H.R. 2147 (Emanuel)

Reauthorization of SCHIP and State Allotments
Reauthorizes SCHIP permanently. Funding for 2008 and beyond at $7.5 billion multiplied by the growth in national health expenditures per capita and child population. Makes state allotments available through the end of the fiscal year, with unused state allotments reallocated to states with shortfalls. Costs of Medicaid presumptive eligibility for children would no longer count against SCHIP allotments.

The Secretary would increase state allotments to account for higher than projected enrollment resulting from outreach to eligible but previously unenrolled children. A cap on aggregate allotment increases for this purpose would be set at 20% of annual total SCHIP allotment, with the Secretary directed to seek supplemental appropriations if the limitation is reached.

Coverage Expansions
Provides for new state option to cover pregnant women meeting SCHIP income eligibility requirements with automatic enrollment of newborns. Also provides state option to cover legal immigrant pregnant women and children under Medicaid and SCHIP.

Creates a new advanceable, refundable, "Healthy Savings Tax Credit" on a sliding scale for coverage of children. Excludes children eligible for Medicaid, SCHIP, Medicare, or health coverage provided to federal employees (FEHBP) or the military. Credit covers 75% of premium for families with incomes above 200% of the FPL and is phased out at 350% of FPL. Credit could be used to purchase employer coverage or state designated group coverage. Qualified employer coverage must be actuarially equivalent to the most popular FEHBP plan and must provide for guaranteed issue and renewability; no underwriting, pre-existing condition exclusions, or riders; and must be community rated without regard to health status.

Other changes to SCHIP or Medicaid coverage for children
Prohibits states from imposing a cap on SCHIP enrollment, a waiting list, or other procedures to delay consideration of enrollment or limit enrollment.

Directs the Secretary to consult with state Medicaid and SCHIP directors and develop a model process for coordination of enrollment and coverage across states for children who are outside their state of residency because they are migrant families, experienced an emergency evacuation, for educational needs, or for other reasons.

Outreach and enrollment
States implementing five specific policies to remove enrollment barriers in Medicaid and SCHIP would receive a two percentage point increase in the respective federal matching rates: 1) presumptive eligibility, 2) 12-month continuous enrollment, 3) automatic renewal, 4) elimination of asset test, and 5) self-declaration of income.

Provides states the option of using an "express lane" process for determining a child's eligibility under Medicaid or SCHIP. Under this process, income determinations made through application federal programs including temporary assistance to needy families (TANF), Food Stamps, child nutrition and school lunch programs can be used to determine eligibility for Medicaid or SCHIP. A child found to be ineligible using the "express lane" process may still apply for these programs directly.

Provides for 75% federal matching rate for state expenditures attributed to mechanized claims processing and administrative systems consistent with model outreach and enrollment practices.

Grants for innovative outreach and enrollment efforts would be provided to eligible entities including local governments, nonprofit organizations, Indian tribes, and safety net health care providers. Authorizes $50 million in appropriations for fiscal years 2008 and 2009 for these grants.

Extends existing requirements for Medicaid outreach to all pregnant women and children.

Other provisions
Provisions would not affect existing state Medicaid or SCHIP waivers.

Financing
Provides offset to costs through changes to the tax code that require brokers, when reporting to the IRS proceeds from securities transactions, to also report the adjusted cost basis.

Effective date
Generally 10/1/2007; Healthy Savings Tax Credit for tax years beginning 1/1/2009.