I 
109TH CONGRESS 
1ST SESSION H. R. 1144 
To continue State coverage of Medicaid prescription drug coverage to Medi-
care dual eligible beneficiaries for 6 months while still allowing the 
Medicare part D benefit to be implemented as scheduled. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 8, 2005 
Mr. ALLEN 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 juris-
diction of the committee concerned 
A BILL 
To continue State coverage of Medicaid prescription drug 
coverage to Medicare dual eligible beneficiaries for 6 
months while still allowing the Medicare part D benefit 
to be implemented as scheduled. 
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 ‘‘Medicare Dual Eligible 
Prescription Drug Coverage Act of 2005’’. 
SEC. 2. FINDINGS. 
The Senate finds the following:
(1) Individuals who are dually eligible for bene-
fits under the medicare program and full benefits 
under the medicaid program— 
(A) are among the most vulnerable popu-
lations in our society; and 
(B) require adequate outreach, education, 
and timing in order to adjust to changes in our 
health care delivery system. 
(2) The transition of 6,400,000 dual eligibles 
from prescription drug coverage under the medicaid 
program to prescription drug coverage under part D 
of the medicare program is the largest transition 
ever of individuals from one insurance program to 
another. 
(3) In its June 2004 report to Congress, the 
Medicare Payment Advisory Commission (MedPAC) 
suggested that large, private employers with 75,000 
employees or less need at least 6 months to transi-
tion their employees’ drug coverage from one phar-
macy benefit management company to another such 
company. The States and the Federal Government 
are taking on a far more complex task with 
6,400,000 dual eligibles having to make the transi-
tion described in paragraph (2).
(4) Timely access to prescription drugs leads to 
higher quality of life and prevents avoidable emer-
gency room visits, hospitalizations, and premature 
nursing home placements. 
(5) Since even a short-term gap in prescription 
drug coverage could have serious health con-
sequences for dual eligibles, Congress must work to 
guarantee as smooth a transition as possible for dual 
eligibles so that no dual eligible is without prescrip-
tion drug coverage even for one day. 
SEC. 3. CONTINUING STATE COVERAGE OF MEDICAID PRE-
SCRIPTION DRUG COVERAGE TO MEDICARE 
DUAL 
ELIGIBLE 
BENEFICIARIES 
FOR 
MONTHS. 
(a) SIX-MONTH
TRANSITION.—For prescriptions 
filled during the period beginning on January 1, 2006, 
and ending on June 30, 2006, section 1935(d) of the So-
cial Security Act (42 U.S.C. 1396u–5(d)) shall not apply 
and, notwithstanding any other provision of law, a State 
(as defined for purposes of title XIX of such Act) shall 
continue to provide (and receive Federal financial partici-
pation for) medical assistance under such title with re-
spect to prescription drugs as if such section 1935(d) had 
not been enacted. 
(b) APPLICATION.—
(1) MEDICARE AS PRIMARY PAYER.—Nothing in 
subsection (a) shall be construed as changing or af-
fecting the primary payer status of a prescription 
drug plan or an MA–PD plan under part D of title 
XVIII of the Social Security Act with respect to pre-
scription drugs furnished to any full-benefit dual eli-
gible individual (as defined in section 1935(c)(6) of 
such Act (42 U.S.C. 1396u–5(c)(6)) during the 6- 
month period described in such subsection. 
(2) THIRD PARTY LIABILITY.—Nothing in sub-
section (a) shall be construed as limiting the author-
ity or responsibility of a State under section 
1902(a)(25) of the Social Security Act (42 U.S.C. 
1396a(a)(25)) to seek reimbursement from a pre-
scription drug plan, an MA–PD plan, or any other 
third party, of the costs incurred by the State in 
providing prescription drug coverage described in 
such subsection. 
SEC. 
4. 
DELAY 
IN 
IMPLEMENTATION 
OF 
MEDICAID 
CLAWBACK PAYMENTS. 
Notwithstanding section 1935(c) of the Social Secu-
rity Act (42 U.S.C. 1396u–5(c)), a State or the District 
of Columbia shall not be required to provide for a payment 
under such section to the Secretary of Health and Human 
Services for any month prior to July 1, 2006.
SEC. 5. EDUCATION AND OUTREACH TO DUAL ELIGIBLES 
REGARDING 
PRESCRIPTION 
DRUG 
COV-
ERAGE AND MONITORING OF THE TRANSI-
TION OF DUAL ELIGIBLES TO PRESCRIPTION 
DRUG COVERAGE UNDER MEDICARE. 
(a) MMA AMOUNTS.—Notwithstanding any other 
provision of law, of the amounts appropriated for the Cen-
ters for Medicare & Medicaid Services under section 
1015(a)(1) of the Medicare Prescription Drug, Improve-
ment, and Modernization Act of 2003 (Public Law 108– 
173; 117 Stat. 2446), the following rules shall apply: 
(1) EDUCATION AND OUTREACH TO DUALS.— 
$100,000,000 shall be used to provide education and 
outreach, including through one-on-one counseling 
and application assistance, to full-benefit dual eligi-
ble individuals (as defined in section 1935(c)(6) of 
the Social Security Act (42 U.S.C. 1396u–5(c)(6))) 
regarding prescription drug coverage under part D 
of title XVIII of such Act. Of such amount— 
(A) at least $20,000,000 (but in no case 
more than $50,000,000) shall be used to award 
grants to States under section 4360 of the Om-
nibus Budget Reconciliation Act of 1990 (42 
U.S.C. 1395b–4) to provide such education and 
outreach; and