[Congressional Record Volume 149, Number 58 (Thursday, April 10, 2003)]
[Senate]
[Pages S5232-S5233]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BREAUX (for himself, Mr. Chafee, Mr. Bingaman, Ms. 
        Landrieu, Mr. Lieberman, Mrs. Clinton, Mr. Miller, and Mr. 
        Graham of Florida):
  S. 883. A bill to amend title XIX of the Social Security Act to 
revise and simplify the transitional medical assistance (TMA) program; 
to the Committee on Finance.
  Mr. BREAUX. Mr. President, I ask unamimous consent that the text of 
the bill be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 883

       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:

[[Page S5233]]

       ``(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.
                                 ______