A BILL 
To amend titles XVIII and XIX of the Social Security Act 
to reduce cost-sharing, align income and resource eligi-
bility tests, simplify enrollment, and provide for other 
program improvements for low-income Medicare bene-
ficiaries. 
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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 ‘‘Helping Seniors Afford 
Health Care Act’’. 
SEC. 2. REDUCING COST-SHARING, ALIGNING INCOME AND 
RESOURCE ELIGIBILITY TESTS, SIMPLIFYING 
ENROLLMENT, AND OTHER PROGRAM IM-
PROVEMENTS 
FOR 
LOW-INCOME 
BENE-
FICIARIES. 
(a) INCREASE IN INCOME ELIGIBILITY TO 135 PER-
CENT
OF
FPL FOR
QUALIFIED
MEDICARE
BENE-
FICIARIES.— 
(1) IN GENERAL.—Section 1905(p)(2)(A) of the 
Social Security Act (42 U.S.C. 1396d(p)(2)(A)) is 
amended by striking ‘‘shall be at least the percent 
provided under subparagraph (B) (but not more 
than 100 percent) of the official poverty line’’ and 
all that follows through the period at the end and 
inserting the following: ‘‘shall be— 
‘‘(i) before January 1, 2021, at least 
the percent provided under subparagraph 
(B) (but not more than 100 percent) of 
the official poverty line (as defined by the 
Office of Management and Budget, and re-
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vised annually in accordance with section 
673(2) of the Omnibus Budget Reconcili-
ation Act of 1981) applicable to a family 
of the size involved; and 
‘‘(ii) on or after January 1, 2021, 
equal to 135 percent of the official poverty 
line (as so defined and revised) applicable 
to a family of the size involved.’’. 
(2) NOT
COUNTING
IN-KIND
SUPPORT
AND 
MAINTENANCE AS INCOME.—Section 1905(p)(2)(D) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396d(p)(2)(D)) is amended by adding at the end 
the following new clause: 
‘‘(iii) In determining income under 
this subsection, support and maintenance 
furnished in kind shall not be counted as 
income.’’. 
(b) INCREASE IN INCOME ELIGIBILITY TO 200 PER-
CENT OF FPL FOR SPECIFIED LOW-INCOME MEDICARE 
BENEFICIARIES.— 
(1) ELIGIBILITY
OF
INDIVIDUALS
WITH
IN-
COMES
BELOW
150
PERCENT
OF
FPL.—Section 
1902(a)(10)(E) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(E)) is amended— 
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(A) by adding ‘‘and’’ at the end of clause 
(ii); 
(B) in clause (iii)— 
(i) by striking ‘‘and 120 percent in 
1995 and years thereafter’’ and inserting 
‘‘120 percent in 1995 and years thereafter 
before 2021, and 200 percent in 2021 and 
years thereafter’’; and 
(ii) by striking ‘‘and’’ at the end; and 
(C) by striking clause (iv). 
(2) REFERENCES.—Section 1905(p)(1) of the 
Social Security Act (42 U.S.C. 1396d(p)(1)) is 
amended by adding at and below subparagraph (C) 
the following flush sentence: 
‘‘The term ‘specified low-income medicare beneficiary’ 
means 
an 
individual 
described 
in 
section 
1902(a)(10)(E)(iii).’’. 
(3) CONFORMING AMENDMENTS.— 
(A) The first sentence of section 1905(b) 
of such Act (42 U.S.C. 1396d(b)) is amended 
by striking ‘‘and section 1933(d)’’. 
(B) Section 1933 of such Act (42 U.S.C. 
1396u–3) is repealed. 
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(c) 100 PERCENT FMAP.—Section 1905 of the So-
cial Security Act (42 U.S.C. 1396d) is amended by adding 
at the end the following new subsection: 
‘‘(gg) INCREASED FMAP FOR EXPANDED MEDICARE 
COST-SHARING POPULATIONS.— 
‘‘(1) IN GENERAL.—Notwithstanding subsection 
(b), with respect to expenditures described in para-
graph (2) the Federal medical assistance percentage 
shall be equal to 100 percent. 
‘‘(2) EXPENDITURES DESCRIBED.—The expend-
itures described in this paragraph are expenditures 
made on or after January 1, 2021, for medical as-
sistance for medicare cost-sharing provided to any 
individual under clause (i), (ii), or (iii) of section 
1902(a)(10)(E) who would not have been eligible for 
medicare cost-sharing under any such clause under 
the income or resource eligibility standards in effect 
on October 1, 2018.’’. 
(d) CONSOLIDATION OF LOW-INCOME SUBSIDY RE-
SOURCE ELIGIBILITY TESTS.— 
(1) IN GENERAL.—Section 1860D–14(a)(3) of 
the Social Security Act (42 U.S.C. 1395w– 
114(a)(3)) is amended— 
(A) by striking subparagraph (D); 
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(B) by redesignating subparagraphs (E) 
through (G) as subparagraphs (D) through (F), 
respectively; and 
(C) in the heading of subparagraph (D), as 
so redesignated, by striking ‘‘ALTERNATIVE’’. 
(2) CLARIFICATION OF CERTAIN RULES RELAT-
ING
TO
INCOME
AND
RESOURCE
DETERMINA-
TIONS.—Section 1860D–14(a)(3) of the Social Secu-
rity Act (42 U.S.C. 1395w–114(a)(3)), as amended 
by paragraph (1), is amended by striking subpara-
graph (F) and inserting the following new subpara-
graphs: 
‘‘(F) RESOURCE
EXCLUSIONS.—In deter-
mining the resources of an individual (and the 
eligible spouse of the individual, if any) under 
section 1613 for purposes of subparagraph 
(D)— 
‘‘(i) no part of the value of any life in-
surance policy shall be taken into account; 
‘‘(ii) no part of the value of any vehi-
cle shall be taken into account; 
‘‘(iii) there shall be excluded an 
amount equal to $1,500 each with respect 
to any individual or eligible spouse of an 
individual who attests that some of the re-
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sources of such individual or spouse will be 
used to meet the burial and related ex-
penses of such individual or spouse; and 
‘‘(iv) no balance in, or benefits re-
ceived under, an employee pension benefit 
plan (as defined in section 3 of the Em-
ployee Retirement Income Security Act of 
1974) shall be taken into account. 
‘‘(G) FAMILY
SIZE.—In determining the 
size of the family of an individual for purposes 
of determining the income eligibility of such in-
dividual under this section, an individual’s fam-
ily shall consist of— 
‘‘(i) the individual; 
‘‘(ii) the individual’s spouse who lives 
in the same household as the individual (if 
any); and 
‘‘(iii) any other individuals who— 
‘‘(I) are related to the individual 
whose income eligibility is in question 
or such individual’s spouse who lives 
in the same household; 
‘‘(II) are living in the same 
household as such individual; and 
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‘‘subparagraph (F)’’ and inserting ‘‘sub-
paragraph (E)’’; and 
(v) in subparagraph (D)(i), in the 
matter preceding subclause (I), by striking 
‘‘subject to the life insurance policy exclu-
sion provided under subparagraph (G)’’ 
and inserting ‘‘subject to the resource ex-
clusions 
provided 
under 
subparagraph 
(F)’’. 
(e) ALIGNMENT
OF LOW-INCOME SUBSIDY
AND 
MEDICARE SAVINGS PROGRAM INCOME AND RESOURCE 
ELIGIBILITY TESTS.— 
(1) APPLICATION
OF
MEDICAID
SPOUSAL
IM-
POVERISHMENT RESOURCE ALLOWANCE TO MSP AND 
LIS RESOURCE ELIGIBILITY.—Section 1905(p)(1)(C) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396d(p)(1)(C)) is amended to read as follows: 
‘‘(C) whose resources (as determined under sec-
tion 1613 for purposes of the supplemental security 
income program subject to the resource exclusions 
under subparagraph (G) of section 1860D–14(a)(3)) 
do not exceed— 
‘‘(i) in the case of an individual with a 
spouse, an amount equal to the sum of the first 
amount specified in subsection (f)(2)(A)(i) of 
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section 1924 (as adjusted under subsection (g) 
of such section) and the amount specified in 
subsection (f)(2)(A)(ii)(II) of such section (as 
so adjusted); or 
‘‘(ii) in the case of an individual who does 
not have a spouse, an amount equal to 1⁄2 of 
the amount described in clause (i).’’. 
(2) 
APPLICATION
TO
QDWIS.—Section 
1905(s)(3) of the Social Security Act (42 U.S.C. 
1396d(s)(3)) is amended to read as follows: 
‘‘(3) whose resources (as determined under sec-
tion 1613 for purposes of the supplemental security 
income program subject to the resource exclusions 
under subparagraph (G) of section 1860D–14(a)(3)) 
do not exceed— 
‘‘(A) in the case of an individual with a 
spouse, the amount in effect for the year under 
clause (i) of subsection (p)(1)(C); and 
‘‘(B) in the case of an individual who does 
not have a spouse, the amount in effect for the 
year under clause (ii) of subsection (p)(1)(C); 
and’’. 
(3) APPLICATION TO LIS.—Clause (i) of section 
1860D–14(a)(3)(D) of the Social Security Act (42 
U.S.C. 1395w–114(a)(3)(D)), as redesignated and 
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amended by subsection (d)(1), is amended to read as 
follows: 
‘‘(i) IN GENERAL.—The resources re-
quirement of this subparagraph is that an 
individual’s resources (as determined under 
section 1613 for purposes of the supple-
mental security income program subject to 
the resource exclusions provided under 
subparagraph (G)) do not exceed the 
amount in effect for the year under section 
1905(p)(1)(C)(ii).’’. 
(f) ENROLLMENT SIMPLIFICATIONS.— 
(1) APPLICATION
OF
3-MONTH
RETROACTIVE 
ELIGIBILITY TO QMBS.— 
(A) IN GENERAL.—Section 1902(e)(8) of 
the Social Security Act (42 U.S.C. 1396a(e)(8)) 
is amended by striking ‘‘after the end of the 
month in which the determination first occurs’’ 
and inserting ‘‘in or after the third month be-
fore the month in which the individual makes 
application for assistance’’. 
(B) PROCESS
FOR
SUBMITTING
CLAIMS 
DURING RETROACTIVE ELIGIBILITY PERIOD.— 
Section 1902(e)(8) of the Social Security Act 
(42 U.S.C. 1396a(e)(8)) is further amended by 
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adding at the end the following: ‘‘The Secretary 
shall provide for a process under which claims 
for medical assistance under the State plan may 
be submitted for services furnished to such an 
individual during such 3-month period before 
the month in which the individual made appli-
cation for assistance.’’. 
(C) CONFORMING
AMENDMENT.—Section 
1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)) is amended, in the matter preceding 
paragraph (1), by striking ‘‘or, in the case of 
medicare cost-sharing with respect to a quali-
fied medicare beneficiary described in sub-
section (p)(1), if provided after the month in 
which the individual becomes such a bene-
ficiary’’. 
(2) STATE OPTION FOR 12-MONTH CONTINUOUS 
ELIGIBILITY
FOR
SLMBS
AND
QWDIS.—Section 
1902(e)(12) of the Social Security Act (42 U.S.C. 
1396a(e)(12)) is amended— 
(A) by redesignating subparagraphs (A) 
and (B) as clauses (i) and (ii), respectively; 
(B) by inserting ‘‘(A)’’ after ‘‘(12)’’; and 
(C) by adding at the end the following: 
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‘‘(B) At the option of the State, the plan may provide 
that an individual who is determined to be eligible for ben-
efits under a State plan approved under this title under 
any of the following eligibility categories, or who is rede-
termined to be eligible for such benefits under any of such 
categories, shall be considered to meet the eligibility re-
quirements met on the date of application and shall re-
main eligible for those benefits until the end of the 12- 
month period following the date of the determination or 
redetermination of eligibility, except that a State may pro-
vide for such determinations more frequently, but not 
more frequently than once every 6 months for an indi-
vidual: 
‘‘(i) A specified low-income medicare beneficiary 
described in subsection (a)(10)(E)(iii) of this section 
who is determined eligible for medicare cost sharing 
described in section 1905(p)(3)(A)(ii). 
‘‘(ii) A qualified disabled and working indi-
vidual described in section 1905(s) who is deter-
mined eligible for medicare cost-sharing described in 
section 1905(p)(3)(A)(i).’’. 
(3) STATE OPTION TO USE EXPRESS LANE ELI-
GIBILITY FOR THE MEDICARE SAVINGS PROGRAM.— 
Section 1902(e)(13)(A) of the Social Security Act 
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(42 U.S.C. 1396a(e)(13)(A)) is amended by adding 
at the end the following new clause: 
‘‘(iii) STATE OPTION TO EXTEND EX-
PRESS LANE ELIGIBILITY TO OTHER POPU-
LATIONS.— 
‘‘(I) IN GENERAL.—At the option 
of the State, the State may apply the 
provisions of this paragraph with re-
spect to determining eligibility under 
this title for an eligible individual (as 
defined in subclause (II)). In applying 
this paragraph in the case of a State 
making such an option, any reference 
in this paragraph to a child with re-
spect to this title (other than a ref-
erence to child health assistance) shall 
be deemed to be a reference to an eli-
gible individual. 
‘‘(II) ELIGIBLE INDIVIDUAL DE-
FINED.—In this clause, the term ‘eli-
gible individual’ means any of the fol-
lowing: 
‘‘(aa) A qualified medicare 
beneficiary described in section 
1905(p)(1) for purposes of deter-
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mining eligibility for medicare 
cost-sharing (as defined in sec-
tion 1905(p)(3)). 
‘‘(bb) A specified low-income 
medicare beneficiary described in 
subsection (a)(10)(E)(iii) of this 
section for purposes of deter-
mining eligibility for medicare 
cost-sharing described in section 
1905(p)(3)(A)(ii). 
‘‘(cc) A qualified disabled 
and working individual described 
in section 1905(s) for purposes of 
determining eligibility for medi-
care cost-sharing described in 
section 1905(p)(3)(A)(i).’’. 
(g) MEDICAID TREATMENT OF CERTAIN MEDICARE 
PROVIDERS.—Section 1902(n) of the Social Security Act 
(42 U.S.C. 1396a(n)) is amended by adding at the end 
the following new paragraph: 
‘‘(4) A State plan shall not deny a claim from a pro-
vider or supplier with respect to medicare cost-sharing de-
scribed in subparagraph (B), (C), or (D) of section 
1905(p)(3) for an item or service which is eligible for pay-
ment under title XVIII on the basis that the provider or 
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supplier does not have a provider agreement in effect 
under this title or does not otherwise serve all individuals 
entitled to medical assistance under this title. The State 
shall create a mechanism through which provider or sup-
pliers that do not otherwise have provider agreements with 
the State can bill the State for medicare cost-sharing for 
qualified medicare beneficiaries.’’. 
(h) ELIGIBILITY FOR OTHER PROGRAMS.—Section 
1905(p) of the Social Security Act (42 U.S.C. 1396d(p)) 
is amended by adding at the end the following new para-
graph: 
‘‘(7) Notwithstanding any other provision of 
law, any medical assistance for some or all medicare 
cost-sharing under this title shall not be considered 
income or resources in determining eligibility for, or 
the amount of assistance or benefits provided under, 
any other public benefit provided under Federal law 
or the law of any State or political subdivision there-
of.’’. 
(i) TREATMENT OF QUALIFIED MEDICARE BENE-
FICIARIES, SPECIFIED LOW-INCOME MEDICARE BENE-
FICIARIES, AND OTHER DUAL ELIGIBLES AS MEDICARE 
BENEFICIARIES.—Section 1862 of the Social Security Act 
(42 U.S.C. 1395y) is amended by adding at the end the 
following new subsection: 
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‘‘(p) TREATMENT OF QUALIFIED MEDICARE BENE-
FICIARIES (QMBS), SPECIFIED LOW-INCOME MEDICARE 
BENEFICIARIES (SLMBS), AND OTHER DUAL ELIGI-
BLES.—Nothing in this title shall be construed as author-
izing a provider of services or supplier to discriminate 
(through a private contractual arrangement or otherwise) 
against an individual who is otherwise entitled to services 
under this title on the basis that the individual is a quali-
fied 
medicare 
beneficiary 
(as 
defined 
in 
section 
1905(p)(1)), a specified low-income medicare beneficiary, 
or is otherwise eligible for medical assistance for medicare 
cost-sharing or other benefits under title XIX.’’. 
(j) ADDITIONAL FUNDING FOR STATE HEALTH IN-
SURANCE ASSISTANCE PROGRAMS.— 
(1) GRANTS.— 
(A) 
IN
GENERAL.—The 
Secretary 
of 
Health and Human Services (in this subsection 
referred to as the ‘‘Secretary’’) shall use 
amounts made available under subparagraph 
(B) to make grants to States for State health 
insurance assistance programs receiving assist-
ance under section 4360 of the Omnibus Budg-
et Reconciliation Act of 1990. 
(B) FUNDING.—For purposes of making 
grants under this subsection, the Secretary 
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shall provide for the transfer, from the Federal 
Hospital Insurance Trust Fund under section 
1817 of the Social Security Act (42 U.S.C. 
1395i) and the Federal Supplementary Medical 
Insurance Trust Fund under section 1841 of 
such Act (42 U.S.C. 1395t), in the same pro-
portion as the Secretary determines under sec-
tion 1853(f) of such Act (42 U.S.C. 1395w– 
23(f)), of $50,000,000 to the Centers for Medi-
care & Medicaid Services Program Management 
Account for each of the fiscal years 2021 
through 2025, to remain available until ex-
pended. 
(2) AMOUNT OF GRANTS.—The amount of a 
grant to a State under this subsection from the total 
amount made available under paragraph (1) shall be 
equal to the sum of the amount allocated to the 
State under paragraph (3)(A) and the amount allo-
cated to the State under subparagraph (3)(B). 
(3) ALLOCATION TO STATES.— 
(A) ALLOCATION BASED ON PERCENTAGE 
OF LOW-INCOME BENEFICIARIES.—The amount 
allocated to a State under this subparagraph 
from 2⁄3 of the total amount made available 
under paragraph (1) shall be based on the num-
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ber of individuals who meet the requirement 
under 
subsection 
(a)(3)(A)(ii) 
of 
section 
1860D–14 of the Social Security Act (42 
U.S.C. 1395w–114) but who have not enrolled 
to receive a subsidy under such section 1860D– 
14 relative to the total number of individuals 
who meet the requirement under such sub-
section (a)(3)(A)(ii) in each State, as estimated 
by the Secretary. 
(B) ALLOCATION BASED ON PERCENTAGE 
OF RURAL BENEFICIARIES.—The amount allo-
cated to a State under this subparagraph from 
1⁄3 of the total amount made available under 
paragraph (1) shall be based on the number of 
part D eligible individuals (as defined in section 
1860D–1(a)(3)(A) of such Act (42 U.S.C. 
1395w–101(a)(3)(A))) residing in a rural area 
relative to the total number of such individuals 
in each State, as estimated by the Secretary. 
(4) PORTION OF GRANT BASED ON PERCENT-
AGE OF LOW-INCOME BENEFICIARIES TO BE USED 
TO PROVIDE OUTREACH TO INDIVIDUALS WHO MAY 
BE
SUBSIDY
ELIGIBLE
INDIVIDUALS
OR
ELIGIBLE 
FOR
THE
MEDICARE
SAVINGS
PROGRAM.—Each 
grant awarded under this subsection with respect to 
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amounts allocated under paragraph (3)(A) shall be 
used to provide outreach to individuals who may be 
subsidy eligible individuals (as defined in section 
1860D–14(a)(3)(A) of the Social Security Act (42 
U.S.C. 1395w–114(a)(3)(A))) or eligible for the pro-
gram of medical assistance for payment of the cost 
of medicare cost-sharing under the Medicaid pro-
gram pursuant to sections 1902(a)(10)(E) and 1933 
of such Act (42 U.S.C. 1396a(a)(10)(E), 1396u–3). 
(k) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments and repeal made by this 
section take effect on January 1, 2021, and, with re-
spect to title XIX of the Social Security Act, apply 
to calendar quarters beginning on or after January 
1, 2021. 
(2) EXCEPTION FOR STATE LEGISLATION.—In 
the case of a State plan for medical assistance under 
title XIX of the Social Security Act which the Sec-
retary of Health and Human Services determines re-
quires State legislation (other than legislation appro-
priating funds) in order for the plan to meet the ad-
ditional requirements imposed by the amendments 
and repeal made by this section, the State plan shall 
not be regarded as failing to comply with the re-
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quirements of such title solely on the basis of its 
failure to meet these additional requirements before 
the first day of the first calendar quarter beginning 
after the close of the first regular session of the 
State legislature that begins after the date of the en-
actment of this Act. For purposes of the previous 
sentence, in the case of a State that has a 2-year 
legislative session, each year of such session shall be 
deemed to be a separate regular session of the State 
legislature. 
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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 Secu-
rity Act to reduce cost-sharing, align income and 
resource eligibility tests, simplify enrollment, and 
provide for other program improvements for low- 
income Medicare beneficiaries. 
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 
VerDate Sep 11 2014 
23:21 Jan 24, 2020
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kjohnson on DSK79L0C42PROD with BILLS