PUBLIC LAW 105-33—AUG. 5, 1997 111 STAT. 561 "(B) for expenditures for health services initiatives under the plan for improving the health of children (including targeted low-income children and other low-income children); "(C) for expenditures for outreach activities as provided in section 2102(c)(1) under the plan; and "(D) for other reasonable costs incurred by the State to administer the plan. "(b) ENHANCED FMAP.—For purposes of subsection (a), the 'enhanced FMAP', for a State for a fiscal year, is equal to the Federal medical assistance percentage (as defined in the first sentence of section 1905(b)) for the State increased by a number of percentage points equal to 30 percent of the number of percentage points by which (1) such Federal medical assistance percentage for the State, is less than (2) 100 percent; but in no case shall the enhanced FMAP for a State exceed 85 percent. "(c) LIMITATION ON CERTAIN PAYMENTS FOR CERTAIN EXPENDI- TURES.— "(1) GENERAL LIMITATIONS. —Funds provided to a State under this title shall only be used to carry out the purposes of this title (as described in section 2101), and any health insurance coverage provided with such funds may include coverage of abortion only if necessary to save the life of the mother or if the pregnancy is the result of an act of rape or incest. "(2) LIMITATION ON EXPENDITURES NOT USED FOR MEDICAID OR HEALTH INSURANCE ASSISTANCE. — "(A) IN GENERAL.— Except as provided in this paragraph, payment shall not be made under subsection (a) for expenditures for items described in subsection (a) (other than paragraph (1)) for a quarter in a fiscal year to the extent the total of such expenditures exceeds 10 percent ofthesumof— "(i) the total Federal payments made under subsection (a) for such quarter in the fiscal year, and "(ii) the total Federal payments made under section 1903(a)(1) based on an enhanced FMAP described in section 1905(u)(2) for such quarter. "(B) WAIVER AUTHORIZED FOR COST-EFFECTIVE ALTER- NATIVE.— The limitation under subparagraph (A) on expenditures for items described in subsection (a)(2) shall not apply to the extent that a State establishes to the satisfaction of the Secretary that— "(i) coverage provided to targeted low-income children through such expenditures meets the requirements of section 2103; "(ii) the cost of such coverage is not greater, on an average per child basis, than the cost of coverage that would otherwise be provided under section 2103; and "(iii) such coverage is provided through the use of a community-based health delivery system, such as through contracts with health centers receiving funds under section 330 of the Public Health Service Act or with hospitals such as those that receive disproportionate share payment adjustments under section 1886(d)(5)(F) or 1923.
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