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1 upon evidence, that such services are effective in one or
2 more of the following:
3 ‘‘(1) Improving maternal or child health and
4 pregnancy outcomes or increasing birth intervals be-
5 tween pregnancies.
6 ‘‘(2) Reducing the incidence of child abuse, ne-
7 glect, and injury, improving family stability (includ-
8 ing reduction in the incidence of intimate partner vi-
9 olence), or reducing maternal and child involvement
10 in the criminal justice system.
11 ‘‘(3) Increasing economic self-sufficiency, em-
12 ployment advancement, school-readiness, and edu-
13 cational achievement, or reducing dependence on
14 public assistance.’’.
15 (b) EFFECTIVE DATE.—The amendments made by
16 this section shall apply to services furnished on or after
17 January 1, 2010.
18 (c) CONSTRUCTION.—Nothing in the amendments
19 made by this section shall be construed as affecting the
20 ability of a State under title XIX or XXI of the Social
21 Security Act to provide nurse home visitation services as
22 part of another class of items and services falling within
23 the definition of medical assistance or child health assist-
24 ance under the respective title, or as an administrative ex-
25 penditure for which payment is made under section

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1 1903(a) or 2105(a) of such Act, respectively, on or after
2 the date of the enactment of this Act.
3 SEC. 1714. STATE ELIGIBILITY OPTION FOR FAMILY PLAN-

4 NING SERVICES.

5 (a) COVERAGE AS OPTIONAL CATEGORICALLY

6 NEEDY GROUP.—
7 (1) IN GENERAL.—Section 1902(a)(10)(A)(ii)
8 of the Social Security Act (42 U.S.C.
9 1396a(a)(10)(A)(ii)) is amended—
10 (A) in subclause (XVIII), by striking ‘‘or’’
11 at the end;
12 (B) in subclause (XIX), by adding ‘‘or’’ at
13 the end; and
14 (C) by adding at the end the following new
15 subclause:
16 ‘‘(XX) who are described in subsection (hh) (re-
17 lating to individuals who meet certain income stand-
18 ards);’’.
19 (2) GROUP DESCRIBED.—Section 1902 of such
20 Act (42 U.S.C. 1396a), as amended by section 1703,
21 is amended by adding at the end the following new
22 subsection:
23 ‘‘(hh)(1) Individuals described in this subsection are
24 individuals—

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1 ‘‘(A) whose income does not exceed an in-
2 come eligibility level established by the State
3 that does not exceed the highest income eligi-
4 bility level established under the State plan
5 under this title (or under its State child health
6 plan under title XXI) for pregnant women; and
7 ‘‘(B) who are not pregnant.
8 ‘‘(2) At the option of a State, individuals de-
9 scribed in this subsection may include individuals
10 who, had individuals applied on or before January 1,
11 2007, would have been made eligible pursuant to the
12 standards and processes imposed by that State for
13 benefits described in clause (XV) of the matter fol-
14 lowing subparagraph (G) of section subsection
15 (a)(10) pursuant to a waiver granted under section
16 1115.
17 ‘‘(3) At the option of a State, for purposes of
18 subsection (a)(17)(B), in determining eligibility for
19 services under this subsection, the State may con-
20 sider only the income of the applicant or recipient.’’.
21 (3) LIMITATION ON BENEFITS.—Section

22 1902(a)(10) of such Act (42 U.S.C. 1396a(a)(10))

23 is amended in the matter following subparagraph
24 (G)—

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1 (A) by striking ‘‘and (XIV)’’ and inserting
2 ‘‘(XIV)’’; and
3 (B) by inserting ‘‘, and (XV) the medical
4 assistance made available to an individual de-
5 scribed in subsection (hh) shall be limited to
6 family planning services and supplies described
7 in section 1905(a)(4)(C) including medical di-
8 agnosis and treatment services that are pro-
9 vided pursuant to a family planning service in
10 a family planning setting’’ after ‘‘cervical can-
11 cer’’.
12 (4) CONFORMING AMENDMENTS.—Section

13 1905(a) of such Act (42 U.S.C. 1396d(a)), as

14 amended by section 1731(c), is amended in the mat-
15 ter preceding paragraph (1)—
16 (A) in clause (xiii), by striking ‘‘or’’ at the
17 end;
18 (B) in clause (xiv), by adding ‘‘or’’ at the
19 end; and
20 (C) by inserting after clause (xiv) the fol-
21 lowing:
22 ‘‘(xv) individuals described in section
23 1902(hh),’’.
24 (b) PRESUMPTIVE ELIGIBILITY.—

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1 (1) IN GENERAL.—Title XIX of the Social Se-
2 curity Act (42 U.S.C. 1396 et seq.) is amended by
3 inserting after section 1920B the following:
4 ‘‘PRESUMPTIVE ELIGIBILITY FOR FAMILY PLANNING

5 SERVICES

6 ‘‘SEC. 1920C. (a) STATE OPTION.—State plan ap-

7 proved under section 1902 may provide for making med-
8 ical assistance available to an individual described in sec-
9 tion 1902(hh) (relating to individuals who meet certain
10 income eligibility standard) during a presumptive eligi-
11 bility period. In the case of an individual described in sec-
12 tion 1902(hh), such medical assistance shall be limited to
13 family planning services and supplies described in
14 1905(a)(4)(C) and, at the State’s option, medical diag-
15 nosis and treatment services that are provided in conjunc-
16 tion with a family planning service in a family planning
17 setting.
18 ‘‘(b) DEFINITIONS.—For purposes of this section:
19 ‘‘(1) PRESUMPTIVE ELIGIBILITY PERIOD.—The

20 term ‘presumptive eligibility period’ means, with re-

21 spect to an individual described in subsection (a),
22 the period that—
23 ‘‘(A) begins with the date on which a
24 qualified entity determines, on the basis of pre-
25 liminary information, that the individual is de-
26 scribed in section 1902(hh); and
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1 ‘‘(B) ends with (and includes) the earlier
2 of—
3 ‘‘(i) the day on which a determination
4 is made with respect to the eligibility of
5 such individual for services under the State
6 plan; or
7 ‘‘(ii) in the case of such an individual
8 who does not file an application by the last
9 day of the month following the month dur-
10 ing which the entity makes the determina-
11 tion referred to in subparagraph (A), such
12 last day.
13 ‘‘(2) QUALIFIED ENTITY.—

14 ‘‘(A) IN GENERAL.—Subject to subpara-

15 graph (B), the term ‘qualified entity’ means
16 any entity that—
17 ‘‘(i) is eligible for payments under a
18 State plan approved under this title; and
19 ‘‘(ii) is determined by the State agen-
20 cy to be capable of making determinations
21 of the type described in paragraph (1)(A).
22 ‘‘(B) RULE OF CONSTRUCTION.—Nothing

23 in this paragraph shall be construed as pre-

24 venting a State from limiting the classes of en-

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1 tities that may become qualified entities in
2 order to prevent fraud and abuse.
3 ‘‘(c) ADMINISTRATION.—
4 ‘‘(1) IN GENERAL.—The State agency shall pro-
5 vide qualified entities with—
6 ‘‘(A) such forms as are necessary for an
7 application to be made by an individual de-
8 scribed in subsection (a) for medical assistance
9 under the State plan; and
10 ‘‘(B) information on how to assist such in-
11 dividuals in completing and filing such forms.
12 ‘‘(2) NOTIFICATION REQUIREMENTS.—A quali-
13 fied entity that determines under subsection
14 (b)(1)(A) that an individual described in subsection
15 (a) is presumptively eligible for medical assistance
16 under a State plan shall—
17 ‘‘(A) notify the State agency of the deter-
18 mination within 5 working days after the date
19 on which determination is made; and
20 ‘‘(B) inform such individual at the time
21 the determination is made that an application
22 for medical assistance is required to be made by
23 not later than the last day of the month fol-
24 lowing the month during which the determina-
25 tion is made.

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1 ‘‘(3) APPLICATION FOR MEDICAL ASSIST-

2 ANCE.—In the case of an individual described in

3 subsection (a) who is determined by a qualified enti-
4 ty to be presumptively eligible for medical assistance
5 under a State plan, the individual shall apply for
6 medical assistance by not later than the last day of
7 the month following the month during which the de-
8 termination is made.
9 ‘‘(d) PAYMENT.—Notwithstanding any other provi-
10 sion of law, medical assistance that—
11 ‘‘(1) is furnished to an individual described in
12 subsection (a)—
13 ‘‘(A) during a presumptive eligibility pe-
14 riod;
15 ‘‘(B) by a entity that is eligible for pay-
16 ments under the State plan; and
17 ‘‘(2) is included in the care and services covered
18 by the State plan,
19 shall be treated as medical assistance provided by such
20 plan for purposes of clause (4) of the first sentence of
21 section 1905(b).’’.
22 (2) CONFORMING AMENDMENTS.—

23 (A) Section 1902(a)(47) of the Social Se-

24 curity Act (42 U.S.C. 1396a(a)(47)) is amend-
25 ed by inserting before the semicolon at the end

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