42 U.S.C. § 1397ll — Optional coverage of targeted low-in-

Page 4508 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397ll 1 So in original. The comma probably should not appear. Editorial Notes REFERENCES IN TEXT Section 6102(c)(3) of the Deficit Reduction Act of 2005, referred to in subsec. (c)(1), is section 6102(c)(3) of Pub. L. 109–171, which is set out as a note under section 1397gg of this title. AMENDMENTS 2015—Subsec. (b)(2)(B)(i). Pub. L. 114–10 substituted ‘‘section 1397dd(m)(5)’’ for ‘‘section 1397dd(m)(4)’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE Section 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 a note under section 1396 of this title. § 1397ll. Optional coverage of targeted low-in- come pregnant women through a State plan amendment (a) In general Subject to the succeeding provisions of this section, a State may elect through an amend- ment to its State child health plan under sec- tion 1397bb of this title to provide pregnancy-re- lated assistance under such plan for targeted low-income pregnant women. (b) Conditions A State may only elect the option under sub- section (a) if the following conditions are satis- fied: (1) Minimum income eligibility levels for preg- nant women and children The State has established an income eligi- bility level— (A) for pregnant women under subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) of section 1396a of this title that is at least 185 percent (or such higher percent as the State has in effect with regard to pregnant women under this subchapter) of the poverty line applicable to a family of the size in- volved, but in no case lower than the percent in effect under any such subsection as of July 1, 2008; and (B) for children under 19 years of age under this subchapter (or subchapter XIX) that is at least 200 percent of the poverty line appli- cable to a family of the size involved. (2) No CHIP income eligibility level for preg- nant women lower than the State’s Med- icaid level The State does not apply an effective income level for pregnant women under the State plan amendment that is lower than the effective in- come level (expressed as a percent of the pov- erty line and considering applicable income disregards) specified under subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) of section 1396a of this title, on February 4, 2009, to be eligible for medical assistance as a preg- nant woman. (3) No coverage for higher income pregnant women without covering lower income pregnant women The State does not provide coverage for pregnant women with higher family income without covering pregnant women with a lower family income. (4) Application of requirements for coverage of targeted low-income children The State provides pregnancy-related assist- ance for targeted low-income pregnant women in the same manner, and subject to the same requirements under section 1397cc(c) of this title, as the State provides child health assist- ance for targeted low-income children under the State child health plan, and in addition to providing child health assistance for such women. (5) No preexisting condition exclusion or wait- ing period The State does not apply any exclusion of benefits for pregnancy-related assistance based on any preexisting condition or any waiting period (including any waiting period imposed to carry out section 1397bb(b)(3)(C) of this title) for receipt of such assistance. (6) Application of cost-sharing protection The State provides pregnancy-related assist- ance to a targeted low-income woman con- sistent with the cost-sharing protections under section 1397cc(e) of this title and applies the limitation on total annual aggregate cost sharing imposed under paragraph (3)(B) of such section to the family of such a woman. (7) No waiting list for children The State does not impose, with respect to the enrollment under the State child health plan of targeted low-income children during the quarter, any enrollment cap or other nu- merical limitation on enrollment, any waiting list, any procedures designed to delay the con- sideration of applications for enrollment, or similar limitation with respect to enrollment. (c) Option to provide presumptive eligibility A State that elects the option under sub- section (a) and satisfies the conditions described in subsection (b) may elect to apply section 1396r–1 of this title (relating to presumptive eli- gibility for pregnant women) to the State child health plan in the same manner as such section applies to the State plan under subchapter XIX. (d) Definitions For purposes of this section: (1) Pregnancy-related assistance The term ‘‘pregnancy-related assistance’’ has the meaning given the term ‘‘child health assistance’’ in section 1397jj(a) of this title with respect to an individual during the period described in paragraph (2)(A). (2) Targeted low-income pregnant woman The term ‘‘targeted low-income pregnant woman’’ means an individual— (A) during pregnancy and through the end of the month in which the 60-day period, or, in the case that subparagraph (A) of section 1396a(e)(16) of this title applies to the State child health plan (or waiver of such plan), pursuant to section 1397gg(e)(1) of this title, the 12-month period,1 (beginning on the last day of her pregnancy) ends; Page 4509 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397mm (B) whose family income exceeds 185 per- cent (or, if higher, the percent applied under subsection (b)(1)(A)) of the poverty line ap- plicable to a family of the size involved, but does not exceed the income eligibility level established under the State child health plan under this subchapter for a targeted low-income child; and (C) who satisfies the requirements of para- graphs (1)(A), (1)(C), (2), and (3) of section 1397jj(b) of this title in the same manner as a child applying for child health assistance would have to satisfy such requirements. (e) Automatic enrollment for children born to women receiving pregnancy-related assist- ance 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 subchapter XIX and to have been found el- igible for such assistance under such subchapter, 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 sen- tence to be eligible for child health or medical assistance, the child health or medical assist- ance eligibility identification number of the mother shall also serve as the identification number of the child, and all claims shall be sub- mitted and paid under such number (unless the State issues a separate identification number for the child before such period expires). (f) States providing assistance through other op- tions (1) Continuation of other options for providing assistance The option to provide assistance in accord- ance with the preceding subsections of this section shall not limit any other option for a State to provide— (A) child health assistance through the ap- plication of sections 457.10, 457.350(b)(2), 457.622(c)(5), and 457.626(a)(3) of title 42, Code of Federal Regulations (as in effect after the final rule adopted by the Secretary and set forth at 67 Fed. Reg. 61956–61974 (October 2, 2002)), or (B) pregnancy-related services through the application of any waiver authority (as in ef- fect on June 1, 2008). (2) Clarification of authority to provide postpartum services Any State that provides child health assist- ance under any authority described in para- graph (1) may continue to provide such assist- ance, as well as postpartum services, through the end of the month in which the 60-day pe- riod (beginning on the last day of the preg- nancy) ends, in the same manner as such as- sistance and postpartum services would be provided if provided under the State plan under subchapter XIX, but only if the mother would otherwise satisfy the eligibility require- ments that apply under the State child health plan (other than with respect to age) during such period. (3) No inference Nothing in this subsection shall be con- strued— (A) to infer congressional intent regarding the legality or illegality of the content of the sections specified in paragraph (1)(A); or (B) to modify the authority to provide pregnancy-related services under a waiver specified in paragraph (1)(B). (Aug. 14, 1935, ch. 531, title XXI, § 2112, as added Pub. L. 111–3, title I, § 111(a), Feb. 4, 2009, 123 Stat. 26; amended Pub. L. 116–127, div. F, § 6004(b)(2), Mar. 18, 2020, 134 Stat. 206; Pub. L. 117–2, title IX, § 9822(a)(2), Mar. 11, 2021, 135 Stat. 221.) Editorial Notes AMENDMENTS 2021—Subsec. (d)(2)(A). Pub. L. 117–2 inserted ‘‘, or, in the case that subparagraph (A) of section 1396a(e)(16) of this title applies to the State child health plan (or waiver of such plan), pursuant to section 1397gg (e)(1) of this title, the 12-month period,’’ after ‘‘60-day period’’. 2020—Subsec. (b)(4). Pub. L. 116–127 inserted ‘‘under section 1397cc(c) of this title’’ after ‘‘same require- ments’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE Section 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 a note under section 1396 of this title. § 1397mm. Grants to improve outreach and en- rollment (a) Outreach and enrollment grants; national campaign (1) In general From the amounts appropriated under sub- section (g), subject to paragraphs (2) and (3), the Secretary shall award grants to eligible entities during the period of fiscal years 2009 through 2029 to conduct outreach and enroll- ment efforts that are designed to increase the enrollment and participation of eligible chil- dren under this subchapter and subchapter XIX. (2) Ten percent set aside for national enroll- ment campaign An amount equal to 10 percent of such amounts shall be used by the Secretary for ex- penditures during such period to carry out a national enrollment campaign in accordance with subsection (h). (3) Ten percent set aside for evaluating and providing technical assistance to grantees For the period of fiscal years 2024 through 2029, an amount equal to 10 percent of such amounts shall be used by the Secretary for the purpose of evaluating and providing technical assistance to eligible entities awarded grants under this section.