IN THE SENATE OF THE UNITED STATES
March 24, 2022
Mr. Inhofe (for himself, Mr. Braun, Mrs. Blackburn, Mr. Kennedy, Mr. Paul, Mr. Scott of Florida, and Mr. Lankford) introduced the following bill; which was read twice and referred to the Committee on Finance
To apply the Medicaid asset verification program to all applicants for, and recipients of, medical assistance in all States and territories, and for other purposes.
This Act may be cited as the
Protecting Medicaid Beneficiaries Act of 2022.
Congress makes the following findings:
Recent estimates show that the Social Security program loses over $4,000,000,000 per year to fraud.
In fiscal year 2020, the Medicaid program lost $86,490,000,000 in improper payments and the Medicare program lost another almost $43,000,000,000.
The fiscal year 2020 national Children's Health Insurance Program (CHIP) improper payment rate estimate is 27 percent, representing $4,780,000,000 in improper payments.
Millions of Americans experience homelessness, hunger, or lack of healthcare coverage. Yet, our country annually wastes more than $130,000,000,000 in the very programs that were designed to correct these serious problems, demonstrating that our system is failing those who need it the most.
Application of Medicaid asset test to all applicants for, and recipients of, medical assistance in all States and territories
Section 1940 of the Social Security Act (42 U.S.C. 1396w) is amended—
in subsection (a), by striking paragraph (4); and
in subsection (b)(1)(A), by striking
on the basis of being aged, blind, or disabled.
The Secretary of Health and Human Services shall promulgate such rules as are necessary to implement the amendments made by subsection (a).
Subject to paragraph (2), the amendments made by subsection (a) shall take effect on the date that is 2 years after the date of enactment of this Act.
Phase-in of implementation
During the 2-year period that begins on the date of enactment of this Act, the Secretary of Health and Human Services shall require States to submit and implement a plan for an electronic asset verification program that meets the requirements under section 1940 of the Social Security Act (as amended by subsection (a)).
Implementation before effective date
Nothing in this subsection or section 1940 of the Social Security Act (42 U.S.C. 1396w) shall be construed as prohibiting a State from implementing an asset verification program that meets the requirements of such section (as amended by subsection (a)) in advance of the effective date specified under paragraph (1).
Delay of effective date
If a State requests a delay of the effective date specified under paragraph (1) on the basis of ongoing economic hardship limitations, as determined by the chief executive officer of the State, the Secretary of Health and Human Services may delay such effective date for up to 365 days.
Medicaid resources eligibility requirement
Section 1902(e)(14)(C) of the Social Security Act (42 U.S.C. 1396a(e)(14)(C)) is amended to read as follows—
Resources test requirement
Notwithstanding any other provision of this title, in the case of an individual with respect to whom a determination of income eligibility for medical assistance under the State plan or under any waiver of such plan is required, the State shall also apply a resources eligibility test that meets the requirement of clause (ii).
A State resources eligibility test meets the requirement of this clause if the test precludes eligibility for any individual whose resources (as determined under section 1613 for purposes of the supplemental security income program) exceed the maximum amount of resources that an individual may have and obtain benefits under that program, or such amount as the State shall establish.
No effect on continuous eligibility for pregnant women
Section 1902(e)(6) of the Social Security Act (42 U.S.C. 1396a(e)(6)) is amended by inserting
or resources after
income each place it appears.
Subject to paragraph (2), the amendment made by subsection (a) shall take effect on the date that is 2 years after the date of enactment of this Act.
Rule for changes requiring State legislation
In the case of a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the State plan to meet the additional requirement imposed by the amendment made by subsection (a), 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 this additional requirement 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 effective date 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.
Allowing States to retain savings from asset verification program and resources eligibility requirements
For each of the first 2 years following the date that is 2 years after the date of enactment of this Act, the Secretary of Health and Human Services shall pay to the State an amount equal to the savings (as estimated by the Secretary) in Federal expenditures that are attributable to the State meeting the requirements imposed by the amendments made by sections 3 and 4.
Use of funds
A State that receives a payment under subsection (a) shall use the funds received under such payment to support enrollment in, and the conduct of, programs for maternal and child health under the State Medicaid program, or for such other purpose in support of the State Medicaid program as the Secretary of Health and Human Services shall approve.
Requiring CMS to track State asset verification programs
Tracking asset verification program savings
No later than 3 years after the date of enactment of this Act, the Secretary of Health and Human Services, acting through the Centers for Medicare & Medicaid Services, shall create a Federal tracking system of the savings in Federal expenditures on the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) that are associated with the asset verification program requirement added under section 3(a).
Reports to Congress
Beginning in the fifth year after the date of enactment of this Act, the Administrator of the Centers for Medicare & Medicaid Services shall issue biannual reports to Congress detailing the performance of State Medicaid asset verification programs during the applicable reporting period. Each such report shall include—
an overview of the savings, both pre- and post-reporting period, attributed to such programs; and
any material changes to the composition of the State Medicaid populations as a result of such programs.
GAO report to Congress on the efficacy of strengthening the fiscal integrity of the Medicaid program
No sooner than 5 years after the date of enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Finance of the Senate and the Committee on Energy and Commerce of the House of Representatives a report that assesses the efficacy of State asset verification programs that meet the requirements of section 1940 of the Social Security Act (42 U.S.C. 1396w) (as amended by section 3(a)). Such report shall include—
an overview of Medicaid enrollment before and after the implementation of the changes to the asset verification system requirements under such section 1940;
an overview of Medicaid spending before and after the implementation of such changes;
information on what is known about the number of individuals who applied for Medicaid or who applied for redetermination of Medicaid and were deemed ineligible due to their financial circumstances (income and resources) after the implementation of such changes; and
any additional recommendations for further changes to the Medicaid asset verification program requirements under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).