I 

108TH CONGRESS 

1ST SESSION H. R. 1744

To amend title XIX of the Social Security Act to revise and simplify the 

transitional medical assistance (TMA) program. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 10, 2003

Mr. LEVIN (for himself and Mr. CASTLE) introduced the following bill; which 

was referred to the Committee on Energy and Commerce 

A BILL

To amend title XIX of the Social Security Act to revise 

and simplify the transitional medical assistance (TMA) 

program.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Welfare to Work 

5 Health Care Act of 2003’’.
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1 SEC. 2. REVISION AND SIMPLIFICATION OF THE TRANSI2 TIONAL MEDICAL ASSISTANCE PROGRAM 

3 (TMA). 

4 (a) OPTION OF CONTINUOUS ELIGIBILITY FOR 12 

5 MONTHS; OPTION OF CONTINUING COVERAGE FOR UP TO

6 AN ADDITIONAL YEAR.—

7 (1) OPTION OF CONTINUOUS ELIGIBILITY FOR

8 12 MONTHS BY MAKING REPORTING REQUIREMENTS

9 OPTIONAL.—Section 1925(b) of the Social Security 

10 Act (42 U.S.C. 1396r–6(b)) is amended—

11 (A) in paragraph (1), by inserting ‘‘, at the 

12 option of a State,’’ after ‘‘and which’’; 

13 (B) in paragraph (2)(A), by inserting 

14 ‘‘Subject to subparagraph (C)—’’ after ‘‘(A) 

15 NOTICES.—’’; 

16 (C) in paragraph (2)(B), by inserting 

17 ‘‘Subject to subparagraph (C)—’’ after ‘‘(B) 

18 REPORTING REQUIREMENTS.—’’; 

19 (D) by adding at the end the following new 

20 subparagraph: 

21 ‘‘(C) STATE OPTION TO WAIVE NOTICE

22 AND REPORTING REQUIREMENTS.—A State 

23 may waive some or all of the reporting require24 ments under clauses (i) and (ii) of subpara25 graph (B). Insofar as it waives such a reporting 

26 requirement, the State need not provide for a 
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1 notice under subparagraph (A) relating to such 

2 requirement.’’; and 

3 (E) in paragraph (3)(A)(iii), by inserting 

4 ‘‘the State has not waived under paragraph 

5 (2)(C) the reporting requirement with respect 

6 to such month under paragraph (2)(B) and if’’ 

7 after ‘‘6-month period if’’. 

8 (2) STATE OPTION TO EXTEND ELIGIBILITY

9 FOR LOW-INCOME INDIVIDUALS FOR UP TO 12 ADDI10 TIONAL MONTHS.—Section 1925 of such Act (42 

11 U.S.C. 1396r–6) is further amended—

12 (A) by redesignating subsections (c) 

13 through (f) as subsections (d) through (g); and 

14 (B) by inserting after subsection (b) the 

15 following new subsection: 

16 ‘‘(c) STATE OPTION OF UP TO 12 MONTHS OF ADDI17 TIONAL ELIGIBILITY.—

18 ‘‘(1) IN GENERAL.—Notwithstanding any other 

19 provision of this title, each State plan approved 

20 under this title may provide, at the option of the 

21 State, that the State shall offer to each family which 

22 received assistance during the entire 6-month period 

23 under subsection (b) and which meets the applicable 

24 requirement of paragraph (2), in the last month of 

25 the period the option of extending coverage under 
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1 this subsection for the succeeding period not to ex2 ceed 12 months. 

3 ‘‘(2) INCOME RESTRICTION.—The option under 

4 paragraph (1) shall not be made available to a fam5 ily for a succeeding period unless the State deter6 mines that the family’s average gross monthly earn7 ings (less such costs for such child care as is nec8 essary for the employment of the caretaker relative) 

9 as of the end of the 6-month period under sub10 section (b) does not exceed 185 percent of the offi11 cial poverty line (as defined by the Office of Man12 agement and Budget, and revised annually in ac13 cordance with section 673(2) of the Omnibus Budget 

14 Reconciliation Act of 1981) applicable to a family of 

15 the size involved. 

16 ‘‘(3) APPLICATION OF EXTENSION RULES.—

17 The provisions of paragraphs (2), (3), (4), and (5) 

18 of subsection (b) shall apply to the extension pro19 vided under this subsection in the same manner as 

20 they apply to the extension provided under sub21 section (b)(1), except that for purposes of this sub22 section—

23 ‘‘(A) any reference to a 6-month period 

24 under subsection (b)(1) is deemed a reference 

25 to the extension period provided under para-
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1 graph (1) and any deadlines for any notices or 

2 reporting and the premium payment periods 

3 shall be modified to correspond to the appro4 priate calendar quarters of coverage provided 

5 under this subsection; and 

6 ‘‘(B) any reference to a provision of sub7 section (a) or (b) is deemed a reference to the 

8 corresponding provision of subsection (b) or of 

9 this subsection, respectively.’’. 

10 (b) STATE OPTION TO WAIVE RECEIPT OF MED11 ICAID FOR 3 OF PREVIOUS 6 MONTHS TO QUALIFY FOR

12 TMA.—Section 1925(a)(1) of such Act (42 U.S.C. 1396r–

13 6(a)(1)) is amended by adding at the end the following: 

14 ‘‘A State may, at its option, also apply the previous sen15 tence in the case of a family that was receiving such aid 

16 for fewer than 3 months, or that had applied for and was 

17 eligible for such aid for fewer than 3 months, during the 

18 6 immediately preceding months described in such sen19 tence.’’. 

20 (c) ELIMINATION OF SUNSET FOR TMA.—

21 (1) Subsection (g) of section 1925 of such Act 

22 (42 U.S.C. 1396r–6), as redesignated under sub23 section (a)(2), is repealed. 

24 (2) Section 1902(e)(1) of such Act (42 U.S.C. 

25 1396a(e)(1)) is amended by striking ‘‘(A) 
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1 Nothwithstanding’’ and all that follows through

2 ‘‘During such period, for’’ in subparagraph (B) and 

3 inserting ‘‘For’’. 

4 (d) CMS REPORT ON ENROLLMENT AND PARTICIPA5 TION RATES UNDER TMA.—Section 1925 of such Act, 

6 as amended by subsections (a)(2) and (c), is amended by 

7 adding at the end the following new subsection: 

8 ‘‘(g) ADDITIONAL PROVISIONS.—

9 ‘‘(1) COLLECTION AND REPORTING OF PARTICI10 PATION INFORMATION.—Each State shall—

11 ‘‘(A) collect and submit to the Secretary, 

12 in a format specified by the Secretary, informa13 tion on average monthly enrollment and average 

14 monthly participation rates for adults and chil15 dren under this section; and 

16 ‘‘(B) make such information publicly avail17 able. 

18 Such information shall be submitted under subpara19 graph (A) at the same time and frequency in which 

20 other enrollment information under this title is sub21 mitted to the Secretary. Using such information, the 

22 Secretary shall submit to Congress annual reports 

23 concerning such rates.’’. 
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1 (e) COORDINATION OF WORK.—Section 1925(g) of 

2 such Act, as added by subsection (d), is amended by add3 ing at the end the following new paragraph: 

4 ‘‘(2) COORDINATION WITH ADMINISTRATION

5 FOR CHILDREN AND FAMILIES.—The Administrator 

6 of the Centers for Medicare & Medicaid Services, in 

7 carrying out this section, shall work with the Assist8 ant Secretary for the Administration for Children 

9 and Families to develop guidance or other technical 

10 assistance for States regarding best practices in 

11 guaranteeing access to transitional medical assist12 ance under this section.’’. 

13 (f) ELIMINATION OF TMA REQUIREMENT FOR

14 STATES THAT EXTEND COVERAGE TO CHILDREN AND

15 PARENTS THROUGH 185 PERCENT OF POVERTY.—

16 (1) IN GENERAL.—Section 1925 of such Act is 

17 further amended by adding at the end the following 

18 new subsection: 

19 ‘‘(h) PROVISIONS OPTIONAL FOR STATES THAT EX20 TEND COVERAGE TO CHILDREN AND PARENTS THROUGH

21 185 PERCENT OF POVERTY.—A State may (but is not re22 quired to) meet the requirements of subsections (a) and 

23 (b) if it provides for medical assistance under section 1931 

24 to families (including both children and caretaker rel25 atives) the average gross monthly earning of which (less 
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1 such costs for such child care as is necessary for the em2 ployment of a caretaker relative) is at or below a level that 

3 is at least 185 percent of the official poverty line (as de4 fined by the Office of Management and Budget, and re5 vised annually in accordance with section 673(2) of the 

6 Omnibus Budget Reconciliation Act of 1981) applicable 

7 to a family of the size involved.’’. 

8 (2) CONFORMING AMENDMENTS.—Such section 

9 is further amended, in subsections (a)(1) and (b)(1), 

10 by inserting ‘‘, but subject to subsection (h),’’ after 

11 ‘‘Notwithstanding any other provision of this title,’’ 

12 each place it appears. 

13 (g) EXTENDING USE OF OUTSTATIONED WORKERS

14 TO ACCEPT APPLICATIONS FOR TRANSITIONAL MEDICAL

15 ASSISTANCE.—Section 1902(a)(55) of such Act (42 

16 U.S.C. 1396a(a)(55)) is amended by inserting ‘‘and under 

17 section 1931’’ after ‘‘(a)(10)(A)(ii)(IX)’’. 

18 (h) EFFECTIVE DATES.—(1) Except as provided in 

19 this subsection, the amendments made by this section shall 

20 apply to calendar quarters beginning on or after the date 

21 of the enactment of this Act, without regard to whether 

22 or not final regulations to carry out such amendments 

23 have been promulgated by such date. 

24 (2) In the case of a State plan for medical assistance 

25 under title XIX of the Social Security Act which the Sec-
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1 retary of Health and Human Services determines requires 

2 State legislation (other than legislation appropriating 

3 funds) in order for the plan to meet the additional require4 ments imposed by the amendments made by this section, 

5 the State plan shall not be regarded as failing to comply 

6 with the requirements of such title solely on the basis of 

7 its failure to meet these additional requirements before the 

8 first day of the first calendar quarter beginning after the 

9 close of the first regular session of the State legislature 

10 that begins after the date of the enactment of this Act. 

11 For purposes of the previous sentence, in the case of a 

12 State that has a 2-year legislative session, each year of 

13 such session shall be deemed to be a separate regular ses14 sion of the State legislature.

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