I 

115TH CONGRESS 

2D SESSION H. R. 7149 

To amend title XIX of the Social Security Act to remove an institutional 

bias by making permanent the protection for recipients of home and 

community-based services against spousal impoverishment. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 16, 2018 

Mrs. DINGELL (for herself and 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 remove 

an institutional bias by making permanent the protection 

for recipients of home and community-based services 

against spousal impoverishment. 

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 ‘‘Protecting Married 

5 Seniors from Impoverishment Act’’. 


pamtmann on DSKBFK8HB2PROD with BILLS
2 

•HR 7149 IH

1 SEC. 2. MAKING PERMANENT THE PROTECTION UNDER 

2 MEDICAID FOR RECIPIENTS OF HOME AND 

3 COMMUNITY-BASED SERVICES AGAINST 

4 SPOUSAL IMPOVERISHMENT. 

5 (a) IN GENERAL.—Section 1924(h)(1)(A) of the So6 cial Security Act (42 U.S.C. 1396r–5(h)(1)(A)) is amend7 ed by striking ‘‘(at the option of the State) is described 

8 in section 1902(a)(10)(A)(ii)(VI)’’ and inserting the fol9 lowing: ‘‘before January 1, 2019, at the option of the 

10 State, is described in section 1902(a)(10)(A)(ii)(VI), or, 

11 beginning January 1, 2019, is eligible for medical assist12 ance for home and community-based services provided 

13 under subsection (c), (d), or (i) of section 1915, under 

14 a waiver approved under section 1115, or who is eligible 

15 for such medical assistance by reason of being determined 

16 eligible under section 1902(a)(10)(C) or by reason of sec17 tion 1902(f) or otherwise on the basis of a reduction of 

18 income based on costs incurred for medical or other reme19 dial care, or who is eligible for medical assistance for home 

20 and community-based attendant services and supports 

21 under section 1915(k)’’. 

22 (b) CONSTRUCTION.— 

23 (1) PROTECTING STATE SPOUSAL INCOME AND

24 ASSET DISREGARD FLEXIBILITY UNDER WAIVERS

25 AND PLAN AMENDMENTS.—Nothing in section 2404 

26 of Public Law 111–148 (42 U.S.C. 1395r–5) or secVerDate Sep 11 2014 02:16 Nov 20, 2018 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H7149.IH H7149

pamtmann on DSKBFK8HB2PROD with BILLS
3 

•HR 7149 IH

1 tion 1924 of the Social Security Act (42 U.S.C. 

2 1396r–5) shall be construed as prohibiting a State 

3 from disregarding an individual’s spousal income 

4 and assets under a State waiver or plan amendment 

5 described in paragraph (2) for purposes of making 

6 determinations of eligibility for home and commu7 nity-based services or home and community-based 

8 attendant services and supports under such waiver 

9 or plan amendment. 

10 (2) STATE WAIVER OR PLAN AMENDMENT DE11 SCRIBED.—A State waiver or plan amendment de12 scribed in this paragraph is any of the following: 

13 (A) A waiver or plan amendment to pro14 vide medical assistance for home and commu15 nity-based services under a waiver or plan 

16 amendment under subsection (c), (d), or (i) of 

17 section 1915 of the Social Security Act (42 

18 U.S.C. 1396n) or under section 1115 of such 

19 Act (42 U.S.C. 1315). 

20 (B) A plan amendment to provide medical 

21 assistance for home and community-based serv22 ices for individuals by reason of being deter23 mined eligible under section 1902(a)(10)(C) of 

24 such Act (42 U.S.C. 1396a(a)(10)(C)) or by 

25 reason of section 1902(f) of such Act (42 


pamtmann on DSKBFK8HB2PROD with BILLS
4 

•HR 7149 IH

1 U.S.C. 1396a(f)) or otherwise on the basis of a 

2 reduction of income based on costs incurred for 

3 medical or other remedial care under which the 

4 State disregarded the income and assets of the 

5 individual’s spouse in determining the initial 

6 and ongoing financial eligibility of an individual 

7 for such services in place of the spousal impov8 erishment provisions applied under section 1924 

9 of such Act (42 U.S.C. 1396r–5). 

10 (C) A plan amendment to provide medical 

11 assistance for home and community-based at12 tendant services and supports under section 

13 1915(k) of such Act (42 U.S.C. 1396n(k)). 

Æ 


pamtmann on DSKBFK8HB2PROD with BILLS