One-year reauthorization of transitional medical assistance : report together with additional views (to accompany H.R. 4584) (including cost estimate of the Congressional Budget Office)

12 Pages·2002·0.44 MB·English

by  United States. Congress. House. Committee on Energy and Commerce

V
I 1Sen'** 2}>O\i\0O).
1072tdhCSeosnsgironess1 HOUSEOFREPRESENTATIVES 1R0e7p-o4r6t1
ONE-YEARREAUTHORIZATIONOFTRANSITIONALMEDICAL
ASSISTANCE
May14,2002.—CommittedtotheCommitteeoftheWholeHouseontheStateof
theUnionandorderedtobeprinted
Mr.Tauzin,fromtheCommitteeonEnergyandCommerce,
submittedthefollowing
REPORT
togetherwith
ADDITIONALVIEWS
[ToaccompanyH.R.4584]
[IncludingcostestimateoftheCongressionalBudgetOffice]
TheCommitteeonEnergyandCommerce,towhomwasreferred
thebill(H.R.4584)toamendtitleXLXoftheSocialSecurityAct
toextendtheauthorizationoftransitionalmedicalassistancefor1
year,havingconsideredthesame,reportfavorablythereonwithout
amendmentandrecommendthatthebilldopass.
CONTENTS
PurposeandSummary Pag2e
BackgroundandNeedforLegislation 2
Hearings 2
CommitteeConsideration 3
CommitteeVotes 3
CommitteeOversightFindings 3
NSteawteBmuedngteotfAGuetnheorriatly,PeErnftoirtmlaenmceentGAouatlhsoraintdy,ObajnedctTiavexsExpenditures 33
CommitteeCostEstimate 3
CongressionalBudgetOfficeEstimate 3
FederalMandatesStatement 7
AdvisoryCommitteeStatement 7
ConstitutionalAuthorityStatement 7
ApplicabilitytoLegislativeBranch 7
ASCdehdcaitntigoieno-nsbayil-nVSEeixceitwsistoinnAgnLalaywsiMsaodfethbeyLtehgeisBliallt,ioansReported 889
99-006
2
PurposeandSummary
ThepurposeofH.R.4584istoreauthorizetransitionalmedical
assistanceforoneyear.
BackgroundandNeedforLegislation
—
asTrtarannssiittiioonnaallmMeeddiiccaalida—ssiwsatsanccereatwehdicthoiesnssuormeettihmaetsfroerfmeerrrewdelt-o
farerecipientshavehealthcarecoverageafterenteringthework-
force.Theseindividualstypicallyenterlow-wagejobsthatdonot
offerprivatecoverageoroffercoveragewithexpensivepremiums.
TtreanndssituipontaolameydeiacraloafsMseisdtiacnaciedwcaosvecrraegaetetdotothfeisllethiinsdivvoiidduaalnsdaenxd-
theirfamilies.
Transitionalmedicalassistance,asprovidedundersection1925
ofthe Social SecurityAct, was established in 1988, although a
morelimitedprovisiondatesbackto1972.Itwasextendedinthe
1996welfarereformlaw,thePersonalResponsibilityandWorkOp-
portunityReconciliationAct,P.L. 104-193.Familiesmovingfrom
welfaretowork,wholoseeligibilityforMedicaidduetoearnings
fromemployment,areentitledtoaninitialsixmonthsofMedicaid
coverage without regard to the amount oftheir earned income.
Thesefamiliesarealsoentitledtoanadditionalsixmonthsofcov-
ecernatgeofiftfhaemifledyeeraalrnpionvges,rtlyeslsevcehl.ilTdocarquealcoisftys,,adofanmoitlyexmcuesetdh1a8v5eperre--
ceivedMedicaidinthreeofthesixmonthsimmediatelybeforebe-
comingineligible as a result ofincreased income. Families lose
tlhoenigrerelaigidbeilpietnydfeonrttrcahnislidtiionnatlhemehdiocmael,awshsiesntatncheeywhfaeilnttohepraeyisannoy
premiums,whentheyfailtomeetquarterlyincomereportingre-
quirements,orwhenthecaretakerrecipienthasnoearnings.
Thefederalwaiverprocessallowsstatestoincreasetheduration
ofassistance,modifytheincomeeligibilitystandards,orchangethe
incomereportingrequirementstoaddresstheneedsoftheirwel-
fare population. However, budget neutrality requirements may
limittheabilityofstatestousethisprocesstopursueprogramex-
pansions or administrative simplifications. In addition, because
thereareno state reportingrequirements regardingtransitional
medicalassistance,thereisnonationwidedataastotheextentto
whicheligiblefamiliesobtainandkeepcoverage.
TransitionalmedicalassistanceissettoexpireonSeptember30,
2002.H.R.4584,introducedbyMr.Upton,Mr.HallofTexas,Mr.
Tauzin,andMr.Bilirakis,providesaone-yearreauthorizationof
transitionalmedicalassistance.
Hearings
TheSubcommitteeonHealthheldahearingon"WelfareReform:
AReviewofAbstinenceEducationandTransitionalMedicalAssist-
ance"onTuesday,April23,2002.TheSubcommitteereceivedtesti-
mony from Jacqueline Del Rosario, Executive Director, ReCap-
turingtheVisionInternational;JoeS. McllhaneyJr.,M.D.,The
MedicalInstituteforSexualHealth;DavidW.Kaplan,M.D.,Head
ofAdolescentMedicineandProfessorofPediatrics,Universityof
ColoradoSchoolofMedicine;CindyMann,J.D.,SeniorFellow,Kai-
serCommissiononMedicaidandtheUninsured;andWilliamJ.
3
Scanlon, Ph.D., Director, Health Care Issues, U.S. General Ac-
countingOffice.
CommitteeConsideration
OnWednesday,April24,2002,theFullCommitteemetinopen
markupsessionandfavorablyorderedreportedaCommitteePrint
toamendtitleXIXoftheSocialSecurityActtoextendtheauthor-
ization of transitional medical assistance for 1 year, without
amendment,byavoicevote,aquorumbeingpresent. TheCom-
mitteealsoagreedtoaunanimousconsentrequestbyChairman
Tauzinthatthe CommitteePrintwouldbeintroducedas abill,
H.R.4584,andtoallowforthisreporttobefiledonthatbill.
CommitteeVotes
Clause3(b)ofruleXIIIoftherulesoftheHouseofRepresenta-
ttoivreseproerqtuliergeissltahteioCnoamnmditatmeeendtomelinsttsthteherreectoo.rdNvootreescoorndtvhoetemsowteiroen
takeninconnectionwithorderingH.R.4584reportedtotheHouse.
A motion by Mr. Tauzin to order H.R. 4584 reported, without
amendment,totheHousewasagreedtobyavoicevote.
CommitteeOversightFindings
Pursuanttoclause3(c)(1)ofruleXIIIoftheRulesoftheHouse
ofRepresentatives,theCommitteeheldanoversighthearingand
madefindingsthatarereflectedinthisreport.
StatementofGeneralPerformanceGoalsandObjectives
TheobjectiveofH.R.4584istoextendtheauthorizationoftran-
sitionalmedicalassistanceforoneyear.
NewBudgetAuthority,EntitlementAuthority,andTax
Expenditures
Incompliancewithclause3(c)(2)ofruleXIIIoftheRulesofthe
HouseofRepresentatives,theCommitteefindsthatH.R.4584,to
atimoennodfttirtalnesXitLiXonoafltmheediSoccailalasSseicsutraintcyeAfcotrt1oyeexatre,ndwotuhledaurtehsourlitzai-n
noneworincreasedbudgetauthority,entitlementauthority,ortax
expendituresorrevenues.
CommitteeCostEstimate
TheCommitteeadoptsasitsownthecostestimatepreparedby
theDirectoroftheCongressionalBudgetOfficepursuanttosection
402oftheCongressionalBudgetActof1974.
CongressionalBudgetOfficeEstimate
Pursuanttoclause3(c)(3)ofruleXIIIoftheRulesoftheHouse
ofRepresentatives,thefollowingisthecostestimateprovidedby
the Congressional Budget Office pursuant to section 402 ofthe
CongressionalBudgetActof1974:
—
4
U.S.Congress,
CongressionalBudgetOffice,
Washington,DC,May10,2002.
Hon.W.J."Billy"Tauzin,
Chairman,CommitteeonEnergyandCommerce,
HouseofRepresentatives,Washington,DC.
DearMr.Chairman:TheCongressionalBudgetOfficehaspre-
XpaLrXedoftthheeeSnocclioasledSeccousrtiteystAicmtatteofeoxrteHn.dR.th4e58a4u,thaorbiilzlattoioanmoefntdratnistil-e
tionalmedicalassistanceforoneyear.
Ifyouwishfurtherdetailsonthisestimate,wewillbepleased
to provide them. The CBO staffcontacts are Eric Rollins and
JeanneDeSa.
Sincerely,
StevenLieberman
(ForDanL.Crippen,Director).
Enclosure.
H.R. 4584—AbilltoamendtitleXIXoftheSocialSecurityActto
extendtheauthorizationoftransitionalmedicalassistancefor
oneyear
Summary:Thisbillwouldextendbyoneyeartherequirement
tkhnaotwsntaatseMterdainsciatiidonparlogmerdaimcsalproavsisidsetuanpceto(1T2MAm)o,ntthoscoefrtelaiignibiMleitdy-,
icaidbeneficiaries (usuallyformerwelfare recipients)whowould
otherwisebe ineligiblebecause theyhavereturnedtowork and
haveincreasedearnings.Undercurrentlaw,therequirementwill
expCiBreOoenstSiempatteemsbtehrat30H,.2R0.024.584wouldincreasedirectspendingby
$355millionoverthe2003-2007period.Withinthattotal,CBOan-
ticipatesthatfederalMedicaidspendingwouldriseby$365million
andthatfederalspendingintheStateChildren'sHealthInsurance
Pworuolgdramaff(eScCtHIdPi)recwtouslpdenddeicnlgi,nepbayy-$a1s0-ymoiul-lgioon.prBoecceaduusreesthiwsoubilldl
apply.
Thisbilldoesnotcontainanyintergovernmentalorprivate-sec-
tormandatesasdefinedintheUnfundedMandatesReformAct
(UMRA). Thebill'sone-yearextensionoftransitionalmedicalas-
sistancewouldresultinadditionalstatespendingof$265million
overthe2003-2007period.
EstimatedcosttotheFederalGovernment:Theestimatedbudg-
etaryimpactofH.R.4584isshowninthefollowingtable.Thecosts
ofthislegislationfallwithinbudgetfunction550(health).
Byfiscalyear,Inmillionsofdollars
2003 2004 2005 2006 2007
CHANGESINDIRECTSPENDING
Medicaid:
EstimatedBudgetAuthority 130 200 25 10 0
EstimatedOutlays 130 200 25 10 0
SCHIP:
EEssttiimmaatteeddOBuutdlgaeytsAuthority -50 -100 50 00 00
TotalcostofH.R.4584:
EstimatedBudgetAuthority 130 200 25 10 0
—
5
Bfiscalyear,inmillionsofdollars
2003 2004 2005 2006 2007
EstimatedOutlays 125 190 30 10 0
Note.—SCHIPistheStateChildren'sHealthInsuranceProgram.
Basisofestimate
Medicaid
StateMedicaidprogramsarerequiredbysection1931oftheSo-
cialSecurityActtocoverindividualswhomeettheeligibilityre-
quirementsforthestate'sAidtoFamilieswithDependentChildren
(AFDC)programthatwereineffectonJuly16, 1996.AFDChas
sincebeenreplacedbytheTemporaryAssistanceforNeedyFami-
lies(TANF)program.Statesthatwishtoexpandeligibilitybeyond
thisminimumrequirementmaydosobydisregardingaportionof
baentawpepelnicManetd'iscaiindcoamnedaTndANaFsseetlsi.giAbilltihtyo,ugmhantyhersetaitsesnohafvoermaalliglniendk
thetwoprograms'eligibilitystandards.Asaresult,mostofthein-
dividualswhoreceiveMedicaidundersection1931arewelfarere-
cipients.
Undercurrentlaw, statesarerequiredtotemporarilycontinue
Medicaidcoverage forcertain individuals (andtheirdependents)
whose earnings increase above the state's eligibilitylevels. This
transitional medical assistance is available for individuals who
havereceivedMedicaidundersection1931foratleastthreeofthe
pcraeuvsieoutsheisirxemaornnitnhgssahnadvewoiunlcrdeaostehde.rwTiMseAlorseecitphieeinrtselairgeibigluitayrabne--
teedtoremaineligibleforMedicaidforsixmonths;afterthat,they
mayremaineligibleforanothersixmonthsiftheyreporttheirin-
comeonaperiodicbasisandhaveincomesbelow185percentofthe
povertylevel.Somestateshaveoptedtosoftenthethree-out-of-six
rteerqmuiinrienmgenetli(gbiybildiitsyr)egoarrdpirnogvisdoemTeMofAafroercilpoinegnte'rspienrcioomdsew(hunednerdea-
waiTvheer).requirementforstatestoprovideTMAcurrentlyappliesto
individualswho losetheireligibilityundersection 1931priorto
tSherpotuegmhbeSrep3t0e,mb2e0r02.30,H.2R0.03.45C8B4Owoeusltidmaetxetsentdhatthtehisrebqiullirweomuelndt
increasefederalMedicaidspendingby$130millionin2003anda
totalof$365millionoverthe2003-2007period.
Number ofBeneficiaries. Many families move on and offthe
MceudmisctaaindcesancdhanTgAeN.FUnrdoelrlscuarsretnhteilrawf,aCmiBlOyaanntdiciepmaptelsoytmhaetntabociurt-
1.4millionfamiliesenrolledundersection1931willlosetheirMed-
iccaasiedcelloigsiubrielsi,tyCiBnO200p3r.ojeBcatssedthaintpsalrigthtolnyemxoprereietnhcaenwiotnhewmeillflairoen
familieswillleavetheTANFrollsin2003.Asnotedearlier,many
ofthosefamilieswillalsolosetheirMedicaideligibility. There-
mainingfamilieswillbeMedicaidrecipientswhowerenotenrolled
inBTaAsNeFd.onresearchonfamiliesleavingwelfare,CBOanticipates
thatabout500,000familieswouldmeetthebasicrequirementsfor
TMAin2003.RecentTANFdataonthenumberofrecipientsin
each family suggest that there are about 500,000 adults and
—
6
9ce0i0v,e00T0ANchFiladnrednhianvethaonseadfualmtilrieecsi.pi(eVnitrtauraellsyinagllle-fpaamrielinetsfatmhialtiesr.e)-
ofFTrMoAmwthoiusldeleignirbollelpaonpualdadtiitoino,naClB3O00,e0s0t0imaadtuelststhaantdt3h6e0,e0xt0e0ncshiioln-
dren in Medicaid. Those estimates account for individuals who
would remain enrolled in Medicaid under other eligibility cat-
egoriesafterlosingtheirsection1931eligibility(andthusnotre-
ceiveTMA).Basedonstudiesoffamiliesleavingwelfare,CBOalso
assumed only moderate participation in TMA. As noted earlier,
manychildreninfamiliesthatlosetheirsection1931eligibilityre-
maineligibleforMedicaidunderothereligibilityrules.However,
studies suggestthatmanychildren dropofftherollsoncetheir
parentsloseeligibility.ByextendingTMA,thebillwouldtherefore
keepsomeofthosechildrenenrolledinMedicaid.
CBO anticipates that the bill's effect on Medicaid enrollment
wouldbemuchsmallerwhenmeasuredonafull-yearequivalent
bbialsiitsy.wUonudledrreccuerirveenftoulrawm,onfatmhislioefselliogsiibniglittyh—eiervseenctwiiotnho1u9t31TMelAigi-
underaseparateprovisionofMedicaidlaw.Thebillwouldthere-
fionrsetepardovoifd1e2.mEosvtenfatmhielni,esrewsietahrcahnoonthTerMAeigrhetcimpioenntthssinodficealtiegisbitlhiatty
manypeopledonotremaineligibleforafull 12monthsbecause
thAefytfearilatcocoruenptoirntgthfeoirrtihnesceomfeasctoorns,aCpeBrOiodeisctibmaasitse.sthatH.R.4584
wouldincreaseMedicaidenrollmentonafull-year-equivalentbasis
byabout115,000in2003, 160,000in2004,andsmalleramounts
icnau2s0e0f5amainldies20w0h6.oTquhaelibfiyllf'sorefTfMecAtsawtoaunlydpeoxitnetndinbtehyaotnydea2r00w3oubled-
beentitledtoasmanyas12monthsofadditionaleligibility,even
isftattheastthpaetripordovoifdeelimgoirbielittyharnun1s2mboeynotnhdso2f00T3.MA(Ftahmriloiuegshlaivwianigveirn
couPledrrCeampaiitnaeCloisgtisb.leCiBntOo2e0s0t5imoarte2s00t6h.a)tthefederalshareofcosts
in2003perfull-yearequivalentwouldbeabout$1,350foranadult
and$975forachild.ThosefiguresarelowerthanCBO'sbaseline
figuresforadultsandchildren(byabout30percentand10percent,
respectively)becauseofanumberofadjustments.First,CBOex-
cluded pregnancy-related costs for adults. Pregnant women are
typicallyeligibleforMedicaidatmuchhigherincomelevelsthan
uTonnMdd,AerCwsBoeuOcltidaosnbse1u9sm3oe1md,estwohhaatthteayhdeuwalolttushlidaenrbdethcuhaninllidokrteelhnyeritnoMerfdeaicmeciialviieedsTrMreecAci.epiiSevenictn-sg
asnodmethTuMsAharveecilpoiweentrscowsotus,ldonreacveeirvaegea.mFoirnaelllyi,miCtBedOsaetssoufmbeednetfhiatts
tvihdaennMoend-iaccauitdeucsauraellseyrvpircoevsidteosTbMecAaurseecisptiaetnetssdinotnhoetirhasveecotnodpsriox--
monthperiodofeligibility.
StateChildren'sHealthInsuranceProgram
CBOanticipatesthatundercurrentlawabout10percentofthe
familiesleavingwelfarein2003becauseofhigherearningswould
have incomes high enoughto make their children ineligible for
Medicaid,andthatsomeofthechildreninthesefamilieswoulden-
roll inSCHIPinstead. By extendingTMA, thebillwouldmake
thosechildreneligibleforMedicaid.Sincechildrenwhoareeligible
—
7
forMedicaidcannotreceiveSCHIP,thebillwouldleadtosavings
inSCHIP.
CBOestimatesthatthebillwouldreducefederalSCHIPoutlays
by$5millionin2003and$10millionin2004.Sincestatesgen-
erallyhavethreeyearstospendtheirSCHIPallotments,thosesav-
ingswouldfreeupfundsthatcouldbespentonbenefitsinlater
years,andCBOestimatesthatspendingwouldincreaseby$5mil-
lionin2005.
Pay-as-you-go considerations: The BalancedBudgetandEmer-
gencyDeficitControlActsetsuppay-as-you-goproceduresforleg-
islationaffectingdirectspendingorreceipts.Thenetchanges in
outlaysthataresubjecttopay-as-you-goproceduresareshownin
the followingtable. Forthe purposes ofenforcing pay-as-you-go
procedures,onlytheeffectsthroughfiscalyear2006arecounted.
Byfiscalyear,inmillionsofdollars
2002 2003 22C4 200: 20C; 2007 20CS 2CC2 2010 2011 2012
Changesinoutlays 0 125 190 30 10 0 0 5 0 0 0
Changesinreceipts Notapplicable
Intergovernmentalandprivate-sectionimpact:Thisbilldoesnot
containanyintergovernmentalorprivate-sectormandatesasde-
finedinUMRA.Thebill'sone-yearextensionoftransitionalmed-
icalassistancewouldresultinadditionalstatespendingof$265
millionoverthe2003-2007period.
Estimatepreparedby:FederalCosts:EricRollinsandJeanneDe
Sa;ImpactonState,Local,orTribalGovernments:LeoLex;and
ImpactonthePrivateSector:AmyFedigan.
Estimateapprovedby:PeterH.Fontaine,DeputyAssistantDi-
rectorforBudgetAnalysis.
FederalMandatesStatement
TheCommitteeadoptsasitsowntheestimateofFederalman-
datespreparedbytheDirectoroftheCongressionalBudgetOffice
pursuanttosection423oftheUnfundedMandatesReformAct.
AdvisoryCommitteeStatement
Noadvisorycommitteeswithinthemeaningofsection5(b)ofthe
FederalAdvisoryCommitteeActwerecreatedbythislegislation.
ConstitutionalAuthorityStatement
Pursuanttoclause3(d)(1)ofruleXIIIoftheRulesoftheHouse
ofRepresentatives,theCommitteefindsthattheConstitutionalau-
thorityforthislegislationisprovidedinArticleI,section8,clause
3,whichgrantsCongressthepowertoregulatecommercewithfor-
eignnations,amongtheseveralStates,andwiththeIndiantribes.
ApplicabilitytoLegislativeBranch
TheCommitteefindsthatthelegislationdoesnotrelatetothe
termsandconditionsofemploymentoraccesstopublicservicesor
accommodationswithinthemeaningofsection102(b)(3)oftheCon-
gressionalAccountabilityAct.
8
Section-by-SectionAnalysisoftheLegislation
Section 1. One-yearreauthorizationoftransitionalmedicalassist-
ance
Undercurrentlaw,transitionalmedicalassistancesunsetsafter
September30,2002.
Thissectionreauthorizestransitionalmedicalassistanceforan
additionalyear,extendingthesunsetdatetoSeptember30,2003.
ChangesinExistingLawMadebytheBill,asReported
Incompliancewithclause3(e)ofruleXIIIoftheRulesofthe
HouseofRepresentatives,changesinexistinglawmadebythebill,
asreported,areshownasfollows(existinglawproposedtobeomit-
teexidstiisneg*nlclaowseidn*iwnhibclhac*nkobrcahcak*negtse,isnep*wrompaotsetde*risissphro*iwnntedinirnoimtaanli)c:,
SOCIALSECURITYACT
*******
TITLEXIX—GRANTSTOSTATESFORMEDICALASSISTANCE
PROGRAMS
*****
STATEPLANSFORMEDICALASSISTANCE
Sec.1902.(a) * * *
* *
(e)(1)(A) * * *
tha(tB)ceSausbepatorabgerealpihgib(lAe)fosrhaalildnuontdearppplayrtwiAthofrteistlpeecItVtdourfianmgiltihees
periodbeginningonApril 1, 1990,andendingonSeptember30,
[2002]2003.Duringsuchperiod,forprovisionsrelatingtoexten-
hsiaovneorfeceeliivgiebdilaiitdypfourrsmueadnitcatloaasSstiastteanpcleanforapcperrotvaeidnufnamdielriepsarwthAo
oftitleIVandhaveearnedincome,seesection1925.
*******
EXTENSIONOFELIGIBILITYFORMEDICALASSISTANCE
Sec.1925.(a) * * *
—
tha(ft)cSeuansseett.obeTheilsigsibelcetifoonrsahiadllunnodterapppalrytwAitohfrteitslpeecDt7taoftfearmiSleipe-s
tember30,[2002]2003.
ADDITIONALVIEWS
Wesupportthislegislation,whichextendsthesunsetoftransi-
tionalmedicalassistance(TMA)foranadditionalyear.Ourstrong
preference,however,isthatCongresseliminatethesunsetentirely,
makingtheprogrammoredependableforthebeneficiarieswhode-
pCeonmdmiotnteietsahnodultdhehasvteatreesautthhaotriazdemdinTisMtAerfoirt.fAivteyaeamrisn,icmounsmi,sttehnet
withthereauthorizationofTemporaryAssistanceforNeedyFami-
lieAsdd(iTtAiNoFn)al.ly, eventhoughTMAisavitalroutetocoveragefor
pmairsesntosutloenavTinMgAweclofvaerreagfeo.rAwcocrokr,diangsitgonitfhiecalnattensutmUbrebranofInpsatrietnuttse
data, two-thirds ofparents lose Medicaid after leaving welfare,
esuvgegnestthionugghthatthesivmapsltifmiacajtoirointsytaoreTMliAkelayretonebeedeeldigtioblaessfourreTMthAa,t
eligiblefamiliessecurethecoverage.Inparticular,therearefour
administrativesimplificationsthatwewishtoseeenacted:
for(1T)MAA:waFiavmeirlioefsrecpaonrtbiengelriegqiublierefmoerntTsMAforfoframuilpietsow1h2omoqunatlhisf;y
however, theymustmeet prescriptivereporting requirements to
keeptheireligibility.ToreceivethefirstsixmonthsofTMA,fami-
liesmustnotifythestateoftheiremploymentandincomestatus
(eventhoughthereisnoincomeeligibilitylimitduringthisperiod).
Theythenmustreportincometothestatebythe21stdayofthe
4th month. In order to maintain eligibility for the second six
months,thefamilymustreportagaintotheredeterminationoffice
aftersixmonthseveniftheirincomehasnotchanged.Inthesec-
boyndthseix21msotndtahysoofftTheMAfi,rstfaamnildiefsoumrtuhstmornetpho.rtAitnrciopmteottohethreedestteart-e
minationofficecanentailanentiredayofffromwork,andifall
paperwork is not correct, the family must make another trip.
Often,adayofffromworkmeansadayofnopay.Ifthefamily
todfhoae(p2tso)vnaTelorhrtteeysa.ehdlyoIifwpmsriutonapvatiteaidssoenarhleoerqfa"euliaTtrdMheydAi,mnecsreouetvrqeauTrniacMrgeeAemteiornsetftqsaeumrifimolririenemtasehtneaettdss.ourtbshaerbtoouovgfehs1ttah8te5ei%sr
regularMedicaidprogram,compliancewithadministrativerulesof
TonM(3AM)eAidsiucstnaanitedecefoosprstaitrohnyreateondwoafdiutvphleiecrapetrqieuvveii.roeumsenstixthmaotnftahmsiliteosqhuaavliefybefeonr
TMA: Currently, inordertobeeligibleforTMA, afamilymust
havehadMedicaidcoverageforthreeoftheprevioussixmonths.
Thisrequirementexcludesfamilieswho,foronereasonoranother,
decidednottoseekmedicalassistanceevenwhentheywereeligi-
berlte(y4:f)oCrAuirt.srteanttelyo,pttihoenitnocoemxepalnimditTfMorATcMoAverisag1e85ab%oovfepo1v8e5rt%y.ofSpoomve-
(9)
10
gstraatemss,thoowiendvievri,duwaolsuladbolvieketthhaetionptcioomnetloeveelxpiannodrdtehreitroTmMakAeptrhoe-
transitionfromwelfaretoworkrewarding.
Whilestatescouldpotentiallyusesection1115oftheSocialSe-
curityActtowaivetheseadministrativerequirements,budgetneu-
tralitymakesthisanunattractiveoptionforstates,becausethey
wasoublednebfeitsforocredelitgoibrileidtuyc.eWperohgarvaemlsopnegndsiunpgpoirnteodtheenracatreiansg,tshuecshe
simplifications,andtwoofthefourwereincludedinH.R.5291,the
"BeneficiaryImprovementandProtectionActof2000,"reportedby
theCommitteeinOctoberof2000.
theIniasdsduietioofn,hewaeltwhouilnsdurlaiknecetocsoeveertahgeeCfoormmpirtetgeneanttakweoamcetinonanodn
childreninMedicaidandtheChildren'sHealthInsuranceProgram
whoarelegalimmigrants.Untilthepassageofthe 1996welfare
reformlaw,legalimmigrantsweregenerallyeligibleforpublicben-
efitsonthesamebasisascitizens.Thewelfarelaweliminatedthe
abilityofmostlegalimmigrantstoreceiveanyfederalbenefits,be-
cause it conditioned eligibility on citizenship status ratherthan
legalstatus,extendingtomostlegalimmigrantstheeligibilityre-
strictionsthathadtraditionallyappliedonlytoundocumentedim-
migrants.Sincepassageofwelfarereform,Congresshasactedin
someinstancestoreinstateeligibilityforpublicbenefits.In1997,
CongressrestoredSupplementalSecurityIncome(SSI)tomostim-
migrantswhowerealreadyintheUnitedStateswhenthewelfare
liamwmiwgarsanetnacchtieldd,reannadnidnf1o9r9e8l,deirtlryesatnodreddisfaoboldedstpaemrpsoenlsigwibhiloitwyefroer
herebeforeAugustof1996.
Asaresult,theeligibilityoflegalimmigrantsforpublicbenefits
variesamongfederalprogramsanddependsonavarietyoffactors,
includingdateofentrytotheUnitedStates,typeofimmigration
status,workhistory,age,andstateofresidence.Welfarereauthor-
izationprovidesanopportunitytoreconsidertherestrictionsand
other immigrant provisions in the welfare law in a more com-
prehensivemannerthanhasbeenundertakentodate.Therefore,
wleegableilimemviegritanwtosulwdhehnavtehebeTeAnNaFppwraosprrieaatuethtooriazdeddr.esstheissueof