Helping Seniors Afford Health Care Act
Bill: H.R.5040 | Sponsor: Rep. Blunt Rochester, Lisa (D-DE)
Policy area: Health

Summary:
Helping Seniors Afford Health Care Act
This bill alters eligibility standards and related processes for several programs that provide premium and cost-sharing assistance to low-income Medicare beneficiaries.
Among other things, the bill expands income eligibility for the Qualified Medicare Beneficiary Program and the Specified Low-Income Medicare Beneficiary Program to up to 135% and 200% of the federal poverty level (FPL), respectively, and provides an enhanced Federal Medical Assistance Percentage (i.e., federal matching rate) to state Medicaid programs for expenditures related to the expansion. The bill also repeals the Qualifying Individual Program (which currently provides premium assistance to beneficiaries with incomes between 120% and 135% of the FPL).

To amend titles XVIII and XIX of the Social Security Act to reduce 
  cost-sharing, align income and resource eligibility tests, simplify 
 enrollment, and provide for other program improvements for low-income 
                        Medicare beneficiaries.

    Be it enacted by the Senate and House of Representatives 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 
              IMPROVEMENTS FOR LOW-INCOME BENEFICIARIES.

    (a) Increase in Income Eligibility to 135 Percent of FPL for 
Qualified Medicare Beneficiaries.--
            (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, 2022, 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 revised annually in 
                        accordance with section 673(2) of the Omnibus 
                        Budget Reconciliation Act of 1981) applicable 
                        to a family of the size involved; and
                            ``(ii) on or after January 1, 2022, 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 Percent of FPL for 
Specified Low-Income Medicare Beneficiaries.--
            (1) Eligibility of individuals with incomes 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--
                    (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 
                        2022, and 200 percent in 2022 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.
    (c) 100 Percent FMAP.--Section 1905 of the Social Security Act (42 
U.S.C. 1396d) is amended by adding at the end the following new 
subsection:
    ``(jj) Increased FMAP for Expanded Medicare Cost-Sharing 
Populations.--
            ``(1) In general.--Notwithstanding subsection (b), with 
        respect to expenditures described in paragraph (2) the Federal 
        medical assistance percentage shall be equal to 100 percent.
            ``(2) Expenditures described.--The expenditures described 
        in this paragraph are expenditures made on or after January 1, 
        2022, for medical assistance 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 Resource 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);
                    (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 relating to income and 
        resource determinations.--Section 1860D-14(a)(3) of the Social 
        Security Act (42 U.S.C. 1395w-114(a)(3)), as amended by 
        paragraph (1), is amended by striking subparagraph (F) and 
        inserting the following new subparagraphs:
                    ``(F) Resource exclusions.--In determining 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 
                        insurance policy shall be taken into account;
                            ``(ii) no part of the value of any vehicle 
                        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 resources of such 
                        individual or spouse will be used to meet the 
                        burial and related expenses of such individual 
                        or spouse; and
                            ``(iv) no balance in, or benefits received 
                        under, an employee pension benefit plan (as 
                        defined in section 3 of the Employee 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 individual under this 
                section, an individual's family 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
                                    ``(III) are dependent on such 
                                individual or such individual's spouse 
                                who is living in the same household for 
                                at least one-half of their financial 
                                support.''.
            (3) Conforming amendments.--Section 1860D-14(a) of the 
        Social Security Act (42 U.S.C. 1395w-114(a)) is amended--
                    (A) in paragraph (1), in the matter preceding 
                subparagraph (A), by inserting ``(as determined under 
                paragraph (3)(G))'' after ``family of the size 
                involved''; and
                    (B) in paragraph (3), as amended by paragraphs (1) 
                and (2)--
                            (i) in subparagraph (A), in the matter 
                        preceding clause (i), by striking 
                        ``subparagraph (F)'' and inserting 
                        ``subparagraph (E)'';
                            (ii) in subparagraph (A)(ii), by inserting 
                        ``(as determined under subparagraph (G))'' 
                        after ``family of the size involved'';
                            (iii) in subparagraph (A)(iii), by striking 
                        ``or (E)'';
                            (iv) in subparagraph (B)(v), in the matter 
                        preceding subclause (I), by striking 
                        ``subparagraph (F)'' and inserting 
                        ``subparagraph (E)''; and
                            (v) in subparagraph (D)(i), in the matter 
                        preceding subclause (I), by striking ``subject 
                        to the life insurance policy exclusion provided 
                        under subparagraph (G)'' and inserting 
                        ``subject to the resource exclusions provided 
                        under subparagraph (F)''.
    (e) Alignment of Low-Income Subsidy and Medicare Savings Program 
Income and Resource Eligibility Tests.--
            (1) Application of medicaid spousal impoverishment 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 section 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 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 section 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 amended by subsection 
        (d)(1), is amended to read as follows:
                            ``(i) In general.--The resources 
                        requirement of this subparagraph is that an 
                        individual's resources (as determined under 
                        section 1613 for purposes of the supplemental 
                        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 before 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 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 application 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 
                qualified medicare beneficiary described in subsection 
                (p)(1), if provided after the month in which the 
                individual becomes such a beneficiary''.
            (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:
    ``(B) At the option of the State, the plan may provide that an 
individual who is determined to be eligible for benefits under a State 
plan approved under this title under any of the following eligibility 
categories, or who is redetermined to be eligible for such benefits 
under any of such categories, shall be considered to meet the 
eligibility requirements met on the date of application and shall 
remain 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 provide for such determinations 
more frequently, but not more frequently than once every 6 months for 
an individual:
            ``(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 individual 
        described in section 1905(s) who is determined eligible for 
        medicare cost-sharing described in section 1905(p)(3)(A)(i).''.
            (3) State option to use express lane eligibility for the 
        medicare savings program.--Section 1902(e)(13)(A) of the Social 
        Security Act (42 U.S.C. 1396a(e)(13)(A)) is amended by adding 
        at the end the following new clause:
                    ``(iii) State option to extend express lane 
                eligibility to other populations.--
                            ``(I) In general.--At the option of the 
                        State, the State may apply the provisions of 
                        this paragraph with respect 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 respect to this title 
                        (other than a reference to child health 
                        assistance) shall be deemed to be a reference 
                        to an eligible individual.
                            ``(II) Eligible individual defined.--In 
                        this clause, the term `eligible individual' 
                        means any of the following:
                                    ``(aa) A qualified medicare 
                                beneficiary described in section 
                                1905(p)(1) for purposes of determining 
                                eligibility for medicare cost-sharing 
                                (as defined in section 1905(p)(3)).
                                    ``(bb) A specified low-income 
                                medicare beneficiary described in 
                                subsection (a)(10)(E)(iii) of this 
                                section for purposes of determining 
                                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 medicare 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 provider or 
supplier with respect to medicare cost-sharing described in 
subparagraph (B), (C), or (D) of section 1905(p)(3) for an item or 
service which is eligible for payment under title XVIII on the basis 
that the provider or 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 suppliers 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 paragraph:
    ``(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 thereof.''.
    (i) Treatment of Qualified Medicare Beneficiaries, Specified Low-
Income Medicare Beneficiaries, 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:
    ``(p) Treatment of Qualified Medicare Beneficiaries (QMBs), 
Specified Low-Income Medicare Beneficiaries (SLMBs), and Other Dual 
Eligibles.--Nothing in this title shall be construed as authorizing 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 qualified 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 Insurance 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 
                assistance under section 4360 of the Omnibus Budget 
                Reconciliation Act of 1990.
                    (B) Funding.--For purposes of making grants under 
                this subsection, the Secretary 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 proportion as the Secretary 
                determines under section 1853(f) of such Act (42 U.S.C. 
                1395w-23(f)), of $50,000,000 to the Centers for 
                Medicare & Medicaid Services Program Management Account 
                for each of the fiscal years 2022 through 2026, to 
                remain available until expended.
            (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 
        allocated 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 
                number 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 subsection 
                (a)(3)(A)(ii) in each State, as estimated by the 
                Secretary.
                    (B) Allocation based on percentage of rural 
                beneficiaries.--The amount allocated 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 percentage 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 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 program of medical 
        assistance for payment of the cost of medicare cost-sharing 
        under the Medicaid program 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 paragraph (2), the 
        amendments and repeal made by this section take effect on 
        January 1, 2022, and, with respect to title XIX of the Social 
        Security Act, apply to calendar quarters beginning on or after 
        January 1, 2022.
            (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 Secretary of Health and Human Services 
        determines requires State legislation (other than legislation 
        appropriating funds) in order for the plan to meet the 
        additional requirements imposed by the amendments and repeal 
        made by this section, the State plan shall not be regarded as 
        failing to comply with the requirements 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 enactment 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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