I 
108TH CONGRESS 
1ST SESSION H. R. 1744
To amend title XIX of the Social Security Act to revise and simplify the 
transitional medical assistance (TMA) program. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 10, 2003
Mr. LEVIN (for himself and Mr. CASTLE) 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 revise 
and simplify the transitional medical assistance (TMA) 
program.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Welfare to Work 
Health Care Act of 2003’’.
SEC. 2. REVISION AND SIMPLIFICATION OF THE TRANSI-
TIONAL 
MEDICAL 
ASSISTANCE 
PROGRAM 
(TMA). 
(a) OPTION OF CONTINUOUS ELIGIBILITY FOR 12 
MONTHS; OPTION OF CONTINUING COVERAGE FOR UP TO 
AN ADDITIONAL YEAR.—
(1) OPTION OF CONTINUOUS ELIGIBILITY FOR 
12 MONTHS BY MAKING REPORTING REQUIREMENTS 
OPTIONAL.—Section 1925(b) of the Social Security 
Act (42 U.S.C. 1396r–6(b)) is amended—
(A) in paragraph (1), by inserting ‘‘, at the 
option of a State,’’ after ‘‘and which’’; 
(B) in paragraph (2)(A), by inserting 
‘‘Subject to subparagraph (C)—’’ after ‘‘(A) 
NOTICES.—’’; 
(C) in paragraph (2)(B), by inserting 
‘‘Subject to subparagraph (C)—’’ after ‘‘(B) 
REPORTING REQUIREMENTS.—’’; 
(D) by adding at the end the following new 
subparagraph: 
‘‘(C) STATE
OPTION
TO
WAIVE
NOTICE 
AND
REPORTING
REQUIREMENTS.—A State 
may waive some or all of the reporting require-
ments under clauses (i) and (ii) of subpara-
graph (B). Insofar as it waives such a reporting 
requirement, the State need not provide for a
this subsection for the succeeding period not to ex-
ceed 12 months. 
‘‘(2) INCOME RESTRICTION.—The option under 
paragraph (1) shall not be made available to a fam-
ily for a succeeding period unless the State deter-
mines that the family’s average gross monthly earn-
ings (less such costs for such child care as is nec-
essary for the employment of the caretaker relative) 
as of the end of the 6-month period under sub-
section (b) does not exceed 185 percent of the offi-
cial poverty line (as defined by the Office of Man-
agement and Budget, and revised annually in ac-
cordance with section 673(2) of the Omnibus Budget 
Reconciliation Act of 1981) applicable to a family of 
the size involved. 
‘‘(3) APPLICATION
OF
EXTENSION
RULES.—
The provisions of paragraphs (2), (3), (4), and (5) 
of subsection (b) shall apply to the extension pro-
vided under this subsection in the same manner as 
they apply to the extension provided under sub-
section (b)(1), except that for purposes of this sub-
section—
‘‘(A) any reference to a 6-month period 
under subsection (b)(1) is deemed a reference 
to the extension period provided under para-
graph (1) and any deadlines for any notices or 
reporting and the premium payment periods 
shall be modified to correspond to the appro-
priate calendar quarters of coverage provided 
under this subsection; and 
‘‘(B) any reference to a provision of sub-
section (a) or (b) is deemed a reference to the 
corresponding provision of subsection (b) or of 
this subsection, respectively.’’. 
(b) STATE OPTION TO WAIVE RECEIPT OF MED-
ICAID FOR 3 OF PREVIOUS 6 MONTHS TO QUALIFY FOR 
TMA.—Section 1925(a)(1) of such Act (42 U.S.C. 1396r–
6(a)(1)) is amended by adding at the end the following: 
‘‘A State may, at its option, also apply the previous sen-
tence in the case of a family that was receiving such aid 
for fewer than 3 months, or that had applied for and was 
eligible for such aid for fewer than 3 months, during the 
6 immediately preceding months described in such sen-
tence.’’. 
(c) ELIMINATION OF SUNSET FOR TMA.—
(1) Subsection (g) of section 1925 of such Act 
(42 U.S.C. 1396r–6), as redesignated under sub-
section (a)(2), is repealed. 
(2) Section 1902(e)(1) of such Act (42 U.S.C. 
1396a(e)(1)) 
is 
amended 
by 
striking 
‘‘(A)
Nothwithstanding’’ and all that follows through
‘‘During such period, for’’ in subparagraph (B) and 
inserting ‘‘For’’. 
(d) CMS REPORT ON ENROLLMENT AND PARTICIPA-
TION RATES UNDER TMA.—Section 1925 of such Act, 
as amended by subsections (a)(2) and (c), is amended by 
adding at the end the following new subsection: 
‘‘(g) ADDITIONAL PROVISIONS.—
‘‘(1) COLLECTION AND REPORTING OF PARTICI-
PATION INFORMATION.—Each State shall—
‘‘(A) collect and submit to the Secretary, 
in a format specified by the Secretary, informa-
tion on average monthly enrollment and average 
monthly participation rates for adults and chil-
dren under this section; and 
‘‘(B) make such information publicly avail-
able. 
Such information shall be submitted under subpara-
graph (A) at the same time and frequency in which 
other enrollment information under this title is sub-
mitted to the Secretary. Using such information, the 
Secretary shall submit to Congress annual reports 
concerning such rates.’’.
(e) COORDINATION OF WORK.—Section 1925(g) of 
such Act, as added by subsection (d), is amended by add-
ing at the end the following new paragraph: 
‘‘(2) COORDINATION
WITH
ADMINISTRATION 
FOR CHILDREN AND FAMILIES.—The Administrator 
of the Centers for Medicare & Medicaid Services, in 
carrying out this section, shall work with the Assist-
ant Secretary for the Administration for Children 
and Families to develop guidance or other technical 
assistance for States regarding best practices in 
guaranteeing access to transitional medical assist-
ance under this section.’’. 
(f) ELIMINATION
OF
TMA REQUIREMENT
FOR 
STATES THAT EXTEND COVERAGE TO CHILDREN AND 
PARENTS THROUGH 185 PERCENT OF POVERTY.—
(1) IN GENERAL.—Section 1925 of such Act is 
further amended by adding at the end the following 
new subsection: 
‘‘(h) PROVISIONS OPTIONAL FOR STATES THAT EX-
TEND COVERAGE TO CHILDREN AND PARENTS THROUGH 
185 PERCENT OF POVERTY.—A State may (but is not re-
quired to) meet the requirements of subsections (a) and 
(b) if it provides for medical assistance under section 1931 
to families (including both children and caretaker rel-
atives) the average gross monthly earning of which (less
such costs for such child care as is necessary for the em-
ployment of a caretaker relative) is at or below a level that 
is at least 185 percent of the official poverty line (as de-
fined by the Office of Management and Budget, and re-
vised annually in accordance with section 673(2) of the 
Omnibus Budget Reconciliation Act of 1981) applicable 
to a family of the size involved.’’. 
(2) CONFORMING AMENDMENTS.—Such section 
is further amended, in subsections (a)(1) and (b)(1), 
by inserting ‘‘, but subject to subsection (h),’’ after 
‘‘Notwithstanding any other provision of this title,’’ 
each place it appears. 
(g) EXTENDING USE OF OUTSTATIONED WORKERS 
TO ACCEPT APPLICATIONS FOR TRANSITIONAL MEDICAL 
ASSISTANCE.—Section 1902(a)(55) of such Act (42 
U.S.C. 1396a(a)(55)) is amended by inserting ‘‘and under 
section 1931’’ after ‘‘(a)(10)(A)(ii)(IX)’’. 
(h) EFFECTIVE DATES.—(1) Except as provided in 
this subsection, the amendments made by this section shall 
apply to calendar quarters beginning on or after the date 
of the enactment of this Act, without regard to whether 
or not final regulations to carry out such amendments 
have been promulgated by such date. 
(2) In the case of a State plan for medical assistance 
under title XIX of the Social Security Act which the Sec-