IB 

Union Calendar No. 305 

116TH CONGRESS 

2D SESSION H. R. 4671 

[Report No. 116–381, Part I] 

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 

JANUARY 24, 2020 

Additional sponsors: Mr. CUELLAR, Ms. MATSUI, Mr. PASCRELL, Mr. 

MALINOWSKI, and Mr. NORCROSS

JANUARY 24, 2020 

Reported from the Committee on Energy and Commerce 

JANUARY 24, 2020 

Committee on Ways and Means discharged, committed to the Committee of 

the Whole House on the State of the Union, and ordered to be printed 


kjohnson on DSK79L0C42PROD with BILLS
2 

•HR 4671 RH

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. 


kjohnson on DSK79L0C42PROD with BILLS
3 

•HR 4671 RH

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’’. 

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

7 RESOURCE ELIGIBILITY TESTS, SIMPLIFYING 

8 ENROLLMENT, AND OTHER PROGRAM IM9 PROVEMENTS FOR LOW-INCOME BENE10 FICIARIES. 

11 (a) INCREASE IN INCOME ELIGIBILITY TO 135 PER12 CENT OF FPL FOR QUALIFIED MEDICARE BENE13 FICIARIES.— 

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

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

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

17 provided under subparagraph (B) (but not more 

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

19 all that follows through the period at the end and 

20 inserting the following: ‘‘shall be— 

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

22 the percent provided under subparagraph 

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

24 the official poverty line (as defined by the 

25 Office of Management and Budget, and reVerDate Sep 11 2014 23:21 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4671.RH H4671

kjohnson on DSK79L0C42PROD with BILLS
4 

•HR 4671 RH

1 vised annually in accordance with section 

2 673(2) of the Omnibus Budget Reconcili3 ation Act of 1981) applicable to a family 

4 of the size involved; and 

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

6 equal to 135 percent of the official poverty 

7 line (as so defined and revised) applicable 

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

9 (2) NOT COUNTING IN-KIND SUPPORT AND

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

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

12 1396d(p)(2)(D)) is amended by adding at the end 

13 the following new clause: 

14 ‘‘(iii) In determining income under 

15 this subsection, support and maintenance 

16 furnished in kind shall not be counted as 

17 income.’’. 

18 (b) INCREASE IN INCOME ELIGIBILITY TO 200 PER19 CENT OF FPL FOR SPECIFIED LOW-INCOME MEDICARE

20 BENEFICIARIES.— 

21 (1) ELIGIBILITY OF INDIVIDUALS WITH IN22 COMES BELOW 150 PERCENT OF FPL.—Section 

23 1902(a)(10)(E) of the Social Security Act (42 

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


kjohnson on DSK79L0C42PROD with BILLS
5 

•HR 4671 RH

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

2 (ii); 

3 (B) in clause (iii)— 

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

5 1995 and years thereafter’’ and inserting 

6 ‘‘120 percent in 1995 and years thereafter 

7 before 2021, and 200 percent in 2021 and 

8 years thereafter’’; and 

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

10 (C) by striking clause (iv). 

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

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

13 amended by adding at and below subparagraph (C) 

14 the following flush sentence: 

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

16 means an individual described in section 

17 1902(a)(10)(E)(iii).’’. 

18 (3) CONFORMING AMENDMENTS.— 

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

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

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

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

23 1396u–3) is repealed. 


kjohnson on DSK79L0C42PROD with BILLS
6 

•HR 4671 RH

1 (c) 100 PERCENT FMAP.—Section 1905 of the So2 cial Security Act (42 U.S.C. 1396d) is amended by adding 

3 at the end the following new subsection: 

4 ‘‘(gg) INCREASED FMAP FOR EXPANDED MEDICARE

5 COST-SHARING POPULATIONS.— 

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

7 (b), with respect to expenditures described in para8 graph (2) the Federal medical assistance percentage 

9 shall be equal to 100 percent. 

10 ‘‘(2) EXPENDITURES DESCRIBED.—The expend11 itures described in this paragraph are expenditures 

12 made on or after January 1, 2021, for medical as13 sistance for medicare cost-sharing provided to any 

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

15 1902(a)(10)(E) who would not have been eligible for 

16 medicare cost-sharing under any such clause under 

17 the income or resource eligibility standards in effect 

18 on October 1, 2018.’’. 

19 (d) CONSOLIDATION OF LOW-INCOME SUBSIDY RE20 SOURCE ELIGIBILITY TESTS.— 

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

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

23 114(a)(3)) is amended— 

24 (A) by striking subparagraph (D); 


kjohnson on DSK79L0C42PROD with BILLS
7 

•HR 4671 RH

1 (B) by redesignating subparagraphs (E) 

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

3 respectively; and 

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

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

6 (2) CLARIFICATION OF CERTAIN RULES RELAT7 ING TO INCOME AND RESOURCE DETERMINA8 TIONS.—Section 1860D–14(a)(3) of the Social Secu9 rity Act (42 U.S.C. 1395w–114(a)(3)), as amended 

10 by paragraph (1), is amended by striking subpara11 graph (F) and inserting the following new subpara12 graphs: 

13 ‘‘(F) RESOURCE EXCLUSIONS.—In deter14 mining the resources of an individual (and the 

15 eligible spouse of the individual, if any) under 

16 section 1613 for purposes of subparagraph 

17 (D)— 

18 ‘‘(i) no part of the value of any life in19 surance policy shall be taken into account; 

20 ‘‘(ii) no part of the value of any vehi21 cle shall be taken into account; 

22 ‘‘(iii) there shall be excluded an 

23 amount equal to $1,500 each with respect 

24 to any individual or eligible spouse of an 

25 individual who attests that some of the reVerDate Sep 11 2014 23:21 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4671.RH H4671

kjohnson on DSK79L0C42PROD with BILLS
8 

•HR 4671 RH

1 sources of such individual or spouse will be 

2 used to meet the burial and related ex3 penses of such individual or spouse; and 

4 ‘‘(iv) no balance in, or benefits re5 ceived under, an employee pension benefit 

6 plan (as defined in section 3 of the Em7 ployee Retirement Income Security Act of 

8 1974) shall be taken into account. 

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

10 size of the family of an individual for purposes 

11 of determining the income eligibility of such in12 dividual under this section, an individual’s fam13 ily shall consist of— 

14 ‘‘(i) the individual; 

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

16 in the same household as the individual (if 

17 any); and 

18 ‘‘(iii) any other individuals who— 

19 ‘‘(I) are related to the individual 

20 whose income eligibility is in question 

21 or such individual’s spouse who lives 

22 in the same household; 

23 ‘‘(II) are living in the same 

24 household as such individual; and 


kjohnson on DSK79L0C42PROD with BILLS
9 

•HR 4671 RH

1 ‘‘(III) are dependent on such in2 dividual or such individual’s spouse 

3 who is living in the same household 

4 for at least one-half of their financial 

5 support.’’. 

6 (3) CONFORMING AMENDMENTS.—Section 

7 1860D–14(a) of the Social Security Act (42 U.S.C. 

8 1395w–114(a)) is amended— 

9 (A) in paragraph (1), in the matter pre10 ceding subparagraph (A), by inserting ‘‘(as de11 termined under paragraph (3)(G))’’ after ‘‘fam12 ily of the size involved’’; and 

13 (B) in paragraph (3), as amended by para14 graphs (1) and (2)— 

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

16 preceding clause (i), by striking ‘‘subpara17 graph (F)’’ and inserting ‘‘subparagraph 

18 (E)’’; 

19 (ii) in subparagraph (A)(ii), by insert20 ing ‘‘(as determined under subparagraph 

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

22 (iii) in subparagraph (A)(iii), by strik23 ing ‘‘or (E)’’; 

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

25 matter preceding subclause (I), by striking 


kjohnson on DSK79L0C42PROD with BILLS
10 

•HR 4671 RH

1 ‘‘subparagraph (F)’’ and inserting ‘‘sub2 paragraph (E)’’; and 

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

4 matter preceding subclause (I), by striking 

5 ‘‘subject to the life insurance policy exclu6 sion provided under subparagraph (G)’’ 

7 and inserting ‘‘subject to the resource ex8 clusions provided under subparagraph 

9 (F)’’. 

10 (e) ALIGNMENT OF LOW-INCOME SUBSIDY AND

11 MEDICARE SAVINGS PROGRAM INCOME AND RESOURCE

12 ELIGIBILITY TESTS.— 

13 (1) APPLICATION OF MEDICAID SPOUSAL IM14 POVERISHMENT RESOURCE ALLOWANCE TO MSP AND

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

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

17 1396d(p)(1)(C)) is amended to read as follows: 

18 ‘‘(C) whose resources (as determined under sec19 tion 1613 for purposes of the supplemental security 

20 income program subject to the resource exclusions 

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

22 do not exceed— 

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

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

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


kjohnson on DSK79L0C42PROD with BILLS
11 

•HR 4671 RH

1 section 1924 (as adjusted under subsection (g) 

2 of such section) and the amount specified in 

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

4 so adjusted); or 

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

not have a spouse, an amount equal to 1 6 ⁄2 of 

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

8 (2) APPLICATION TO QDWIS.—Section 

9 1905(s)(3) of the Social Security Act (42 U.S.C. 

10 1396d(s)(3)) is amended to read as follows: 

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

17 spouse, the amount in effect for the year under 

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

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

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

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

22 and’’. 

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

24 1860D–14(a)(3)(D) of the Social Security Act (42 

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


kjohnson on DSK79L0C42PROD with BILLS
12 

•HR 4671 RH

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

2 follows: 

3 ‘‘(i) IN GENERAL.—The resources re4 quirement of this subparagraph is that an 

5 individual’s resources (as determined under 

6 section 1613 for purposes of the supple7 mental security income program subject to 

8 the resource exclusions provided under 

9 subparagraph (G)) do not exceed the 

10 amount in effect for the year under section 

11 1905(p)(1)(C)(ii).’’. 

12 (f) ENROLLMENT SIMPLIFICATIONS.— 

13 (1) APPLICATION OF 3-MONTH RETROACTIVE

14 ELIGIBILITY TO QMBS.— 

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

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

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

18 month in which the determination first occurs’’ 

19 and inserting ‘‘in or after the third month be20 fore the month in which the individual makes 

21 application for assistance’’. 

22 (B) PROCESS FOR SUBMITTING CLAIMS

23 DURING RETROACTIVE ELIGIBILITY PERIOD.— 

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

25 (42 U.S.C. 1396a(e)(8)) is further amended by 


kjohnson on DSK79L0C42PROD with BILLS
13 

•HR 4671 RH

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

2 shall provide for a process under which claims 

3 for medical assistance under the State plan may 

4 be submitted for services furnished to such an 

5 individual during such 3-month period before 

6 the month in which the individual made appli7 cation for assistance.’’. 

8 (C) CONFORMING AMENDMENT.—Section 

9 1905(a) of the Social Security Act (42 U.S.C. 

10 1396d(a)) is amended, in the matter preceding 

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

12 medicare cost-sharing with respect to a quali13 fied medicare beneficiary described in sub14 section (p)(1), if provided after the month in 

15 which the individual becomes such a bene16 ficiary’’. 

17 (2) STATE OPTION FOR 12-MONTH CONTINUOUS

18 ELIGIBILITY FOR SLMBS AND QWDIS.—Section 

19 1902(e)(12) of the Social Security Act (42 U.S.C. 

20 1396a(e)(12)) is amended— 

21 (A) by redesignating subparagraphs (A) 

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

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

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


kjohnson on DSK79L0C42PROD with BILLS
14 

•HR 4671 RH

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

2 that an individual who is determined to be eligible for ben3 efits under a State plan approved under this title under 

4 any of the following eligibility categories, or who is rede5 termined to be eligible for such benefits under any of such 

6 categories, shall be considered to meet the eligibility re7 quirements met on the date of application and shall re8 main eligible for those benefits until the end of the 12- 

9 month period following the date of the determination or 

10 redetermination of eligibility, except that a State may pro11 vide for such determinations more frequently, but not 

12 more frequently than once every 6 months for an indi13 vidual: 

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

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

16 who is determined eligible for medicare cost sharing 

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

18 ‘‘(ii) A qualified disabled and working indi19 vidual described in section 1905(s) who is deter20 mined eligible for medicare cost-sharing described in 

21 section 1905(p)(3)(A)(i).’’. 

22 (3) STATE OPTION TO USE EXPRESS LANE ELI23 GIBILITY FOR THE MEDICARE SAVINGS PROGRAM.— 

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


kjohnson on DSK79L0C42PROD with BILLS
15 

•HR 4671 RH

1 (42 U.S.C. 1396a(e)(13)(A)) is amended by adding 

2 at the end the following new clause: 

3 ‘‘(iii) STATE OPTION TO EXTEND EX4 PRESS LANE ELIGIBILITY TO OTHER POPU5 LATIONS.— 

6 ‘‘(I) IN GENERAL.—At the option 

7 of the State, the State may apply the 

8 provisions of this paragraph with re9 spect to determining eligibility under 

10 this title for an eligible individual (as 

11 defined in subclause (II)). In applying 

12 this paragraph in the case of a State 

13 making such an option, any reference 

14 in this paragraph to a child with re15 spect to this title (other than a ref16 erence to child health assistance) shall 

17 be deemed to be a reference to an eli18 gible individual. 

19 ‘‘(II) ELIGIBLE INDIVIDUAL DE20 FINED.—In this clause, the term ‘eli21 gible individual’ means any of the fol22 lowing: 

23 ‘‘(aa) A qualified medicare 

24 beneficiary described in section 

25 1905(p)(1) for purposes of deterVerDate Sep 11 2014 23:21 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H4671.RH H4671

kjohnson on DSK79L0C42PROD with BILLS
16 

•HR 4671 RH

1 mining eligibility for medicare 

2 cost-sharing (as defined in sec3 tion 1905(p)(3)). 

4 ‘‘(bb) A specified low-income 

5 medicare beneficiary described in 

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

7 section for purposes of deter8 mining eligibility for medicare 

9 cost-sharing described in section 

10 1905(p)(3)(A)(ii). 

11 ‘‘(cc) A qualified disabled 

12 and working individual described 

13 in section 1905(s) for purposes of 

14 determining eligibility for medi15 care cost-sharing described in 

16 section 1905(p)(3)(A)(i).’’. 

17 (g) MEDICAID TREATMENT OF CERTAIN MEDICARE

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

19 (42 U.S.C. 1396a(n)) is amended by adding at the end 

20 the following new paragraph: 

21 ‘‘(4) A State plan shall not deny a claim from a pro22 vider or supplier with respect to medicare cost-sharing de23 scribed in subparagraph (B), (C), or (D) of section 

24 1905(p)(3) for an item or service which is eligible for pay25 ment under title XVIII on the basis that the provider or 


kjohnson on DSK79L0C42PROD with BILLS
17 

•HR 4671 RH

1 supplier does not have a provider agreement in effect 

2 under this title or does not otherwise serve all individuals 

3 entitled to medical assistance under this title. The State 

4 shall create a mechanism through which provider or sup5 pliers that do not otherwise have provider agreements with 

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

7 qualified medicare beneficiaries.’’. 

8 (h) ELIGIBILITY FOR OTHER PROGRAMS.—Section 

9 1905(p) of the Social Security Act (42 U.S.C. 1396d(p)) 

10 is amended by adding at the end the following new para11 graph: 

12 ‘‘(7) Notwithstanding any other provision of 

13 law, any medical assistance for some or all medicare 

14 cost-sharing under this title shall not be considered 

15 income or resources in determining eligibility for, or 

16 the amount of assistance or benefits provided under, 

17 any other public benefit provided under Federal law 

18 or the law of any State or political subdivision there19 of.’’. 

20 (i) TREATMENT OF QUALIFIED MEDICARE BENE21 FICIARIES, SPECIFIED LOW-INCOME MEDICARE BENE22 FICIARIES, AND OTHER DUAL ELIGIBLES AS MEDICARE

23 BENEFICIARIES.—Section 1862 of the Social Security Act 

24 (42 U.S.C. 1395y) is amended by adding at the end the 

25 following new subsection: 


kjohnson on DSK79L0C42PROD with BILLS
18 

•HR 4671 RH

1 ‘‘(p) TREATMENT OF QUALIFIED MEDICARE BENE2 FICIARIES (QMBS), SPECIFIED LOW-INCOME MEDICARE

3 BENEFICIARIES (SLMBS), AND OTHER DUAL ELIGI4 BLES.—Nothing in this title shall be construed as author5 izing a provider of services or supplier to discriminate 

6 (through a private contractual arrangement or otherwise) 

7 against an individual who is otherwise entitled to services 

8 under this title on the basis that the individual is a quali9 fied medicare beneficiary (as defined in section 

10 1905(p)(1)), a specified low-income medicare beneficiary, 

11 or is otherwise eligible for medical assistance for medicare 

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

13 (j) ADDITIONAL FUNDING FOR STATE HEALTH IN14 SURANCE ASSISTANCE PROGRAMS.— 

15 (1) GRANTS.— 

16 (A) IN GENERAL.—The Secretary of 

17 Health and Human Services (in this subsection 

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

19 amounts made available under subparagraph 

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

21 insurance assistance programs receiving assist22 ance under section 4360 of the Omnibus Budg23 et Reconciliation Act of 1990. 

24 (B) FUNDING.—For purposes of making 

25 grants under this subsection, the Secretary 


kjohnson on DSK79L0C42PROD with BILLS
19 

•HR 4671 RH

1 shall provide for the transfer, from the Federal 

2 Hospital Insurance Trust Fund under section 

3 1817 of the Social Security Act (42 U.S.C. 

4 1395i) and the Federal Supplementary Medical 

5 Insurance Trust Fund under section 1841 of 

6 such Act (42 U.S.C. 1395t), in the same pro7 portion as the Secretary determines under sec8 tion 1853(f) of such Act (42 U.S.C. 1395w– 

9 23(f)), of $50,000,000 to the Centers for Medi10 care & Medicaid Services Program Management 

11 Account for each of the fiscal years 2021 

12 through 2025, to remain available until ex13 pended. 

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

15 grant to a State under this subsection from the total 

16 amount made available under paragraph (1) shall be 

17 equal to the sum of the amount allocated to the 

18 State under paragraph (3)(A) and the amount allo19 cated to the State under subparagraph (3)(B). 

20 (3) ALLOCATION TO STATES.— 

21 (A) ALLOCATION BASED ON PERCENTAGE

22 OF LOW-INCOME BENEFICIARIES.—The amount 

23 allocated to a State under this subparagraph 

from 2 24 ⁄3 of the total amount made available 

25 under paragraph (1) shall be based on the numVerDate Sep 11 2014 23:21 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H4671.RH H4671

kjohnson on DSK79L0C42PROD with BILLS
20 

•HR 4671 RH

1 ber of individuals who meet the requirement 

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

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

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

5 to receive a subsidy under such section 1860D– 

6 14 relative to the total number of individuals 

7 who meet the requirement under such sub8 section (a)(3)(A)(ii) in each State, as estimated 

9 by the Secretary. 

10 (B) ALLOCATION BASED ON PERCENTAGE

11 OF RURAL BENEFICIARIES.—The amount allo12 cated to a State under this subparagraph from 

1 13 ⁄3 of the total amount made available under 

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

15 part D eligible individuals (as defined in section 

16 1860D–1(a)(3)(A) of such Act (42 U.S.C. 

17 1395w–101(a)(3)(A))) residing in a rural area 

18 relative to the total number of such individuals 

19 in each State, as estimated by the Secretary. 

20 (4) PORTION OF GRANT BASED ON PERCENT21 AGE OF LOW-INCOME BENEFICIARIES TO BE USED

22 TO PROVIDE OUTREACH TO INDIVIDUALS WHO MAY

23 BE SUBSIDY ELIGIBLE INDIVIDUALS OR ELIGIBLE

24 FOR THE MEDICARE SAVINGS PROGRAM.—Each 

25 grant awarded under this subsection with respect to 


kjohnson on DSK79L0C42PROD with BILLS
21 

•HR 4671 RH

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

2 used to provide outreach to individuals who may be 

3 subsidy eligible individuals (as defined in section 

4 1860D–14(a)(3)(A) of the Social Security Act (42 

5 U.S.C. 1395w–114(a)(3)(A))) or eligible for the pro6 gram of medical assistance for payment of the cost 

7 of medicare cost-sharing under the Medicaid pro8 gram pursuant to sections 1902(a)(10)(E) and 1933 

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

10 (k) EFFECTIVE DATE.— 

11 (1) IN GENERAL.—Except as provided in para12 graph (2), the amendments and repeal made by this 

13 section take effect on January 1, 2021, and, with re14 spect to title XIX of the Social Security Act, apply 

15 to calendar quarters beginning on or after January 

16 1, 2021. 

17 (2) EXCEPTION FOR STATE LEGISLATION.—In 

18 the case of a State plan for medical assistance under 

19 title XIX of the Social Security Act which the Sec20 retary of Health and Human Services determines re21 quires State legislation (other than legislation appro22 priating funds) in order for the plan to meet the ad23 ditional requirements imposed by the amendments 

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

25 not be regarded as failing to comply with the reVerDate Sep 11 2014 23:21 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H4671.RH H4671

kjohnson on DSK79L0C42PROD with BILLS
22 

•HR 4671 RH

1 quirements of such title solely on the basis of its 

2 failure to meet these additional requirements before 

3 the first day of the first calendar quarter beginning 

4 after the close of the first regular session of the 

5 State legislature that begins after the date of the en6 actment of this Act. For purposes of the previous 

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

8 legislative session, each year of such session shall be 

9 deemed to be a separate regular session of the State 

10 legislature. 


kjohnson on DSK79L0C42PROD with BILLS

kjohnson on DSK79L0C42PROD with BILLS
Union Calendar No. 305 

116TH CONGRESS 

2D SESSION H. R. 4671 

[Report No. 116–381, Part I] 

A BILL 

To amend titles XVIII and XIX of the Social Secuincome Medicare beneficiaries. provide for other program improvements for low- resource eligibility tests, simplify enrollment, and rity Act to reduce cost-sharing, align income and 

JANUARY 24, 2020 

Reported from the Committee on Energy and Commerce 

JANUARY 24, 2020 

Committee on Ways and Means discharged, committed to 

Union, and ordered to be printed the Committee of the Whole House on the State of the 


kjohnson on DSK79L0C42PROD with BILLS