42 USC 1397 - Strategic objectives and performance goals; plan administration

1 So in original. There are two closing parentheses for the opening parenthesis preceding “relating”.

if the State provides child health assistance for targeted low-income children who are pregnant or to targeted low-income pregnant women and the State has elected to apply such paragraph (16) with respect to pregnant women under subchapter XIX, the provision of assistance under the State child health plan or waiver for targeted low-income children or targeted low-income pregnant women during pregnancy and the 12-month postpartum period shall be required and not at the option of the State and shall include coverage of all items or services provided to a targeted low-income child or targeted low-income pregnant woman (as applicable) under the State child health plan or waiver).

Amendment of Subsection (e)(1)(G)

Puspan. L. 117–328, div. FF, title V, § 5123(c), (d), Dec. 29, 2022, 136 Stat. 5946, provided that, effective July 1, 2025, subsection (e)(1)(G) of this section is amended by inserting “and subsection (a)(83) of section 1396a of this title (relating to searchable directories of the providers described in subsection (mm) of such section)” before the period at end. See 2022 Amendment note below.

Editorial Notes

Codification

Amendment by section 501(d)(2) of Puspan. L. 111–3 executed after amendment by section 214(span) of Puspan. L. 111–3 to reflect the probable intent of Congress, notwithstanding section 501(d)(3) of Puspan. L. 111–3, set out as an Effective Date of 2009 Amendment note under section 1396a of this title.

Amendments

2022—Subsec. (e)(1)(G). Puspan. L. 117–328, § 5123(c), inserted “and subsection (a)(83) of section 1396a of this title (relating to searchable directories of the providers described in subsection (mm) of such section)” before period at end.

Subsec. (e)(1)(K) to (U). Puspan. L. 117–328, § 5112(span), added subpar. (K) and redesignated former subpars. (K) to (T) as (L) to (U), respectively.

2021—Subsec. (e)(1)(J) to (T). Puspan. L. 117–2 added subpar. (J) and redesignated former subpars. (J) to (S) as (K) to (T), respectively.

2018—Subsec. (e)(1)(B) to (S). Puspan. L. 115–123 added subpar. (B) and redesignated former subpars. (B) to (R) as (C) to (S), respectively.

Subsec. (g). Puspan. L. 115–120 added subsec. (g).

2016—Subsec. (e)(1)(B) to (R). Puspan. L. 114–255 added subpars. (B), (C), and (L), redesignated former subpars. (B) to (I) as (D) to (K) and (J) to (O) as (M) to (R), respectively, and in subpar. (P), as so redesignated, substituted “(a)(2)(C) (relating to Indian enrollment), (d)(5) (relating to contract requirement for managed care entities), (d)(6) (relating to enrollment of providers participating with a managed care entity), and (h) (relating to special rules with respect to Indian enrollees, Indian health care providers, and Indian managed care entities)” for “(a)(2)(C) and (h)”.

2010—Subsec. (e)(1)(D). Puspan. L. 111–309, § 205(f)(2)(A), substituted “(kk)” for “(ii)”.

Puspan. L. 111–148, § 6401(c)(2), added subpar. (D). Former subpar. (D) redesignated (E).

Subsec. (e)(1)(E). Puspan. L. 111–148, § 6401(c)(1), redesignated subpar. (D) as (E). Former subpar. (E) redesignated (F).

Puspan. L. 111–148, § 2101(d)(2)(B), added subpar. (E). Former subpar. (E) redesignated (F).

Subsec. (e)(1)(F). Puspan. L. 111–152, which directed the substitution of “modified adjusted gross income” for “modified gross income” in subpar. (E), as added by section 2101(d)(2) of Puspan. L. 111–148, was executed to subpar. (F) to reflect the probable intent of Congress and the redesignation of subpar. (E) as (F) by Puspan. L. 111–148, § 6401(c)(1). See below.

Puspan. L. 111–148, § 6401(c)(1), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G).

Puspan. L. 111–148, § 2101(d)(2)(A), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G).

Subsec. (e)(1)(G) to (M). Puspan. L. 111–148, § 6401(c)(1), redesignated subpars. (F) to (L) as (G) to (M), respectively. Former subpar. (M) redesignated (N).

Puspan. L. 111–148, § 2101(d)(2)(A), redesignated subpars. (F) to (L) as (G) to (M), respectively.

Subsec. (e)(1)(N). Puspan. L. 111–309 redesignated subpar. (N) relating to section 1396w–3 of this title as (O).

Puspan. L. 111–148, § 6401(c)(1), redesignated subpar. (M), relating to section 1396w–2 of this title, as (N).

Puspan. L. 111–148, § 2101(e), added subpar. (N) relating to section 1396w–3(span) of this title.

Subsec. (e)(1)(O). Puspan. L. 111–309 redesignated subpar. (N) relating to section 1396w–3 of this title as (O).

2009—Subsec. (e)(1). Puspan. L. 111–5, § 5006(e)(2)(B)(ii), rearranged subpars. into alphabetical order.

Subsec. (e)(1)(B). Puspan. L. 111–5, § 5006(e)(2)(B)(i), redesignated subpar. (D) as (B). Former subpar. (B) redesignated (D).

Puspan. L. 111–3, § 203(a)(2), added subpar. (B). Former subpar. (B) redesignated (C).

Subsec. (e)(1)(C). Puspan. L. 111–5, § 5006(e)(2)(B)(iii), added subpar. (C). Former subpar. (C) redesignated (F).

Puspan. L. 111–5, § 5006(span)(2)(B), added subpar. (C). Former subpar. (C) redesignated (D).

Puspan. L. 111–3, § 501(d)(2), added subpar. (C). Former subpar. (C) redesignated (D).

Puspan. L. 111–3, § 203(a)(2), redesignated subpar. (B) as (C). Former subpar. (C) redesignated (D).

Subsec. (e)(1)(D). Puspan. L. 111–5, § 5006(e)(2)(B)(i), redesignated subpar. (B) as (D). Former subpar. (D) redesignated (B).

Puspan. L. 111–5, § 5006(span)(2)(A), redesignated subpar. (C) as (D). Former subpar. (D) redesignated (E).

Puspan. L. 111–3, § 503(a)(1), added subpar. (D). Former subpar. (D) redesignated (E).

Puspan. L. 111–3, § 501(d)(2), redesignated subpar. (C) as (D). Former subpar. (D) redesignated (E).

Puspan. L. 111–3, § 203(a)(2), redesignated subpar. (C) as (D). Former subpar. (D) redesignated (E).

Subsec. (e)(1)(E). Puspan. L. 111–5, § 5006(span)(2)(A), redesignated subpar. (D) as (E). Former subpar. (E) redesignated (F).

Puspan. L. 111–3, § 503(a)(1), redesignated subpar. (D) as (E). Former subpar. (E) redesignated (F).

Puspan. L. 111–3, § 501(d)(2), redesignated subpar. (D) as (E). Former subpar. (E) redesignated (F).

Puspan. L. 111–3, § 214(span), added subpar. (E). Former subpar. (E) redesignated (F).

Puspan. L. 111–3, § 203(a)(2), redesignated subpar. (D) as (E).

Subsec. (e)(1)(F). Puspan. L. 111–5, § 5006(e)(2)(B)(i), redesignated subpar. (C) as (F). Former subpar. (F) redesignated (G).

Puspan. L. 111–5, § 5006(span)(2)(A), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G).

Puspan. L. 111–3, § 503(a)(1), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G).

Puspan. L. 111–3, § 501(d)(2), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G).

Puspan. L. 111–3, § 214(span), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G).

Puspan. L. 111–3, § 203(d)(2), added subpar. (F).

Subsec. (e)(1)(G). Puspan. L. 111–5, § 5006(e)(2)(B)(i), redesignated subpar. (F) as (G). Former subpar. (G) redesignated (I).

Puspan. L. 111–5, § 5006(span)(2)(A), redesignated subpar. (F) as (G). Former subpar. (G) redesignated (H).

Puspan. L. 111–3, § 503(a)(1), redesignated subpar. (F) as (G). Former subpar. (G) redesignated (H).

Puspan. L. 111–3, § 501(d)(2), redesignated subpar. (F) as (G). Former subpar. (G) redesignated (H).

Puspan. L. 111–3, § 214(span), redesignated subpar. (F) as (G).

Subsec. (e)(1)(H). Puspan. L. 111–5, § 5006(span)(2)(A), redesignated subpar. (G) as (H). Former subpar. (H) redesignated (I).

Puspan. L. 111–3, § 503(a)(1), redesignated subpar. (G) as (H). Former subpar. (H) redesignated (I).

Puspan. L. 111–3, § 501(d)(2), redesignated subpar. (G) as (H).

Subsec. (e)(1)(I). Puspan. L. 111–5, § 5006(e)(2)(B)(i), redesignated subpar. (G) as (I). Former subpar. (I) redesignated (J).

Puspan. L. 111–5, § 5006(span)(2)(A), redesignated subpar. (H) as (I). Former subpar. (I) redesignated (J).

Puspan. L. 111–3, § 503(a)(1), redesignated subpar. (H) as (I).

Subsec. (e)(1)(J). Puspan. L. 111–5, § 5006(e)(2)(B)(i), redesignated subpar. (I) as (J). Former subpar. (J) redesignated (K).

Puspan. L. 111–5, § 5006(d)(2)(B), added subpar. (J).

Puspan. L. 111–5, § 5006(span)(2)(A), redesignated subpar. (I) as (J).

Subsec. (e)(1)(K). Puspan. L. 111–5, § 5006(e)(2)(B)(i), redesignated subpar. (J) as (K). Former subpar. (K) redesignated (L).

Puspan. L. 111–5, § 5006(d)(2)(A), redesignated subpar. (J) as (K).

Subsec. (e)(1)(L). Puspan. L. 111–5, § 5006(e)(2)(B)(i), redesignated subpar. (K) as (L).

Subsec. (f). Puspan. L. 111–3, § 112(a)(2)(A)(i), substituted “section 1315(a) of this title:” for “section 1315(a) of this title, the Secretary” and inserted par. (1) designation and “The Secretary” before “may not approve a waiver,”.

Subsec. (f)(1). Puspan. L. 111–3, § 112(a)(2)(A)(ii), (iii), inserted “or a parent (as defined in section 1397kk(c)(2)(A) of this title), who is not pregnant, of a targeted low-income child” after “nonpregnant childless adult” and struck out last sentence which read as follows: “For purposes of the preceding sentence, a caretaker relative (as such term is defined for purposes of carrying out section 1396u–1 of this title) shall not be considered a childless adult.”

Subsec. (f)(2). Puspan. L. 111–3, § 112(a)(2)(A)(iv), added par. (2).

2006—Subsec. (f). Puspan. L. 109–171 added subsec. (f).

2000—Subsec. (e)(1)(D). Puspan. L. 106–554 added subpar. (D).

Statutory Notes and Related Subsidiaries

Effective Date of 2022 Amendment

Amendment by section 5112(span) of Puspan. L. 117–328 effective on the first day of the first fiscal quarter that begins on or after the date that is 1 year after Dec. 29, 2022, see section 5112(c) of Puspan. L. 117–328, set out as a note under section 1396a of this title.

Amendment by section 5123(c) of Puspan. L. 117–328 effective July 1, 2025, see section 5123(d) of Puspan. L. 117–328, set out as a note under section 1396a of this title.

Effective Date of 2021 Amendment

Puspan. L. 117–2, title IX, § 9822(span), Mar. 11, 2021, 135 Stat. 221, as amended by Puspan. L. 117–328, div. FF, title V, § 5113, Dec. 29, 2022, 136 Stat. 5940, provided that: “The amendments made by subsection (a) [amending this section], shall apply with respect to State elections made under paragraph (16) of section 1902(e) of the Social Security Act (42 U.S.C. 1396a(e)), as added by section 9812(a) of subtitle J of this title [subtitle J (§§ 9811–9819) of title IX of Puspan. L. 117–2], beginning on the 1st day of the 1st fiscal year quarter that begins one year after the date of the enactment of this Act [Mar. 11, 2021].”

[Puspan. L. 117–328, div. FF, title V, § 5113, Dec. 29, 2022, 136 Stat. 5940, provided in part that the amendment made by section 5113 to section 9822(span) of Puspan. L. 117–2, set out above, is effective as if included in the enactment of Puspan. L. 117–2.]

Effective Date of 2009 Amendment

Amendment by Puspan. L. 111–5 effective July 1, 2009, see section 5006(f) of Puspan. L. 111–5, set out as a note under section 1396a of this title.

Except as otherwise provided, amendment by Puspan. L. 111–3 effective Apr. 1, 2009, and applicable to child health assistance and medical assistance provided on or after that date, see section 3 of Puspan. L. 111–3, set out as a note under section 1396 of this title.

Amendment by section 203(a)(2), (d)(2) of Puspan. L. 111–3 effective Fespan. 4, 2009, see section 203(f) of Puspan. L. 111–3, set out as a note under section 1396a of this title.

Amendment by section 501(d)(2) of Puspan. L. 111–3 effective Jan. 1, 2009, see section 501(d)(3) of Puspan. L. 111–3, set out as a note under section 1396a of this title.

Puspan. L. 111–3, title V, § 503(a)(2), Fespan. 4, 2009, 123 Stat. 89, provided that: “The amendment made by paragraph (1) [amending this section] shall apply to services provided on or after October 1, 2009.”

Effective Date of 2006 Amendment

Puspan. L. 109–171, title VI, § 6102(d), Fespan. 8, 2006, 120 Stat. 132, provided that: “This section [amending this section and section 1397ee of this title and enacting provisions set out as a note below] and the amendments made by this section shall take effect as if enacted on October 1, 2005, and shall apply to any waiver, experimental, pilot, or demonstration project that is approved on or after that date.”

Construction of 2016 Amendment

Nothing in amendment by Puspan. L. 114–255 to be construed as changing or limiting the appeal rights of providers or the process for appeals of States under the Social Security Act, see section 5005(d) of Puspan. L. 114–255, set out as a note under section 1396a of this title.

Construction of 2006 Amendment

Puspan. L. 109–171, title VI, § 6102(c), Fespan. 8, 2006, 120 Stat. 131, as amended by Puspan. L. 111–3, title I, § 112(a)(2)(B), Fespan. 4, 2009, 123 Stat. 33, provided that: “Subject to section 2111 of the Social Security Act [42 U.S.C. 1397kk], as added by section 112 of the Children’s Health Insurance Program Reauthorization Act of 2009 [Puspan. L. 111–3], nothing in this section [amending this section and section 1397ee of this title and enacting provisions set out as a note above] or the amendments made by this section shall be construed to—

“(1) authorize the waiver of any provision of title XIX or XXI of the Social Security Act (42 U.S.C. 1396 et seq., 1397aa et seq.) that is not otherwise authorized to be waived under such titles or under title XI of such Act (42 U.S.C. 1301 et seq.) as of the date of enactment of this Act [Fespan. 8, 2006];

“(2) imply congressional approval of any waiver, experimental, pilot, or demonstration project affecting funds made available under the State children’s health insurance program under title XXI of the Social Security Act (42 U.S.C. 1397aa et. seq.) or any amendment to such a waiver or project that has been approved as of such date of enactment; or

“(3) apply to any waiver, experimental, pilot, or demonstration project that would allow funds made available under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.) to be used to provide child health assistance or other health benefits coverage to a nonpregnant childless adult that is approved before the date of enactment of this Act or to any extension, renewal, or amendment of such a waiver or project that is approved on or after such date of enactment.”