—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 consid- ered to be described in paragraph (2)(A) during the pe- riod 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), sub- stituted ‘‘substance use’’ for ‘‘substance abuse’’. Subsec. (b)(5)(A)(i). Pub. L. 115–271, § 5022(b)(2)(C), sub- stituted ‘‘subsection (c)(6)’’ for ‘‘subsection (c)(5)’’. 2015—Subsec. (c)(9)(B)(v). Pub. L. 114–95 made tech- nical amendment to reference in original act which ap- pears 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 in- dividual who is a child, with care related to the treat- ment 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), in- serted ‘‘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 head- ing 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), sub- stituted ‘‘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), in- serted ‘‘, 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 intro- ductory 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 de- termined under the State child health plan) exceeds the medicaid applicable income level (as defined in para- graph (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 ap- plicable beginning on the first day of the first calendar Page 4505 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397kk 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 effec- tive 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 pro- grams 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 sec- tion 2102(a)(7) of Pub. L. 111–148 is effective as if in- cluded in the enactment of the Children’s Health Insur- ance 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 as- sistance provided on or after that date, with certain ex- ceptions, see section 3 of Pub. L. 111–3, set out as an Ef- fective 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 MED- ICAID 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 in- come, 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.]).’’ § 1397kk. Phase-out of coverage for nonpregnant childless adults; conditions for coverage of parents (a) Termination of coverage for nonpregnant childless adults (1) No new CHIP waivers; automatic exten- sions at State option through 2009 Notwithstanding section 1315 of this title or any other provision of this subchapter, except as provided in this subsection— (A) the Secretary shall not on or after Feb- ruary 4, 2009, approve or renew a waiver, ex- perimental, pilot, or demonstration project that would allow funds made available under this subchapter to be used to provide child health assistance or other health benefits coverage to a nonpregnant childless adult; and (B) notwithstanding the terms and condi- tions of an applicable existing waiver, the provisions of paragraph (2) shall apply for purposes of any period beginning on or after January 1, 2010, in determining the period to which the waiver applies, the individuals eli- gible to be covered by the waiver, and the amount of the Federal payment under this subchapter. (2) Termination of CHIP coverage under appli- cable existing waivers at the end of 2009 (A) In general No funds shall be available under this sub- chapter for child health assistance or other health benefits coverage that is provided to a nonpregnant childless adult under an ap- plicable existing waiver after December 31, 2009. (B) Extension upon State request If an applicable existing waiver described in subparagraph (A) would otherwise expire before January 1, 2010, notwithstanding the requirements of subsections (e) and (f) of section 1315 of this title, a State may sub- mit, not later than September 30, 2009, a re- quest to the Secretary for an extension of the waiver. The Secretary shall approve a request for an extension of an applicable ex- isting waiver submitted pursuant to this subparagraph, but only through December 31, 2009. (C) Application of enhanced FMAP The enhanced FMAP determined under section 1397ee(b) of this title shall apply to expenditures under an applicable existing waiver for the provision of child health as- sistance or other health benefits coverage to a nonpregnant childless adult during the pe- riod beginning on February 4, 2009, and end- ing on December 31, 2009. (3) State option to apply for Medicaid waiver to continue coverage for nonpregnant childless adults (A) In general Each State for which coverage under an applicable existing waiver is terminated under paragraph (2)(A) may submit, not later than September 30, 2009, an application