S T A T E O F N E W Y O R K
________________________________________________________________________
9245--A
I N A S S E M B L Y
February 9, 2022
___________
Introduced by M. of A. GOTTFRIED, McDONALD, BICHOTTE HERMELYN, CYMBROW-
ITZ, ABINANTI, THIELE -- read once and referred to the Committee on
Health -- reported and referred to the Committee on Ways and Means --
committee discharged, bill amended, ordered reprinted as amended and
recommitted to said committee
AN ACT to amend the social services law, in relation to expanding eligi-
bility for the medicare savings program
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subdivision 3 of section 367-a of the social services law,
as amended by chapter 558 of the laws of 1989, paragraph (a) as amended
by chapter 81 of the laws of 1995, subparagraph 1 of paragraph (b) as
designated and subparagraph 2 as added by section 41 of part C of chap-
ter 58 of the laws of 2008, paragraph (c) as added by chapter 651 of the
laws of 1990, paragraph (d) as amended by section 27 of part B of chap-
ter 109 of the laws of 2010, paragraph (e) as added by section 16 of
part D of chapter 56 of the laws of 2013, subparagraph 2 of paragraph
(e) as amended by section 52 of part C of chapter 60 of the laws of
2014, is amended to read as follows:
3. (a) AS USED IN THIS SUBDIVISION, THE FOLLOWING TERMS SHALL HAVE THE
FOLLOWING MEANINGS:
(1) "QUALIFIED MEDICARE BENEFICIARY" MEANS A PERSON WHO IS ENTITLED TO
HOSPITAL INSURANCE BENEFITS UNDER PART A OF TITLE XVIII OF THE FEDERAL
SOCIAL SECURITY ACT, WHOSE INCOME DOES NOT EXCEED ONE HUNDRED PERCENT OF
THE OFFICIAL FEDERAL POVERTY LINE APPLICABLE TO THE PERSON'S FAMILY SIZE
AND WHOSE RESOURCES DO NOT EXCEED TWICE THE MAXIMUM AMOUNT OF RESOURCES
A PERSON MAY HAVE IN ORDER TO QUALIFY FOR BENEFITS UNDER THE FEDERAL
SUPPLEMENTAL SECURITY INCOME PROGRAM OF TITLE XVI OF THE FEDERAL SOCIAL
SECURITY ACT, AS DETERMINED FOR PURPOSES OF SUCH PROGRAM. TO THE
EXTENT THAT FEDERAL FINANCIAL PARTICIPATION IS AVAILABLE, A PERSON
WHOSE RESOURCES ARE IN EXCESS OF THE AMOUNT SPECIFIED IN THIS
SUBPARAGRAPH BUT OTHERWISE MEETS THE REQUIREMENTS SHALL BE
CONSIDERED A "QUALIFIED MEDICARE BENEFICIARY".
(2) "SPECIFIED LOW INCOME MEDICARE BENEFICIARY" MEANS A PERSON WHO
WOULD BE A QUALIFIED MEDICARE BENEFICIARY EXCEPT THAT PERSON'S INCOME
EXCEEDS ONE HUNDRED PERCENT OF THE FEDERAL INCOME POVERTY LINE APPLICA-
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD14542-03-2
A. 9245--A 2
BLE TO THE PERSON'S FAMILY SIZE, BUT IS LESS THAN ONE HUNDRED TWENTY
PERCENT OF SUCH POVERTY LINE.
(3) "QUALIFIED INDIVIDUAL" MEANS A PERSON WHO IS ENTITLED TO HOSPITAL
INSURANCE BENEFITS UNDER PART A OF TITLE XVIII OF THE FEDERAL SOCIAL
SECURITY ACT AND WHOSE INCOME EXCEEDS THE INCOME LEVEL ESTABLISHED BY
THE STATE AND IS AT LEAST ONE HUNDRED TWENTY PERCENT, BUT LESS THAN ONE
HUNDRED THIRTY-FIVE PERCENT, OF THE FEDERAL POVERTY LEVEL, FOR A FAMILY
OF THE SIZE INVOLVED AND WHO IS NOT OTHERWISE ELIGIBLE FOR MEDICAL
ASSISTANCE UNDER THIS ARTICLE; REFERRED TO AS A QUALIFIED INDIVIDUAL.
(4) "QUALIFIED DISABLED AND WORKING INDIVIDUAL" MEANS AN INDIVID-
UAL WHO IS NOT OTHERWISE ELIGIBLE FOR MEDICAL ASSISTANCE AND:
(I) WHO IS ENTITLED TO ENROLL FOR HOSPITAL INSURANCE BENEFITS UNDER
SECTION 1818A OF PART A OF TITLE XVIII OF THE FEDERAL SOCIAL SECURITY
ACT;
(II) WHOSE INCOME DOES NOT EXCEED TWO HUNDRED PERCENT OF THE OFFICIAL
FEDERAL POVERTY LINE APPLICABLE TO THE PERSON'S FAMILY SIZE; AND
(III) WHOSE RESOURCES DO NOT EXCEED TWICE THE MAXIMUM AMOUNT OF
RESOURCES THAT AN INDIVIDUAL OR A COUPLE, IN THE CASE OF A MARRIED
INDIVIDUAL, MAY HAVE AND OBTAIN FEDERAL SUPPLEMENTAL SECURITY INCOME
BENEFITS UNDER TITLE XVI OF THE FEDERAL SOCIAL SECURITY ACT, AS
DETERMINED FOR PURPOSES OF THAT PROGRAM.
FOR PURPOSES OF THIS SUBPARAGRAPH, INCOME AND RESOURCES ARE
DETERMINED BY THE SAME METHODOLOGY AS IS USED FOR DETERMINING
ELIGIBILITY UNDER THE FEDERAL SUPPLEMENTAL SECURITY INCOME BENEFITS
UNDER TITLE XVI OF THE FEDERAL SOCIAL SECURITY ACT.
(B) Payment of premiums for enrolling qualified disabled and working
individuals and qualified medicare beneficiaries under Part A of title
XVIII of the federal social security act and for enrolling such benefi-
ciaries and eligible recipients of public assistance under part B of
title XVIII of the federal social security act, together with the costs
of the applicable co-insurance and deductible amounts on behalf of such
beneficiaries, and recipients, and premiums under section 1839 of the
federal social security act for [persons who would be qualified medicare
beneficiaries except that their incomes exceed one hundred percent of
the federal income poverty line applicable to the person's family size
but, in calendar years nineteen hundred ninety-three and nineteen
hundred ninety-four, is less than one hundred ten percent of such pover-
ty line and, in calendar year beginning in nineteen hundred ninety-five,
is less than one hundred twenty percent of such poverty line] SPECIFIED
LOW INCOME MEDICARE BENEFICIARIES shall be made and the cost thereof
borne by the state or by the state and social services districts,
respectively, in accordance with the regulations of the department,
provided, however, that the share of the cost to be borne by a social
services district, if any, shall in no event exceed the proportionate
share borne by such district with respect to other expenditures under
this title. Moreover, if the director of the budget approves, payment
of premiums for enrolling persons who have been determined to be eligi-
ble for medical assistance only may be made and the cost thereof borne
or shared pursuant to this subdivision.
[(b) (1) For purposes of this subdivision, "qualified medicare benefi-
ciaries" are those persons who are entitled to hospital insurance bene-
fits under part A of title XVIII of the federal social security act,
whose income does not exceed one hundred percent of the official federal
poverty line applicable to the person's family size and whose resources
do not exceed twice the maximum amount of resources a person may have in
order to qualify for benefits under the federal supplemental security
A. 9245--A 3
income program of title XVI of the federal social security act, as
determined for purposes of such program.
(2) Notwithstanding any provision of subparagraph one of this para-
graph to the contrary, to the extent that federal financial partic-
ipation is available, a person whose resources are in excess of the
amount specified but otherwise meets the requirements of subparagraph
one of this paragraph shall be considered a "qualified medicare benefi-
ciary" for the purposes of this subdivision. The commissioner is author-
ized to submit amendments to the state plan for medical assistance
and/or submit one or more applications for waivers of the federal social
security act, to obtain the federal approvals necessary to implement
this subparagraph.
(c) (1) For purposes of this subdivision, "qualified disabled and
working individuals" are individuals who are not otherwise eligible for
medical assistance and:
(i) who are entitled to enroll for hospital insurance benefits under
section 1818A of part A of title XVIII of the federal social security
act;
(ii) whose income does not exceed two hundred percent of the official
federal poverty line applicable to the person's family size; and
(iii) whose resources do not exceed twice the maximum amount of
resources that an individual or a couple, in the case of a married indi-
vidual, may have and obtain federal supplemental security income bene-
fits under title XVI of the federal social security act, as determined
for purposes of that program.
(2) For purposes of this paragraph, income and resources are deter-
mined by the same methodology as is used for determining eligibility
under the federal supplemental security income benefits under title XVI
of the federal social security act.
(d)] (C) (1) Beginning April first, two thousand two and to the extent
that federal financial participation is available at a one hundred
percent federal Medical assistance percentage and subject to sections
1933 and 1902(a)(10)(E)(iv) of the federal social security act, medical
assistance shall be available for full payment of medicare part B premi-
ums for QUALIFIED individuals [(referred to as qualified individuals 1)
who are entitled to hospital insurance benefits under part A of title
XVIII of the federal social security act and whose income exceeds the
income level established by the state and is at least one hundred twenty
percent, but less than one hundred thirty-five percent, of the federal
poverty level, for a family of the size involved and who are not other-
wise eligible for medical assistance under the state plan;].
(2) Premium payments for the individuals described in subparagraph one
of this paragraph will be one hundred percent federally funded up to the
amount of the federal allotment. The department shall discontinue
enrollment into the program when the part B premium payments made pursu-
ant to subparagraph one of this paragraph meet the yearly federal allot-
ment.
[(3) The commissioner of health shall develop a simplified application
form, consistent with federal law, for payments pursuant to this
section. The commissioner of health, in cooperation with the office for
the aging, shall publicize the availability of such payments to medicare
beneficiaries.]
(D) COMMENCING APRIL FIRST, TWO THOUSAND TWENTY-TWO, AND SUBJECT TO
FEDERAL APPROVAL, WHICH THE COMMISSIONER SHALL SEEK, THE FOLLOWING SHALL
APPLY:
A. 9245--A 4
(1) FOR QUALIFIED MEDICARE BENEFICIARIES ALL COUNTABLE INCOME OVER ONE
HUNDRED PERCENT OF THE FEDERAL POVERTY LEVEL, UP TO ONE HUNDRED TWENTY
PERCENT OF THE FEDERAL POVERTY LEVEL, SHALL BE DISREGARDED, AFTER TAKING
ALL OTHER DISREGARDS, DEDUCTIONS, AND EXCLUSIONS UNDER FEDERAL AND STATE
LAW INTO ACCOUNT FOR THOSE PERSONS ELIGIBLE PURSUANT TO THIS SECTION.
(2) FOR SPECIFIED LOW INCOME MEDICARE BENEFICIARIES ALL COUNTABLE
INCOME OVER ONE HUNDRED TWENTY PERCENT OF THE FEDERAL POVERTY LEVEL, UP
TO ONE HUNDRED THIRTY-EIGHT PERCENT OF THE FEDERAL POVERTY LEVEL, SHALL
BE DISREGARDED, AFTER TAKING ALL OTHER DISREGARDS, DEDUCTIONS, AND
EXCLUSIONS UNDER FEDERAL AND STATE LAW INTO ACCOUNT FOR THOSE PERSONS
ELIGIBLE PURSUANT TO THIS SECTION.
(3) FOR QUALIFYING INDIVIDUALS ALL COUNTABLE INCOME OVER ONE HUNDRED
THIRTY-EIGHT PERCENT OF THE FEDERAL POVERTY LEVEL, UP TO ONE HUNDRED
FIFTY-SIX PERCENT OF THE FEDERAL POVERTY LEVEL, SHALL BE DISREGARDED,
AFTER TAKING ALL OTHER DISREGARDS, DEDUCTIONS, AND EXCLUSIONS UNDER
FEDERAL AND STATE LAW INTO ACCOUNT FOR THOSE PERSONS ELIGIBLE PURSUANT
TO THIS SECTION.
(e) (1) Payment of premiums for enrolling individuals in qualified
health plans offered through a health insurance exchange established
pursuant to the federal Patient Protection and Affordable Care Act (P.L.
111-148), as amended by the federal Health Care and Education Reconcil-
iation Act of 2010 (P.L. 111-152), shall be available to individuals
who:
(i) immediately prior to being enrolled in the qualified health plan,
were or would have been eligible under the family health plus program as
a parent or stepparent of a child under the age of twenty-one, and whose
MAGI household income, as defined in subparagraph eight of paragraph (a)
of subdivision one of section three hundred sixty-six of this title,
exceeds one hundred thirty-three percent of the federal poverty line for
the applicable family size;
(ii) are not otherwise eligible for medical assistance under this
title; and
(iii) are enrolled in a standard health plan in the silver level, as
defined in 42 U.S.C. 18022.
(2) Payment pursuant to this paragraph shall be for premium obli-
gations of the individual under the qualified health plan and shall
continue only if and for so long as the individual's MAGI household
income exceeds one hundred thirty-three percent, but does not exceed one
hundred fifty percent, of the federal poverty line for the applicable
family size, or, if earlier, until the individual is eligible for
enrollment in a standard health plan pursuant to section three hundred
sixty-nine-gg of this article.
(3) The commissioner of health shall submit amendments to the state
plan for medical assistance and/or submit one or more applications for
waivers of the federal social security act as may be necessary to
receive federal financial participation in the costs of payments made
pursuant to this paragraph; provided further, however, that nothing in
this subparagraph shall be deemed to affect payments for premiums pursu-
ant to this paragraph if federal financial participation in the costs of
such payments is not available.
§ 2. This act shall take effect on the thirtieth day after it shall
have become a law. Effective immediately, the addition, amendment and/or
repeal of any rule or regulation necessary for the implementation of
this act on its effective date are authorized to be made and completed
on or before such effective date.