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1 (1) in paragraph (1), by inserting before the pe-
2 riod at the end the following: ‘‘, and who is not pro-
3 vided medical assistance under section 1943(b)(2) of
4 this title or section 205(d)(1)(B) of the America’s
5 Affordable Health Choices Act of 2009’’; and
6 (2) by adding at the end the following:
7 ‘‘(2) Amounts expended for medical assistance
8 for children described in section 203(d)(1)(A) of the
9 America’s Affordable Health Choices Act of 2009
10 during the time period specified in such section.’’.
11 (d) NETWORK ADEQUACY.—Section 1932(a)(2) of
12 the Social Security Act (42 U.S.C. 1396u–2(a)(2)) is
13 amended by adding at the end the following new subpara-
14 graph:
15 ‘‘(D) ENROLLMENT OF NON-TRADITIONAL

16 MEDICAID ELIGIBLES.—A State may not re-

17 quire under paragraph (1) the enrollment in a
18 managed care entity of an individual described
19 in section 1902(a)(10)(A)(i)(VIII) unless the
20 State demonstrates, to the satisfaction of the
21 Secretary, that the entity, through its provider
22 network and other arrangements, has the ca-
23 pacity to meet the health, mental health, and
24 substance abuse needs of such individuals.’’.

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1 (e) EFFECTIVE DATE.—The amendments made by
2 this section shall take effect on the first day of Y1, and
3 shall apply with respect to items and services furnished
4 on or after such date.
5 SEC. 1702. REQUIREMENTS AND SPECIAL RULES FOR CER-

6 TAIN MEDICAID ELIGIBLE INDIVIDUALS.

7 (a) IN GENERAL.—Title XIX of the Social Security

8 Act is amended by adding at the end the following new
9 section:
10 ‘‘ REQUIREMENTS AND SPECIAL RULES FOR CERTAIN

11 MEDICAID ELIGIBLE INDIVIDUALS

12 ‘‘SEC. 1943. (a) COORDINATION WITH NHI EX-

13 CHANGE THROUGH MEMORANDUM OF UNDER-
14 STANDING.—

15 ‘‘(1) IN GENERAL.—The State shall enter into

16 a Medicaid memorandum of understanding described
17 in section 204(e)(4) of the America’s Affordable
18 Health Choices Act of 2009 with the Health Choices
19 Commissioner, acting in consultation with the Sec-
20 retary, with respect to coordinating the implementa-
21 tion of the provisions of division A of such Act with
22 the State plan under this title in order to ensure the
23 enrollment of Medicaid eligible individuals in accept-
24 able coverage. Nothing in this section shall be con-
25 strued as permitting such memorandum to modify or

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1 vitiate any requirement of a State plan under this
2 title.
3 ‘‘(2) ENROLLMENT OF EXCHANGE-REFERRED

4 INDIVIDUALS.—

5 ‘‘(A) NON-TRADITIONAL INDIVIDUALS.—

6 Pursuant to such memorandum the State shall

7 accept without further determination the enroll-
8 ment under this title of an individual deter-
9 mined by the Commissioner to be a non-tradi-
10 tional Medicaid eligible individual. The State
11 shall not do any redeterminations of eligibility
12 for such individuals unless the periodicity of
13 such redeterminations is consistent with the pe-
14 riodicity for redeterminations by the Commis-
15 sioner of eligibility for affordability credits
16 under subtitle C of title II of division A of the
17 America’s Affordable Health Choices Act of
18 2009, as specified under such memorandum.
19 ‘‘(B) TRADITIONAL INDIVIDUALS.—

20 ‘‘(i) REGULAR ENROLLMENT OP-

21 TION.—Pursuant to such memorandum,

22 insofar as the memorandum has selected
23 the option described in section
24 205(e)(3)(A) of the America’s Affordable
25 Health Choices Act of 2009, the State

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1 shall accept without further determination
2 the enrollment under this title of an indi-
3 vidual determined by the Commissioner to
4 be a traditional Medicaid eligible indi-
5 vidual. The State may do redeterminations
6 of eligibility of such individual consistent
7 with such section and the memorandum.
8 ‘‘(ii) PRESUMPTIVE ELIGIBILITY OP-

9 TION.—Pursuant to such memorandum,

10 insofar as the memorandum has selected
11 the option described in section
12 205(e)(3)(B) of the America’s Affordable
13 Health Choices Act of 2009, the State
14 shall provide for making medical assistance
15 available during the presumptive eligibility
16 period and shall, upon application of the
17 individual for medical assistance under this
18 title, promptly make a determination (and
19 subsequent redeterminations) of eligibility
20 in the same manner as if the individual
21 had applied directly to the State for such
22 assistance except that the State shall use
23 the income-related information used by the
24 Commissioner and provided to the State
25 under the memorandum in making the pre-

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749
1 sumptive eligibility determination to the
2 maximum extent feasible.
3 ‘‘(3) DETERMINATIONS OF ELIGIBILITY FOR

4 AFFORDABILITY CREDITS.—If the Commissioner de-

5 termines that a State Medicaid agency has the ca-
6 pacity to make determinations of eligibility for af-
7 fordability credits under subtitle C of title II of divi-
8 sion A of the America’s Affordable Health Choices
9 Act of 2009, under such memorandum—
10 ‘‘(A) the State Medicaid agency shall con-
11 duct such determinations for any Exchange-eli-
12 gible individual who requests such a determina-
13 tion;
14 ‘‘(B) in the case that a State Medicaid
15 agency determines that an Exchange-eligible in-
16 dividual is not eligible for affordability credits,
17 the agency shall forward the information on the
18 basis of which such determination was made to
19 the Commissioner; and
20 ‘‘(C) the Commissioner shall reimburse the
21 State Medicaid agency for the costs of con-
22 ducting such determinations.
23 ‘‘(b) TREATMENT OF CERTAIN NEWBORNS.—
24 ‘‘(1) IN GENERAL.—In the case of a child who
25 is deemed under section 205(d)(1) of the America’s

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750
1 Affordable Health Choices Act of 2009 to be a non-
2 traditional Medicaid eligible individual and enrolled
3 under this title pursuant to such section, the State
4 shall provide for a determination, by not later than
5 the end of the period referred to in subparagraph
6 (A) of such section, of the child’s eligibility for med-
7 ical assistance under this title.
8 ‘‘(2) EXTENDED TREATMENT AS TRADITIONAL

9 MEDICAID ELIGIBLE INDIVIDUAL.—In accordance

10 with subparagraph (B) of section 205(d)(1) of the
11 America’s Affordable Health Choices Act of 2009, in
12 the case of a child described in subparagraph (A) of
13 such section who at the end of the period referred
14 to in such subparagraph is not otherwise covered
15 under acceptable coverage, the child shall be deemed
16 (until such time as the child obtains such coverage
17 or the State otherwise makes a determination of the
18 child’s eligibility for medical assistance under its
19 plan under this title pursuant to paragraph (1)) to
20 be a traditional Medicaid eligible individual de-
21 scribed in section 1902(l)(1)(B).
22 ‘‘(c) DEFINITIONS .—In this section:
23 ‘‘(1) MEDICAID ELIGIBLE INDIVIDUALS.—In

24 this section, the terms ‘Medicaid eligible individual’,

25 ‘traditional Medicaid eligible individual’, and ‘non-

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1 traditional Medicaid eligible individual’ have the
2 meanings given such terms in section 205(e)(5) of
3 the America’s Affordable Health Choices Act of
4 2009.
5 ‘‘(2) MEMORANDUM.—The term ‘memorandum’
6 means a Medicaid memorandum of understanding
7 under section 205(e)(4) of the America’s Affordable
8 Health Choices Act of 2009.
9 ‘‘(3) Y1.—The term ‘Y1’ has the meaning given
10 such term in section 100(c) of the America’s Afford-
11 able Health Choices Act of 2009.’’.
12 (b) CONFORMING AMENDMENTS TO ERROR RATE.—
13 (1) Section 1903(u)(1)(D) of the Social Secu-
14 rity Act (42 U.S.C. 1396b(u)(1)(D)) is amended by
15 adding at the end the following new clause:
16 ‘‘(vi) In determining the amount of erroneous excess
17 payments, there shall not be included any erroneous pay-
18 ments made that are attributable to an error in an eligi-
19 bility determination under subtitle C of title II of division
20 A of the America’s Affordable Health Choices Act of
21 2009.’’.
22 (2) Section 2105(c)(11) of such Act (42 U.S.C.
23 1397ee(c)(11)) is amended by adding at the end the
24 following new sentence: ‘‘Clause (vi) of section
25 1903(u)(1)(D) shall apply with respect to the appli-

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752
1 cation of such requirements under this title and title
2 XIX.’’.
3 SEC. 1703. CHIP AND MEDICAID MAINTENANCE OF EFFORT.

4 (a) CHIP MAINTENANCE OF EFFORT.—Section

5 1902 of the Social Security Act (42 U.S.C. 1396a) is
6 amended—
7 (1) in subsection (a), as amended by section
8 1631(b)(1)(D)—
9 (A) by striking ‘‘and’’ at the end of para-
10 graph (72);
11 (B) by striking the period at the end of
12 paragraph (73) and inserting ‘‘; and’’; and
13 (C) by inserting after paragraph (74) the
14 following new paragraph:
15 ‘‘(75) provide for maintenance of effort under
16 the State child health plan under title XXI in ac-
17 cordance with subsection (gg).’’; and
18 (2) by adding at the end the following new sub-
19 section:
20 ‘‘(gg) CHIP MAINTENANCE OF EFFORT REQUIRE-
21 MENT.—

22 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

23 as a condition of its State plan under this title under
24 subsection (a)(75) and receipt of any Federal finan-
25 cial assistance under section 1903(a) for calendar

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