II

103D CONGRESS

1ST SESSION S. 1423

To amend the Social Security Act to improve access to medicaid benefits

and to reduce State administrative burdens under the medicaid program.

IN THE SENATE OF THE UNITED STATES

AUGUST 6 (legislative day, JUNE 30), 1993

Mr. CHAFEE (for himself and Mr. BRADLEY) introduced the following bill;

which was read twice and referred to the Committee on Finance

A BILL

To amend the Social Security Act to improve access to medicaid benefits and to reduce State administrative burdens

under 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; REFERENCE TO SOCIAL SECU4 RITY ACT.

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

6 ‘‘Medicaid Eligibility Simplification Act.’’

7 (b) REFERENCE TO SOCIAL SECURITY ACT.—Except

8 as otherwise specifically provided, whenever in this Act an

9 amendment is expressed in terms of an amendment to or

10 repeal of a section or other provision, the reference shall
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1 be considered to be made to that section or other provision

2 of the Social Security Act.

3 SEC. 2. COVERAGE OF PREGNANCY RELATED SERVICES

4 FOR ALIEN WOMEN DURING PREGNANCY.

5 (a) IN GENERAL.—Section 1903(v) (42 U.S.C.

6 1396b(v)) is amended—

7 (1) in paragraph (1) by striking ‘‘paragraph

8 (2)’’ and inserting ‘‘paragraphs (2) and (3)’’;

9 (2) in paragraph (2) by striking ‘‘only’’;

10 (3) by redesignating paragraph (3) as para11 graph (4); and

12 (4) by inserting after paragraph (2) the follow13 ing new paragraph:

14 ‘‘(3) Payment shall be made under this section for

15 care and services that are furnished, at the option of the

16 State, to an alien woman described in paragraph (1) dur17 ing pregnancy if—

18 ‘‘(A) such care and services would be available

19 to a woman described in section 1902(l)(1)(A), and

20 ‘‘(B) such alien woman otherwise meets the eli21 gibility requirements for medical assistance under

22 the State plan approved under this title (other than

23 the requirement of the receipt of aid or assistance

24 under title IV, supplemental security income benefits
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1 under title XVI, or a State supplementary pay2 ment).’’.

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

4 this section shall apply to payments under title XIX of

5 the Social Security Act for calendar quarters beginning

6 on or after October 1, 1993.

7 SEC. 3. SIMPLIFICATION OF APPLICATION PROCESS FOR

8 ALIENS.

9 (a) IN GENERAL.—Section 1902 (42 U.S.C. 1396a)

10 is amended by adding at the end the following new sub11 section:

12 ‘‘(z) Notwithstanding any other provision of law, in

13 order to meet the requirements of subsection (a)(46) and

14 section 1137 a State may provide that the signature of

15 an adult representative of each household that is applying

16 for medical assistance under this title is sufficient to com17 ply with any provisions of Federal law requiring household

18 members to sign the application or statements in connec19 tion with the application process for such medical assist20 ance, but only if such representative certifies in writing,

21 under penalty of perjury, that the information contained

22 in the application for medical assistance is true and that

23 all members of the household applying for such medical

24 assistance are either citizens or nationals of the United
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1 States or are eligible to receive such assistance under this

2 title.’’.

3 (b) CONFORMING AMENDMENT.—Section

4 1902(a)(46) (42 U.S.C. 1936a(a)(46)) is amended by in5 serting ‘‘except as provided in subsection (z),’’ after

6 ‘‘(46)’’.

7 (c) EFFECTIVE DATE.—The amendments made by

8 this section shall apply to applications for medical assist9 ance under title XIX of the Social Security Act beginning

10 on or after October 1, 1993.

11 SEC. 4. ELIGIBILITY DETERMINATIONS FOR CERTAIN

12 MONTHS IN THE CASE OF INDIVIDUALS WITH

13 WEEKLY OR BIWEEKLY INCOME.

14 (a) IN GENERAL.—Section 1611(c) (42 U.S.C.

15 1382(c)) is amended—

16 (1) in paragraph (1), by inserting ‘‘(subject to

17 paragraph (8))’’ after ‘‘An individual’s eligibility for

18 a benefit under this title for a month’’; and

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

20 paragraph:

21 ‘‘(8)(A) If an individual is paid or otherwise receives

22 income in any month on a regular weekly or biweekly basis

23 (or is deemed under section 1614(f) to have income so

24 paid or received), the determination under paragraph (1)

25 of an individual’s eligibility for benefits under this title
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1 for such month shall be made by treating such amounts

2 as having been paid or received on a monthly basis at the

3 same annual rate if such treatment would result in the

4 individual becoming eligible for such benefits.

5 ‘‘(B) For purposes of subparagraph (A)—

6 ‘‘(i) the annual rate of income being paid to or

7 received by an individual on a weekly basis in any

8 month is 52 times the amount of the weekly income

9 during such month (or of the average weekly income,

10 if there is a change in the actual weekly rate during

11 such month), and the annual rate of income being

12 paid to or received by an individual on a biweekly

13 basis in any month is 26 times the amount of the

14 biweekly income during such month (or of the aver15 age biweekly income, if there is a change in the ac16 tual biweekly rate during such month); and

17 ‘‘(ii) the amount of such income to be consid18 ered as being paid to or received by an individual on

19 a regular monthly basis at the ‘same annual rate’ (in

such month) is 1 20 ⁄12 of the annual rate determined

21 under clause (i) with respect to the weekly or bi22 weekly income involved.’’.

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

24 this section shall become effective with respect to deter-
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1 minations of eligibility beginning on or after October 1,

2 1993.

3 SEC. 5. OPTIONAL REPORTING REQUIREMENTS UNDER

4 MEDICAID TRANSITIONAL MEDICAL ASSIST5 ANCE.

6 (a) IN GENERAL.—Section 1925(b)(2)(B) (42 U.S.C.

7 1396r–6(b)(2)(B)) is amended—

8 (1) in clause (i), by striking ‘‘Each State shall’’

9 and inserting ‘‘A State may’’; and

10 (2) in clause (ii), by striking ‘‘Each State shall’’

11 and inserting ‘‘A State may’’.

12 (b) CONFORMING AMENDMENTS.—Section 1925 (42

13 U.S.C. 1396r–6) is amended—

14 (1) in subsection (a)(2)(A), by inserting ‘‘, if

15 any,’’ after ‘‘subsection (b)(2)(B)(i)’’;

16 (2) in subsection (b)(1), by inserting ‘‘, if any,’’

17 after ‘‘paragraph (2)(B)(i)’’;

18 (3) in subsection (b)(2)(A)(i), by inserting ‘‘if

19 any,’’ after ‘‘subparagraph (B)(i),’’ and ‘‘subpara20 graph (B)(ii),’’;

21 (4) in subsection (b)(2)(A)(ii), by inserting ‘‘, if

22 any,’’ after ‘‘subparagraph (B)(ii)’’;

23 (5) in subsection (b)(3)(A)(iii), by inserting

24 ‘‘the State does not require the reporting of such in25 formation, or’’ after ‘‘unless’’; and
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1 (6) the last sentence of subsection (b)(3)(A), is

2 amended to read as follows: ‘‘If a State requires a

3 family to report information under paragraph

4 (2)(B)(ii), the State shall make determinations

5 under clause (iii)(III) for a family each time such a

6 report is received.’’.

7 (c) EFFECTIVE DATE.—The amendments made by

8 this section shall apply to eligibility determinations for cal9 endar quarters beginning on or after October 1, 1993.

10 SEC. 6. PRESUMPTIVE ELIGIBILITY FOR PREGNANT

11 WOMEN.

12 (a) QUALIFIED PROVIDER.—Section 1920 (42 U.S.C.

13 1396r–1) is amended in subsection (b)(2) by inserting

14 ‘‘any individual who is employed by the State and who

15 is determined by the State agency to be capable of making

16 determinations of the type described in paragraph (1)(A)

17 or’’ after ‘‘the term ‘qualified provider’ means’’.

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

19 this section shall apply to payments under title XIX of

20 the Social Security Act for calendar quarters beginning

21 on or after October 1, 1993.
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1 SEC. 7. MODIFICATION TO INCOME REQUIREMENTS FOR

2 PREGNANT WOMEN AND COVERAGE FOR RE3 PRODUCTIVE HEALTH SERVICES.

4 (a) COVERAGE FOR REPRODUCTIVE HEALTH SERV5 ICES.—Section 1902(e)(6) (42 U.S.C. 1396a(e)(6)) is

6 amended—

7 (1) by striking ‘‘(6) In the case’’ and inserting

8 ‘‘(6)(A) In the case’’;

9 (2) by inserting ‘‘and, with respect to reproduc10 tive health services (as defined in subparagraph

11 (B)), such woman shall be deemed to continue to be

12 an individual described in subsection

13 (a)(10)(A)(i)(IV) and subsection (l)(1)(A) without

14 regard to such change of income through the last

15 day of the month in which the 18-month period (be16 ginning with the month following the month in

17 which occurs the last day of her pregnancy) ends’’

18 after ‘‘her pregnancy) ends’’; and

19 (3) by adding at the end the following new sub20 paragraph:

21 ‘‘(B) For purposes of this paragraph, the term ‘‘re22 productive health services’’ means—

23 ‘‘(i) services related to contraception (including

24 contraceptive supplies), voluntary sterilization,

25 screening for sexually transmitted diseases and can26 cer of the reproductive system, preconceptional risk
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1 assessment and care, maternity care (including pre2 natal, delivery, and postnatal care), and

3 ‘‘(ii) services providing information and edu4 cation necessary to the effectiveness of the services

5 described in clause (i).

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

7 this section shall apply to payments under title XIX of

8 the Social Security Act for calendar quarters beginning

9 on or after October 1, 1993.

10 SEC. 8. MEDICARE PREMIUMS AND COST-SHARING FOR

11 MEDICALLY NEEDY INDIVIDUALS.

12 (a) IN GENERAL.—Section 1905(p)(1)(B) (42 U.S.C.

13 1396d(p)(1)(B)) is amended by inserting ‘‘or, at the op14 tion of the State, who is eligible under section

15 1902(a)(10)(C)’’ after ‘‘paragraph (2)’’.

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

17 this section shall apply to payments under title XIX of

18 the Social Security Act for calendar quarters beginning

19 on or after October 1, 1993.

20 SEC. 9. CLARIFICATION OF INCOME METHODOLOGY USED

21 IN DETERMINING ELIGIBILITY OF CERTAIN

22 MEDICALLY NEEDY INDIVIDUALS FOR MED23 ICAID BENEFITS.

24 (a) IN GENERAL.—Section 1903(f) (42 U.S.C.

25 1396b(f)) is amended—
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1 (1) by redesignating paragraph (4) as para2 graph (5); and

3 (2) by inserting after paragraph (3) the follow4 ing new paragraph:

5 ‘‘(4) With respect to the methodology to be

6 used in determining income and resource eligibility

7 for individuals under section 1902(a)(10)(C)(i)(III),

8 the applicable income limitation described in para9 graph (1)(B) shall be compared to the adjusted in10 come of such individuals after the State income

11 methodology has been applied, including methodol12 ogy allowed under section 1902(r)(2).’’.

13 (b) CONFORMING AMENDMENT.—Section

14 1903(f)(1)(A) (42 U.S.C. 1396b(f)(1)(A)) is amended by

15 striking ‘‘(4)’’ and inserting ‘‘(5)’’.

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