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STATE COVERAGE OF MEDICARE COST-SHARING FOR ADDITIONAL LOW-INCOME MEDICARE BENEFICIARIES

Sec1933[42 U.S.C. 1396u–3] (a) In General.—A State plan under this title shall provide, under section 1902(a)(10)(E)(iv) and subject to the succeeding provisions of this section and through a plan amendment, for medical assistance for payment of the cost of medicare cost–sharing described in such section on behalf of all individuals described in such section (in this section referred to as “qualifying individuals”) who are selected to receive such assistance under subsection (b).

(b) Selection of Qualifying Individuals.—A State shall select qualifying individuals, and provide such individuals with assistance, under this section consistent with the following:

(1) All qualifying individuals may apply.—The State shall permit all qualifying individuals to apply for assistance during a calendar year.

(2) Selection on first–come, first–served basis.—

(A) In general.—For each calendar year (beginning with 1998), from (and to the extent of) the amount of the allocation under subsection (c) for the State for the fiscal year ending in such calendar year, the State shall select qualifying individuals who apply for the assistance in the order in which they apply.

(B) Carryover.—For calendar years after 1998, the State shall give preference to individuals who were provided such assistance (or other assistance described in section 1902(a)(10)(E)) in the last month of the previous year and who continue to be (or become) qualifying individuals.

(3) Limit on number of individuals based on allocation.—The State shall limit the number of qualifying individuals selected with respect to assistance in a calendar year so that the aggregate amount of such assistance provided to such individuals in such year is estimated to be equal to (but not exceed) the State’s allocation under subsection (c) for the fiscal year ending in such calendar year.

(4) Receipt of assistance during duration of year.—If a qualifying individual is selected to receive assistance under this section for a month in a year, the individual is entitled to receive such assistance for the remainder of the year if the individual continues to be a qualifying individual. The fact that an individual is selected to receive assistance under this section at any time during a year does not entitle the individual to continued assistance for any succeeding year.

(c) Allocation.—

(1) Total allocation.—The total amount available for allocation under this section for—

(A) fiscal year 1998 is $200,000,000;

(B) fiscal year 1999 is $250,000,000;

(C) fiscal year 2000 is $300,000,000;

(D) fiscal year 2001 is $350,000,000; and

(E) each of fiscal years 2002 and 2003 is $400,000,000.

(2) Allocation to states.—The Secretary shall provide for the allocation of the total amount described in paragraph (1) for a fiscal year, among the States that executed a plan amendment in accordance with subsection (a), based upon the Secretary’s estimate of the ratio of—

(A) an amount equal to the total number of individuals described in section 1902(a)(10)(E)(iv) in the State; to

(B) the sum of the amounts computed under subparagraph (A) for all eligible States.

(d) Applicable FMAP.—With respect to assistance described in section 1902(a)(10)(E)(iv) furnished in a State for calendar quarters in a calendar year—

(1) to the extent that such assistance does not exceed the State’s allocation under subsection (c) for the fiscal year ending in the calendar year, the Federal medical assistance percentage shall be equal to 100 percent; and

(2) to the extent that such assistance exceeds such allocation, the Federal medical assistance percentage is 0 percent.

(e) Limitation on Entitlement.—Except as specifically provided under this section, nothing in this title shall be construed as establishing any entitlement of individuals described in section 1902(a)(10)(E)(iv) to assistance described in such section.

(f) Coverage of Costs Through Part B of the Medicare Program.—For each fiscal year, the Secretary shall provide for the transfer from the Federal Supplementary Medical Insurance Trust Fund under section 1841 to the appropriate account in the Treasury that provides for payments under section 1903(a) with respect to medical assistance provided under this section, of an amount equivalent to the total of the amount of payments made under such section that is attributable to this section and such transfer shall be treated as an expenditure from such Trust Fund for purposes of section 1839.

(g) Special Rules.—

(1) In general.—With respect to each period described in paragraph (2), a State shall select qualifying individuals, subject to paragraph (3), and provide such individuals with assistance, in accordance with the provisions of this section as in effect with respect to calendar year 2003, except that for such purpose—

(A) references in the preceding subsections of this section to a year, whether fiscal or calendar, shall be deemed to be references to such period; and

(B) the total allocation amount under subsection (c) for such period shall be the amount described in paragraph (2) for that period.

(2) Periods and total allocation amounts described.—For purposes of this subsection—

(A) for the period that begins on January 1, 2004, and ends on September 30, 2004, the total allocation amount is $300,000,000;

(B) for the period that begins on October 1, 2004, and ends on December 31, 2004, the total allocation amount is $100,000,000;

(C) for the period that begins on January 1, 2005, and ends on September 30, 2005, the total allocation amount is $300,000,000;

(D) for the period that begins on October 1, 2005, and ends on December 31, 2005, the total allocation amount is $100,000,000;

(E) for the period that begins on January 1, 2006, and ends on September 30, 2006, the total allocation amount is $300,000,000;

(F) for the period that begins on October 1, 2006, and ends on December 31, 2006, the total allocation amount is $100,000,000; and

(G) for the period that begins on January 1, 2007, and ends on September 30, 2007, the total allocation amount is $300,000,000;

(H) for the period that begins on October 1, 2007, and ends on December 31, 2007, the total allocation amount is $100,000,000;

(I) for the period that begins on January 1, 2008, and ends on September 30, 2008, the total allocation amount is $315,000,000

(J) for the period that begins on October 1, 2008, and ends on December 31, 2008, the total allocation amount is $130,000,000;

(K) for the period that begins on January 1, 2009, and ends on September 30, 2009, the total allocation amount is $350,000,000;

(L) for the period that begins on October 1, 2009, and ends on December 31, 2009, the total allocation amount is $150,000,000;

(M) for the period that begins on January 1, 2010, and ends on September 30, 2010, the total allocation amount is $462,500,000;

(N) for the period that begins on October 1, 2010, and ends on December 31, 2010, the total allocation amount is $165,000,000;

(O) for the period that begins on January 1, 2011, and ends on September 30, 2011, the total allocation amount is $720,000,000;[230]

(P) for the period that begins on October 1, 2011, and ends on December 31, 2011, the total allocation amount is $280,000,000; [231]

(Q)[232] for the period that begins on January 1, 2012, and ends on September 30, 2012, the total allocation amount is $450,000,000[233];[234]

(R)[235] for the period that begins on October 1, 2012, and ends on December 31, 2012, the total allocation amount is $280,000,000;[236]

(S)[237] for the period that begins on January 1, 2013, and ends on September 30, 2013, the total allocation amount is $485,000,000; and

(T)[238] for the period that begins on October 1, 2013, and ends on December 31, 2013, the total allocation amount is $300,000,000.

(3) Rules for periods that begin after january 1.—For any specific period described in subparagraph (B), (D), (F), (H), (J) (L), (N), (P), (R) or (T)[239] of paragraph (2), the following applies:

(A) The specific period shall be treated as a continuation of the immediately preceding period in that calendar year for purposes of applying subsection (b)(2) and qualifying individuals who received assistance in the last month of such immediately preceding period shall be deemed to be selected for the specific period (without the need to complete an application for assistance for such period).

(B) The limit to be applied under subsection (b)(3) for the specific period shall be the same as the limit applied under such subsection for the immediately preceding period.

(C) The ratio to be applied under subsection (c)(2) for the specific period shall be the same as the ratio applied under such subsection for the immediately preceding period.


[230]  P.L. 112-78, §310(b)(1)(B), struck out “and”.and inserted “; and”.

P.L. 112-78, §3101(b)(1)(A), struck out “and”.

[231]  P.L. 112-96, §3101(b)(1)(A), struck out “and”

[232]  P.L. 112-78, §310(b)(1)(C), added this new subparagraph (Q), effective December 23, 2011.

[233]  P.L. 112-96, §3101(b)(1)(B), struck out “February 29, 2012, the total allocation amount is $150,000,000.” and inserted “September 30, 2012, the total allocation amount is $450,000,000; and”, effective February 22, 2012.

[234]  P.L. 112-240, §621(b)(1)(A), struck out “and”.

[235]  P.L. 112-96, §3101(b)(1)(C), added this new subparagraph (R), effective February 22, 2012.

[236]  P.L. 112-240, §621(b)(1)(B), struck out the period and inserted a semicolon.

[237]  P.L. 112-240, §621(b)(1)(C), added this new subparagraph (S), effective January 2, 2013.

[238]  P.L. 112-240, §621(b)(1)(C), added this new subparagraph (T), effective January 2, 2013.

[239]  P.L. 112-96, §3101(b)(2), struck out “or P” and inserted “(P), or (R)*”.

*P.L. 112-240, §621(b)(2), struck out “or R” and inserted “(R), or (T), effective January 2, 2013.