[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 883 Introduced in Senate (IS)]






108th CONGRESS
  1st Session
                                 S. 883

 To amend title XIX of the Social Security Act to revise and simplify 
           the transitional medical assistance (TMA) program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 10, 2003

  Mr. Breaux (for himself, Mr. Chafee, Mr. Bingaman, Ms. Landrieu, Mr. 
    Lieberman, Mrs. Clinton, Mr. Miller, and Mr. Graham of Florida) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend title XIX of the Social Security Act to revise and simplify 
           the transitional medical assistance (TMA) program.

    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 ``Transitional Medical Assistance 
Improvement Act of 2003''.

SEC. 2. REVISION AND SIMPLIFICATION OF THE TRANSITIONAL MEDICAL 
              ASSISTANCE PROGRAM (TMA).

    (a) Option of Continuous Eligibility for 12 Months; Option of 
Continuing Coverage for Up To an Additional Year.--
            (1) Option of continuous eligibility for 12 months by 
        making reporting requirements optional.--Section 1925(b) of the 
        Social Security Act (42 U.S.C. 1396r-6(b)) is amended--
                    (A) in paragraph (1), by inserting ``, at the 
                option of a State,'' after ``and which'';
                    (B) in paragraph (2)(A), by inserting ``Subject to 
                subparagraph (C):'' after ``(A) Notices.--'';
                    (C) in paragraph (2)(B), by inserting ``Subject to 
                subparagraph (C):'' after ``(B) Reporting 
                requirements.--'';
                    (D) by adding at the end the following new 
                subparagraph:
                    ``(C) State option to waive notice and reporting 
                requirements.--A State may waive some or all of the 
                reporting requirements under clauses (i) and (ii) of 
                subparagraph (B). Insofar as it waives such a reporting 
                requirement, the State need not provide for a notice 
                under subparagraph (A) relating to such requirement.''; 
                and
                    (E) in paragraph (3)(A)(iii), by inserting ``the 
                State has not waived under paragraph (2)(C) the 
                reporting requirement with respect to such month under 
                paragraph (2)(B) and if'' after ``6-month period if''.
            (2) State option to extend eligibility for low-income 
        individuals for up to 12 additional months.--Section 1925 of 
        such Act (42 U.S.C. 1396r-6) is further amended--
                    (A) by redesignating subsections (c) through (f) as 
                subsections (d) through (g), respectively; and
                    (B) by inserting after subsection (b) the following 
                new subsection:
    ``(c) State Option of Up To 12 Months of Additional Eligibility.--
            ``(1) In general.--Notwithstanding any other provision of 
        this title, each State plan approved under this title may 
        provide, at the option of the State, that the State shall offer 
        to each family which received assistance during the entire 6-
        month period under subsection (b) and which meets the 
        applicable requirement of paragraph (2), in the last month of 
        the period the option of extending coverage under this 
        subsection for the succeeding period not to exceed 12 months.
            ``(2) Income restriction.--The option under paragraph (1) 
        shall not be made available to a family for a succeeding period 
        unless the State determines that the family's average gross 
        monthly earnings (less such costs for such child care as is 
        necessary for the employment of the caretaker relative) as of 
        the end of the 6-month period under subsection (b) does not 
        exceed 185 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.
            ``(3) Application of extension rules.--The provisions of 
        paragraphs (2), (3), (4), and (5) of subsection (b) shall apply 
        to the extension provided under this subsection in the same 
        manner as they apply to the extension provided under subsection 
        (b)(1), except that for purposes of this subsection--
                    ``(A) any reference to a 6-month period under 
                subsection (b)(1) is deemed a reference to the 
                extension period provided under paragraph (1) and any 
                deadlines for any notices or reporting and the premium 
                payment periods shall be modified to correspond to the 
                appropriate calendar quarters of coverage provided 
                under this subsection; and
                    ``(B) any reference to a provision of subsection 
                (a) or (b) is deemed a reference to the corresponding 
                provision of subsection (b) or of this subsection, 
                respectively.''.
    (b) State Option To Waive Receipt of Medicaid for 3 of Previous 6 
Months To Qualify for TMA.--Section 1925(a)(1) of such Act (42 U.S.C. 
1396r-6(a)(1)) is amended by adding at the end the following: ``A State 
may, at its option, also apply the previous sentence in the case of a 
family that was receiving such aid for fewer than 3 months, or that had 
applied for and was eligible for such aid for fewer than 3 months, 
during the 6 immediately preceding months described in such 
sentence.''.
    (c) Elimination of Sunset for TMA.--
            (1) Subsection (g) of section 1925 of such Act (42 U.S.C. 
        1396r-6), as redesignated under subsection (a)(2), is repealed.
            (2) Section 1902(e)(1) of such Act (42 U.S.C. 1396a(e)(1)) 
        is amended by striking ``(A) Notwithstanding'' and all that 
        follows through ``During such period, for'' in subparagraph (B) 
        and inserting ``For''.
    (d) CMS Report on Enrollment and Participation Rates Under TMA.--
Section 1925 of such Act (42 U.S.C. 1396r-6), as amended by subsections 
(a)(2)(A) and (c)(1), is amended by inserting after subsection (f) the 
following:
    ``(g) Additional Provisions.--
            ``(1) Collection and reporting of participation 
        information.--Each State shall--
                    ``(A) collect and submit to the Secretary, in a 
                format specified by the Secretary, information on 
                average monthly enrollment and average monthly 
                participation rates for adults and children under this 
                section; and
                    ``(B) make such information publicly available.
        Such information shall be submitted under subparagraph (A) at 
        the same time and frequency in which other enrollment 
        information under this title is submitted to the Secretary. 
        Using such information, the Secretary shall submit to Congress 
        annual reports concerning such rates.''.
    (e) Coordination of Work.--Section 1925(g) of such Act (42 U.S.C. 
1396r-6(g)), as added by subsection (d), is amended by adding at the 
end the following new paragraph:
            ``(2) Coordination with administration for children and 
        families.--The Administrator of the Centers for Medicare & 
        Medicaid Services, in carrying out this section, shall work 
        with the Assistant Secretary for the Administration for 
        Children and Families to develop guidance or other technical 
        assistance for States regarding best practices in guaranteeing 
        access to transitional medical assistance under this 
        section.''.
    (f) Elimination of TMA Requirement for States That Extend Coverage 
to Children and Parents Through 185 Percent of Poverty.--
            (1) In general.--Section 1925 of such Act (42 U.S.C. 1396r-
        6) is further amended by adding at the end the following:
    ``(h) Provisions Optional for States That Extend Coverage to 
Children and Parents Through 185 Percent of Poverty.--A State may meet 
(but is not required to meet) the requirements of subsections (a) and 
(b) if it provides for medical assistance under section 1931 to 
families (including both children and caretaker relatives) the average 
gross monthly earning of which (less such costs for such child care as 
is necessary for the employment of a caretaker relative) is at or below 
a level that is at least 185 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.''.
            (2) Conforming amendments.--Section 1925 of such Act (42 
        U.S.C. 1396r-6) is further amended, in subsections (a)(1) and 
        (b)(1), by inserting ``, but subject to subsection (h),'' after 
        ``Notwithstanding any other provision of this title,'' each 
        place it appears.
    (g) Requirement of Notice for All Families Losing TANF.--Subsection 
(a)(2) of section 1925 of such Act (42 U.S.C. 1396r-6) is amended by 
adding at the end the following flush sentences:
        ``Each State shall provide, to families whose aid under part A 
        or E of title IV has terminated but whose eligibility for 
        medical assistance under this title continues, written notice 
        of their ongoing eligibility for such medical assistance. If a 
        State makes a determination that any member of a family whose 
        aid under part A or E of title IV is being terminated is also 
        no longer eligible for medical assistance under this title, the 
        notice of such determination shall be supplemented by a 1-page 
        notification form describing the different ways in which 
        individuals and families may qualify for such medical 
        assistance and explaining that individuals and families do not 
        have to be receiving aid under part A or E of title IV in order 
        to qualify for such medical assistance. Such notice shall 
        further be supplemented by information on how to apply for 
        child health assistance under the State children's health 
        insurance program under title XXI and how to apply for medical 
        assistance under this title.''.
    (h) Extending Use of Outstationed Workers To Accept Applications 
for Transitional Medical Assistance.--Section 1902(a)(55) of such Act 
(42 U.S.C. 1396a(a)(55)) is amended by inserting ``and under section 
1931'' after ``(a)(10)(A)(ii)(IX)''.
    (i) Effective Dates.--
            (1) In general.--Except as provided in this subsection, the 
        amendments made by this section shall apply to calendar 
        quarters beginning on or after October 1, 2002.
            (2) Notice.--The amendment made by subsection (g) shall 
        take effect 6 months after the date of enactment of this Act.
            (3) Delay permitted for state plan amendment.--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 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 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.
                                 <all>