Unintended Pregnancy Reduction Act of 2006 - Amends title XIX (Medicaid) of the Social Security Act to: (1) prohibit a state from providing for medical assistance through enrollment of an individual with benchmark coverage or benchmark-equivalent coverage unless it includes certain family planning services and supplies; (2 ) include women who are not pregnant but who meet certain income eligibility standards in a mandatory categorically needy group for family planning services purposes; and (3) allow a state Medicaid plan to provide for making medical assistance available to such individuals during a presumptive eligibility period.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 2916 Introduced in Senate (IS)]
109th CONGRESS
2d Session
S. 2916
To amend title XIX of the Social Security Act to expand access to
contraceptive services for women and men under the Medicaid program,
help low income women and couples prevent unintended pregnancies and
reduce abortion, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 19, 2006
Mrs. Clinton (for herself, Mr. Reid, Mr. Kerry, Mrs. Boxer, Mr. Harkin,
Mr. Lautenberg, Mr. Obama, Mr. Jeffords, Mr. Bingaman, and Ms.
Cantwell) introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to expand access to
contraceptive services for women and men under the Medicaid program,
help low income women and couples prevent unintended pregnancies and
reduce abortion, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Unintended Pregnancy Reduction Act
of 2006''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Rates of unintended pregnancy in the United States
increased by nearly 30 percent among low-income women between
1994 and 2002, and a low-income woman today is 4 times as
likely to have an unintended pregnancy as her higher income
counterpart.
(2) Abortion rates decreased among higher income women but
increased among low income women between 1994 and 2002, and a
low income woman is more than 4 times as likely to have an
abortion as her higher income counterpart.
(3) Contraceptive use reduces a woman's probability of
having an abortion by 85 percent.
(4) Levels of contraceptive use among low-income women at
risk of unintended pregnancy declined significantly between
1994 and 2002, from 92 percent to 86 percent.
(5) Publicly funded contraceptive services have been shown
to prevent 1,300,000 unintended pregnancies each year, and in
the absence of these services the United States abortion rate
would likely be 40 percent higher than it is.
(6) By helping couples avoid unintended pregnancy,
Medicaid-funded contraceptive services are highly cost-
effective, and every public dollar spent on family planning
saves $3 in the cost of pregnancy-related care alone.
(7) Federal law requires State Medicaid programs to cover
pregnancy-related care for women with incomes up to 133 percent
of poverty, and 17 States have expanded this coverage to women
with incomes up to 200 percent of poverty.
(8) 18 States have expanded Medicaid coverage for family
planning services to the same level at which they provide
Medicaid funded pregnancy-related care.
(9) Equalizing the eligibility levels for family planning
and pregnancy-related care nationwide would maximize the cost-
savings to both the Federal and State Governments.
(10) A woman should have equal access to contraceptive
services to help prevent an unintended pregnancy and to
pregnancy-related care if she does become pregnant.
SEC. 3. CLARIFICATION OF COVERAGE OF FAMILY PLANNING SERVICES AND
SUPPLIES.
Section 1937(b) of the Social Security Act (42 U.S.C. 1396u-7(b))
is amended by adding at the end the following:
``(5) Coverage of family planning services and supplies.--
Notwithstanding the previous provisions of this section, a
State may not provide for medical assistance through enrollment
of an individual with benchmark coverage or benchmark-
equivalent coverage under this section unless that coverage
includes family planning services and supplies as described in
section 1905(a)(4)(C).''.
SEC. 4. EXPANSION OF FAMILY PLANNING SERVICES.
(a) Coverage as Mandatory Categorically Needy Group.--
(1) In general.--Section 1902(a)(10)(A)(i) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(A)(i)) is amended--
(A) in subclause (VI), by striking ``or'' at the
end;
(B) in subclause (VII), by adding ``or'' at the
end; and
(C) by adding at the end the following new
subclause:
``(VIII) who are described in
subsection (dd) (relating to
individuals who meet the income
standards for pregnant women);''.
(2) Group described.--Section 1902 of the Social Security
Act (42 U.S.C. 1396a) is amended by adding at the end the
following new subsection:
``(dd)(1) Individuals described in this subsection are individuals
who--
``(A) meet at least the income eligibility standards
established under the State plan as of May 1, 2006, for
pregnant women or such higher income eligibility standard for
such women as the State may establish; and
``(B) are not pregnant.
``(2) At the option of a State, individuals described in this
subsection may include individuals who are determined to meet the
income eligibility standards referred to in paragraph (1)(A) under the
terms and conditions applicable to making eligibility determinations
for medical assistance under this title under a waiver to provide the
benefits described in clause (XV) of the matter following subparagraph
(G) of section 1902(a)(10) granted to the State under section 1115 as
of May 1, 2006.''.
(3) Limitation on benefits.--Section 1902(a)(10) of the
Social Security Act (42 U.S.C. 1396a(a)(10)) is amended in the
matter following subparagraph (G)--
(A) by striking ``and (XIV)'' and inserting
``(XIV)''; and
(B) by inserting ``, and (XV) the medical
assistance made available to an individual described in
subsection (dd) who is eligible for medical assistance
only because of subparagraph (A)(10)(i)(VIII) shall be
limited to family planning services and supplies
described in 1905(a)(4)(C) and, at the State's option,
medical diagnosis or treatment services that are
provided in conjunction with a family planning service
in a family planning setting provided during the period
in which such an individual is eligible;'' after
``cervical cancer''.
(4) Conforming amendments.--Section 1905(a) of the Social
Security Act (42 U.S.C. 1396d(a)) is amended in the matter
preceding paragraph (1)--
(A) in clause (xii), by striking ``or'' at the end;
(B) in clause (xii), by adding ``or'' at the end;
and
(C) by inserting after clause (xiii) the following:
``(xiv) individuals described in section
1902(dd),''.
(b) Presumptive Eligibility.--
(1) In general.--Title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) is amended by inserting after section
1920B the following:
``presumptive eligibility for family planning services
``Sec. 1902C. (a) State Option.--A State plan approved under
section 1902 may provide for making medical assistance available to an
individual described in section 1902(dd) (relating to individuals who
meet the income eligibility standard for pregnant women in the State)
during a presumptive eligibility period. In the case of an individual
described in section 1902(dd) who is eligible for medical assistance
only because of subparagraph (A)(10)(i)(VIII), such medical assistance
may be limited to family planning services and supplies described in
1905(a)(4)(C) and, at the State's option, medical diagnosis or
treatment services that are provided in conjunction with a family
planning service in a family planning setting provided during the
period in which such an individual is eligible.
``(b) Definitions.--For purposes of this section:
``(1) Presumptive eligibility period.--The term
`presumptive eligibility period' means, with respect to an
individual described in subsection (a), the period that--
``(A) begins with the date on which a qualified
entity determines, on the basis of preliminary
information, that the individual is described in
section 1902(dd); and
``(B) ends with (and includes) the earlier of--
``(i) the day on which a determination is
made with respect to the eligibility of such
individual for services under the State plan;
or
``(ii) in the case of such an individual
who does not file an application by the last
day of the month following the month during
which the entity makes the determination
referred to in subparagraph (A), such last day.
``(2) Qualified entity.--
``(A) In general.--Subject to subparagraph (B), the
term `qualified entity' means any entity that--
``(i) is eligible for payments under a
State plan approved under this title; and
``(ii) is determined by the State agency to
be capable of making determinations of the type
described in paragraph (1)(A).
``(B) Regulations.--The Secretary may issue
regulations further limiting those entities that may
become qualified entities in order to prevent fraud and
abuse and for other reasons.
``(C) Rule of construction.--Nothing in this
paragraph shall be construed as preventing a State from
limiting the classes of entities that may become
qualified entities, consistent with any limitations
imposed under subparagraph (B).
``(c) Administration.--
``(1) In general.--The State agency shall provide qualified
entities with--
``(A) such forms as are necessary for an
application to be made by an individual described in
subsection (a) for medical assistance under the State
plan; and
``(B) information on how to assist such individuals
in completing and filing such forms.
``(2) Notification requirements.--A qualified entity that
determines under subsection (b)(1)(A) that an individual
described in subsection (a) is presumptively eligible for
medical assistance under a State plan shall--
``(A) notify the State agency of the determination
within 5 working days after the date on which
determination is made; and
``(B) inform such individual at the time the
determination is made that an application for medical
assistance is required to be made by not later than the
last day of the month following the month during which
the determination is made.
``(3) Application for medical assistance.--In the case of
an individual described in subsection (a) who is determined by
a qualified entity to be presumptively eligible for medical
assistance under a State plan, the individual shall apply for
medical assistance by not later than the last day of the month
following the month during which the determination is made.
``(d) Payment.--Notwithstanding any other provision of this title,
medical assistance that--
``(1) is furnished to an individual described in subsection
(a)--
``(A) during a presumptive eligibility period;
``(B) by a entity that is eligible for payments
under the State plan; and
``(2) is included in the care and services covered by the
State plan, shall be treated as medical assistance provided by
such plan for purposes of clause (4) of the first sentence of
section 1905(b).''.
(2) Conforming amendments.--
(A) Section 1902(a)(47) of the Social Security Act
(42 U.S.C. 1396a(a)(47)) is amended by inserting before
the semicolon at the end the following: ``and provide
for making medical assistance available to individuals
described in subsection (a) of section 1920C during a
presumptive eligibility period in accordance with such
section.''.
(B) Section 1903(u)(1)(D)(v) of such Act (42 U.S.C.
1396b(u)(1)(D)(v)) is amended--
(i) by striking ``or for'' and inserting
``, for''; and
(ii) by inserting before the period the
following: ``, or for medical assistance
provided to an individual described in
subsection (a) of section 1920C during a
presumptive eligibility period under such
section''.
SEC. 5. EFFECTIVE DATE.
(a) In General.--Except as provided in paragraph (2), the
amendments made by this Act take effect on October 1, 2006.
(b) Extension of Effective Date for State Law Amendment.--In the
case of a State plan under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) which the Secretary of Health and Human Services
determines requires State legislation in order for the plan to meet the
additional requirements imposed by the amendments made by this Act, the
State plan shall not be regarded as failing to comply with the
requirements of such title solely on the basis of its failure to meet
these additional requirements before the first day of the first
calendar quarter beginning after the close of the first regular session
of the State legislature that begins after the date of enactment of
this Act. For purposes of the previous sentence, in the case of a State
that has a 2-year legislative session, each year of the session is
considered to be a separate regular session of the State legislature.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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