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us/statute/42/1396u–3 — State coverage of medicare cost-sharing for additional low-income medicare beneficiaries · Axiom

(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 1396a(a)(10)(E) of this title ) 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.

(b)(1)All qualifying individuals may apply#

The State shall permit all qualifying individuals to apply for assistance during a calendar year.

(b)(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 1396a(a)(10)(E) of this title ) in the last month of the previous year and who continue to be (or become) qualifying individuals.

(b)(2)(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)(2)(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 1396a(a)(10)(E) of this title ) in the last month of the previous year and who continue to be (or become) qualifying individuals.

(b)(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.

(b)(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 1396a(a)(10)(E)(iv) of this title in the State; to (B) the sum of the amounts computed under subparagraph (A) for all eligible States.

(c)(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;

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

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

(c)(1)(A)#

fiscal year 1998 is $200,000,000;

(c)(1)(B)#

fiscal year 1999 is $250,000,000;

(c)(1)(C)#

fiscal year 2000 is $300,000,000;

(c)(1)(D)#

fiscal year 2001 is $350,000,000; and

(c)(1)(E)#

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

(c)(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 1396a(a)(10)(E)(iv) of this title in the State; to

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

(c)(2)(A)#

an amount equal to the total number of individuals described in section 1396a(a)(10)(E)(iv) of this title in the State; to

(c)(2)(B)#

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

(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, 2008 , and ends on September 30, 2008 , the total allocation amount is $315,000,000; (B) for the period that begins on October 1, 2008 , and ends on December 31, 2008 , the total allocation amount is $130,000,000; (C) for the period that begins on January 1, 2009 , and ends on September 30, 2009 , the total allocation amount is $350,000,000; (D) for the period that begins on October 1, 2009 , and ends on December 31, 2009 , the total allocation amount is $150,000,000; (E) for the period that begins on January 1, 2010 , and ends on September 30, 2010 , the total allocation amount is $462,500,000; (F) for the period that begins on October 1, 2010 , and ends on December 31, 2010 , the total allocation amount is $165,000,000; (G) for the period that begins on January 1, 2011 , and ends on September 30, 2011 , the total allocation amount is $720,000,000; (H) for the period that begins on October 1, 2011 , and ends on December 31, 2011 , the total allocation amount is $280,000,000; (I) for the period that begins on January 1, 2012 , and ends on September 30, 2012 , the total allocation amount is $450,000,000; (J) for the period that begins on October 1, 2012 , and ends on December 31, 2012 , the total allocation amount is $280,000,000; (K) for the period that begins on January 1, 2013 , and ends on September 30, 2013 , the total allocation amount is $485,000,000; (L) for the period that begins on October 1, 2013 , and ends on December 31, 2013 , the total allocation amount is $300,000,000; (M) for the period that begins on January 1, 2014 , and ends on September 30, 2014 , the total allocation amount is $485,000,000; (N) for the period that begins on October 1, 2014 , and ends on December 31, 2014 , the total allocation amount is $300,000,000; (O) for the period that begins on January 1, 2015 , and ends on March 31, 2015 , the total allocation amount is $250,000,000; (P) for the period that begins on April 1, 2015 , and ends on December 31, 2015 , the total allocation amount is $535,000,000; and (Q) for 2016 and, subject to paragraph (4), for each subsequent year, the total allocation amount is $980,000,000.

(3) Rules for periods that begin after January 1 For any specific period described in subparagraph (B), (D), (F), (H), (J), (L), (N), or (P) 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.

(4) Adjustment to allocations The Secretary may increase the allocation amount under paragraph (2)(Q) for a year (beginning with 2017) up to an amount that does not exceed the product of the following: (A) Maximum allocation amount for previous year In the case of 2017, the allocation amount for 2016, or in the case of a subsequent year, the maximum allocation amount allowed under this paragraph for the previous year. (B) Increase in part B premium The monthly premium rate determined under section 1395r of this title for the year divided by the monthly premium rate determined under such section for the previous year. (C) Increase in part B enrollment The average number of individuals (as estimated by the Chief Actuary of the Centers for Medicare & Medicaid Services in September of the previous year) to be enrolled under part B of subchapter XVIII for months in the year divided by the average number of such individuals (as so estimated) under this subparagraph with respect to enrollments in months in the previous year.

(g)(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.

(g)(1)(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

(g)(1)(B)#

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

(g)(2)Periods and total allocation amounts described#

For purposes of this subsection—

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

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

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

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

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

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

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

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

(I) for the period that begins on January 1, 2012 , and ends on September 30, 2012 , the total allocation amount is $450,000,000;

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

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

(L) for the period that begins on October 1, 2013 , and ends on December 31, 2013 , the total allocation amount is $300,000,000;

(M) for the period that begins on January 1, 2014 , and ends on September 30, 2014 , the total allocation amount is $485,000,000;

(N) for the period that begins on October 1, 2014 , and ends on December 31, 2014 , the total allocation amount is $300,000,000;

(O) for the period that begins on January 1, 2015 , and ends on March 31, 2015 , the total allocation amount is $250,000,000;

(P) for the period that begins on April 1, 2015 , and ends on December 31, 2015 , the total allocation amount is $535,000,000; and

(Q) for 2016 and, subject to paragraph (4), for each subsequent year, the total allocation amount is $980,000,000.

(g)(2)(A)#

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

(g)(2)(B)#

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

(g)(2)(C)#

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

(g)(2)(D)#

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

(g)(2)(E)#

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

(g)(2)(F)#

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

(g)(2)(G)#

for the period that begins on January 1, 2011 , and ends on September 30, 2011 , the total allocation amount is $720,000,000;

(g)(2)(H)#

for the period that begins on October 1, 2011 , and ends on December 31, 2011 , the total allocation amount is $280,000,000;

(g)(2)(I)#

for the period that begins on January 1, 2012 , and ends on September 30, 2012 , the total allocation amount is $450,000,000;

(g)(2)(J)#

for the period that begins on October 1, 2012 , and ends on December 31, 2012 , the total allocation amount is $280,000,000;

(g)(2)(K)#

for the period that begins on January 1, 2013 , and ends on September 30, 2013 , the total allocation amount is $485,000,000;

(g)(2)(L)#

for the period that begins on October 1, 2013 , and ends on December 31, 2013 , the total allocation amount is $300,000,000;

(g)(2)(M)#

for the period that begins on January 1, 2014 , and ends on September 30, 2014 , the total allocation amount is $485,000,000;

(g)(2)(N)#

for the period that begins on October 1, 2014 , and ends on December 31, 2014 , the total allocation amount is $300,000,000;

(g)(2)(O)#

for the period that begins on January 1, 2015 , and ends on March 31, 2015 , the total allocation amount is $250,000,000;

(g)(2)(P)#

for the period that begins on April 1, 2015 , and ends on December 31, 2015 , the total allocation amount is $535,000,000; and

(g)(2)(Q)#

for 2016 and, subject to paragraph (4), for each subsequent year, the total allocation amount is $980,000,000.

(g)(3)Rules for periods that begin after January 1#

For any specific period described in subparagraph (B), (D), (F), (H), (J), (L), (N), or (P) 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.

(g)(3)(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).

(g)(3)(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.

(g)(3)(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.

(g)(4)Adjustment to allocations#

The Secretary may increase the allocation amount under paragraph (2)(Q) for a year (beginning with 2017) up to an amount that does not exceed the product of the following:

(A) Maximum allocation amount for previous year In the case of 2017, the allocation amount for 2016, or in the case of a subsequent year, the maximum allocation amount allowed under this paragraph for the previous year.

(B) Increase in part B premium The monthly premium rate determined under section 1395r of this title for the year divided by the monthly premium rate determined under such section for the previous year.

(C) Increase in part B enrollment The average number of individuals (as estimated by the Chief Actuary of the Centers for Medicare & Medicaid Services in September of the previous year) to be enrolled under part B of subchapter XVIII for months in the year divided by the average number of such individuals (as so estimated) under this subparagraph with respect to enrollments in months in the previous year.

(g)(4)(A)Maximum allocation amount for previous year#

In the case of 2017, the allocation amount for 2016, or in the case of a subsequent year, the maximum allocation amount allowed under this paragraph for the previous year.

(g)(4)(B)Increase in part B premium#

The monthly premium rate determined under section 1395r of this title for the year divided by the monthly premium rate determined under such section for the previous year.

(g)(4)(C)Increase in part B enrollment#

The average number of individuals (as estimated by the Chief Actuary of the Centers for Medicare & Medicaid Services in September of the previous year) to be enrolled under part B of subchapter XVIII for months in the year divided by the average number of such individuals (as so estimated) under this subparagraph with respect to enrollments in months in the previous year.

(a)In general#