[Congressional Record Volume 151, Number 125 (Friday, September 30, 2005)]
[Senate]
[Pages S10802-S10805]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN:
  S. 1808. A bill to amend title XIX of the Social Security Act to 
improve the qualified medicare beneficiary (QMB) and specified low-
income medicare beneficiary (SLMB) programs within the medicaid 
program; to the Committee on Finance.
  Mr. BINGAMAN. Mr. President, I rise today to introduce the ``Medicare 
Beneficiary Assistance Improvement Act.'' This legislation would 
improve what are referred to as the Medicare Savings Programs, which 
includes the Qualified Medicare Beneficiary, QMB, and Specified Low-
income Medicare Beneficiary, SLMB, and Qualifying Individual-1 (QI-1) 
programs that provide cost-sharing assistance for low-income Medicare 
beneficiaries through the Medicaid program. It would also make 
permanent the QI-1 program, which expires today due to inaction by the 
House of Representatives to extend the program.
  The QI-1 program was established as part of the Balanced Budget Act 
of 1997 and was authorized for 5 years. In 2002 and 2003, extensions of 
the program were included in various continuing resolutions. The 
program was further extended through passage of Public Law 108-448 in 
2004, through today's expiration date.
  There is no reason that the Congress must participate in this annual 
last minute scramble to try and extend the program for a few months or 
a year. It is a disservice to the States, who must watch the Congress 
closely to constantly prepare to send out disenrollment notices and 
layoff staff, even though they are relatively certain the program will 
be extended. But, more importantly, it is a disservice to those that 
need this important assistance, as many of those enrolled worry this 
benefit will be taken away and many of those never enrolled never are 
told of the benefit since States and advocates are spending their time 
trying to get the program extended rather than conducting outreach.
  While I remain very hopeful that the Congress will pass an extension 
of the QI-1 program for an additional period in the coming week, I am 
introducing the ``Medicare Beneficiary Assistance Improvement Act'' 
today in the hope that Congress will end this process of temporary 
extensions and permanently authorize the program, as provided for in 
this legislation.
  To reiterate, low-income senior citizens and disabled Americans 
nationwide should not be subjected to the constant risk of losing 
crucial health care benefits. Furthermore, the Centers for Medicare & 
Medicaid Services, CMS, the Social Security Administration, SSA, and 
the States should be spared the administrative burdens and cost 
associated with reauthorizing the program each year--sometimes more 
than once in a year.
  Furthermore, the bill proposes several improvements to the Medicare 
Savings Programs and application processes that will make these low-
income benefits both more efficient to administer and more accessible 
to the individuals who need them. It would also seek to simplify the 
process and make the Medicare Savings Programs more understandable to 
low-income senior citizens and people with disabilities, as well as 
State and Federal Government officials.
  In New Mexico, over 1,500 low-income Medicare beneficiaries receive 
the QI-1 benefit, which saves them almost $1,000 in Medicare Part B 
premium out-of-pocket costs annually. Unfortunately, according to 
estimates made by the Medicare Rights Center using Census Bureau data, 
over 11,000 are likely to be eligible. Many are completely unaware of 
the assistance this program offers.
  The same is true among those of us that created the three different 
Medicare Savings Programs. In fact, I am almost absolutely certain that 
few of my Senate colleagues could accurately explain how any of these 
programs work and that is precisely the problem with them. They are 
intended serve our Nation's most vulnerable, low-income citizens with 
their Medicare cost-sharing burdens, but do so in a very complicated 
manner that few can understand. It is no wonder that many of our 
Nation's elderly and people with disabilities that qualify for this 
assistance do not participate.
  For example, the QI-1 program is Federal grant payment to States for 
the purpose of paying the Medicare Part B premium, which is $78.20 per 
month in 2005 and will increase to $88.50 per month or over $1000 per 
year in 2006, for individuals with income between 120 and 135 percent 
of the Federal Poverty Level. Through this Federal grant, States must 
pay the full amount of the Medicare Part B premium for qualifying 
individuals but may cap or otherwise limit enrollment if the State 
projects that further enrollment will result in exhaustion of their 
State allotment.
  Six States had enrollment this year that would exceed their allotment 
so were forced to cap funding. The Centers for Medicare & Medicaid 
Services, CMS, responded to this problem with a rule on August 26, 
2005, that reallocated unspent funding from some States to those that 
had exhausted their funds in order to eliminate the enrollment caps in 
the States of Oregon, Arizona, Mississippi, Louisiana, Alabama, and 
Connecticut.
  Three days later Hurricane Katrina hit three of the six States and 
now their entire health care systems are in chaos, and Congress has 
failed to act to address their need. While that has gained a great deal 
of much needed attention and deserves even greater attention from the 
media and public, the House of Representatives yesterday failed to 
extend the QI-1 program and went out of session for the week even 
though it expires today. Senators Grassley and Baucus were working with 
the House of Representatives on a last minute extension through the 
introduction of S. 1718, but it failed to move in the waning hours of 
the fiscal year and the House of Representatives took no action 
whatsoever.
  Even though CMS has apparently notified the Congress that it can 
continue to run the program for a few days, the failure of the Congress 
to take action in a timely manner to ensure that disenrollment notices 
are not sent out by the States to an estimated 185,000 low-income 
Medicare beneficiaries nationwide is absolutely unacceptable and also 
is deserving of attention and media scrutiny.
  Furthermore, while the QI-1 program has always played an important 
role in helping low-income Medicare afford health care coverage, the 
QI-1 program would, in the future, play an important role in helping 
low-income Medicare beneficiaries access prescription drug coverage 
through Medicare's new drug benefit. Enrollment in the QI-1 program is 
supposed to automatically qualify a person for the Medicare Part D drug 
benefit's low-income subsidy beginning on January 1,2006.

  To briefly describe the most critical aspects of the legislation, 
Section 2 of the bill simply provides for one unified name for the 
Federal programs that offer cost sharing and benefit assistance for 
low-income Medicare beneficiaries. Rather than separately referring to 
the QMB, SLMB, and QI-1 programs, the bill provides one common name for 
all of these programs, the ``Medicare Savings Programs.''
  Low enrollment in these assistance programs is in large part due to 
the lack of knowledge and understanding of the programs or benefits 
offered. This simple change has been pilot tested with Medicare 
beneficiary groups and found to elicit a positive response and interest 
from Medicare beneficiaries.
  Section 3 of the legislation would make permanent the QI-1 category 
by incorporating these individuals into the SLMB category at the State 
Children's Health Insurance Program enhanced matching rate. In addition 
to simplifying and making permanent the program, States would see a 
financial benefit from this change.

[[Page S10803]]

  Section 4 eliminates some of the critical barriers to enrollment. As 
I noted earlier, just 1,500 of the estimated 11,000 low-income Medicare 
beneficiaries in New Mexico eligible for the QI-1 benefit are enrolled. 
This section provides for several important enrollment simplification 
procedures, such as allowing self-certification of income and 
continuous eligibility, and expanded outreach efforts.
  Section 5 eliminates the limit on assets, which is set at $4,000 for 
an individual and $6,000 for a couple and disqualifies millions of 
Medicare beneficiaries with very low incomes from qualifying for 
assistance. Some States have waived or disallowed the counting of some 
assets for the purposes of eligibility determination and have seen much 
higher enrollment rates.
  I urge the Congress to pass a temporary extension of the QI-1 program 
early next week, but then to immediately begin work to permanently 
authorize the QI-1 program and to simplify and streamline all the 
Medicare Savings Programs. Our Nation's low-income Medicare 
beneficiaries and the States deserve nothing less.
  I ask unanimous consent to print a summary and text of this 
legislation in the Record.
  There being no objection, the materials were ordered to be printed in 
the Record, as follows:

                               Fact Sheet

          ``Medicare Beneficiary Assistance Improvement Act''

       Sponsor: Senator Bingaman
       Purpose: To amend title XIX of the Social Security Act to 
     improve the Qualified Medicare Beneficiary (QMB) and 
     Specified Low-income Medicare Beneficiary (SLMB) programs 
     within the Medicaid program, and in doing so to make 
     permanent the Qualifying Individual-1 (QI-1) program.
       Background: The QI-1 program is a federal grant payment to 
     states for the purposes of paying the Medicare Part B 
     premium, which is $78.20 per month in 2005 and will increase 
     to $88.50 per month (over $1000 per year) in 2006, for 
     individuals with income between 120 and 135 percent of the 
     Federal Poverty Level. Federal assistance for QI-1s was 
     created in the Balanced Budget Act of 1997 for a five-year 
     period and has been extended on a year-to-year basis since 
     December 2002. The program is currently slated to expire on 
     September 30, 2005.
       Now is a critical time to make QI-1 a permanent program. 
     Approximately 185,000 low-income Medicare beneficiaries 
     nationwide currently rely on the QI-1 program for payment of 
     their Part B premium and will be hard pressed to afford 
     Medicare coverage without this assistance. The QI-1 program 
     also plays an important role in helping low-income Medicare 
     beneficiaries access prescription drug assistance through 
     Medicare's new drug benefit. Enrollment in the QI-1 program 
     automatically qualifies a person for the Part D drug 
     benefit's low-income subsidy beginning on January 1, 2006.
       The legislation would ensure that low-income older and 
     disabled Americans nationwide are no longer at risk of losing 
     crucial health care benefits. Furthermore, states, the 
     Centers for Medicare and Medicaid Services (CMS), the Social 
     Security Administration (SSA) would be spared the 
     administrative burden and cost associated with reauthorizing 
     the program each year--sometimes more than once in a year.
       Furthermore, the bill proposes several improvements to the 
     QMB and SLMB programs and application processes that will 
     make these low-income benefits both more efficient to 
     administer and more accessible to the individuals who need 
     them.


                                Summary

     Section 1. Short Title.
       This section gives the bill's title: the ``Medicare 
     Beneficiary Assistance Improvement Act.''
     Section 2. Renaming the Program to Eliminate Confusion.
       This section provides for one unified name for the federal 
     programs that offer cost sharing and benefit assistance for 
     low-income Medicare beneficiaries. Currently, 
     beneficiaries may be in ``dual eligible'' programs, 
     ``Qualified Medicare Beneficiary'' programs (QMB), 
     ``Specified Low-income Medicare Beneficiary'' programs 
     (SLMB), or Qualifying Individual-1 (QI-1) programs. This 
     bill provides one common name for all of these programs, 
     the ``Medicare Savings Programs.''
       One of the problems contributing to low enrollment in the 
     assistance programs is lack of understanding of the programs 
     or benefits offered, in part due to confusing nomenclature. 
     The new name has been pilot tested with Medicare 
     beneficiaries groups and found to elicit a positive response 
     and interest from Medicare beneficiaries.
     Section 3. Expanding Protections by Increasing SLMB 
         Eligibility Income Level to 135 Percent of Poverty.
       This section would make permanent the QI-1 category, which 
     provides assistance with the cost of the Medicare Part B 
     premium for beneficiaries with incomes between 120 percent 
     and 135 percent of poverty, by incorporating these 
     individuals into the SLMB category. In addition, the 
     legislation provides enhanced matching payments (at the 
     state's CHIP rate) for the SLMB population (100-135% FPL).
     Section 4. Eliminating Barriers to Enrollment.
       In the states that use 209(b) or SSI criteria for 
     eligibility for the QMB program, Medicare beneficiaries are 
     not automatically made eligible for assistance, even though 
     they qualify. In other states that do not use these criteria, 
     Medicare beneficiaries are automatically eligible if they 
     meet the income thresholds to qualify for SSI payments. 
     Subsection (a) requires that states that use these 
     alternative definitions for eligibility make Medicare 
     beneficiaries automatically eligible for assistance as well.
       Subsection (b) allows individuals to certify their income 
     without having to provide additional documentation. Many 
     eligible Medicare beneficiaries decline to participate in 
     assistance programs because they have difficulty producing 
     the necessary documents and generally are reluctant to 
     provide such information.
       Subsection (c) provides for continuous eligibility in the 
     assistance programs. Just as Medicare beneficiaries apply 
     once for Medicare, they can apply once for assistance 
     programs as well, without the need for yearly 
     recertification.
       Subsection (d) requires states to allow applications for 
     assistance programs on a simplified application form by 
     telephone or mail without the need for a face-to-face 
     interview. Many eligible individuals choose not to apply for 
     government programs because of the stigma associated with a 
     Social Services office. Research shows that individuals are 
     more likely to apply for a benefit when they are not required 
     to have an in-person interview at one of these offices.
       Subsection (e) expands the role of Social Security in the 
     Medicare Savings Program application process by requiring 
     local Social Security offices to provide oral and written 
     information about Medicare Savings Program benefits and offer 
     Medicare beneficiaries the ability to apply for assistance at 
     these offices, as is the application protocol for the drug 
     benefit's low-income subsidy program.
       Subsection (f) allows states to outstation eligibility 
     workers at local Social Security field offices.
     Section 5. Elimination of Asset Test.
       This section eliminates the strict limit on assets that 
     disqualifies millions of Medicare Beneficiaries with very low 
     incomes from qualifying for assistance. States with high or 
     no asset tests have maximized their QI-1 funding allotments, 
     while states with standard assets tests have seen extremely 
     low QI-1 enrollment.
     Section 6. Improving Assistance With Out-of-Pocket Costs.
       Subsection (a) prohibits estate recovery against QMBs for 
     the cost-sharing or benefits provided through this program. 
     Many individuals do not apply for assistance because they 
     fear a surviving spouse will lose what little income they 
     have by having to repay the state for benefits received upon 
     death.
       Subsection (b) gives QMBs three months of retroactive 
     eligibility, allowing the state to pay for Medicare cost-
     sharing and premiums for the previous three months. Other 
     categories of individuals who receive assistance through 
     Medicaid (SLMBs, QI-1s, and dual eligibles) are eligible for 
     assistance beginning three months prior to the date which 
     they are enrolled. Because of the low incomes of these 
     beneficiaries, coupled with the fact that lower-income 
     individuals have higher health care costs, such retroactive 
     assistance is particularly important.
     Section 7. Improving Program Information and Coordination 
         With State, Local, and Other Partners.
       This section authorizes a data match demonstration project 
     between Health and Human Services, the Internal Revenue 
     Service, and SSA to match information to identify individuals 
     who are potentially eligible for assistance programs but not 
     enrolled. This section also authorizes $100 million in grants 
     to states to use the information identified through the 
     demonstration project to improve enrollment in the Medicare 
     Savings Programs and the low-income subsidy, as well as 
     grants to other entities like the Indian Health Service and 
     Veterans' Affairs to do coordinated outreach with these 
     programs.
     Section 8. Notices to Certain New Medicare Beneficiaries.
       This section requires SSA, upon sending out initial 
     notification of Medicare eligibility, to include information 
     and an application for the Medicare Savings Programs to 
     individuals the Commissioner identifies as likely to be 
     eligible for benefits under those programs. The section also 
     requires the Secretary of Health and Human Services to 
     include in the annual Medicare & You handbook information on 
     the availability of the Medicare Savings Programs and a toll 
     free number for beneficiaries to call to obtain additional 
     information.
                                  ____


                                S. 1808

       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''.

[[Page S10804]]

       (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 2005 and 135 percent 
     in 2006 and years thereafter''.
       (b) Conforming Removal of QI-1 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, 2006.
       (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 2006.

     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) by 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 amended by inserting after paragraph (6) 
     the following new paragraph:
       ``(7) In determining whether an individual is 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 amended by inserting after paragraph (7) the following new 
     paragraph:
       ``( 8) In the case of an individual who has been determined 
     to be a qualified medicare beneficiary or 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 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 eligibility 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 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 an 
     individual who is a qualified medicare beneficiary or is 
     eligible for benefits under section 1902(a)(10)(E)(iii) 
     through utilization of the process established under section 
     1860D-14; 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--
       (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, 2006.

     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 preceding 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 submitted 
     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 identitfy individuals who are 
     medicare beneficiaries and who, based on data from the 
     Internal Revenue Service (such as their not filing tax 
     returns or other appropriate filters) are likely to be--
       (A) a qualified medicare beneficiary (as defined in 
     1905(p)(1) of the Social Security Act (42 U.S.C. 
     1396d(p)(1)));
       (B) otherwise eligible for medical assistance under section 
     1902(a)(10)(E) of the Social Security Act (42 U.S.C. 
     1396a(a)(10)(E)); or
       (C) entitled to a premium or cost-sharing subsidy under 
     section 1860D-14 of such Act (42 U.S.C. 1395w-114).
       (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

[[Page S10805]]

     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 
     utilize other methods for identifying and enrolling 
     individuals who are potentially--
       (A) a qualified medicare beneficiary (as defined in 
     1905(p)(1) of the Social Security Act (42 U.S.C. 
     1396d(p)(1)));
       (B) 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)); or
       (C) entitled to a premium or cost-sharing subsidy under 
     section 1860D-14 of such Act (42 U.S.C. 1395w-114).
       (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 and low-income 
     subsidy programs under section 1860D-14 of such Act (42 
     U.S.C. 1395w-114). 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 such projects, as the Secretary deems 
     appropriate.

     SEC. 8. NOTICES TO CERTAIN NEW MEDICARE BENEFICIARIES.

       (a) SSA Notice.--
       (1) In general.--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--
       (A) a qualified medicare beneficiary (as defined in 
     1905(p)(1) of the Social Security Act (42 U.S.C. 
     1396d(p)(1)));
       (B) 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)); or
       (C) entitled to a premium or cost-sharing subsidy under 
     section 1860D-14 of such Act (42 U.S.C. 1395w-114).
       (2) Additional information required.--Such notice and 
     application shall be accompanied by information on how to 
     submit such an application and 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.

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