I 

116TH CONGRESS 

1ST SESSION H. R. 4671 

To amend titles XVIII and XIX of the Social Security Act to reduce costsharing, 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 committee concerned 

A BILL 

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. 

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 ‘‘Helping Seniors Afford 

5 Health Care Act’’. 


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1 SEC. 2. REDUCING COST-SHARING, ALIGNING INCOME AND 

2 RESOURCE ELIGIBILITY TESTS, SIMPLIFYING 

3 ENROLLMENT, AND OTHER PROGRAM IM4 PROVEMENTS FOR LOW-INCOME BENE5 FICIARIES. 

6 (a) INCREASE IN INCOME ELIGIBILITY TO 135 PER7 CENT OF FPL FOR QUALIFIED MEDICARE BENE8 FICIARIES.— 

9 (1) IN GENERAL.—Section 1905(p)(2)(A) of the 

10 Social Security Act (42 U.S.C. 1396d(p)(2)(A)) is 

11 amended by striking ‘‘shall be at least the percent 

12 provided under subparagraph (B) (but not more 

13 than 100 percent) of the official poverty line’’ and 

14 all that follows through the period at the end and 

15 inserting the following: ‘‘shall be— 

16 ‘‘(i) before January 1, 2021, at least 

17 the percent provided under subparagraph 

18 (B) (but not more than 100 percent) of 

19 the official poverty line (as defined by the 

20 Office of Management and Budget, and re21 vised annually in accordance with section 

22 673(2) of the Omnibus Budget Reconcili23 ation Act of 1981) applicable to a family 

24 of the size involved; and 

25 ‘‘(ii) on or after January 1, 2021, 

26 equal to 135 percent of the official poverty 


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1 line (as so defined and revised) applicable 

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

3 (2) NOT COUNTING IN-KIND SUPPORT AND

4 MAINTENANCE AS INCOME.—Section 1905(p)(2)(D) 

5 of the Social Security Act (42 U.S.C. 

6 1396d(p)(2)(D)) is amended by adding at the end 

7 the following new clause: 

8 ‘‘(iii) In determining income under 

9 this subsection, support and maintenance 

10 furnished in kind shall not be counted as 

11 income.’’. 

12 (b) INCREASE IN INCOME ELIGIBILITY TO 200 PER13 CENT OF FPL FOR SPECIFIED LOW-INCOME MEDICARE

14 BENEFICIARIES.— 

15 (1) ELIGIBILITY OF INDIVIDUALS WITH IN16 COMES BELOW 150 PERCENT OF FPL.—Section 

17 1902(a)(10)(E) of the Social Security Act (42 

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

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

20 (ii); 

21 (B) in clause (iii)— 

22 (i) by striking ‘‘and 120 percent in 

23 1995 and years thereafter’’ and inserting 

24 ‘‘120 percent in 1995 and years thereafter 


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1 before 2021, and 200 percent in 2021 and 

2 years thereafter’’; and 

3 (ii) by striking ‘‘and’’ at the end; and 

4 (C) by striking clause (iv). 

5 (2) REFERENCES.—Section 1905(p)(1) of the 

6 Social Security Act (42 U.S.C. 1396d(p)(1)) is 

7 amended by adding at and below subparagraph (C) 

8 the following flush sentence: 

9 ‘‘The term ‘specified low-income medicare beneficiary’ 

10 means an individual described in section 

11 1902(a)(10)(E)(iii).’’. 

12 (3) CONFORMING AMENDMENTS.— 

13 (A) The first sentence of section 1905(b) 

14 of such Act (42 U.S.C. 1396d(b)) is amended 

15 by striking ‘‘and section 1933(d)’’. 

16 (B) Section 1933 of such Act (42 U.S.C. 

17 1396u–3) is repealed. 

18 (c) 100 PERCENT FMAP.—Section 1905 of the So19 cial Security Act (42 U.S.C. 1396d) is amended by adding 

20 at the end the following new subsection: 

21 ‘‘(gg) INCREASED FMAP FOR EXPANDED MEDICARE

22 COST-SHARING POPULATIONS.— 

23 ‘‘(1) IN GENERAL.—Notwithstanding subsection 

24 (b), with respect to expenditures described in paraVerDate Sep 11 2014 22:00 Oct 16, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4671.IH H4671

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1 graph (2) the Federal medical assistance percentage 

2 shall be equal to 100 percent. 

3 ‘‘(2) EXPENDITURES DESCRIBED.—The expend4 itures described in this paragraph are expenditures 

5 made on or after January 1, 2021, for medical as6 sistance for medicare cost-sharing provided to any 

7 individual under clause (i), (ii), or (iii) of section 

8 1902(a)(10)(E) who would not have been eligible for 

9 medicare cost-sharing under any such clause under 

10 the income or resource eligibility standards in effect 

11 on October 1, 2018.’’. 

12 (d) CONSOLIDATION OF LOW-INCOME SUBSIDY RE13 SOURCE ELIGIBILITY TESTS.— 

14 (1) IN GENERAL.—Section 1860D–14(a)(3) of 

15 the Social Security Act (42 U.S.C. 1395w– 

16 114(a)(3)) is amended— 

17 (A) by striking subparagraph (D); 

18 (B) by redesignating subparagraphs (E) 

19 through (G) as subparagraphs (D) through (F), 

20 respectively; and 

21 (C) in the heading of subparagraph (D), as 

22 so redesignated, by striking ‘‘ALTERNATIVE’’. 

23 (2) CLARIFICATION OF CERTAIN RULES RELAT24 ING TO INCOME AND RESOURCE DETERMINA25 TIONS.—Section 1860D–14(a)(3) of the Social SecuVerDate Sep 11 2014 22:00 Oct 16, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4671.IH H4671

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1 rity Act (42 U.S.C. 1395w–114(a)(3)), as amended 

2 by paragraph (1), is amended by striking subpara3 graph (F) and inserting the following new subpara4 graphs: 

5 ‘‘(F) RESOURCE EXCLUSIONS.—In deter6 mining the resources of an individual (and the 

7 eligible spouse of the individual, if any) under 

8 section 1613 for purposes of subparagraph 

9 (D)— 

10 ‘‘(i) no part of the value of any life in11 surance policy shall be taken into account; 

12 ‘‘(ii) no part of the value of any vehi13 cle shall be taken into account; 

14 ‘‘(iii) there shall be excluded an 

15 amount equal to $1,500 each with respect 

16 to any individual or eligible spouse of an 

17 individual who attests that some of the re18 sources of such individual or spouse will be 

19 used to meet the burial and related ex20 penses of such individual or spouse; and 

21 ‘‘(iv) no balance in, or benefits re22 ceived under, an employee pension benefit 

23 plan (as defined in section 3 of the Em24 ployee Retirement Income Security Act of 

25 1974) shall be taken into account. 


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1 ‘‘(G) FAMILY SIZE.—In determining the 

2 size of the family of an individual for purposes 

3 of determining the income eligibility of such in4 dividual under this section, an individual’s fam5 ily shall consist of— 

6 ‘‘(i) the individual; 

7 ‘‘(ii) the individual’s spouse who lives 

8 in the same household as the individual (if 

9 any); and 

10 ‘‘(iii) any other individuals who— 

11 ‘‘(I) are related to the individual 

12 whose income eligibility is in question 

13 or such individual’s spouse who lives 

14 in the same household; 

15 ‘‘(II) are living in the same 

16 household as such individual; and 

17 ‘‘(III) are dependent on such in18 dividual or such individual’s spouse 

19 who is living in the same household 

20 for at least one-half of their financial 

21 support.’’. 

22 (3) CONFORMING AMENDMENTS.—Section 

23 1860D–14(a) of the Social Security Act (42 U.S.C. 

24 1395w–114(a)) is amended— 


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1 (A) in paragraph (1), in the matter pre2 ceding subparagraph (A), by inserting ‘‘(as de3 termined under paragraph (3)(G))’’ after ‘‘fam4 ily of the size involved’’; and 

5 (B) in paragraph (3), as amended by para6 graphs (1) and (2)— 

7 (i) in subparagraph (A), in the matter 

8 preceding clause (i), by striking ‘‘subpara9 graph (F)’’ and inserting ‘‘subparagraph 

10 (E)’’; 

11 (ii) in subparagraph (A)(ii), by insert12 ing ‘‘(as determined under subparagraph 

13 (G))’’ after ‘‘family of the size involved’’; 

14 (iii) in subparagraph (A)(iii), by strik15 ing ‘‘or (E)’’; 

16 (iv) in subparagraph (B)(v), in the 

17 matter preceding subclause (I), by striking 

18 ‘‘subparagraph (F)’’ and inserting ‘‘sub19 paragraph (E)’’; and 

20 (v) in subparagraph (D)(i), in the 

21 matter preceding subclause (I), by striking 

22 ‘‘subject to the life insurance policy exclu23 sion provided under subparagraph (G)’’ 

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1 clusions provided under subparagraph 

2 (F)’’. 

3 (e) ALIGNMENT OF LOW-INCOME SUBSIDY AND

4 MEDICARE SAVINGS PROGRAM INCOME AND RESOURCE

5 ELIGIBILITY TESTS.— 

6 (1) APPLICATION OF MEDICAID SPOUSAL IM7 POVERISHMENT RESOURCE ALLOWANCE TO MSP AND

8 LIS RESOURCE ELIGIBILITY.—Section 1905(p)(1)(C) 

9 of the Social Security Act (42 U.S.C. 

10 1396d(p)(1)(C)) is amended to read as follows: 

11 ‘‘(C) whose resources (as determined under sec12 tion 1613 for purposes of the supplemental security 

13 income program subject to the resource exclusions 

14 under subparagraph (G) of section 1860D–14(a)(3)) 

15 do not exceed— 

16 ‘‘(i) in the case of an individual with a 

17 spouse, an amount equal to the sum of the first 

18 amount specified in subsection (f)(2)(A)(i) of 

19 section 1924 (as adjusted under subsection (g) 

20 of such section) and the amount specified in 

21 subsection (f)(2)(A)(ii)(II) of such section (as 

22 so adjusted); or 

23 ‘‘(ii) in the case of an individual who does 

not have a spouse, an amount equal to 1 24 ⁄2 of 

25 the amount described in clause (i).’’. 


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1 (2) APPLICATION TO QDWIS.—Section 

2 1905(s)(3) of the Social Security Act (42 U.S.C. 

3 1396d(s)(3)) is amended to read as follows: 

4 ‘‘(3) whose resources (as determined under sec5 tion 1613 for purposes of the supplemental security 

6 income program subject to the resource exclusions 

7 under subparagraph (G) of section 1860D–14(a)(3)) 

8 do not exceed— 

9 ‘‘(A) in the case of an individual with a 

10 spouse, the amount in effect for the year under 

11 clause (i) of subsection (p)(1)(C); and 

12 ‘‘(B) in the case of an individual who does 

13 not have a spouse, the amount in effect for the 

14 year under clause (ii) of subsection (p)(1)(C); 

15 and’’. 

16 (3) APPLICATION TO LIS.—Clause (i) of section 

17 1860D–14(a)(3)(D) of the Social Security Act (42 

18 U.S.C. 1395w–114(a)(3)(D)), as redesignated and 

19 amended by subsection (d)(1), is amended to read as 

20 follows: 

21 ‘‘(i) IN GENERAL.—The resources re22 quirement of this subparagraph is that an 

23 individual’s resources (as determined under 

24 section 1613 for purposes of the supple25 mental security income program subject to 


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1 the resource exclusions provided under 

2 subparagraph (G)) do not exceed the 

3 amount in effect for the year under section 

4 1905(p)(1)(C)(ii).’’. 

5 (f) ENROLLMENT SIMPLIFICATIONS.— 

6 (1) APPLICATION OF 3-MONTH RETROACTIVE

7 ELIGIBILITY TO QMBS.— 

8 (A) IN GENERAL.—Section 1902(e)(8) of 

9 the Social Security Act (42 U.S.C. 1396a(e)(8)) 

10 is amended by striking ‘‘after the end of the 

11 month in which the determination first occurs’’ 

12 and inserting ‘‘in or after the third month be13 fore the month in which the individual makes 

14 application for assistance’’. 

15 (B) PROCESS FOR SUBMITTING CLAIMS

16 DURING RETROACTIVE ELIGIBILITY PERIOD.— 

17 Section 1902(e)(8) of the Social Security Act 

18 (42 U.S.C. 1396a(e)(8)) is further amended by 

19 adding at the end the following: ‘‘The Secretary 

20 shall provide for a process under which claims 

21 for medical assistance under the State plan may 

22 be submitted for services furnished to such an 

23 individual during such 3-month period before 

24 the month in which the individual made appli25 cation for assistance.’’. 


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1 (C) CONFORMING AMENDMENT.—Section 

2 1905(a) of the Social Security Act (42 U.S.C. 

3 1396d(a)) is amended, in the matter preceding 

4 paragraph (1), by striking ‘‘or, in the case of 

5 medicare cost-sharing with respect to a quali6 fied medicare beneficiary described in sub7 section (p)(1), if provided after the month in 

8 which the individual becomes such a bene9 ficiary’’. 

10 (2) STATE OPTION FOR 12-MONTH CONTINUOUS

11 ELIGIBILITY FOR SLMBS AND QWDIS.—Section 

12 1902(e)(12) of the Social Security Act (42 U.S.C. 

13 1396a(e)(12)) is amended— 

14 (A) by redesignating subparagraphs (A) 

15 and (B) as clauses (i) and (ii), respectively; 

16 (B) by inserting ‘‘(A)’’ after ‘‘(12)’’; and 

17 (C) by adding at the end the following: 

18 ‘‘(B) At the option of the State, the plan may provide 

19 that an individual who is determined to be eligible for ben20 efits under a State plan approved under this title under 

21 any of the following eligibility categories, or who is rede22 termined to be eligible for such benefits under any of such 

23 categories, shall be considered to meet the eligibility re24 quirements met on the date of application and shall re25 main eligible for those benefits until the end of the 12- 


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1 month period following the date of the determination or 

2 redetermination of eligibility, except that a State may pro3 vide for such determinations more frequently, but not 

4 more frequently than once every 6 months for an indi5 vidual: 

6 ‘‘(i) A specified low-income medicare beneficiary 

7 described in subsection (a)(10)(E)(iii) of this section 

8 who is determined eligible for medicare cost sharing 

9 described in section 1905(p)(3)(A)(ii). 

10 ‘‘(ii) A qualified disabled and working indi11 vidual described in section 1905(s) who is deter12 mined eligible for medicare cost-sharing described in 

13 section 1905(p)(3)(A)(i).’’. 

14 (3) STATE OPTION TO USE EXPRESS LANE ELI15 GIBILITY FOR THE MEDICARE SAVINGS PROGRAM.— 

16 Section 1902(e)(13)(A) of the Social Security Act 

17 (42 U.S.C. 1396a(e)(13)(A)) is amended by adding 

18 at the end the following new clause: 

19 ‘‘(iii) STATE OPTION TO EXTEND EX20 PRESS LANE ELIGIBILITY TO OTHER POPU21 LATIONS.— 

22 ‘‘(I) IN GENERAL.—At the option 

23 of the State, the State may apply the 

24 provisions of this paragraph with re25 spect to determining eligibility under 


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1 this title for an eligible individual (as 

2 defined in subclause (II)). In applying 

3 this paragraph in the case of a State 

4 making such an option, any reference 

5 in this paragraph to a child with re6 spect to this title (other than a ref7 erence to child health assistance) shall 

8 be deemed to be a reference to an eli9 gible individual. 

10 ‘‘(II) ELIGIBLE INDIVIDUAL DE11 FINED.—In this clause, the term ‘eli12 gible individual’ means any of the fol13 lowing: 

14 ‘‘(aa) A qualified medicare 

15 beneficiary described in section 

16 1905(p)(1) for purposes of deter17 mining eligibility for medicare 

18 cost-sharing (as defined in sec19 tion 1905(p)(3)). 

20 ‘‘(bb) A specified low-income 

21 medicare beneficiary described in 

22 subsection (a)(10)(E)(iii) of this 

23 section for purposes of deter24 mining eligibility for medicare 


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1 cost-sharing described in section 

2 1905(p)(3)(A)(ii). 

3 ‘‘(cc) A qualified disabled 

4 and working individual described 

5 in section 1905(s) for purposes of 

6 determining eligibility for medi7 care cost-sharing described in 

8 section 1905(p)(3)(A)(i).’’. 

9 (g) MEDICAID TREATMENT OF CERTAIN MEDICARE

10 PROVIDERS.—Section 1902(n) of the Social Security Act 

11 (42 U.S.C. 1396a(n)) is amended by adding at the end 

12 the following new paragraph: 

13 ‘‘(4) A State plan shall not deny a claim from a pro14 vider or supplier with respect to medicare cost-sharing de15 scribed in subparagraph (B), (C), or (D) of section 

16 1905(p)(3) for an item or service which is eligible for pay17 ment under title XVIII on the basis that the provider or 

18 supplier does not have a provider agreement in effect 

19 under this title or does not otherwise serve all individuals 

20 entitled to medical assistance under this title. The State 

21 shall create a mechanism through which provider or sup22 pliers that do not otherwise have provider agreements with 

23 the State can bill the State for medicare cost-sharing for 

24 qualified medicare beneficiaries.’’. 


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1 (h) ELIGIBILITY FOR OTHER PROGRAMS.—Section 

2 1905(p) of the Social Security Act (42 U.S.C. 1396d(p)) 

3 is amended by adding at the end the following new para4 graph: 

5 ‘‘(7) Notwithstanding any other provision of 

6 law, any medical assistance for some or all medicare 

7 cost-sharing under this title shall not be considered 

8 income or resources in determining eligibility for, or 

9 the amount of assistance or benefits provided under, 

10 any other public benefit provided under Federal law 

11 or the law of any State or political subdivision there12 of.’’. 

13 (i) TREATMENT OF QUALIFIED MEDICARE BENE14 FICIARIES, SPECIFIED LOW-INCOME MEDICARE BENE15 FICIARIES, AND OTHER DUAL ELIGIBLES AS MEDICARE

16 BENEFICIARIES.—Section 1862 of the Social Security Act 

17 (42 U.S.C. 1395y) is amended by adding at the end the 

18 following new subsection: 

19 ‘‘(p) TREATMENT OF QUALIFIED MEDICARE BENE20 FICIARIES (QMBS), SPECIFIED LOW-INCOME MEDICARE

21 BENEFICIARIES (SLMBS), AND OTHER DUAL ELIGI22 BLES.—Nothing in this title shall be construed as author23 izing a provider of services or supplier to discriminate 

24 (through a private contractual arrangement or otherwise) 

25 against an individual who is otherwise entitled to services 


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1 under this title on the basis that the individual is a quali2 fied medicare beneficiary (as defined in section 

3 1905(p)(1)), a specified low-income medicare beneficiary, 

4 or is otherwise eligible for medical assistance for medicare 

5 cost-sharing or other benefits under title XIX.’’. 

6 (j) ADDITIONAL FUNDING FOR STATE HEALTH IN7 SURANCE ASSISTANCE PROGRAMS.— 

8 (1) GRANTS.— 

9 (A) IN GENERAL.—The Secretary of 

10 Health and Human Services (in this subsection 

11 referred to as the ‘‘Secretary’’) shall use 

12 amounts made available under subparagraph 

13 (B) to make grants to States for State health 

14 insurance assistance programs receiving assist15 ance under section 4360 of the Omnibus Budg16 et Reconciliation Act of 1990. 

17 (B) FUNDING.—For purposes of making 

18 grants under this subsection, the Secretary 

19 shall provide for the transfer, from the Federal 

20 Hospital Insurance Trust Fund under section 

21 1817 of the Social Security Act (42 U.S.C. 

22 1395i) and the Federal Supplementary Medical 

23 Insurance Trust Fund under section 1841 of 

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1 tion 1853(f) of such Act (42 U.S.C. 1395w– 

2 23(f)), of $50,000,000 to the Centers for Medi3 care & Medicaid Services Program Management 

4 Account for each of the fiscal years 2021 

5 through 2025, to remain available until ex6 pended. 

7 (2) AMOUNT OF GRANTS.—The amount of a 

8 grant to a State under this subsection from the total 

9 amount made available under paragraph (1) shall be 

10 equal to the sum of the amount allocated to the 

11 State under paragraph (3)(A) and the amount allo12 cated to the State under subparagraph (3)(B). 

13 (3) ALLOCATION TO STATES.— 

14 (A) ALLOCATION BASED ON PERCENTAGE

15 OF LOW-INCOME BENEFICIARIES.—The amount 

16 allocated to a State under this subparagraph 

from 2 17 ⁄3 of the total amount made available 

18 under paragraph (1) shall be based on the num19 ber of individuals who meet the requirement 

20 under subsection (a)(3)(A)(ii) of section 

21 1860D–14 of the Social Security Act (42 

22 U.S.C. 1395w–114) but who have not enrolled 

23 to receive a subsidy under such section 1860D– 

24 14 relative to the total number of individuals 

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1 section (a)(3)(A)(ii) in each State, as estimated 

2 by the Secretary. 

3 (B) ALLOCATION BASED ON PERCENTAGE

4 OF RURAL BENEFICIARIES.—The amount allo5 cated to a State under this subparagraph from 

1 6 ⁄3 of the total amount made available under 

7 paragraph (1) shall be based on the number of 

8 part D eligible individuals (as defined in section 

9 1860D–1(a)(3)(A) of such Act (42 U.S.C. 

10 1395w–101(a)(3)(A))) residing in a rural area 

11 relative to the total number of such individuals 

12 in each State, as estimated by the Secretary. 

13 (4) PORTION OF GRANT BASED ON PERCENT14 AGE OF LOW-INCOME BENEFICIARIES TO BE USED

15 TO PROVIDE OUTREACH TO INDIVIDUALS WHO MAY

16 BE SUBSIDY ELIGIBLE INDIVIDUALS OR ELIGIBLE

17 FOR THE MEDICARE SAVINGS PROGRAM.—Each 

18 grant awarded under this subsection with respect to 

19 amounts allocated under paragraph (3)(A) shall be 

20 used to provide outreach to individuals who may be 

21 subsidy eligible individuals (as defined in section 

22 1860D–14(a)(3)(A) of the Social Security Act (42 

23 U.S.C. 1395w–114(a)(3)(A))) or eligible for the pro24 gram of medical assistance for payment of the cost 

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1 gram pursuant to sections 1902(a)(10)(E) and 1933 

2 of such Act (42 U.S.C. 1396a(a)(10)(E), 1396u–3). 

3 (k) EFFECTIVE DATE.— 

4 (1) IN GENERAL.—Except as provided in para5 graph (2), the amendments and repeal made by this 

6 section take effect on January 1, 2021, and, with re7 spect to title XIX of the Social Security Act, apply 

8 to calendar quarters beginning on or after January 

9 1, 2021. 

10 (2) EXCEPTION FOR STATE LEGISLATION.—In 

11 the case of a State plan for medical assistance under 

12 title XIX of the Social Security Act which the Sec13 retary of Health and Human Services determines re14 quires State legislation (other than legislation appro15 priating funds) in order for the plan to meet the ad16 ditional requirements imposed by the amendments 

17 and repeal made by this section, the State plan shall 

18 not be regarded as failing to comply with the re19 quirements of such title solely on the basis of its 

20 failure to meet these additional requirements before 

21 the first day of the first calendar quarter beginning 

22 after the close of the first regular session of the 

23 State legislature that begins after the date of the en24 actment of this Act. For purposes of the previous 

25 sentence, in the case of a State that has a 2-year 


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1 legislative session, each year of such session shall be 

2 deemed to be a separate regular session of the State 

3 legislature. 

Æ 


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