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NSCLC Washington Weekly News Alert
News alert: House Introduces S-CHIP Legislation; Bill Would Improve Medicare Part D, Medicaid Spousal Impoverishment Protections
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<P><FONT FACE="Palatino Linotype, serif"><FONT SIZE=6><B><SPAN STYLE="background: transparent"><FONT COLOR="#000000">NSCLC
Washington </FONT>Weekly <BR>News Alert<BR><FONT SIZE=4>July
27, 2007</FONT></SPAN></B></FONT></FONT></P>
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<P STYLE="margin-top: 0.17in"><FONT FACE="Verdana, sans-serif"><FONT SIZE=5 STYLE="font-size: 20pt">HOUSE
INTRODUCES S-CHIP LEGISLATION</FONT></FONT></P>
<P><FONT FACE="Verdana, sans-serif"><FONT SIZE=4>Bill Would
Improve Medicare Part D, Medicaid Spousal Impoverishment
Protections</FONT></FONT></P>
<P STYLE="margin-bottom: 0in"><FONT FACE="Verdana, sans-serif">House
Democrats introduced this week the Children’s Health and
Medicare Protection Act (the CHAMP Act, H.R. 3121), a bill
primarily designed to continue funding for the State
Children’s Health Insurance Program (S-CHIP, or “CHIP”),
which is set to expire later this year. As the name of the
bill implies, however, there are significant Medicare
provisions contained in the bill, and there is also a
provision in the bill which will expand Medicaid spousal
impoverishment protections.</FONT></P>
<P STYLE="margin-bottom: 0in"><FONT FACE="Verdana, sans-serif"><FONT SIZE=4><B>In
a Nutshell . . . </B></FONT></FONT>
</P>
<P STYLE="margin-bottom: 0in"><FONT FACE="Verdana, sans-serif"><FONT SIZE=3>The
bill commits $50 billion for the reauthorization of the CHIP
program, a federal/state program which currently provides
coverage for six million children. An increase in the federal
tobacco tax and cuts in payments to Medicare managed care
plans will pay for the program’s extension. The bill is
currently being marked up by House committees, and a vote on
the bill is anticipated next week. The pending Senate CHIP
legislation contains only $35 billion in spending, which means
that the two chambers will have significant work to do in
reconciliation when and if each passes its own bill. President
Bush and other administration officials have suggested that a
veto of Congress’ CHIP legislation is a distinct
possibility, although influential Republicans in the Senate
have been very critical of these threats. </FONT></FONT>
</P>
<P STYLE="margin-bottom: 0in"><FONT FACE="Verdana, sans-serif"><FONT SIZE=4><B>Improving
Medicaid’s Spousal Impoverishment Protections</B></FONT></FONT></P>
<P STYLE="margin-bottom: 0in"><FONT FACE="Verdana, sans-serif"><FONT SIZE=3>Putting
this aside, the House’s pending bill has some very
important Medicaid and Medicare provisions. To begin with, the
bill contains an amendment to Medicaid’s spousal
impoverishment statute that targets CMS’ very narrow
reading of the scope of the current law. This issue surfaced
last year when New York was informed by CMS that the agency
would not approve a home and community-based care (HCBS)
waiver submitted by the state because the waiver would extend
spousal impoverishment protections to the community spouses of
medically needy enrollees. The agency argued that the
definition of an “institutionalized spouse”
contained in the spousal impoverishment statute, 42 U.S.C.
§1396r-5(h)(1), limited the HCBS population that could be
included in the definition to those whose income is below the
state’s institutional threshold (those who “would
be eligible if in an institution”). See <I>NSCLC
Washington Weekly</I>, December 1, 2006. The agency opined
that individuals meeting a spenddown in the community would
not necessarily meet a spenddown in an institution. </FONT></FONT>
</P>
<P STYLE="margin-bottom: 0in"><FONT FACE="Verdana, sans-serif">Section
804 of the CHAMP Act expands the definition of an
“institutionalized spouse” in 42 U.S.C.
§1396r-5(h)(1) to include (at a state’s option)
<I>anyone</I> being provided Medicaid coverage for HCBS. The
current language of this provision refers specifically to that
portion of the HCBS population contained in 42 U.S.C.
§1396a(a)(10)(A)(ii)(VI), an optional categorically needy
population. The specific reference to this provision is
dropped from 42 U.S.C. §1396r-5(h)(1), and replaced with
the broad reference to the entire HCBS population. For more
information, please contact </FONT><A HREF="mailto:gcoffey@nsclc.org"><FONT FACE="Verdana, sans-serif">Gene
Coffey</FONT></A> <FONT FACE="Verdana, sans-serif">in NSCLC’s
D.C. office. </FONT>
</P>
<P STYLE="margin-bottom: 0in"><FONT FACE="Verdana, sans-serif"><FONT SIZE=4><B>Improving
Medicare</B></FONT></FONT></P>
<P STYLE="margin-bottom: 0in"><FONT FACE="Verdana, sans-serif"><FONT SIZE=3>The
CHAMP Act also includes significant sections related to
Medicare Part D and other aspects of the Medicare program.
Proposed improvements to Medicare Part D include loosening the
asset limits and simplifying application procedures for the
Low-Income Subsidy (LIS); providing an “intelligent”
auto-assignment procedure; setting an annual cap on
out-of-pocket expenditures by LIS recipients; eliminating cost
sharing for dual eligibles receiving services through HCBS
waivers; and making a variety of other beneficiary-friendly
changes to Part D, many of which are aimed at low-income
beneficiaries.</FONT></FONT></P>
<P STYLE="margin-bottom: 0in"><FONT FACE="Verdana, sans-serif"><FONT SIZE=3>The
Act also promotes the provision of linguistically and
culturally appropriate services to Limited English Proficient
Medicare beneficiaries by requiring several studies about the
current effectiveness of service delivery to LEP populations
and authorizing a demonstration project to test various
payment methods for LEP services. The bill would also increase
the availability of Medicare-covered preventative services,
equalize Medicare Advantage plan payments with payments for
traditional fee-for-service Medicare and give States authority
to regulate the agents and brokers who have been fraudulently
marketing Medicare health plans.</FONT></FONT></P>
<P STYLE="margin-bottom: 0in"><FONT FACE="Verdana, sans-serif"><FONT SIZE=3>The
bill would also make significant changes to the Medicare
Savings Programs (MSPs), which help many low-income Medicare
beneficiaries with health care costs. The bill would make the
Qualified Individual program permanent, raise the income limit
for the QI program to 150% of the federal poverty level, and
increase the asset limit for all MSPs.</FONT></FONT></P>
<P STYLE="margin-bottom: 0in"><FONT FACE="Verdana, sans-serif">There
are several other bills that specifically relate to low-income
Medicare Part D beneficiaries currently pending in Congress.
For a more detailed description of these bills visit the </FONT><A HREF="http://www.nsclc.org/areas/medicare-part-d/area_folder.2006-09-28.5758698482/area_folder.2007-05-21.0796643774"><FONT FACE="Verdana, sans-serif">NSCLC
website</FONT></A><FONT FACE="Verdana, sans-serif">. </FONT>
</P>
<P><FONT FACE="Verdana, sans-serif"><FONT SIZE=3>Advocates
expect that the CHAMP Act will be the major legislative
vehicle for Part D changes and that some provisions of other
bills may be folded into that legislation. </FONT></FONT>
</P>
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