Helping Seniors Afford Health Care Act

IB Union Calendar No. 305 116TH CONGRESS 2D SESSION H. R. 4671 [Report No. 116–381, Part I] To amend titles XVIII and XIX of the Social Security Act to reduce cost- sharing, align income and resource eligibility tests, simplify enrollment, and provide for other program improvements for low-income Medicare beneficiaries. IN THE HOUSE OF REPRESENTATIVES OCTOBER 15, 2019 Mr. KIM (for himself, Ms. BLUNT ROCHESTER, and Mr. EVANS) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the com- mittee concerned JANUARY 24, 2020 Additional sponsors: Mr. CUELLAR, Ms. MATSUI, Mr. PASCRELL, Mr. MALINOWSKI, and Mr. NORCROSS JANUARY 24, 2020 Reported from the Committee on Energy and Commerce JANUARY 24, 2020 Committee on Ways and Means discharged, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed VerDate Sep 11 2014 23:21 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H4671.RH H4671 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 4671 RH A BILL To amend titles XVIII and XIX of the Social Security Act to reduce cost-sharing, align income and resource eligi- bility tests, simplify enrollment, and provide for other program improvements for low-income Medicare bene- ficiaries. VerDate Sep 11 2014 23:21 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6652 E:\BILLS\H4671.RH H4671 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 4671 RH Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Helping Seniors Afford 4 Health Care Act’’. 5 SEC. 2. REDUCING COST-SHARING, ALIGNING INCOME AND 6 RESOURCE ELIGIBILITY TESTS, SIMPLIFYING 7 ENROLLMENT, AND OTHER PROGRAM IM- 8 PROVEMENTS FOR LOW-INCOME BENE- 9 FICIARIES. 10 (a) INCREASE IN INCOME ELIGIBILITY TO 135 PER- 11 CENT OF FPL FOR QUALIFIED MEDICARE BENE- 12 FICIARIES.— 13 (1) IN GENERAL.—Section 1905(p)(2)(A) of the 14 Social Security Act (42 U.S.C. 1396d(p)(2)(A)) is 15 amended by striking ‘‘shall be at least the percent 16 provided under subparagraph (B) (but not more 17 than 100 percent) of the official poverty line’’ and 18 all that follows through the period at the end and 19 inserting the following: ‘‘shall be— 20 ‘‘(i) before January 1, 2021, at least 21 the percent provided under subparagraph 22 (B) (but not more than 100 percent) of 23 the official poverty line (as defined by the 24 Office of Management and Budget, and re- 25 VerDate Sep 11 2014 23:21 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4671.RH H4671 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 4671 RH vised annually in accordance with section 1 673(2) of the Omnibus Budget Reconcili- 2 ation Act of 1981) applicable to a family 3 of the size involved; and 4 ‘‘(ii) on or after January 1, 2021, 5 equal to 135 percent of the official poverty 6 line (as so defined and revised) applicable 7 to a family of the size involved.’’. 8 (2) NOT COUNTING IN-KIND SUPPORT AND 9 MAINTENANCE AS INCOME.—Section 1905(p)(2)(D) 10 of the Social Security Act (42 U.S.C. 11 1396d(p)(2)(D)) is amended by adding at the end 12 the following new clause: 13 ‘‘(iii) In determining income under 14 this subsection, support and maintenance 15 furnished in kind shall not be counted as 16 income.’’. 17 (b) INCREASE IN INCOME ELIGIBILITY TO 200 PER- 18 CENT OF FPL FOR SPECIFIED LOW-INCOME MEDICARE 19 BENEFICIARIES.— 20 (1) ELIGIBILITY OF INDIVIDUALS WITH IN- 21 COMES BELOW 150 PERCENT OF FPL.—Section 22 1902(a)(10)(E) of the Social Security Act (42 23 U.S.C. 1396a(a)(10)(E)) is amended— 24 VerDate Sep 11 2014 23:21 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4671.RH H4671 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 4671 RH (A) by adding ‘‘and’’ at the end of clause 1 (ii); 2 (B) in clause (iii)— 3 (i) by striking ‘‘and 120 percent in 4 1995 and years thereafter’’ and inserting 5 ‘‘120 percent in 1995 and years thereafter 6 before 2021, and 200 percent in 2021 and 7 years thereafter’’; and 8 (ii) by striking ‘‘and’’ at the end; and 9 (C) by striking clause (iv). 10 (2) REFERENCES.—Section 1905(p)(1) of the 11 Social Security Act (42 U.S.C. 1396d(p)(1)) is 12 amended by adding at and below subparagraph (C) 13 the following flush sentence: 14 ‘‘The term ‘specified low-income medicare beneficiary’ 15 means an individual described in section 16 1902(a)(10)(E)(iii).’’. 17 (3) CONFORMING AMENDMENTS.— 18 (A) The first sentence of section 1905(b) 19 of such Act (42 U.S.C. 1396d(b)) is amended 20 by striking ‘‘and section 1933(d)’’. 21 (B) Section 1933 of such Act (42 U.S.C. 22 1396u–3) is repealed. 23 VerDate Sep 11 2014 23:21 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4671.RH H4671 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 4671 RH (c) 100 PERCENT FMAP.—Section 1905 of the So- 1 cial Security Act (42 U.S.C. 1396d) is amended by adding 2 at the end the following new subsection: 3 ‘‘(gg) INCREASED FMAP FOR EXPANDED MEDICARE 4 COST-SHARING POPULATIONS.— 5 ‘‘(1) IN GENERAL.—Notwithstanding subsection 6 (b), with respect to expenditures described in para- 7 graph (2) the Federal medical assistance percentage 8 shall be equal to 100 percent. 9 ‘‘(2) EXPENDITURES DESCRIBED.—The expend- 10 itures described in this paragraph are expenditures 11 made on or after January 1, 2021, for medical as- 12 sistance for medicare cost-sharing provided to any 13 individual under clause (i), (ii), or (iii) of section 14 1902(a)(10)(E) who would not have been eligible for 15 medicare cost-sharing under any such clause under 16 the income or resource eligibility standards in effect 17 on October 1, 2018.’’. 18 (d) CONSOLIDATION OF LOW-INCOME SUBSIDY RE- 19 SOURCE ELIGIBILITY TESTS.— 20 (1) IN GENERAL.—Section 1860D–14(a)(3) of 21 the Social Security Act (42 U.S.C. 1395w– 22 114(a)(3)) is amended— 23 (A) by striking subparagraph (D); 24 VerDate Sep 11 2014 23:21 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4671.RH H4671 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 4671 RH (B) by redesignating subparagraphs (E) 1 through (G) as subparagraphs (D) through (F), 2 respectively; and 3 (C) in the heading of subparagraph (D), as 4 so redesignated, by striking ‘‘ALTERNATIVE’’. 5 (2) CLARIFICATION OF CERTAIN RULES RELAT- 6 ING TO INCOME AND RESOURCE DETERMINA- 7 TIONS.—Section 1860D–14(a)(3) of the Social Secu- 8 rity Act (42 U.S.C. 1395w–114(a)(3)), as amended 9 by paragraph (1), is amended by striking subpara- 10 graph (F) and inserting the following new subpara- 11 graphs: 12 ‘‘(F) RESOURCE EXCLUSIONS.—In deter- 13 mining the resources of an individual (and the 14 eligible spouse of the individual, if any) under 15 section 1613 for purposes of subparagraph 16 (D)— 17 ‘‘(i) no part of the value of any life in- 18 surance policy shall be taken into account; 19 ‘‘(ii) no part of the value of any vehi- 20 cle shall be taken into account; 21 ‘‘(iii) there shall be excluded an 22 amount equal to $1,500 each with respect 23 to any individual or eligible spouse of an 24 individual who attests that some of the re- 25 VerDate Sep 11 2014 23:21 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4671.RH H4671 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 4671 RH sources of such individual or spouse will be 1 used to meet the burial and related ex- 2 penses of such individual or spouse; and 3 ‘‘(iv) no balance in, or benefits re- 4 ceived under, an employee pension benefit 5 plan (as defined in section 3 of the Em- 6 ployee Retirement Income Security Act of 7 1974) shall be taken into account. 8 ‘‘(G) FAMILY SIZE.—In determining the 9 size of the family of an individual for purposes 10 of determining the income eligibility of such in- 11 dividual under this section, an individual’s fam- 12 ily shall consist of— 13 ‘‘(i) the individual; 14 ‘‘(ii) the individual’s spouse who lives 15 in the same household as the individual (if 16 any); and 17 ‘‘(iii) any other individuals who— 18 ‘‘(I) are related to the individual 19 whose income eligibility is in question 20 or such individual’s spouse who lives 21 in the same household; 22 ‘‘(II) are living in the same 23 household as such individual; and 24 VerDate Sep 11 2014 23:21 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4671.RH H4671 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 4671 RH ‘‘(III) are dependent on such in- 1 dividual or such individual’s spouse 2 who is living in the same household 3 for at least one-half of their financial 4 support.’’. 5 (3) CONFORMING AMENDMENTS.—Section 6 1860D–14(a) of the Social Security Act (42 U.S.C. 7 1395w–114(a)) is amended— 8 (A) in paragraph (1), in the matter pre- 9 ceding subparagraph (A), by inserting ‘‘(as de- 10 termined under paragraph (3)(G))’’ after ‘‘fam- 11 ily of the size involved’’; and 12 (B) in paragraph (3), as amended by para- 13 graphs (1) and (2)— 14 (i) in subparagraph (A), in the matter 15 preceding clause (i), by striking ‘‘subpara- 16 graph (F)’’ and inserting ‘‘subparagraph 17 (E)’’; 18 (ii) in subparagraph (A)(ii), by insert- 19 ing ‘‘(as determined under subparagraph 20 (G))’’ after ‘‘family of the size involved’’; 21 (iii) in subparagraph (A)(iii), by strik- 22 ing ‘‘or (E)’’; 23 (iv) in subparagraph (B)(v), in the 24 matter preceding subclause (I), by striking 25 VerDate Sep 11 2014 23:21 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4671.RH H4671 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 4671 RH ‘‘subparagraph (F)’’ and inserting ‘‘sub- 1 paragraph (E)’’; and 2 (v) in subparagraph (D)(i), in the 3 matter preceding subclause (I), by striking 4 ‘‘subject to the life insurance policy exclu- 5 sion provided under subparagraph (G)’’ 6 and inserting ‘‘subject to the resource ex- 7 clusions provided under subparagraph 8 (F)’’. 9 (e) ALIGNMENT OF LOW-INCOME SUBSIDY AND 10 MEDICARE SAVINGS PROGRAM INCOME AND RESOURCE 11 ELIGIBILITY TESTS.— 12 (1) APPLICATION OF MEDICAID SPOUSAL IM- 13 POVERISHMENT RESOURCE ALLOWANCE TO MSP AND 14 LIS RESOURCE ELIGIBILITY.—Section 1905(p)(1)(C) 15 of the Social Security Act (42 U.S.C. 16 1396d(p)(1)(C)) is amended to read as follows: 17 ‘‘(C) whose resources (as determined under sec- 18 tion 1613 for purposes of the supplemental security 19 income program subject to the resource exclusions 20 under subparagraph (G) of section 1860D–14(a)(3)) 21 do not exceed— 22 ‘‘(i) in the case of an individual with a 23 spouse, an amount equal to the sum of the first 24 amount specified in subsection (f)(2)(A)(i) of 25 VerDate Sep 11 2014 23:21 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4671.RH H4671 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 4671 RH section 1924 (as adjusted under subsection (g) 1 of such section) and the amount specified in 2 subsection (f)(2)(A)(ii)(II) of such section (as 3 so adjusted); or 4 ‘‘(ii) in the case of an individual who does 5 not have a spouse, an amount equal to 1⁄2 of 6 the amount described in clause (i).’’. 7 (2) APPLICATION TO QDWIS.—Section 8 1905(s)(3) of the Social Security Act (42 U.S.C. 9 1396d(s)(3)) is amended to read as follows: 10 ‘‘(3) whose resources (as determined under sec- 11 tion 1613 for purposes of the supplemental security 12 income program subject to the resource exclusions 13 under subparagraph (G) of section 1860D–14(a)(3)) 14 do not exceed— 15 ‘‘(A) in the case of an individual with a 16 spouse, the amount in effect for the year under 17 clause (i) of subsection (p)(1)(C); and 18 ‘‘(B) in the case of an individual who does 19 not have a spouse, the amount in effect for the 20 year under clause (ii) of subsection (p)(1)(C); 21 and’’. 22 (3) APPLICATION TO LIS.—Clause (i) of section 23 1860D–14(a)(3)(D) of the Social Security Act (42 24 U.S.C. 1395w–114(a)(3)(D)), as redesignated and 25 VerDate Sep 11 2014 23:21 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H4671.RH H4671 kjohnson on DSK79L0C42PROD with BILLS 12 •HR 4671 RH amended by subsection (d)(1), is amended to read as 1 follows: 2 ‘‘(i) IN GENERAL.—The resources re- 3 quirement of this subparagraph is that an 4 individual’s resources (as determined under 5 section 1613 for purposes of the supple- 6 mental security income program subject to 7 the resource exclusions provided under 8 subparagraph (G)) do not exceed the 9 amount in effect for the year under section 10 1905(p)(1)(C)(ii).’’. 11 (f) ENROLLMENT SIMPLIFICATIONS.— 12 (1) APPLICATION OF 3-MONTH RETROACTIVE 13 ELIGIBILITY TO QMBS.— 14 (A) IN GENERAL.—Section 1902(e)(8) of 15 the Social Security Act (42 U.S.C. 1396a(e)(8)) 16 is amended by striking ‘‘after the end of the 17 month in which the determination first occurs’’ 18 and inserting ‘‘in or after the third month be- 19 fore the month in which the individual makes 20 application for assistance’’. 21 (B) PROCESS FOR SUBMITTING CLAIMS 22 DURING RETROACTIVE ELIGIBILITY PERIOD.— 23 Section 1902(e)(8) of the Social Security Act 24 (42 U.S.C. 1396a(e)(8)) is further amended by 25 VerDate Sep 11 2014 23:21 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H4671.RH H4671 kjohnson on DSK79L0C42PROD with BILLS 13 •HR 4671 RH adding at the end the following: ‘‘The Secretary 1 shall provide for a process under which claims 2 for medical assistance under the State plan may 3 be submitted for services furnished to such an 4 individual during such 3-month period before 5 the month in which the individual made appli- 6 cation for assistance.’’. 7 (C) CONFORMING AMENDMENT.—Section 8 1905(a) of the Social Security Act (42 U.S.C. 9 1396d(a)) is amended, in the matter preceding 10 paragraph (1), by striking ‘‘or, in the case of 11 medicare cost-sharing with respect to a quali- 12 fied medicare beneficiary described in sub- 13 section (p)(1), if provided after the month in 14 which the individual becomes such a bene- 15 ficiary’’. 16 (2) STATE OPTION FOR 12-MONTH CONTINUOUS 17 ELIGIBILITY FOR SLMBS AND QWDIS.—Section 18 1902(e)(12) of the Social Security Act (42 U.S.C. 19 1396a(e)(12)) is amended— 20 (A) by redesignating subparagraphs (A) 21 and (B) as clauses (i) and (ii), respectively; 22 (B) by inserting ‘‘(A)’’ after ‘‘(12)’’; and 23 (C) by adding at the end the following: 24 VerDate Sep 11 2014 23:21 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H4671.RH H4671 kjohnson on DSK79L0C42PROD [Text truncated for display. Full text available on Congress.gov.]