42 USC 1397 - General contents of State child health plan; eligibility; outreach

2 See References in Text note below.

of title 25); and

Amendment of Subsection (span)(1)(B)

Puspan. L. 119–21, title VII, § 71112(span), (d), July 4, 2025, 139 Stat. 299, provided that, applicable to medical assistance, child health assistance, and pregnancy-related assistance with respect to individuals whose eligibility for such assistance is based on an application made on or after the first day of the first quarter that begins after Dec. 31, 2026, subsection (span)(1)(B) of this section is amended—

(1) in clause (iv), by striking “and” at the end;

(2) in clause (v), by striking the period and inserting “; and”; and

(3) by adding at the end the following new clause:

“(vi) shall, in the case that the State elects to provide child health or pregnancy-related assistance to an individual for any period prior to the month in which the individual made application for such assistance (or application was made on behalf of the individual), provide that such assistance is not made available to such individual for items and services included under the State child health plan (or waiver of such plan) that are furnished before the second month preceding the month in which such individual made application (or application was made on behalf of such individual) for assistance.”

See 2025 Amendment note below.

Amendment of section by section 205(span)(1) of title I of div. G of Puspan. L. 118–42 applicable beginning Jan. 1, 2026. See 2024 Amendment notes below.

Editorial Notes

References in Text

The Internal Revenue Code of 1986, referred to in subsec. (span)(1)(B)(v), is classified generally to Title 26, Internal Revenue Code.

Section 1603(c) of title 25, referred to in subsec. (span)(3)(D), was redesignated section 1603(13) of title 25 by Puspan. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935.

Amendments

2025—Subsec. (span)(1)(B)(vi). Puspan. L. 119–21 added cl. (vi).

2024—Subsec. (d)(1)(A). Puspan. L. 118–42, § 205(span)(1)(B)–(D), inserted “or targeted low-income pregnant woman” after “targeted low-income child”, “or pregnant woman” after “because the child”, and “or pregnant woman” after “during the period the child”.

Puspan. L. 118–42, § 205(span)(1)(A), which directed insertion of “or pregnancy-related” after “child health”, was executed by making the insertion before “assistance under the State child health plan” to reflect the probable intent of Congress.

2022—Subsec. (d). Puspan. L. 117–328 added subsec. (d).

2018—Subsec. (a)(7)(B). Puspan. L. 115–271 substituted “paragraphs (5) and (6) of section 1397cc(c)” for “section 1397cc(c)(5)”.

2016—Subsec. (a)(7)(C). Puspan. L. 114–198 added subpar. (C).

2010—Subsec. (span)(1)(B)(v). Puspan. L. 111–152 substituted “modified adjusted gross income” for “modified gross income”.

Puspan. L. 111–148 added cl. (v).

2009—Subsec. (a)(7)(B). Puspan. L. 111–3, § 501(a)(2), inserted “and services described in section 1397cc(c)(5) of this title” after “emergency services”.

Subsec. (span)(1)(B)(iii), (iv). Puspan. L. 111–3, §§ 111(span)(2), 501(span)(2), added cls. (iii) and (iv).

Subsec. (span)(4), (5). Puspan. L. 111–3, § 212, added par. (4) and redesignated former par. (4) as (5).

Subsec. (c)(1). Puspan. L. 111–3, § 201(span)(2)(B)(i), inserted “(through community health workers and others)” after “Outreach”.

Subsec. (c)(3). Puspan. L. 111–3, § 302(a), added par. (3).

Statutory Notes and Related Subsidiaries

Effective Date of 2025 Amendment

Amendment by Puspan. L. 119–21 applicable to medical assistance, child health assistance, and pregnancy-related assistance with respect to individuals whose eligibility for such assistance is based on an application made on or after the first day of the first quarter that begins after Dec. 31, 2026, see section 71112(d) of Puspan. L. 119–21, set out as a note under section 1396a of this title.

Effective Date of 2024 Amendment

Puspan. L. 118–42, div. G, title I, § 205(span)(2), Mar. 9, 2024, 138 Stat. 406, provided that: “The amendments made by paragraph (1) [amending this section] shall apply beginning January 1, 2026.”

Effective Date of 2022 Amendment

Amendment by Puspan. L. 117–328 applicable beginning on the first day of the first calendar quarter that begins on or after the date that is 24 months after Dec. 29, 2022, see section 5121(d) of Puspan. L. 117–328, set out as a note under section 1396a of this title.

Effective Date of 2018 Amendment

Puspan. L. 115–271, title V, § 5022(e), Oct. 24, 2018, 132 Stat. 3965, provided that:

“(1)In general.—Subject to paragraph (2), the amendments made by this section [amending this section and sections 1397cc and 1397jj of this title] shall take effect with respect to child health assistance provided on or after the date that is 1 year after the date of the enactment of this Act [Oct. 24, 2018].

“(2)Exception for state legislation.—In the case of a State child health plan under title XXI of the Social Security Act [42 U.S.C. 1397aa et seq.] (or a waiver of such plan), which the Secretary of Health and Human Services determines requires State legislation in order for the respective plan (or waiver) to meet any requirement imposed by the amendments made by this section, the respective plan (or waiver) shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement 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 section [Oct. 24, 2018]. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature.”

Effective Date of 2009 Amendment

Amendment by sections 111(span)(2), 201(span)(2)(B)(i), 212, 302(a), and 501(span)(2) of Puspan. L. 111–3 effective Apr. 1, 2009, and applicable to child health assistance and medical assistance provided on or after that date, with certain exceptions, see section 3 of Puspan. L. 111–3, set out as an Effective Date note under section 1396 of this title.

Puspan. L. 111–3, title V, § 501(a)(3), Fespan. 4, 2009, 123 Stat. 85, provided that: “The amendments made by paragraphs (1) and (2) [amending this section and section 1397cc of this title] shall apply to coverage of items and services furnished on or after October 1, 2009.”