I 

115TH CONGRESS 

1ST SESSION H. R. 829 

To amend title XIX of the Social Security Act to clarify the treatment 

of lottery winnings and other lump sum income for purposes of income 

eligibility under the Medicaid program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 2, 2017 

Mr. UPTON 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 clarify 

the treatment of lottery winnings and other lump sum 

income for purposes of income eligibility under the Medicaid program, and for other purposes. 

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 ‘‘Prioritizing the Most 

5 Vulnerable Over Lottery Winners Act of 2017’’. 


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1 SEC. 2. TREATMENT OF LOTTERY WINNINGS AND OTHER 

2 LUMP-SUM INCOME FOR PURPOSES OF IN3 COME ELIGIBILITY UNDER MEDICAID. 

4 (a) IN GENERAL.—Section 1902 of the Social Secu5 rity Act (42 U.S.C. 1396a) is amended— 

6 (1) in subsection (a)(17), by striking ‘‘(e)(14), 

7 (e)(14)’’ and inserting ‘‘(e)(14), (e)(15)’’; and 

8 (2) in subsection (e)— 

9 (A) in paragraph (14) (relating to modified 

10 adjusted gross income), by adding at the end 

11 the following new subparagraph: 

12 ‘‘(J) TREATMENT OF CERTAIN LOTTERY

13 WINNINGS AND INCOME RECEIVED AS A LUMP

14 SUM.— 

15 ‘‘(i) IN GENERAL.—In the case of an 

16 individual who is the recipient of qualified 

17 lottery winnings (pursuant to lotteries oc18 curring on or after January 1, 2018) or 

19 qualified lump sum income (received on or 

20 after such date) and whose eligibility for 

21 medical assistance is determined based on 

22 the application of modified adjusted gross 

23 income under subparagraph (A), a State 

24 shall, in determining such eligibility, in25 clude such winnings or income (as applica26 ble) as income received— 


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1 ‘‘(I) in the month in which such 

2 winnings or income (as applicable) is 

3 received if the amount of such 

4 winnings or income is less than 

5 $80,000; 

6 ‘‘(II) over a period of 2 months 

7 if the amount of such winnings or in8 come (as applicable) is greater than or 

9 equal to $80,000 but less than 

10 $90,000; 

11 ‘‘(III) over a period of 3 months 

12 if the amount of such winnings or in13 come (as applicable) is greater than or 

14 equal to $90,000 but less than 

15 $100,000; and 

16 ‘‘(IV) over a period of 3 months 

17 plus 1 additional month for each in18 crement of $10,000 of such winnings 

19 or income (as applicable) received, not 

20 to exceed a period of 120 months (for 

21 winnings or income of $1,260,000 or 

22 more), if the amount of such winnings 

23 or income is greater than or equal to 

24 $100,000. 


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1 ‘‘(ii) COUNTING IN EQUAL INSTALL2 MENTS.—For purposes of subclauses (II), 

3 (III), and (IV) of clause (i), winnings or 

4 income to which such subclause applies 

5 shall be counted in equal monthly install6 ments over the period of months specified 

7 under such subclause. 

8 ‘‘(iii) HARDSHIP EXEMPTION.—An in9 dividual whose income, by application of 

10 clause (i), exceeds the applicable eligibility 

11 threshold established by the State, shall 

12 continue to be eligible for medical assist13 ance to the extent that the State deter14 mines, under procedures established by the 

15 State (in accordance with standards speci16 fied by the Secretary), that the denial of 

17 eligibility of the individual would cause an 

18 undue medical or financial hardship as de19 termined on the basis of criteria estab20 lished by the Secretary. 

21 ‘‘(iv) NOTIFICATIONS AND ASSIST22 ANCE REQUIRED IN CASE OF LOSS OF ELI23 GIBILITY.—A State shall, with respect to 

24 an individual who loses eligibility for med25 ical assistance under the State plan (or a 


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1 waiver of such plan) by reason of clause 

2 (i)— 

3 ‘‘(I) before the date on which the 

4 individual loses such eligibility, inform 

5 the individual— 

6 ‘‘(aa) of the individual’s op7 portunity to enroll in a qualified 

8 health plan offered through an 

9 Exchange established under title 

10 I of the Patient Protection and 

11 Affordable Care Act during the 

12 special enrollment period speci13 fied in section 9801(f)(3) of the 

14 Internal Revenue Code of 1986 

15 (relating to loss of Medicaid or 

16 CHIP coverage); and 

17 ‘‘(bb) of the date on which 

18 the individual would no longer be 

19 considered ineligible by reason of 

20 clause (i) to receive medical as21 sistance under the State plan or 

22 under any waiver of such plan 

23 and be eligible to reapply to re24 ceive such medical assistance; 

25 and 


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1 ‘‘(II) provide technical assistance 

2 to the individual seeking to enroll in 

3 such a qualified health plan. 

4 ‘‘(v) QUALIFIED LOTTERY WINNINGS

5 DEFINED.—In this subparagraph, the term 

6 ‘qualified lottery winnings’ means winnings 

7 from a sweepstakes, lottery, or pool de8 scribed in paragraph (3) of section 4402 of 

9 the Internal Revenue Code of 1986 or a 

10 lottery operated by a multistate or multi11 jurisdictional lottery association, including 

12 amounts awarded as a lump sum payment. 

13 ‘‘(vi) QUALIFIED LUMP SUM INCOME

14 DEFINED.—In this subparagraph, the term 

15 ‘qualified lump sum income’ means income 

16 that is received as a lump sum from one 

17 of the following sources: 

18 ‘‘(I) Monetary winnings from 

19 gambling (as defined by the Secretary 

20 and including gambling activities de21 scribed in section 1955(b)(4) of title 

22 18, United States Code). 

23 ‘‘(II) Damages received, whether 

24 by suit or agreement and whether as 

25 lump sums or as periodic payments 


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1 (other than monthly payments), on 

2 account of causes of action other than 

3 causes of action arising from personal 

4 physical injuries or physical sickness. 

5 ‘‘(III) Income received as liquid 

6 assets from the estate (as defined in 

7 section 1917(b)(4)) of a deceased in8 dividual.’’; and 

9 (B) by striking ‘‘(14) EXCLUSION’’ and in10 serting ‘‘(15) EXCLUSION’’. 

11 (b) RULES OF CONSTRUCTION.— 

12 (1) INTERCEPTION OF LOTTERY WINNINGS AL13 LOWED.—Nothing in the amendment made by sub14 section (a)(2)(A) shall be construed as preventing a 

15 State from intercepting the State lottery winnings 

16 awarded to an individual in the State to recover 

17 amounts paid by the State under the State Medicaid 

18 plan under title XIX of the Social Security Act for 

19 medical assistance furnished to the individual. 

20 (2) APPLICABILITY LIMITED TO ELIGIBILITY OF

21 RECIPIENT OF LOTTERY WINNINGS OR LUMP SUM

22 INCOME.—Nothing in the amendment made by sub23 section (a)(2)(A) shall be construed, with respect to 

24 a determination of household income for purposes of 

25 a determination of eligibility for medical assistance 


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1 under the State plan under title XIX of the Social 

2 Security Act (42 U.S.C. 1396 et seq.) (or a waiver 

3 of such plan) made by applying modified adjusted 

4 gross income under subparagraph (A) of section 

5 1902(e)(14) of such Act (42 U.S.C. 1396a(e)(14)), 

6 as limiting the eligibility for such medical assistance 

7 of any individual that is a member of the household 

8 other than the individual who received qualified lot9 tery winnings or qualified lump-sum income (as de10 fined in subparagraph (J) of such section 

11 1902(e)(14), as added by subsection (a)(2)(A) of 

12 this section). 

Æ 


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