42 USC 1320b-14 - Outreach efforts to increase awareness of the availability of medicare cost-sharing and subsidies for low-income individuals under subchapter XVIII

U.S Code last checked for updates: Apr 03, 2025

§ 1320b–14.

Outreach efforts to increase awareness of the availability of medicare cost-sharing and subsidies for low-income individuals under subchapter XVIII

(a)

Outreach

(1)

In general

The Commissioner of Social Security (in this section referred to as the “Commissioner”) shall conduct outreach efforts to—

(A)

identify individuals entitled to benefits under the medicare program under subchapter XVIII who may be eligible for medical assistance for payment of the cost of medicare cost-sharing under the medicaid program pursuant to sections 1396a(a)(10)(E) and 1396u–3 of this title 1

 So in original. Probably should be followed by a comma.

for the transitional assistance under

, or for premium and cost-sharing subsidies under

(B)

notify such individuals of the availability of such medical assistance, program, and subsidies under such sections.

(2)

Content of notice

Any notice furnished under paragraph (1) shall state that eligibility for medicare cost-sharing assistance, the transitional assistance under section 1395w–141(f) of this title, or premium and cost-sharing subsidies under section 1395w–114 of this title under such sections is conditioned upon—

(A)

the individual providing to the State information about income and resources (in the case of an individual residing in a State that imposes an assets test for eligibility for medicare cost-sharing under the medicaid program); and

(B)

meeting the applicable eligibility criteria.

(b)

Coordination with States

(1)

In general

In conducting the outreach efforts under this section, the Commissioner shall—

(A)

furnish the agency of each State responsible for the administration of the medicaid program and any other appropriate State agency with information consisting of the name and address of individuals residing in the State that the Commissioner determines may be eligible for medical assistance for payment of the cost of medicare cost-sharing under the medicaid program pursuant to sections 1396a(a)(10)(E) and 1396u–3 of this title, for transitional assistance under section 1395w–141(f) of this title, or for premium and cost-sharing subsidies for low-income individuals under section 1395w–114 of this title; and

(B)

update any such information not less frequently than once per year.

(2)

Information in periodic updates

(c)

Assistance with Medicare Savings Program and low-income subsidy program applications

(1)

Distribution of applications and information to individuals who are potentially eligible for low-income subsidy program

For each individual who submits an application for low-income subsidies under section 1395w–114 of this title, requests an application for such subsidies, or is otherwise identified as an individual who is potentially eligible for such subsidies, the Commissioner shall do the following:

(A)

Provide information describing the low-income subsidy program under section 1395w–114 of this title and the Medicare Savings Program (as defined in paragraph (7)).

(B)

Provide an application for enrollment under such low-income subsidy program (if not already received by the Commissioner).

(C)

In accordance with paragraph (3), transmit data from such an application for purposes of initiating an application for benefits under the Medicare Savings Program.

(D)

Provide information on how the individual may obtain assistance in completing such application and an application under the Medicare Savings Program, including information on how the individual may contact the State health insurance assistance program (SHIP).

(E)

Make the application described in subparagraph (B) and the information described in subparagraphs (A) and (D) available at local offices of the Social Security Administration.

(2)

Training personnel in explaining benefit programs and assisting in completing LIS application

(3)

Transmittal of data to States

(4)

Coordination with outreach

(5)

Reimbursement of Social Security Administration administrative costs

(A)

Initial Medicare Savings Program costs; additional low-income subsidy costs

(i)

Initial Medicare Savings Program costs

(ii)

Additional amount for low-income subsidy activities

(B)

Subsequent funding under agreements

(i)

In general

Effective for fiscal years beginning on or after October 1, 2010, the Commissioner and the Secretary shall enter into an agreement which shall provide funding (subject to the amount appropriated under clause (ii)) to cover the administrative costs of the Commissioner’s activities under this subsection. Such agreement shall—

(I)

provide funds to the Commissioner for the full cost of the Social Security Administration’s work related to the Medicare Savings Program required under this section;

(II)

provide such funding quarterly in advance of the applicable quarter based on estimating methodology agreed to by the Commissioner and the Secretary; and

(III)

require an annual accounting and reconciliation of the actual costs incurred and funds provided under this subsection.

(ii)

Appropriation

(C)

Limitation

(6)

GAO analysis and report

(A)

Analysis

The Comptroller General of the United States shall prepare an analysis of the impact of this subsection—

(i)

in increasing participation in the Medicare Savings Program, and

(ii)

on States and the Social Security Administration.

(B)

Report

(7)

Medicare Savings Program defined

(Aug. 14, 1935, ch. 531, title XI, § 1144, as added Pub. L. 106–554, § 1(a)(6) [title IX, § 911(a)(1)], Dec. 21, 2000, 114 Stat. 2763, 2763A–583; amended Pub. L. 108–173, title I, § 103(g), Dec. 8, 2003, 117 Stat. 2160; Pub. L. 110–275, title I, § 113(a), July 15, 2008, 122 Stat. 2503.)

cite as: 42 USC 1320b-14