I 
109TH CONGRESS 
1ST SESSION H. R. 3980 
To amend title XIX of the Social Security Act to improve the qualified 
Medicare beneficiary (QMB) and specified low-income Medicare bene-
ficiary (SLMB) programs within the Medicaid Program. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 6, 2005 
Mr. DINGELL (for himself, Mr. BROWN of Ohio, Mr. WAXMAN, Mrs. CAPPS, 
Mr. PALLONE, Mr. BOUCHER, and Ms. BALDWIN) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce 
A BILL 
To amend title XIX of the Social Security Act to improve 
the qualified Medicare beneficiary (QMB) and specified 
low-income Medicare beneficiary (SLMB) programs with-
in the Medicaid 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; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Medicare Beneficiary Assistance Improvement Act’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows:
Sec. 1. Short title; table of contents. 
Sec. 2. Renaming program to eliminate confusion. 
Sec. 3. Expanding protections by increasing SLMB eligibility income level to 
135 percent of poverty. 
Sec. 4. Eliminating barriers to enrollment. 
Sec. 5. Elimination of asset test. 
Sec. 6. Improving assistance with out-of-pocket costs. 
Sec. 7. Improving program information and coordination with State, local, and 
other partners. 
Sec. 8. Notices to certain new medicare beneficiaries. 
SEC. 2. RENAMING PROGRAM TO ELIMINATE CONFUSION. 
The programs of benefits for lower income medicare 
beneficiaries provided under section 1902(a)(10)(E) of the 
Social Security Act (42 U.S.C. 1396a(a)(10)(E)) shall be 
known as the ‘‘Medicare Savings Programs’’. 
SEC. 3. EXPANDING PROTECTIONS BY INCREASING SLMB 
ELIGIBILITY INCOME LEVEL TO 135 PERCENT 
OF POVERTY. 
(a) IN GENERAL.—Section 1902(a)(10)(E)(iii) of the 
Social Security Act (42 U.S.C. 1396a(a)(10)(E)(iii)) is 
amended by striking ‘‘120 percent in 1995 and years 
thereafter’’ and inserting ‘‘120 percent in 1995 through 
2005 and 135 percent in 2006 and years thereafter’’. 
(b) CONFORMING REMOVAL OF QI–1 PROVISIONS.— 
(1) Section 1902(a)(10)(E) of such Act (42 
U.S.C. 1396a(a)(10)(E)) is further amended— 
(A) by adding ‘‘and’’ at the end of clause 
(ii); 
(B) by striking ‘‘and’’ at the end of clause 
(iii); and
(C) by striking clause (iv). 
(2) Section 1933 of such Act (42 U.S.C. 
1396u–3) is repealed. 
(3) The amendments made by this subsection 
shall take effect as of January 1, 2006. 
(c) APPLICATION OF CHIP ENHANCED MATCHING 
RATE FOR SLMB ASSISTANCE.— 
(1) IN GENERAL.—Section 1905(b)(4) of such 
Act (42 U.S.C. 1396d(b)(4)) is amended by insert-
ing ‘‘or section 1902(a)(10)(E)(iii)’’ after ‘‘section 
1902(a)(10)(A)(ii)(XVIII)’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to medical assistance 
for medicare cost-sharing for months beginning with 
January 2006. 
SEC. 4. ELIMINATING BARRIERS TO ENROLLMENT. 
(a) AUTOMATIC ELIGIBILITY FOR SSI RECIPIENTS IN 
209(B) STATES
AND SSI CRITERIA STATES.—Section 
1905(p) of the Social Security Act (42 U.S.C. 1396d(p)) 
is amended— 
(1) by redesignating paragraph (6) as para-
graph (11); and 
(2) by adding at the end the following new 
paragraph:
‘‘(6) In the case of a State which has elected treat-
ment under section 1902(f) for aged, blind, and disabled 
individuals, individuals with respect to whom supplemental 
security income payments are being paid under title XVI 
are deemed for purposes of this title to be qualified medi-
care beneficiaries.’’. 
(b) 
SELF-CERTIFICATION
OF
INCOME.—Section 
1905(p) of the Social Security Act (42 U.S.C. 1396d(p)), 
as amended by subsection (a), is amended by inserting 
after paragraph (6) the following new paragraph: 
‘‘(7) In determining whether an individual is a quali-
fied medicare beneficiary or is eligible for benefits under 
section 1902(a)(10)(E)(iii), the State shall permit individ-
uals to qualify on the basis of self-certifications of income 
without the need to provide additional documentation.’’. 
(c) AUTOMATIC REENROLLMENT WITHOUT NEED TO 
REAPPLY.— 
(1) IN GENERAL.—Section 1905(p) of the So-
cial Security Act (42 U.S.C. 1396d(p)), as amended 
by subsections (a) and (b), is amended by inserting 
after paragraph (7) the following new paragraph: 
‘‘(8) In the case of an individual who has been deter-
mined to be a qualified medicare beneficiary or eligible for 
benefits under section 1902(a)(10)(E)(iii), the individual 
shall be deemed to continue to be so qualified or eligible
without the need for any annual or periodic application 
unless and until the individual notifies the State that the 
individual’s eligibility conditions have changed so that the 
individual is no longer so qualified or eligible.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1902(e)(8) of the Social Security Act (42 U.S.C. 
1396a(e)(8)) is amended by striking the second sen-
tence. 
(d) USE OF SIMPLIFIED APPLICATION PROCESS.— 
Section 1905(p) of the Social Security Act (42 U.S.C. 
1396d(p)), as amended by subsections (a), (b), and (c), 
is amended by inserting after paragraph (8) the following 
new paragraph: 
‘‘(9) A State shall permit individuals to apply to qual-
ify as a qualified medicare beneficiary or for eligibility for 
benefits under section 1902(a)(10)(E)(iii) through the use 
of the simplified application form developed under section 
1905(p)(5)(A) and shall permit such an application to be 
made over the telephone or by mail, without the need for 
an interview in person by the applicant or a representative 
of the applicant.’’. 
(e) ROLE OF SOCIAL SECURITY OFFICES.— 
(1) ENROLLMENT AND PROVISION OF INFORMA-
TION
AT
SOCIAL
SECURITY
OFFICES.—Section 
1905(p) of the Social Security Act (42 U.S.C.
1396d(p)), as amended by subsections (a), (b), (c), 
and (d) is amended by inserting after paragraph (9) 
the following new paragraph: 
‘‘(10) The Commissioner of Social Security shall pro-
vide, through local offices of the Social Security Adminis-
tration— 
‘‘(A) for the enrollment under State plans 
under this title for appropriate medicare cost-shar-
ing benefits for an individual who is a qualified 
medicare beneficiary or is eligible for benefits under 
section 1902(a)(10)(E)(iii) through utilization of the 
process established under section 1860D–14; and 
‘‘(B) for providing oral and written notice of 
the availability of such benefits.’’. 
(2) 
CLARIFYING
AMENDMENT.—Section 
1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)) is 
amended by inserting ‘‘as provided in section 
1905(p)(10),’’ after ‘‘except’’. 
(f) OUTSTATIONING OF STATE ELIGIBILITY WORK-
ERS AT SSA FIELD OFFICES.—Section 1902(a)(55) of 
such Act (42 U.S.C. 1396a(a)(55)) is amended— 
(1) in the matter preceding subparagraph (A), 
by 
striking 
‘‘subsection 
(a)(10)(A)(i)(IV), 
(a)(10)(A)(i)(VI), 
(a)(10)(A)(i)(VII), 
or 
(a)(10)(A)(ii)(IX)’’ 
and 
inserting 
‘‘paragraph
(10)(A)(i)(IV), 
(10)(A)(i)(VI), 
(10)(A)(i)(VII), 
(10)(A)(ii)(IX), or (10)(E)’’; and 
(2) 
in 
subparagraph 
(A), 
by 
striking 
‘‘1905(1)(2)(B)’’ and inserting ‘‘1905(l)(2)(B), and 
in the case of applications of individuals for medical 
assistance under paragraph (10)(E), at locations 
that include field offices of the Social Security Ad-
ministration’’. 
SEC. 5. ELIMINATION OF ASSET TEST. 
(a) IN GENERAL.—Section 1905(p)(1) of the Social 
Security Act (42 U.S.C. 1396d(p)(1)) is amended— 
(1) by adding ‘‘and’’ at the end of subpara-
graph (A); 
(2) by striking ‘‘, and’’ at the end of subpara-
graph (B) and inserting a period; and 
(3) by striking subparagraph (C). 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to eligibility determinations for 
medicare cost-sharing furnished for periods beginning on 
or after January 1, 2006. 
SEC. 6. IMPROVING ASSISTANCE WITH OUT-OF-POCKET 
COSTS. 
(a) ELIMINATING APPLICATION OF ESTATE RECOV-
ERY PROVISIONS.—Section 1917(b)(1)(B)(ii) of the Social 
Security Act (42 U.S.C. 1396p(b)(1)(B)(ii)) is amended
by inserting ‘‘(but not including medical assistance for 
medicare cost-sharing or for benefits described in section 
1902(a)(10)(E))’’ before the period at the end. 
(b) PROVIDING FOR 3 MONTHS RETROACTIVE ELIGI-
BILITY.— 
(1) IN GENERAL.—Section 1905(a) of such Act 
(42 U.S.C. 1396d(a)) is amended, in the matter pre-
ceding paragraph (1), by striking ‘‘described in sub-
section (p)(1), if provided after the month’’ and in-
serting ‘‘described in subsection (p)(1), if provided 
in or after the third month before the month’’. 
(2) CONFORMING AMENDMENTS.—(A) The first 
sentence of section 1902(e)(8) of such Act (42 
U.S.C. 1396a(e)(8)), as amended by section 4(c)(2), 
is amended by striking ‘‘(8)’’ and the first sentence. 
(B) Section 1848(g)(3) of such Act (42 U.S.C. 
1395w–4(g)(3)) is amended by adding at the end 
the following new subparagraph: 
‘‘(C) TREATMENT OF RETROACTIVE ELIGI-
BILITY.—In the case of an individual who is de-
termined to be eligible for medical assistance 
described in subparagraph (A) retroactively, the 
Secretary shall provide a process whereby 
claims submitted for services furnished during 
the period of retroactive eligibility which were
not submitted in accordance with such subpara-
graph are resubmitted and re-processed in ac-
cordance with such subparagraph.’’. 
SEC. 7. IMPROVING PROGRAM INFORMATION AND COORDI-
NATION WITH STATE, LOCAL, AND OTHER 
PARTNERS. 
(a) DATA MATCH DEMONSTRATION PROJECT.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (acting through the Administrator 
of the Centers for Medicare & Medicaid Services), 
the Secretary of the Treasury, and the Commis-
sioner of Social Security shall enter into an arrange-
ment under which a demonstration is conducted, 
consistent with this subsection, for the exchange be-
tween the Centers for Medicare & Medicaid Services, 
the Internal Revenue Service, and the Social Secu-
rity Administration of information in order to iden-
tity individuals who are medicare beneficiaries and 
who, based on data from the Internal Revenue Serv-
ice (such as their not filing tax returns or other ap-
propriate filters) are likely to be— 
(A) a qualified medicare beneficiary (as de-
fined in 1905(p)(1) of the Social Security Act 
(42 U.S.C. 1396d(p)(1)));
(B) otherwise eligible for medical assist-
ance under section 1902(a)(10)(E) of the Social 
Security Act (42 U.S.C. 1396a(a)(10)(E)); or 
(C) entitled to a premium or cost-sharing 
subsidy under section 1860D–14 of such Act 
(42 U.S.C. 1395w–114). 
(2) LIMITATION ON USE OF INFORMATION.— 
Notwithstanding any other provision of law, specific 
information on income or related matters exchanged 
under paragraph (1) may be disclosed only as re-
quired to carry out subsection (b) and for related 
Federal and State outreach efforts. 
(3) PERIOD.—The project under this subsection 
shall be for an initial period of 3 years and may be 
extended for additional periods (not to exceed 3 
years each) after such an extension is recommended 
in a report under subsection (d). 
(b) STATE DEMONSTRATION GRANTS.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall enter into a demonstration 
project with States (as defined for purposes of title 
XIX of the Social Security Act (42 U.S.C. 1396 et 
seq.) to provide funds to States to use information 
identified under subsection (a), and other appro-
priate information, in order to do ex parte deter-
minations or utilize other methods for identifying 
and enrolling individuals who are potentially— 
(A) a qualified medicare beneficiary (as de-
fined in 1905(p)(1) of the Social Security Act 
(42 U.S.C. 1396d(p)(1))); 
(B) otherwise eligible for medical assist-
ance described in section 1902(a)(10)(E) of the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)(10)(E)); or 
(C) entitled to a premium or cost-sharing 
subsidy under section 1860D–14 of such Act 
(42 U.S.C. 1395w–114). 
(2) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated such sums 
as may be necessary to the Secretary of Health and 
Human Services for the purpose of making grants 
under this subsection. 
(c) ADDITIONAL CMS FUNDING FOR OUTREACH AND 
ENROLLMENT
PROJECTS.—There are hereby appro-
priated, out of any funds in the Treasury not otherwise 
appropriated, to the Secretary of Health and Human 
Services through the Administrator of the Centers for 
Medicare & Medicaid Services, $100,000,000 which shall 
be used only for the purpose of providing grants to States 
to fund projects to improve outreach and increase enroll-
ment in Medicare Savings Programs and low-income sub-
sidy programs under section 1860D–14 of such Act (42 
U.S.C. 1395w–114). Such projects may include coopera-
tive grants and contracts with community groups and 
other groups (such as the Department of Veterans’ Affairs 
and the Indian Health Service) to assist in the enrollment 
of eligible individuals. 
(d) REPORTS.—The Secretary of Health and Human 
Services shall submit to Congress periodic reports on the 
projects conducted under this section. Such reports shall 
include such recommendations for extension of such 
projects, and changes in laws based on such projects, as 
the Secretary deems appropriate. 
SEC. 8. NOTICES TO CERTAIN NEW MEDICARE BENE-
FICIARIES. 
(a) SSA NOTICE.— 
(1) IN GENERAL.—At the time that the Com-
missioner of Social Security sends a notice to indi-
viduals that they have been determined to be eligible 
for benefits under part A or B of title XVIII of the 
Social Security Act (42 U.S.C. 1395 et seq., 1395j 
et seq.), the Commissioner shall send a notice and 
application for benefits under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.) to those indi-
viduals the Commissioner identifies as being likely to 
be— 
(A) a qualified medicare beneficiary (as de-
fined in 1905(p)(1) of the Social Security Act 
(42 U.S.C. 1396d(p)(1))); 
(B) eligible for benefits under clause (i), 
(ii), or (iii) of section 1902(a)(10)(E) of such 
Act (42 U.S.C. 1396a(a)(10)(E)); or 
(C) entitled to a premium or cost-sharing 
subsidy under section 1860D–14 of such Act 
(42 U.S.C. 1395w–114). 
(2) ADDITIONAL
INFORMATION
REQUIRED.— 
Such notice and application shall be accompanied by 
information on how to submit such an application 
and where to obtain more information (including an-
swers to questions) on the application process. 
(b) INCLUDING INFORMATION IN MEDICARE & YOU 
HANDBOOK.—The Secretary of Health and Human Serv-
ices shall include in the annual handbook distributed 
under section 1804(a) of the Social Security Act (42 
U.S.C. 1395b–2(a)) information on the availability of 
Medicare Savings Programs and a toll-free telephone num-
ber that medicare beneficiaries may use to obtain addi-
tional information about the program. 
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