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Title II, Subtitle B
‘‘(D) CERTAIN ALIENS.—An alien who is
not lawfully admitted for permanent residence
or not otherwise permanently residing in the
United States under color of law (as defined in
paragraph (3)).
‘‘(E) NONRESIDENTS.—An individual who
is not residing in any State.
‘‘(2) SSI RECIPIENT.—The term ‘SSI recipient’
means, for a month, an individual—
‘‘(A) with respect to whom supplemental
security income benefits are being paid under
title XVI for the month,
‘‘(B) who is receiving a supplemental pay-
ment under section 1616 or under section 212
of Public Law 93–66 for the month,
‘‘(C) who is receiving monthly benefits
under section 1619(a) (whether or not pursuant
to section 1616(c)(3)) for the month, or
‘‘(D) who is treated under section 1619(b)
as receiving supplemental security income bene-
fits in a month for purposes of title XIX.
‘‘(3) ALIEN PERMANENTLY RESIDING IN THE
UNITED STATES UNDER COLOR OF LAW.—The term
‘alien permanently residing in the United States
under color of law’ means an alien lawfully admitted
176
Title II, Subtitle B
for permanent residence (within the meaning of sec-
tion 101(a)(20) of the Immigration and Nationality
Act), and includes any of the following:
‘‘(A) An alien who is admitted as a refugee
under section 207 of the Immigration and Na-
tionality Act.
‘‘(B) An alien who is granted asylum
under section 208 of such Act.
‘‘(C) An alien whose deportation is with-
held under section 243(h) of such Act.
‘‘(D) An alien whose deportation is sus-
pended under section 244 of such Act.
‘‘(E) An alien who is granted conditional
entry pursuant to section 203(a)(7) of such
Act, as in effect before April 1, 1980.
‘‘(F) An alien who is admitted for tem-
porary residence under section 210, 210A, or
245A of such Act.
‘‘(G) An alien who has been paroled into
the United States under section 212(d)(5) of
such Act for an indefinite period or who has
been granted extended voluntary departure as a
member of a nationality group.
‘‘(H) An alien who is the spouse or unmar-
ried child under 21 years of age of a citizen of
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Title II, Subtitle B
the United States, or the parent of such a citi-
zen if the citizen is over 21 years of age, and
with respect to whom an application for adjust-
ment to lawful permanent residence is pending.
‘‘(e) PROTECTION OF CURRENT BENEFICIARIES.—
‘‘(1) IN GENERAL.—In this title, the term ‘pre-
mium assistance eligible individual’ also includes,
with respect to a State as of December 31, 1997, an
individual described in paragraph (2) whose eligi-
bility for premium assistance has not terminated
under paragraph (3).
‘‘(2) CURRENT
BENEFICIARIES
DESCRIBED.—
An individual described in this paragraph is an indi-
vidual who—
‘‘(A) is not excluded under subsection (d),
‘‘(B) is enrolled to receive medical assist-
ance under the State plan under title XIX (and
for which Federal financial participation was
available) as of December 31, 1997, and
‘‘(C) would remain enrolled to receive such
assistance under the State plan under title XIX
but for amendments made by the Bipartisan
Health Care Reform Act of 1994.
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Title II, Subtitle B
‘‘(3) LIMITATION.—An individual is a premium
assistance eligible individual pursuant to this sub-
section only until the earlier of—
‘‘(A) June 30, 1998, or
‘‘(B) the first date after December 31,
1997, on which the individual’s eligibility for
medical assistance under the State plan under
title XIX would have been terminated if the
amendments made by the Bipartisan Health
Care Reform Act of 1994 had not been enacted.
‘‘SEC. 2103. PREMIUM AND COST-SHARING ASSISTANCE.
‘‘(a) IN GENERAL.—
‘‘(1) PREMIUM ASSISTANCE.—
‘‘(A) IN GENERAL.—The premium assist-
ance under a State subsidy program shall be in
the form of a premium assistance certificate
that is in the amount computed under sub-
section (b) and that may be applied toward
qualifying coverage (as defined in subparagraph
(B)). A carrier or group health plan providing
such coverage that is tendered such a certificate
with respect to an individual shall reduce the
amount of the premium by the amount of the
certificate, except as provided in subsection
(c)(1)(C).
179
Title II, Subtitle B
‘‘(B) QUALIFYING COVERAGE DEFINED.—
For purposes of this part—
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), the term ‘qualifying
coverage’ means standard coverage de-
scribed in section 1102 of the Bipartisan
Health Care Reform Act of 1994.
‘‘(ii) OPTIONAL
USE
OF
HIGH-DE-
DUCTIBLE COVERAGE.—At the election of
a premium assistance eligible individual,
the term ‘qualifying coverage’ includes
high-deductible coverage described in sec-
tion 1103 of the Bipartisan Health Care
Reform Act of 1994 with respect to an in-
dividual, but only if the individual—
‘‘(I) has been determined under
section 2104 to have family modified
adjusted income not less than 100
percent of the applicable poverty line
(or in the case of an individual de-
scribed in section 2102(a)(2), 185
percent of such applicable poverty
line), and
‘‘(II) demonstrates to the satis-
faction of the State that the individual
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Title II, Subtitle B
meets the requirements of section
1101(b)(2) of the Bipartisan Health
Care Reform Act of 1994 (relating to
requirement for available assets).
‘‘(iii) TREATMENT
OF
VA
HEALTH
COVERAGE.—For purposes of this part, VA
health coverage (as defined in section
1801(2) of title 38, United States Code)
provided by the Department of Veterans
Affairs shall be considered to be standard
health insurance coverage (referred to in
subparagraph (A)) provided by a carrier.
‘‘(2) COST-SHARING
ASSISTANCE.—The cost-
sharing assistance under a State subsidy program
shall be in the form of a cost-sharing assistance cer-
tificate (or other means) that may be applied with
respect to standard coverage. A carrier providing
health insurance coverage or a group health plan
that is tendered such a certificate with respect to an
individual shall reduce the cost-sharing otherwise
imposed with respect to health coverage to amounts
that are nominal (as specified by the State, consist-
ent with the regulations established to carry out sec-
tion 1916(a)(3)) and shall not impose any cost-shar-
ing in the case of preventive benefits described in
181
Title II, Subtitle B
section 1102(b)(4) of the Bipartisan Health Care
Reform Act of 1994.
‘‘(3) CONSOLIDATED
AND
ELECTRONIC
CER-
TIFICATES.—Nothing in this section shall be con-
strued as preventing a State from—
‘‘(A) in the case of an individual who is
both a premium assistance eligible individual
and a cost-sharing assistance eligible individual,
from consolidating the premium and cost-shar-
ing certificates of the individual, and
‘‘(B) providing premium and cost-sharing
assistance certificates through electronic or
other means.
‘‘(b) AMOUNT OF PREMIUM ASSISTANCE.—
‘‘(1) AMOUNT OF ASSISTANCE.—
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the amount of premium assistance
under this subsection for a month for an indi-
vidual is the lesser of—
‘‘(i) the premium assistance reference
amount determined under paragraph (2),
or
‘‘(ii) the amount of the monthly pre-
mium for the qualifying coverage provided
to the individual.
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Title II, Subtitle B
‘‘(B) TAKING
INTO
ACCOUNT
EMPLOYER
CONTRIBUTIONS.—If an employer is making a
contribution for the health coverage of a pre-
mium assistance eligible individual, the amount
of the premium assistance under this subsection
for a month shall not exceed the amount by
which the premium amount described in sub-
paragraph (A)(ii) exceeds the amount of the
employer contribution.
‘‘(2) 
PREMIUM
ASSISTANCE
REFERENCE
AMOUNT DETERMINED.—
‘‘(A) IN GENERAL.—Subject to paragraph
(4), the premium assistance reference amount
determined under this paragraph is an amount
equal to 1⁄12 of the premium assistance percent-
age (as defined in paragraph (3)) multiplied by
the weighted average annual premium (deter-
mined in accordance with subparagraph (B))
for the individual’s family class of enrollment
for qualified standard health coverage offered in
the fair rating area (as defined in section 1903
of the Bipartisan Health Care Reform Act of
1994) in the individual/small group market in
which the individual resides.
183
Title II, Subtitle B
‘‘(B) DETERMINATION OF WEIGHTED AV-
ERAGE
ANNUAL
PREMIUM.—For purposes of
subparagraph (A), the weighted average annual
premium for a family class of enrollment for
qualified standard health coverage shall be
based on the number of families (or individuals
in the case of the individual class of enrollment)
so covered in the class and area involved.
‘‘(C) FAMILY CLASS OF ENROLLMENT.—In
this paragraph, the term ‘family class of enroll-
ment’ means a class of enrollment described in
section 1021(a)(3) of the Bipartisan Health
Care Reform Act of 1994.
‘‘(3) PREMIUM ASSISTANCE PERCENTAGE.—For
purposes of this part and subject to section
2141(e)(3)—
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the term ‘premium assistance per-
centage’ means 100 percent reduced (but not
below zero) by the number of percentage points
(rounded to the nearest whole number) by
which such individual’s family income (ex-
pressed as a percent) exceeds 100 percent of
the applicable poverty line.
184
Title II, Subtitle B
‘‘(B) 
CHILDREN
AND
PREGNANT
WOMEN.—In the case of a premium assistance
eligible individual described in paragraph (2) of
section 2102(b), the term ‘premium assistance
percentage’ means 100 percent reduced (but
not below zero) by 1 percentage point for each
.55 percentage points by which such individual’s
family income (expressed as a percent) exceeds
185 percent of the applicable poverty line.
‘‘(C) 
CURRENT
MEDICAID
BENE-
FICIARIES.—In the case of an individual who is
a premium assistance eligible individual pursu-
ant to 2102(d), the term ‘premium assistance
percentage’ means 100 percent.
‘‘(4) SPECIAL RULE FOR FAMILIES WITH CHIL-
DREN AND PREGNANT WOMEN.—In the case of a
family consisting of premium assistance eligible indi-
viduals in which the modified adjusted gross income
exceeds 100 percent of the applicable poverty line,
but which includes one or more individuals described
in paragraph (2) of section 2102(b), the premium
assistance amount may be computed in a manner
(specified by the Secretary in regulations) based on
the sum of separate premium amounts for family
members based on individual class of enrollment,
185
Title II, Subtitle B
rather than based on the appropriate family class of
enrollment.
‘‘(c) PAYMENTS OF ASSISTANCE.—
‘‘(1) PREMIUM ASSISTANCE.—
‘‘(A) IN GENERAL.—The State issuing a
premium assistance certificate shall, upon ten-
der to the State of such certificate by the car-
rier or group health plan providing qualiyfing
coverage, pay the carrier or plan the amount of
the certificate.
‘‘(B) TIMING
OF
PAYMENTS.—Payments
under this paragraph shall commence in the
first month during which the individual obtains
qualifying coverage and is determined under
section 2104 to be a premium assistance eligible
individual.
‘‘(C) TREATMENT
OF
SURPLUSES
AND
DEFICITS.—
‘‘(i) DEFICIT.—If the premium for
coverage is greater than the amount of the
premium assistance for an individual, the
individual is responsible for payment of
any difference.
‘‘(ii) SURPLUS.—If the premium for
coverage is less than the amount of the