[Congressional Record Volume 148, Number 108 (Thursday, August 1, 2002)]
[Senate]
[Pages S7918-S7920]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. Rockefeller, and Mr. Graham):
  S. 2855. A bill to amend title XIX of the Social Security Act to 
improve the qualified medicare beneficiary (QMB) and special low-income 
medicare beneficiary (SLMB) programs within the medicaid program; to 
the Committee on Finance.
  Mr. BINGAMAN. Mr. President, today I am introducing a bill with 
Senator Rockefeller that will make significant and long-overdue 
improvements in the programs that provide assistance to low-income 
Medicare beneficiaries. This bill is a companion bill to H.R. 5276, 
which was introduced by Representatives John Dingell, Sherrod Brown, 
Henry Waxman, and Pete Stark last week.
  Medicare provides coverage to all 40 million elderly and disabled 
beneficiaries, regardless of income, but the cost of uncovered 
services, premiums, and cost-sharing is a serious burden on those with 
the lowest incomes.
  More than 40 percent of Medicare beneficiaries have incomes below 200 
percent of poverty, including 47 percent or 102,000 seniors in New 
Mexico, at income levels below $17,720 for an individual and $23,880 
for a couple. These low-income beneficiaries are nearly twice as likely 
as higher-income beneficiaries to report their health status as fair or 
poor, but are less likely to have private supplemental insurance to 
cover the cost of uncovered services or Medicare cost-sharing. Poor 
beneficiaries also bear a disproportionate burden in out-of-pocket 
health care costs, spending more than a third of their incomes on 
health care compared to only 10 percent for higher-income 
beneficiaries.
  Medicaid, through what is known as the ``Medicare Savings Programs,'' 
fills in Medicare's gaps for low-income beneficiaries, providing 
supplemental coverage to 17 percent of all Medicare beneficiaries. 
According to the Center for Medicare Education, which is funded by the 
Robert Wood Johnson Foundation, the costs for low-income beneficiaries 
enrolled in the Qualified Medicare Beneficiary, or QMB, program drops 
out-of-pocket expenditures from 34 percent to 13 percent for low-income 
beneficiaries. Moreover, Medicare beneficiaries with full Medicaid 
coverage have out-of-pocket expenses of about 5 percent of their income 
or $295 a year.
  This is a significant and important protection for our Nation's most 
financially vulnerable seniors and disabled citizens. Unfortunately, 
millions of beneficiaries, who are eligible for assistance under the 
Medicare Savings Programs, are not enrolled. Again, the Center for 
Medicare Education estimates that only half of the beneficiaries below 
poverty who are eligible for assistance are actually enrolled. Lack of 
outreach, complex and burdensome enrollment procedures, and restrictive 
asset requirements keep millions of seniors from receiving the 
assistance they desperately need.
  The ``Medicare Beneficiary Improvement Act of 2002'' takes a number 
of steps to address these problems. First, the legislation improves 
eligibility requirements for these programs. It raises the income level 
for eligibility for Medicare Part B premium assistance from 120 to 135 
percent of poverty. This expansion was originally enacted in 1997 but 
it expires this year. The Congress needs to take action this year to 
maintain these important protections for the Nation's elderly and 
should take the additional action to make this provision permanent.

  In addition, the bill also ensures that all seniors who meet 
supplemental security income, or SSI, criteria are automatically 
eligible for assistance. Currently, automatic eligibility is only 
required in certain States, meaning that beneficiaries in other states 
may miss out on critical assistance unless they know enough to apply.
  The bill also eliminates the restrictive assets test that requires 
seniors to become completely destitute in order to qualify for 
assistance. Most low-income Medicare beneficiaries have limited assets 
to begin with but the asset restrictions are so severe, a beneficiary

[[Page S7919]]

could not keep a fund or more than $1,500 for burial expenses without 
being disqualified from assistance. Moreover, own a car and you are 
likely to be denied financial protections under current law.
  According to the Kaiser Family Foundation, it is estimated that up to 
40 percent of low-income elderly that are otherwise eligible for 
financial assistance are denied protections due to the assets test. Any 
senior citizen making less than $13,290 a year who somehow has managed 
to scrape together $4,000 in a savings account for emergency are not 
eligible for financial protections from Medicare's cost sharing 
requirements. This runs counter to the goal of the Medicare program of 
providing security to the elderly rather than requiring impoverishment 
of them.
  Furthermore, the legislation take steps to eliminate barriers to 
enrollment under the program. Again, according to the Center for 
Medicare Education, ``While some states have conducted activities to 
reach and enroll people in the Medicare Savings Programs, there is a 
need for more outreach activity in states. For example, in 1999, only 
18 states reported that they used a short application form for the 
Medicare Savings Programs, and less than half of the states placed 
eligibility workers in settings other than welfare offices.''
  The bill allows Medicare beneficiaries to apply for assistance at 
local social security offices, encourages states to station eligibility 
workers at these offices, as well as at other sites frequented by 
senior citizens and individuals with disabilities, and ensures that 
beneficiaries can apply for the program using a simplified application 
form. In addition, this bill will ensure that once an individual is 
found eligible for assistance, the individual remains continuously 
eligible and does not need to re-apply annually.
  Another important step the legislation takes for low-income Medicare 
beneficiaries is that it provides 3 months of retroactive for QMBs. All 
other groups of beneficiaries have this protection currently. In 
addition, it prohibits estate recovery for QMBs for the cost of their 
cost-sharing or benefits provided through this program. The fear that 
Medicaid will recoup such costs from a surviving spouse is often a 
deterrent for many seniors to apply for such assistance.
  And finally, the legislation funds a demonstration project to improve 
information and coordination between federal state, and local entities 
to increase enrollment of eligible Medicare beneficiaries. This 
demonstration would help agencies identify individuals who are 
potentially eligible for assistance by coordinating various data and 
sharing it with states for the purposes of locating and enrolling these 
individuals. In addition, the legislation provides grant money for 
additional innovative outreach and enrollment projects for the Medicare 
Savings Programs.
  I would like to thank Representative Dingell for his leadership on 
this issue and am pleased to be introducing the Senate companion bill 
to his legislation.
  I look forward to working with my colleagues to pass this important 
legislation.
  I ask unanimous consent that the text of the bill be printed in the 
Record.

                                S. 2855

       Be it enacted by the Senate and House of Representatives 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 of 2002''.
       (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 2002 and 135 percent 
     in 2003 and years thereafter''.
       (b) Conforming Removal of QI-1 and QI-2 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, 2003.
       (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 inserting ``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 2003.

     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) be redesignating paragraph (6) as paragraph (11); and
       (2) by adding at the end the following new paragraph:
       ``(6) In the case of a State which has elected treatment 
     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 medicare 
     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 further amended by inserting after 
     paragraph (6) the following new paragraph:
       ``(7) In determining whether an individual qualifies as a 
     qualified medicare beneficiary or is eligible for benefits 
     under section 1902(a)(10)(E)(iii), the State shall permit 
     individuals 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 Social Security Act 
     (42 U.S.C. 1396d(p)), as amended by subsections (a) and (b), 
     is further amended by inserting after paragraph (7) the 
     following new paragraph:
       ``(8) In the case of an individual who has been determined 
     to qualify as a qualified medicare beneficiary or to be 
     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 sentence.
       (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 further amended by 
     inserting after paragraph (8) the following new paragraph:
       ``(9) A State shall permit individuals to apply to qualify 
     as a qualified medicare beneficiary or 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 information 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 further amended by inserting after paragraph 
     (9) the following new paragraph:
       ``(10) The Commissioner of Social Security shall provide, 
     through local offices of the Social Security Administration--
       ``(A) for the enrollment under State plans under this title 
     for appropriate medicare cost-sharing benefits for 
     individuals who qualify as a qualified medicare beneficiary 
     or for benefits under section 1902(a)(10)(E)(iii); 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 Workers at SSA Field 
     Offices.--Section 1902(a)(55) of such Act (42 U.S.C. 
     1396a(a)(55)) is amended--

[[Page S7920]]

       (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 Administration''.

     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 subparagraph (A);
       (2) by striking ``, and'' at the end of subparagraph (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, 2003.

     SEC. 6. IMPROVING ASSISTANCE WITH OUT-OF-POCKET COSTS.

       (a) Eliminating Application of Estate Recovery 
     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 Eligibility.--
       (1) In general.--Section 1905(a) of such Act (42 U.S.C. 
     1396d(a)) is amended, in the matter before paragraph (1), by 
     striking ``described in subsection (p)(1), if provided after 
     the month'' and inserting ``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 eligibility.--In the case of 
     an individual who is determined to be eligible for medical 
     assistance described in subparagraph (A) retroactively, the 
     Secretary shall provide a process whereby claims previously 
     for services furnished during the period of retroactive 
     eligibility which were not submitted in accordance with such 
     subparagraph are resubmitted and re-processed in accordance 
     with such subparagraph.''.

     SEC. 7. IMPROVING PROGRAM INFORMATION AND COORDINATION 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 
     Commissioner of Social Security shall enter into an 
     arrangement under which a demonstration is conducted, 
     consistent with this subsection, for the exchange between the 
     Centers for Medicare & Medicaid Services, the Internal 
     Revenue Service, and the Social Security Administration of 
     information in order to identity individuals who are medicare 
     beneficiaries and who, based on data from the Internal 
     Revenue Service that (such as their not filing tax returns or 
     other appropriate filters) are likely to be qualified 
     medicare beneficiaries or individuals otherwise eligible for 
     medical assistance under section 1902(a)(10)(E) of the Social 
     Security Act (42 U.S.C. 1396a(a)(10)(E)).
       (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 required 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 
     appropriate information, in order to do ex parte 
     determinations or other methods for identifying and enrolling 
     individuals who are potentially eligible to be qualified 
     medicare beneficiaries or otherwise eligible for medical 
     assistance described in section 1902(a)(10)(E) of the Social 
     Security Act (42 U.S.C. 1396a(a)(10)(E)).
       (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 appropriated, 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 
     enrollment in Medicare Savings Programs. Such projects may 
     include cooperative 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 based projects, as the Secretary deems 
     appropriate.

     SEC. 8. NOTICES TO CERTAIN NEW MEDICARE BENEFICIARIES.

       (a) SSA Notice.--At the time that the Commissioner of 
     Social Security sends a notice to individuals 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 individuals 
     the Commissioner identifies as being likely to be 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)). Such 
     notice and application shall be accompanied by information on 
     how to submit such an application and on where to obtain more 
     information (including answers to questions) on the 
     application process.
       (b) Including Information in Medicare & You Handbook.--The 
     Secretary of Health and Human Services 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 number that medicare beneficiaries may use to 
     obtain additional information about the program.
                                 ______