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.