II 

109TH CONGRESS 

1ST SESSION S. 1808 

To amend title XIX of the Social Security Act to improve the qualified 

medicare beneficiary (QMB) and specified low-income medicare beneficiary (SLMB) programs within the medicaid program. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 30, 2005 

Mr. BINGAMAN introduced the following bill; which was read twice and 

referred to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to improve 

the qualified medicare beneficiary (QMB) and specified 

low-income medicare beneficiary (SLMB) programs within the medicaid 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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Medicare Beneficiary Assistance Improvement Act’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Renaming program to eliminate confusion. 
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Sec. 3. Expanding protections by increasing SLMB eligibility income level to 

135 percent of poverty. 

Sec. 4. Eliminating barriers to enrollment. 

Sec. 5. Elimination of asset test. 

Sec. 6. Improving assistance with out-of-pocket costs. 

Sec. 7. Improving program information and coordination with State, local, and 

other partners. 

Sec. 8. Notices to certain new medicare beneficiaries. 

1 SEC. 2. RENAMING PROGRAM TO ELIMINATE CONFUSION. 

2 The programs of benefits for lower income medicare 

3 beneficiaries provided under section 1902(a)(10)(E) of the 

4 Social Security Act (42 U.S.C. 1396a(a)(10)(E)) shall be 

5 known as the ‘‘Medicare Savings Programs’’. 

6 SEC. 3. EXPANDING PROTECTIONS BY INCREASING SLMB 

7 ELIGIBILITY INCOME LEVEL TO 135 PERCENT 

8 OF POVERTY. 

9 (a) IN GENERAL.—Section 1902(a)(10)(E)(iii) of the 

10 Social Security Act (42 U.S.C. 1396a(a)(10)(E)(iii)) is 

11 amended by striking ‘‘120 percent in 1995 and years 

12 thereafter’’ and inserting ‘‘120 percent in 1995 through 

13 2005 and 135 percent in 2006 and years thereafter’’. 

14 (b) CONFORMING REMOVAL OF QI–1 PROVISIONS.— 

15 (1) Section 1902(a)(10)(E) of such Act (42 

16 U.S.C. 1396a(a)(10)(E)) is further amended— 

17 (A) by adding ‘‘and’’ at the end of clause 

18 (ii); 

19 (B) by striking ‘‘and’’ at the end of clause 

20 (iii); and 

21 (C) by striking clause (iv). 
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1 (2) Section 1933 of such Act (42 U.S.C. 

2 1396u–3) is repealed. 

3 (3) The amendments made by this subsection 

4 shall take effect as of January 1, 2006. 

5 (c) APPLICATION OF CHIP ENHANCED MATCHING

6 RATE FOR SLMB ASSISTANCE.— 

7 (1) IN GENERAL.—Section 1905(b)(4) of such 

8 Act (42 U.S.C. 1396d(b)(4)) is amended by insert9 ing ‘‘or section 1902(a)(10)(E)(iii)’’ after ‘‘section 

10 1902(a)(10)(A)(ii)(XVIII)’’. 

11 (2) EFFECTIVE DATE.—The amendment made 

12 by paragraph (1) shall apply to medical assistance 

13 for medicare cost-sharing for months beginning with 

14 January 2006. 

15 SEC. 4. ELIMINATING BARRIERS TO ENROLLMENT. 

16 (a) AUTOMATIC ELIGIBILITY FOR SSI RECIPIENTS IN

17 209(b) STATES AND SSI CRITERIA STATES.—Section 

18 1905(p) of the Social Security Act (42 U.S.C. 1396d(p)) 

19 is amended— 

20 (1) by redesignating paragraph (6) as para21 graph (11); and 

22 (2) by adding at the end the following new 

23 paragraph: 

24 ‘‘(6) In the case of a State which has elected treat25 ment under section 1902(f) for aged, blind, and disabled 
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1 individuals, individuals with respect to whom supplemental 

2 security income payments are being paid under title XVI 

3 are deemed for purposes of this title to be qualified medi4 care beneficiaries.’’. 

5 (b) SELF-CERTIFICATION OF INCOME.—Section 

6 1905(p) of the Social Security Act (42 U.S.C. 1396d(p)), 

7 as amended by subsection (a), is amended by inserting 

8 after paragraph (6) the following new paragraph: 

9 ‘‘(7) In determining whether an individual is a quali10 fied medicare beneficiary or is eligible for benefits under 

11 section 1902(a)(10)(E)(iii), the State shall permit individ12 uals to qualify on the basis of self-certifications of income 

13 without the need to provide additional documentation.’’. 

14 (c) AUTOMATIC REENROLLMENT WITHOUT NEED TO

15 REAPPLY.— 

16 (1) IN GENERAL.—Section 1905(p) of the So17 cial Security Act (42 U.S.C. 1396d(p)), as amended 

18 by subsections (a) and (b), is amended by inserting 

19 after paragraph (7) the following new paragraph: 

20 ‘‘(8) In the case of an individual who has been deter21 mined to be a qualified medicare beneficiary or eligible for 

22 benefits under section 1902(a)(10)(E)(iii), the individual 

23 shall be deemed to continue to be so qualified or eligible 

24 without the need for any annual or periodic application 

25 unless and until the individual notifies the State that the 
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1 individual’s eligibility conditions have changed so that the 

2 individual is no longer so qualified or eligible.’’. 

3 (2) CONFORMING AMENDMENT.—Section 

4 1902(e)(8) of the Social Security Act (42 U.S.C. 

5 1396a(e)(8)) is amended by striking the second sen6 tence. 

7 (d) USE OF SIMPLIFIED APPLICATION PROCESS.— 

8 Section 1905(p) of the Social Security Act (42 U.S.C. 

9 1396d(p)), as amended by subsections (a), (b), and (c), 

10 is amended by inserting after paragraph (8) the following 

11 new paragraph: 

12 ‘‘(9) A State shall permit individuals to apply to qual13 ify as a qualified medicare beneficiary or for eligibility for 

14 benefits under section 1902(a)(10)(E)(iii) through the use 

15 of the simplified application form developed under section 

16 1905(p)(5)(A) and shall permit such an application to be 

17 made over the telephone or by mail, without the need for 

18 an interview in person by the applicant or a representative 

19 of the applicant.’’. 

20 (e) ROLE OF SOCIAL SECURITY OFFICES.— 

21 (1) ENROLLMENT AND PROVISION OF INFORMA22 TION AT SOCIAL SECURITY OFFICES.—Section 

23 1905(p) of the Social Security Act (42 U.S.C. 

24 1396d(p)), as amended by subsections (a), (b), (c), 
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1 and (d) is amended by inserting after paragraph (9) 

2 the following new paragraph: 

3 ‘‘(10) The Commissioner of Social Security shall pro4 vide, through local offices of the Social Security Adminis5 tration— 

6 ‘‘(A) for the enrollment under State plans 

7 under this title for appropriate medicare cost-shar8 ing benefits for an individual who is a qualified 

9 medicare beneficiary or is eligible for benefits under 

10 section 1902(a)(10)(E)(iii) through utilization of the 

11 process established under section 1860D–14; and 

12 ‘‘(B) for providing oral and written notice of 

13 the availability of such benefits.’’. 

14 (2) CLARIFYING AMENDMENT.—Section 

15 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)) is 

16 amended by inserting ‘‘as provided in section 

17 1905(p)(10),’’ after ‘‘except’’. 

18 (f) OUTSTATIONING OF STATE ELIGIBILITY WORK19 ERS AT SSA FIELD OFFICES.—Section 1902(a)(55) of 

20 such Act (42 U.S.C. 1396a(a)(55)) is amended— 

21 (1) in the matter preceding subparagraph (A), 

22 by striking ‘‘subsection (a)(10)(A)(i)(IV), 

23 (a)(10)(A)(i)(VI), (a)(10)(A)(i)(VII), or 

24 (a)(10)(A)(ii)(IX)’’ and inserting ‘‘paragraph 
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1 (10)(A)(i)(IV), (10)(A)(i)(VI), (10)(A)(i)(VII), 

2 (10)(A)(ii)(IX), or (10)(E)’’; and 

3 (2) in subparagraph (A), by striking 

4 ‘‘1905(1)(2)(B)’’ and inserting ‘‘1905(l)(2)(B), and 

5 in the case of applications of individuals for medical 

6 assistance under paragraph (10)(E), at locations 

7 that include field offices of the Social Security Ad8 ministration’’. 

9 SEC. 5. ELIMINATION OF ASSET TEST. 

10 (a) IN GENERAL.—Section 1905(p)(1) of the Social 

11 Security Act (42 U.S.C. 1396d(p)(1)) is amended— 

12 (1) by adding ‘‘and’’ at the end of subpara13 graph (A); 

14 (2) by striking ‘‘, and’’ at the end of subpara15 graph (B) and inserting a period; and 

16 (3) by striking subparagraph (C). 

17 (b) EFFECTIVE DATE.—The amendments made by 

18 subsection (a) shall apply to eligibility determinations for 

19 medicare cost-sharing furnished for periods beginning on 

20 or after January 1, 2006. 

21 SEC. 6. IMPROVING ASSISTANCE WITH OUT-OF-POCKET 

22 COSTS. 

23 (a) ELIMINATING APPLICATION OF ESTATE RECOV24 ERY PROVISIONS.—Section 1917(b)(1)(B)(ii) of the Social 

25 Security Act (42 U.S.C. 1396p(b)(1)(B)(ii)) is amended 
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1 by inserting ‘‘(but not including medical assistance for 

2 medicare cost-sharing or for benefits described in section 

3 1902(a)(10)(E))’’ before the period at the end. 

4 (b) PROVIDING FOR 3-MONTHS RETROACTIVE ELIGI5 BILITY.— 

6 (1) IN GENERAL.—Section 1905(a) of such Act 

7 (42 U.S.C. 1396d(a)) is amended, in the matter pre8 ceding paragraph (1), by striking ‘‘described in sub9 section (p)(1), if provided after the month’’ and in10 serting ‘‘described in subsection (p)(1), if provided 

11 in or after the third month before the month’’. 

12 (2) CONFORMING AMENDMENTS.—(A) The first 

13 sentence of section 1902(e)(8) of such Act (42 

14 U.S.C. 1396a(e)(8)), as amended by section 4(c)(2), 

15 is amended by striking ‘‘(8)’’ and the first sentence. 

16 (B) Section 1848(g)(3) of such Act (42 U.S.C. 

17 1395w–4(g)(3)) is amended by adding at the end 

18 the following new subparagraph: 

19 ‘‘(C) TREATMENT OF RETROACTIVE ELIGI20 BILITY.—In the case of an individual who is de21 termined to be eligible for medical assistance 

22 described in subparagraph (A) retroactively, the 

23 Secretary shall provide a process whereby 

24 claims submitted for services furnished during 

25 the period of retroactive eligibility which were 
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1 not submitted in accordance with such subpara2 graph are resubmitted and re-processed in ac3 cordance with such subparagraph.’’. 

4 SEC. 7. IMPROVING PROGRAM INFORMATION AND COORDI5 NATION WITH STATE, LOCAL, AND OTHER 

6 PARTNERS. 

7 (a) DATA MATCH DEMONSTRATION PROJECT.— 

8 (1) IN GENERAL.—The Secretary of Health and 

9 Human Services (acting through the Administrator 

10 of the Centers for Medicare & Medicaid Services), 

11 the Secretary of the Treasury, and the Commis12 sioner of Social Security shall enter into an arrange13 ment under which a demonstration is conducted, 

14 consistent with this subsection, for the exchange be15 tween the Centers for Medicare & Medicaid Services, 

16 the Internal Revenue Service, and the Social Secu17 rity Administration of information in order to iden18 tity individuals who are medicare beneficiaries and 

19 who, based on data from the Internal Revenue Serv20 ice (such as their not filing tax returns or other ap21 propriate filters) are likely to be— 

22 (A) a qualified medicare beneficiary (as de23 fined in 1905(p)(1) of the Social Security Act 

24 (42 U.S.C. 1396d(p)(1))); 
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1 (B) otherwise eligible for medical assist2 ance under section 1902(a)(10)(E) of the Social 

3 Security Act (42 U.S.C. 1396a(a)(10)(E)); or 

4 (C) entitled to a premium or cost-sharing 

5 subsidy under section 1860D–14 of such Act 

6 (42 U.S.C. 1395w–114). 

7 (2) LIMITATION ON USE OF INFORMATION.— 

8 Notwithstanding any other provision of law, specific 

9 information on income or related matters exchanged 

10 under paragraph (1) may be disclosed only as re11 quired to carry out subsection (b) and for related 

12 Federal and State outreach efforts. 

13 (3) PERIOD.—The project under this subsection 

14 shall be for an initial period of 3 years and may be 

15 extended for additional periods (not to exceed 3 

16 years each) after such an extension is recommended 

17 in a report under subsection (d). 

18 (b) STATE DEMONSTRATION GRANTS.— 

19 (1) IN GENERAL.—The Secretary of Health and 

20 Human Services shall enter into a demonstration 

21 project with States (as defined for purposes of title 

22 XIX of the Social Security Act (42 U.S..C 1396 et 

23 seq.) to provide funds to States to use information 

24 identified under subsection (a), and other appro25 priate information, in order to do ex parte deter-
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1 minations or utilize other methods for identifying 

2 and enrolling individuals who are potentially— 

3 (A) a qualified medicare beneficiary (as de4 fined in 1905(p)(1) of the Social Security Act 

5 (42 U.S.C. 1396d(p)(1))); 

6 (B) otherwise eligible for medical assist7 ance described in section 1902(a)(10)(E) of the 

8 Social Security Act (42 U.S.C. 

9 1396a(a)(10)(E)); or 

10 (C) entitled to a premium or cost-sharing 

11 subsidy under section 1860D–14 of such Act 

12 (42 U.S.C. 1395w–114). 

13 (2) AUTHORIZATION OF APPROPRIATIONS.— 

14 There are authorized to be appropriated such sums 

15 as may be necessary to the Secretary of Health and 

16 Human Services for the purpose of making grants 

17 under this subsection. 

18 (c) ADDITIONAL CMS FUNDING FOR OUTREACH AND

19 ENROLLMENT PROJECTS.—There are hereby appro20 priated, out of any funds in the Treasury not otherwise 

21 appropriated, to the Secretary of Health and Human 

22 Services through the Administrator of the Centers for 

23 Medicare & Medicaid Services, $100,000,000 which shall 

24 be used only for the purpose of providing grants to States 

25 to fund projects to improve outreach and increase enroll-
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1 ment in Medicare Savings Programs and low-income sub2 sidy programs under section 1860D–14 of such Act (42 

3 U.S.C. 1395w–114). Such projects may include coopera4 tive grants and contracts with community groups and 

5 other groups (such as the Department of Veterans’ Affairs 

6 and the Indian Health Service) to assist in the enrollment 

7 of eligible individuals. 

8 (d) REPORTS.—The Secretary of Health and Human 

9 Services shall submit to Congress periodic reports on the 

10 projects conducted under this section. Such reports shall 

11 include such recommendations for extension of such 

12 projects, and changes in laws based on such projects, as 

13 the Secretary deems appropriate. 

14 SEC. 8. NOTICES TO CERTAIN NEW MEDICARE BENE15 FICIARIES. 

16 (a) SSA NOTICE.— 

17 (1) IN GENERAL.—At the time that the Com18 missioner of Social Security sends a notice to indi19 viduals that they have been determined to be eligible 

20 for benefits under part A or B of title XVIII of the 

21 Social Security Act (42 U.S.C. 1395 et seq., 1395j 

22 et seq.), the Commissioner shall send a notice and 

23 application for benefits under title XIX of the Social 

24 Security Act (42 U.S.C. 1396 et seq.) to those indi-
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1 viduals the Commissioner identifies as being likely to 

2 be— 

3 (A) a qualified medicare beneficiary (as de4 fined in 1905(p)(1) of the Social Security Act 

5 (42 U.S.C. 1396d(p)(1))); 

6 (B) eligible for benefits under clause (i), 

7 (ii), or (iii) of section 1902(a)(10)(E) of such 

8 Act (42 U.S.C. 1396a(a)(10)(E)); or 

9 (C) entitled to a premium or cost-sharing 

10 subsidy under section 1860D–14 of such Act 

11 (42 U.S.C. 1395w–114). 

12 (2) ADDITIONAL INFORMATION REQUIRED.— 

13 Such notice and application shall be accompanied by 

14 information on how to submit such an application 

15 and where to obtain more information (including an16 swers to questions) on the application process. 

17 (b) INCLUDING INFORMATION IN MEDICARE & YOU

18 HANDBOOK.—The Secretary of Health and Human Serv19 ices shall include in the annual handbook distributed 

20 under section 1804(a) of the Social Security Act (42 

21 U.S.C. 1395b–2(a)) information on the availability of 

22 Medicare Savings Programs and a toll-free telephone num23 ber that medicare beneficiaries may use to obtain addi24 tional information about the program. 

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