,,ii  #aae? ,,congress  #b;d ,session   
,s4 #ccaf  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,augu/ #a1 #bjah,mr4   
,nelson introduc$ ! foll[+ bill2 :i* 0  
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
improve ! af=dability & enrollm5t       
proc$ures ( ! ,m$ic>e program1 & = o!r  
purposes4  #a4 ,%ort title2 table (     
cont5ts  7a7 ,%ort title ,?is ,act may  
be cit$ z ! ,help+ ,s5iors ,af=d ,m$ic>e
 ,act ( #bjah4  7b7 ,table ( cont5ts ,! 
table ( cont5ts ( ?is ,act is z foll[s3 
,sec4 #a4 ,%ort title2 table ( cont5ts4 
,sec4 #b4 ,protect+ aga9/ high          
out-(-pocket exp5ditures = ,m$ic>e      
fee-=-s]vice b5efits4 ,sec4 #c4 ,r$uc+  
co/-%>+1 align+ income & res\rce        
eligibility te/s1 & simplify+ enrollm5t 
= l[-income b5efici>ies4 ,sec4 #d4      
,r$uc+ ,m$ic>e co/-%>+ = l[-income      
b5efici>ies4 ,sec4 #e4 ,improv+ ,m$ic>e 
b5efici>y enrollm5t proc$ures &         
effective dates ( cov]age4  #b4         

,protect+ aga9/ high out-(-pocket       
exp5ditures = ,m$ic>e fee-=-s]vice      
b5efits ,title ,,xviii ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #acie et  
seq47 is am5d$ by add+ at ! end ! foll[+
 new section3  #ahii;,c4 ,protection    
aga9/ high out-(-pocket exp5ditures  7a7
 ,9 g5]al ,not)/&+ any o!r provision (  
?is title1 9 ! case ( an individual     
entitl$ to1 or enroll$ =1 b5efits "u "p 
,a or enroll$ 9 "p ,b1 if ! am\nt ( !   
out-(-pocket co/-%>+ ( su* individual = 
a ye> 7beg9n+ ) #bjai7 equals or exce$s 
! annual out-(-pocket limit "u          
subsection 7b7 = t ye>--  7#a7 ! am\nt  
o!rwise payable "u "p ,a & ! total am\nt
 ( exp5ses incurr$ by ! individual :i*  
w\ld 7except = ?is section7 con/itute   
incurr$ exp5ses = :i* b5efits are       
payable "u "p ,b1 %all be #ajj p]c5t (  
su* am\nt = ! rema9d] ( t ye>2 &  7#b7 !
 individual %all n be responsible =     
out-(-pocket co/-%>+ incurr$ dur+ !     
rema9d] ( t ye>4  7b7 ,annual           
out-(-,pocket limit  7#a7 ,9 g5]al ,!   

am\nt ( ! annual out-(-pocket limit "u  
?is subsection %all be-- 7,a7 = #bjai1  
#e1ejj2 or  7,b7 = a subsequ5t ye>1 !   
am\nt specifi$ 9 ?is subsection = !     
prec$+ ye> increas$ or decreas$ by !    
p]c5tage *ange 9 ! ,consum] ,price      
,index = ,all ,urban ,consum]s = !      
#ab-mon? p]iod end+ ) ,june ( su* prec$+
 ye>4  7#b7 ,r\nd+ ,if any am\nt det]m9$
 "u p>agraph 7#a77;,b7 is n a multiple (
 #e1 su* am\nt %all be r\nd$ to ! ne>e/ 
multiple ( #e4  7c7 ,out-(-,pocket      
co/-,%>+ def9$  7#a7 ,9 g5]al ,subject  
to p>agraphs 7#b7 & 7#c71 9 ?is section1
 ! t]m out-(-pocket co/-%>+ means1 )    
respect to an individual1 ! am\nt ( !   
exp5ses incurr$ by ! individual t are   
attributable to--  7,a7 d$uctibles1     
co9surance & copaym5ts applicable "u "p 
,a or ,b2 or  7,b7 = items & s]vices t  
w\ld h o!rwise be5 cov]$ "u "p ,a or ,b 
b = ! exhau/ion ( ^? b5efits4  7#b7     
,c]ta9 co/s n includ$  7,a7 ,non-cov]$  
items & s]vices ,exp5ses incurr$ = items
 & s]vices :i* are n cov]$ "u "p ,a or  

,b %all n be consid]$ incurr$ exp5ses = 
purposes ( det]m9+ out-(-pocket co/-%>+ 
"u p>agraph 7#a74  7,b7 ,items & s]vices
 n furni%$ on an assignm5t-relat$ basis 
,if an item or s]vice is furni%$ to an  
individual "u ?is title & is n furni%$  
on an assignm5t-relat$ basis1 any       
additional exp5ses ! individual incurs  
above ! am\nt ! individual w\ld h       
incurr$ if ! item or s]vice 0 furni%$ on
 an assignm5t-relat$ basis %all n be    
consid]$ incurr$ exp5ses = purposes (   
det]m9+ out-(-pocket co/-%>+ "u p>agraph
 7#a74  7#c7 ,s\rce ( paym5t ,= purposes
 ( p>agraph 7#a71 ! ,secret>y %all      
consid] exp5ses to be incurr$ by !      
individual )\t reg>d to :e!r !          
individual or ano!r p]son1 includ+ a    
,/ate program1 an employ]1 a m$ic>e     
supplem5tal policy1 or o!r ?ird-p>ty    
cov]age1 has paid = su* exp5ses4  7d7   
,ann\ncem5t ( ! annual out-(-,pocket    
limit ,! ,secret>y %all 7beg9n+ 9 #bjai7
 ann\nce 79 a mann] int5d$ to provide   
notice to all int]e/$ p>ties7 ! annual  

out-(-pocket limit "u ?is section t w be
 applicable = ! succe$+ ye>4  4  #c4    
,r$uc+ co/-%>+1 align+ income & res\rce 
eligibility te/s1 & simplify+ enrollm5t 
= l[-income b5efici>ies  7a7 ,increase 9
 income eligibility to #ace p]c5t (     
,,fpl = qualifi$ ,m$ic>e b5efici>ies    
,section #aije7p77#b7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#acif;d7p77#b77 is am5d$--  7#a7 9      
subp>agraph 7,a71 by /rik+ #ajj p]c5t & 
ins]t+ #ace p]c5t2  7#b7 9 subp>agraph  
7,b7--  7,a7 by /rik+ & at ! end (      
clause 7ii72  7,b7 by /rik+ ! p]iod at !
 end ( clause 7iii7 & ins]t+ 1 &2 &     
7,c7 by add+ at ! end ! foll[+3  7iv7   
,janu>y #a1 #bjbj1 is #ace p]c5t4  2 &  
7#c7 9 subp>agraph 7,c7--  7,a7 by /rik+
 & at ! end ( clause 7iii72  7,b7 by    
/rik+ ! p]iod at ! end ( clause 7iv7 &  
ins]t+ 1 &2 &  7,c7 by add+ at ! end !  
foll[+3  7v7 ,janu>y #a1 #bjbj1 is #ace 
p]c5t4  4  7b7 ,increase 9 income       
eligibility to #aej p]c5t ( ,,fpl =     
specifi$ l[-,income ,m$ic>e b5efici>ies 

7#a7 ,eligibility ( individuals )       
incomes bel[ #aej p]c5t ( ,,fpl ,section
 #aijb7;a77#aj77;,e7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acif;b7a77#aj77;,e77 is am5d$--  7,a7  
by add+ & at ! end ( clause 7ii72  7,b7 
9 clause 7iii7--  7i7 by /rik+ & #abj   
p]c5t 9 #aiie & ye>s !reaft] & ins]t+   
#abj p]c5t 9 #aiie & ye>s !reaft] be=e  
#bjbj1 & #aej p]c5t 9 #bjbj & ye>s      
!reaft]2 &  7ii7 by /rik+ & at ! end2 & 
7,c7 by /rik+ clause 7iv74  7#b7        
,ref]5ces ,section #aije7p77#a7 ( su*   
,act 7#db ,u4,s4,c4 #acif;d7p77#a77 is  
am5d$ by ins]t+ aft] subp>agraph 7,c7 ! 
foll[+ flu% s5t5ce3  ,! t]m specifi$    
l[-income m$ic>e b5efici>y means an     
individual describ$ 9 section           
#aijb7;a77#aj77;,e77iii74 4  7#c7       
,con=m+ am5dm5ts  7,a7 ,! fir/ s5t5ce ( 
section #aije7;b7 ( su* ,act 7#db       
,u4,s4,c4 #acif;d7b77 is am5d$ by /rik+ 
& section #aicc7;d74  7,b7 ,section     
#aicc ( su* ,act 7#db ,u4,s4,c4         
#acifu-#c7 is repeal$4  7c7 #ajj p]c5t  

,,fmap ,section #aije ( ! ,social       
,security ,act 7#db ,u4,s4,c4 #acif;d7  
is am5d$-- 7#a7 9 subsection 7b71 by    
/rik+ & 7aa7 & ins]t+ 7aa71 & 7ee72 &   
7#b7 by add+ at ! end ! foll[+ new      
subsection3  7ee7 ,increas$ ,,fmap =    
exp&$ m$ic>e co/-,%>+ populations  7#a7 
,9 g5]al ,not)/&+ subsection 7b71 )     
respect to exp5ditures describ$ 9       
p>agraph 7#b71 ! ,f$]al m$ical assi/ance
 p]c5tage %all be equal to #ajj p]c5t4  
7#b7 ,exp5ditures describ$ ,!           
exp5ditures describ$ 9 ?is p>agraph are 
exp5ditures made on or aft] ,janu>y #a1 
#bjbj1 = m$ical assi/ance = m$ic>e      
co/-%>+ provid$ to any individual "u    
clause 7i71 7ii71 or 7iii7 ( section    
#aijb7;a77#aj77;,e7 :o w\ld n h be5     
eligible = m$ic>e co/-%>+ "u any su*    
clause "u ! income or res\rce           
eligibility /&>ds 9 effect on ,octob]   
#a1 #bjah4  4  7d7 ,consolidation (     
l[-,income subsidy res\rce eligibility  
te/s  7#a7 ,9 g5]al ,section            
#ahfj;,d-#ad7;a77#c7 ( ! ,social        

,security ,act 7#db ,u4,s4,c4           
#aciew-#aad7;a77#c77 is am5d$-- 7,a7 by 
/rik+ subp>agraph 7,d72  7,b7 by        
r$esignat+ subp>agraphs 7,e7 ?r\gh 7,g7 
z subp>agraphs 7,d7 ?r\gh 7,f71         
respectively2 &  7,c7 9 ! head+ (       
subp>agraph 7,d71 z s r$esignat$1 by    
/rik+ ,alt]native4  7#b7 ,cl>ification (
 c]ta9 rules relat+ to income & res\rce 
det]m9ations ,section                   
#ahfj;,d-#ad7;a77#c7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciew-#aad7;a77#c771 z am5d$ by        
p>agraph 7#a71 is am5d$ by /rik+        
subp>agraph 7,f7 & ins]t+ ! new foll[+  
new subp>agraphs3  7,f7 ,res\rce        
exclusions ,9 det]m9+ ! res\rces ( an   
individual 7& ! eligible sp\se ( !      
individual1 if any7 "u section #afac =  
purposes ( subp>agraph 7,d7--  7i7 no "p
 ( ! value ( any life insurance policy  
%all be tak5 into acc\nt2  7ii7 no "p ( 
! value ( any vehicle %all be tak5 into 
acc\nt2 &  7iii7 !re %all be exclud$ an 
am\nt equal to #a1ejj ea* ) respect to  

any individual or eligible sp\se ( an   
individual :o atte/s t "s ( ! res\rces (
 su* individual or sp\se w be us$ to    
meet ! burial & relat$ exp5ses ( su*    
individual or sp\se4  7,g7 ,family size 
,9 det]m9+ ! size ( ! family ( an       
individual = purposes ( det]m9+ ! income
 eligibility ( su* individual "u ?is    
section1 an individual's family %all    
consi/ (--  7i7 ! individual2  7ii7 !   
individual's sp\se :o lives 9 ! same    
h\sehold z ! individual 7if any72 &     
7iii7 any o!r individuals :o-- 7,i7 are 
relat$ to ! individual ^: income        
eligibility is 9 "q or su* individual's 
sp\se :o lives 9 ! same h\sehold2       
7,,ii7 are liv+ 9 ! same h\sehold z su* 
individual2 &  7,,iii7 are dep5d5t on   
su* individual or su* individual's sp\se
 :o is liv+ 9 ! same h\sehold = at lea/ 
"o-half ( _! f9ancial support4  4  7#c7 
,con=m+ am5dm5ts ,section               
#ahfj;,d-#ad7;a7 ( ! ,social ,security  
,act 7#db ,u4,s4,c4 #aciew-#aad7;a77 is 
am5d$-- 7,a7 9 p>agraph 7#a71 9 ! matt] 

prec$+ subp>agraph 7,a71 by ins]t+ 7z   
det]m9$ "u p>agraph 7#c77;,g77 aft]     
family ( ! size involv$2 &  7,b7 9      
p>agraph 7#c71 z am5d$ by p>agraphs 7#a7
 & 7#b7-- 7i7 9 subp>agraph 7,a71 9 !   
matt] prec$+ clause 7i71 by /rik+       
subp>agraph 7,f7 & ins]t+ subp>agraph   
7,e72  7ii7 9 subp>agraph 7,a77ii71 by  
ins]t+ 7z det]m9$ "u subp>agraph 7,g77  
aft] family ( ! size involv$2  7iii7 9  
subp>agraph 7,a77iii71 by /rik+ or 7,e72
  7iv7 9 subp>agraph 7,b77v71 9 ! matt] 
prec$+ subclause 7,i71 by /rik+         
subp>agraph 7,f7 & ins]t+ subp>agraph   
7,e72 &  7v7 9 subp>agraph 7,d77i71 9 ! 
matt] prec$+ subclause 7,i71 by /rik+   
subject to ! life insurance policy      
exclusion provid$ "u subp>agraph 7,g7 & 
ins]t+ subject to ! res\rce exclusions  
provid$ "u subp>agraph 7,f74  7e7       
,alignm5t ( l[-,income subsidy & m$ic>e 
sav+s program income & res\rce          
eligibility te/s  7#a7 ,application (   
,m$icaid sp\sal impov]i%m5t res\rce     
all[ance to ,,msp & ,,lis res\rce       

eligibility  7,a7 ,9 g5]al ,section     
#aije7p77#a77;,c7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acif;d7p77#a77;,c77
 is am5d$ to read z foll[s3  7,c7 ^:    
res\rces 7z det]m9$ "u section #afac =  
purposes ( ! supplem5tal security income
 program subject to ! res\rce exclusions
 "u subp>agraph 7,f7 ( section          
#ahfj;,d-#ad7;a77#c77 d n exce$--  7i7 9
 ! case ( an individual ) a sp\se1 an   
am\nt equal to ! sum ( ! fir/ am\nt     
specifi$ 9 subsection 7f77#b77;,a77i7 ( 
section #aibd 7z adju/$ "u subsection   
7g7 ( su* section7 & ! am\nt specifi$ 9 
subsection 7f77#b77;,a77ii77,,ii7 ( su* 
section 7z s adju/$72 or  7ii7 9 ! case 
( an individual :o does n h a sp\se1 an 
am\nt equal to #a_/b ( ! am\nt describ$ 
9 clause 7i74  4  7,b7 ,application to  
,q,d,w,is ,section #aije7s77#c7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acif;d7s77#c77 is am5d$ to read z      
foll[s3  7#c7 ^: res\rces 7z det]m9$ "u 
section #afac = purposes ( ! supplem5tal
 security income program subject to !   

res\rce exclusions "u subp>agraph 7,f7 (
 section #ahfj;,d-#ad7;a77#c77 d n      
exce$--  7,a7 9 ! case ( an individual )
 a sp\se1 ! am\nt 9 effect = ! ye> "u   
clause 7i7 ( subsection 7p77#a77;,c72 & 
7,b7 9 ! case ( an individual :o does n 
h a sp\se1 ! am\nt 9 effect = ! ye> "u  
clause 7ii7 ( subsection 7p77#a77;,c72 &
  4  7,c7 ,application to ,,lis ,clause 
7i7 ( section #ahfj;,d-#ad7;a77#c77;,d71
 z r$esignat$ & am5d$ by subsection     
7d77#a71 is am5d$ to read z foll[s3  7i7
 ,9 g5]al ,! res\rces requirem5t ( ?is  
subp>agraph is t an individual's        
res\rces 7z det]m9$ "u section #afac =  
purposes ( ! supplem5tal security income
 program subject to ! res\rce exclusions
 provid$ "u subp>agraph 7,f77 d n exce$ 
! am\nt 9 effect = ! ye> "u section     
#aije7p77#a77;,c77ii74  4  7f7          
,enrollm5t simplifications  7#a7        
,application ( #c-mon? retroactive      
eligibility to ,q,m,bs  7,a7 ,9 g5]al   
,section #aijb7;e77#h7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           

#acif;a7e77#h77 is am5d$ by /rik+ aft] !
 end ( ! mon? 9 :i* ! det]m9ation fir/  
occurs & ins]t+ 9 or aft] ! ?ird mon?   
be=e ! mon? 9 :i* ! individual makes    
application = assi/ance4  7,b7 ,con=m+  
am5dm5t ,section #aije7;a7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acif;d7a77 is am5d$1 9 ! matt] prec$+  
p>agraph 7#a71 by /rik+ or1 9 ! case (  
m$ic>e co/-%>+ ) respect to a qualifi$  
m$ic>e b5efici>y describ$ 9 subsection  
7p77#a71 if provid$ aft] ! mon? 9 :i* ! 
individual becomes su* a b5efici>y4     
7#b7  ,/ate option = #ab-mon? cont9u\s  
eligibility = ,s,l,m,bs & ,q,w,d,is     
,section #aijb7;e77#ab7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acif;a7e77#ab77 is am5d$-- 7,a7 by     
r$esignat+ subp>agraphs 7,a7 & 7,b7 z   
clauses 7i7 & 7ii71 respectively2  7,b7 
by ins]t+ 7,a7 aft] 7#ab72 &  7,c7 by   
add+ at ! end ! foll[+3  7,b7 ,at !     
option ( ! ,/ate1 ! plan may provide t  
an individual :o is det]m9$ to be       
eligible = b5efits "u a ,/ate plan      

approv$ "u ?is title "u any ( ! foll[+  
eligibility categories1 or :o is        
r$et]m9$ to be eligible = su* b5efits "u
 any ( su* categories1 %all be consid]$ 
to meet ! eligibility requirem5ts met on
 ! date ( application & %all rema9      
eligible = ^? b5efits until ! end ( !   
#ab-mon? p]iod foll[+ ! date ( !        
det]m9ation or r$et]m9ation (           
eligibility1 except t a ,/ate may       
provide = su* det]m9ations m frequ5tly1 
b n m frequ5tly ?an once e #f mon?s = an
 individual3  7i7 ,a specifi$ l[-income 
m$ic>e b5efici>y describ$ 9 subsection  
7a77#aj77;,e77iii7 ( ?is section :o is  
det]m9$ eligible = m$ic>e co/ %>+       
describ$ 9 section                      
#aije7p77#c77;,a77ii74  7ii7 ,a qualifi$
 disabl$ & work+ individual describ$ 9  
section #aije7s7 :o is det]m9$ eligible 
= m$ic>e co/-%>+ describ$ 9 section     
#aije7p77#c77;,a77i74  4  7#c7 ,/ate    
option to use ,express ,lane eligibility
 = ! ,m$ic>e ,sav+s ,program  ,section  
#aijb7;e77#ac77;,a7 ( ! ,social         

,security ,act 7#db ,u4,s4,c4           
#acif;a7e77#ac77;,a77 is am5d$ by add+  
at ! end ! foll[+ new clause3  7iii7    
,/ate option to ext5d express lane      
eligibility to o!r populations  7,i7 ,9 
g5]al ,at ! option ( ! ,/ate1 ! ,/ate   
may apply ! provisions ( ?is p>agraph ) 
respect to det]m9+ eligibility "u ?is   
title = an eligible individual 7z def9$ 
9 subclause 7,,ii774 ,9 apply+ ?is      
p>agraph 9 ! case ( a ,/ate mak+ su* an 
option1 any ref]5ce 9 ?is p>agraph to a 
*ild ) respect to ?is title 7o!r ?an a  
ref]5ce to *ild heal? assi/ance7 %all be
 deem$ to be a ref]5ce to an eligible   
individual4  7,,ii7 ,eligible individual
 def9$ ,9 ?is clause1 ! t]m eligible    
individual means any ( ! foll[+3 7aa7 ,a
 qualifi$ m$ic>e b5efici>y describ$ 9   
section #aije7p77#a7 = purposes (       
det]m9+ eligibility = m$ic>e co/-%>+ 7z 
def9$ 9 section #aije7p77#c774  7bb7 ,a 
specifi$ l[-income m$ic>e b5efici>y     
describ$ 9 subsection 7a77#aj77;,e77iii7
 ( ?is section = purposes ( det]m9+     

eligibility = m$ic>e co/-%>+ describ$ 9 
section #aije7p77#c77;,a77ii74  7cc7 ,a 
qualifi$ disabl$ & work+ individual     
describ$ 9 section #aije7s7 = purposes (
 det]m9+ eligibility = m$ic>e co/-%>+   
describ$ 9 section #aije7p77#c77;,a77i74
  7dd7 ,dur+ ! p]iod t beg9s on ! date (
 enactm5t ( ?is clause & ends on        
,decemb] #ca1 #bjai1 a qualify+         
individual describ$ 9 subsection        
7a77#aj77;,e77iv7 = purposes ( det]m9+  
eligibility = m$ic>e co/-%>+ describ$ 9 
section #aije7p77#c77;,a77ii74  4  7g7  
,effective date  7#a7 ,9 g5]al ,except z
 provid$ 9 p>agraphs 7#b7 & 7#c71 !     
am5dm5ts & repeal made by ?is section   
take effect on ,janu>y #a1 #bjbj1 &1 )  
respect to title ,,xix ( ! ,social      
,security ,act1 apply to cal5d> qu>t]s  
beg9n+ on or aft] ,janu>y #a1 #bjbj4    
7#b7 ,express lane eligibility = ,,msp  
,! am5dm5ts made by subsection 7f77#c7  
take effect on ! date ( enactm5t ( ?is  
,act4  7#c7 ,exception = ,/ate          
legislation ,9 ! case ( a ,/ate plan =  

m$ical assi/ance "u title ,,xix ( !     
,social ,security ,act :i* ! ,secret>y (
 ,heal? & ,human ,s]vices det]m9es      
requires ,/ate legislation 7o!r ?an     
legislation appropriat+ funds7 9 ord] = 
! plan to meet ! additional requirem5ts 
impos$ by ! am5dm5ts & repeal made by   
?is section 7o!r ?an ! am5dm5ts made by 
subsection 7f77#c771 ! ,/ate plan %all n
 be reg>d$ z fail+ to comply ) !        
requirem5ts ( su* title solely on !     
basis ( its failure to meet ^!          
additional requirem5ts be=e ! fir/ day (
 ! fir/ cal5d> qu>t] beg9n+ aft] ! close
 ( ! fir/ regul> session ( ! ,/ate      
legislature t beg9s aft] ! date ( !     
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 su* session %all be deem$ to be a      
sep>ate regul> session ( ! ,/ate        
legislature4  #d4 ,r$uc+ ,m$ic>e co/-%>+
 = l[-income b5efici>ies  7a7 ,9 g5]al  
,title ,,xviii ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acie et seq471 z   

am5d$ by section #b1 is am5d$ by add+ at
 ! end ! foll[+ new section3  #ahii;,d4 
,r$uction 9 ,m$ic>e co/-%>+ = l[-income 
b5efici>ies  7a7 ,9 g5]al ,not)/&+ any  
o!r provision ( ?is title1 9 ! case (   
items & s]vices furni%$ on or aft]      
,janu>y #a1 #bjai1 to an applicable     
l[-income individual1 ! am\nt ( any     
co9surance or copaym5t o!rwise          
applicable to ! item or s]vice "u "p ,a 
or ,b %all be r$uc$ by #ej p]c5t4  7b7  
,applicable l[-,income individual def9$ 
7#a7 ,9 g5]al ,9 ?is section1 ! t]m     
applicable l[-income individual means an
 individual-- 7,a7 entitl$ to1 or       
enroll$ =1 b5efits "u "p ,a or enroll$ 9
 "p ,b2  7,b7 :o is det]m9$ to h income 
t is great] ?an #ace p]c5t & less ?an or
 equal to #bjj p]c5t ( ! pov]ty l9e     
applicable to a family ( ! size involv$2
 &  7,c7 ^: res\rces 7z det]m9$ "u      
section #afac = purposes ( ! supplem5tal
 security income program subject to !   
res\rce exclusions provid$ "u section   
#ahfj;,d-#ad7;a77#c77;,f77 d n exce$ !  

am\nt 9 effect = ! ye> "u section       
#aije7p77#a77;,c77ii74  7#b7 ,income    
det]m9ations ,= purposes ( apply+ ?is   
section-- 7,a7 income %all be det]m9$ 9 
! mann] describ$ 9 section              
#aije7p77#a77;,b71 )\t reg>d to !       
application ( section #aijb7r77#b72 &   
7,b7 pov]ty l9e has ! mean+ giv5 su* t]m
 9 section #fgc7b7 ( ! ,community       
,s]vices ,block ,grant ,act 7#db        
,u4,s4,c4 #iijb7b771 includ+ any        
revision requir$ by su* section4  ,no?+ 
9 subp>agraph 7,a7 %all be con/ru$ to   
affect ! application ( section          
#aijb7r77#b7 = ! det]m9ation (          
eligibility = m$ical assi/ance "u title 
,,xix4  7c7 ,e/abli%m5t ( proc$ures =   
id5tification ( applicable l[-,income   
individuals & notification ( provid]s ( 
s]vices & suppli]s  7#a7 ,9 g5]al ,!    
,secret>y1 9 consultation ) !           
,commission] ( ,social ,security & !    
,secret>y ( ! ,treasury1 %all e/abli%   
proc$ures =--  7,a7 ! det]m9ation ( :e!r
 an individual is an applicable         

l[-income individual2 &  7,b7 !         
notification ( provid]s ( s]vices &     
suppli]s 9 ! case :]e an individual is  
an applicable l[-income individual s t !
 r$uction 9 any co9surance or copaym5t  
"u subsection 7a7 is appli$ at ! "t !   
item or s]vice is provid$ to !          
applicable l[-income individual4  7#b7  
,det]m9ations  7,a7 9 g5]al ,!          
provisions ( section                    
#ahfj;,d-#ad7;a77#c77;,b77i7 %all apply 
to ! det]m9ation ( :e!r an individual is
 an applicable l[-income individual "u  
?is section 9 ! same mann] z su*        
provisions apply to ! det]m9ation ( :e!r
 a "p ,d eligible is a subsidy eligible 
individual "u section                   
#ahfj;,d-#ad7;a77#c77;,b77i74  7,b7     
,effective p]iod ,det]m9ations "u ?is   
subsection %all be effective = a p]iod  
det]m9$ appropriate by ! ,secret>y4  7d7
 ,no effect on paym5t to provid]s (     
s]vices or suppli]s ,not)/&+ any o!r    
provision ( ?is title1 9 ! case ( an    
item or s]vice = :i* ! r$uction 9       

co9surance or copaym5t "u subsection 7a7
 applies1 ! am\nt ( paym5t o!rwise      
applicable = ! item or s]vice "u "p ,a  
or ,b %all be increas$ by ! am\nt ( !   
r$uction 9 co9surance or copaym5t "u su*
 subsection4  4  7b7 ,disclosure        
,section #fajc7l77#g77;,d77ii7 ( !      
,int]nal ,rev5ue ,code ( #aihf is       
am5d$-- 7#a7 by /rik+ or subsidies &    
ins]t+ 1 subsidies2 &  7#b7 by ins]t+ 1 
or r$uc$ co/-%>+ provid$ "u section     
#ahii;,d be=e ! p]iod at ! end4  #e4    
,improv+ ,m$ic>e b5efici>y enrollm5t    
proc$ures & effective dates ( cov]age   
7a7 ,g5]al enrollm5t p]iod ,section     
#ahcg7;e7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #aciep7e77 is am5d$ to   
read z foll[s3  7e7 ,g5]al & special    
enrollm5t p]iods  7#a7 ,g5]al enrollm5t 
7,a7 ,= cov]age dur+ ye>s be=e #bjbj    
,!re %all be a g5]al enrollm5t p]iod    
dur+ ! p]iod beg9n+ on ,janu>y #a & end+
 on ,m>* #ca ( ea* ye> be=e #bjbj4  7,b7
 ,= cov]age dur+ ye>s beg9n+ ) #bjbj    
,subject to subp>agraph 7,b71 !re %all  

be a g5]al enrollm5t p]iod beg9n+ on    
,octob] #ae & end+ on ,decemb] #ca (    
#bjai & ea* subsequ5t ye>4  7#b7        
,special enrollm5t ,beg9n+ ,janu>y #a1  
#bjbj1 ! ,secret>y %all e/abli% special 
enrollm5t p]iods 9 ! case ( individual  
:o meets su* exceptional conditions z ! 
,secret>y may provide4  4  7b7          
,effective dates ( cov]age  7#a7 ,9     
g5]al ,section #ahch7;a7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4 #acieq7a77
 is am5d$-- 7,a7 by am5d+ p>agraph 7#b7 
to read z foll[s3  7#b7 7,a7 9 ! case ( 
an individual :o enrolls pursuant to    
subsection 7d7 ( section #ahcg be=e !   
mon? 9 :i* he fir/ satisfies p>agraph   
7#a7 or 7#b7 ( section #ahcf1 ! fir/ day
 ( su* mon?2 or  7,b7 9 ! case ( an     
individual n describ$ 9 subp>agraph 7,a7
 :o fir/ satisfies su* p>agraph 9 a mon?
 beg9n+ be=e ,janu>y #a1 #bjbj & :o     
enrolls--  7i7 pursuant to su*          
subsection 7d7 9 su* mon? 9 :i* he fir/ 
satisfies su* p>agraph1 ! fir/ day ( !  
mon? foll[+ ! mon? 9 :i* he s enrolls2  

or  7ii7 pursuant to su* subsection 7d7 
9 ! mon? foll[+ su* mon? 9 :i* he fir/  
satisfies su* p>agraph1 ! fir/ day ( !  
second mon? foll[+ ! mon? 9 :i* he s    
enrolls2 or  7iii7 pursuant to su*      
subsection 7d7 m ?an "o mon? foll[+ su* 
mon? 9 :i* he satisfies su* p>agraph1 ! 
fir/ day ( ! ?ird mon? foll[+ ! mon? 9  
:i* he s enrolls2 or  7,c7 9 ! case ( an
 individual n describ$ 9 subp>agraph    
7,a7 :o enrolls pursuant to subsection  
7e7 ( section #ahcg 9 a mon? beg9n+--   
7i7 be=e ,april #a1 #bjai1 ! ,july #a   
foll[+ ! mon? 9 :i* he s enrolls2 or    
7ii7 on or aft] ,octob] #a1 #bjai1 !    
fir/ day ( ! mon? foll[+ ! mon? 9 :i* he
 s enrolls2 or  7,d7 9 ! case ( an      
individual n describ$ 9 subp>agraph 7,a7
 :o fir/ satisfies su* p>agraph 9 a mon?
 beg9n+ on or aft] ,janu>y #a1 #bjbj1 & 
:o enrolls pursuant to su* subsection   
7d7 9 su* mon? 9 :i* he fir/ satisfies  
su* p>agraph or 9 any subsequ5t mon? 9 !
 initial enrollm5t p]iod1 ! fir/ day ( !
 mon? foll[+ ! mon? 9 :i* he s enrolls2 

or  2 &  7,b7 9 p>agraph 7#c71 by /rik+ 
subp>agraphs 7,b71 7,c71 7,d71 & 7,e7 ( 
p>agraph 7#b7 ( ?is subsection & ins]t+ 
subp>agraphs 7,b7 & 7,c7 ( p>agraph     
7#b71 z applicable4  7#b7 ,te*nical     
correction ,section #ahci7;b7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acier7b77 is am5d$1 9 ! second s5t5ce1 
by /rik+ close ( ! enrollm5t p]iod ea*  
place x appe>s & ins]t+ close ( ! mon?4 
7c7 ,application ( ! "p ,a late         
enrollm5t p5alty "t limitation provision
 to ! "p ,b late enrollm5t p5alty  7#a7 
,9 g5]al ,section #ahci7;b7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4 #acier7b77
 is am5d$ by add+ at ! end ! foll[+ new 
s5t5ce3 ,any p]c5t increase 9 an        
individual's mon?ly premium "u ! fir/   
s5t5ce %all only apply to premiums paid 
dur+ a p]iod equal to twice ! numb] (   
mon?s 9 ! full #ab-mon? p]iods describ$ 
9 ! fir/ s5t5ce44  7#b7 ,con=m+ am5dm5t 
to ! "p ,a late enrollm5t p5alty        
,section #ahah7;c77#f7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           

#acie;i-#b7;c77#f77 is am5d$ by /rik+ & 
%all only apply to premiums paid dur+ a 
p]iod equal to twice ! numb] ( mon?s 9 !
 full #ab-mon? p]iods describ$ 9 t      
section4  7#c7 ,effective date  7,a7 ,9 
g5]al ,! am5dm5ts made by ?is section   
%all take effect on ! date ( ! enactm5t 
( ?is ,act & %all apply to premiums =   
mon?s beg9n+ on or aft] ,janu>y #a1     
#bjbj4  7,b7 ,c\nt+ ( mon?s ,9 apply+ ! 
am5dm5t made by p>agraph 7#a71 mon?s    
7occurr+ be=e1 dur+1 or aft] ! mon? t   
includes ! date ( ! enactm5t ( ?is ,act7
 9 :i* an individual's mon?ly premium is
 increas$ "u subsection 7b7 ( section   
#ahci ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acier7 %all be tak5 into     
acc\nt 9 det]m9+ :e!r ! limitation "u ! 
la/ s5t5ce ( su* subsection 7b71 z add$ 
by p>agraph 7#a71 is applicable4  7d7   
,application ( "p ,b deem$ enrollm5t    
process to resid5ts ( ,pu]to ,rico2     
special enrollm5t p]iod & limit on late 
enrollm5t p5alties  7#a7 ,application ( 
"p ,b deem$ enrollm5t process to        

resid5ts ( ,pu]to ,rico ,section        
#ahcg7;f77#c7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciep7f77#c77 is am5d$ 
by /rik+ 1 exclusive ( ,pu]to ,rico4    
7#b7 ,effective date ,! am5dm5t made by 
p>agraph 7#a7 %all apply to individuals 
^: initial enrollm5t p]iod "u section   
#ahcg7;d7 ( ! ,social ,security ,act    
beg9s on or aft] ! fir/ day ( !         
effective mon?1 specifi$ by ! ,secret>y 
( ,heal? & ,human ,s]vices "u section   
#ahci7;j77#a77;,c7 ( su* ,act1 z add$ by
 subsection 7c77#b74  7#c7 ,transition  
provid+ special enrollm5t p]iod & limit 
on late enrollm5t p5alties = c]ta9      
,m$ic>e b5efici>ies ,section #ahci ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acier7 is am5d$-- 7,a7 9 ! fir/ s5t5ce 
( subsection 7b71 by ins]t+ subject to  
section #ahci7;j77#b71 aft] subsection  
7i77#d7 or 7l7 ( section #ahcg12 &  7,b7
 by add+ at ! end ! foll[+ new          
subsection3  7j7 ,special rules = c]ta9 
resid5ts ( ,pu]to ,rico  7#a7 ,special  
enrollm5t p]iod1 cov]age p]iod =        

resid5ts :o are eligible b n enroll$    
7,a7 ,9 g5]al ,9 ! case ( a transition  
individual 7z def9$ 9 p>agraph 7#c77 :o 
is n enroll$ "u ?is "p z ( ! day be=e ! 
fir/ day ( ! effective mon? 7z def9$ 9  
subp>agraph 7,c771 ! ,secret>y %all     
provide = a special enrollm5t p]iod "u  
section #ahcg ( #g mon?s beg9n+ ) su*   
effective mon? dur+ :i* ! individual may
 be enroll$ "u ?is "p4  7,b7 ,cov]age   
p]iod ,9 ! case ( su* an individual :o  
enrolls dur+ su* special enrollm5t      
p]iod1 ! cov]age p]iod "u section #ahch 
%all beg9 on ! fir/ day ( ! second mon? 
aft] ! mon? 9 :i* ! individual enrolls4 
7,c7 ,effective mon? def9$ ,9 ?is       
section1 ! t]m effective mon? means a   
mon?1 n e>li] ?an ,octob] #bjai & n lat]
 ?an ,janu>y #bjbj1 specifi$ by !       
,secret>y4  7#b7 ,r$uction 9 late       
enrollm5t p5alties = curr5t enrollees & 
individuals enroll+ dur+ transition     
7,a7 ,9 g5]al ,9 ! case ( a transition  
individual :o is enroll$ "u ?is "p z ( !
 day be=e ! fir/ day ( ! effective mon? 

or :o enrolls "u ?is "p on or aft] !    
date ( ! enactm5t ( ?is subsection b    
be=e ! end ( ! special enrollm5t p]iod  
"u p>agraph 7#a77;,a71 ! am\nt ( ! late 
enrollm5t p5alty impos$ "u section      
#ahci7;b7 %all be recalculat$ by r$uc+ !
 p5alty to #ae p]c5t ( ! p5alty o!rwise 
e/abli%$4  7,b7 ,application            
,subp>agraph 7,a7 %all be appli$ 9 !    
case ( a transition individual :o-- 7i7 
is enroll$ "u ?is "p z ( ! mon? be=e !  
effective mon?1 = premiums = mon?s      
beg9n+ ) su* effective mon?2 or  7ii7   
enrolls "u ?is "p on or aft] ! date ( ! 
enactm5t ( ?is ,act & be=e ! end ( !    
special enrollm5t p]iod "u p>agraph     
7#a77;,a71 = premiums = mon?s dur+ !    
cov]age p]iod "u ?is "p :i* occur dur+  
or aft] ! effective mon?4  7,c7 ,loss ( 
r$uction if individual t]m9ates         
enrollm5t ,subp>agraph 7,a7 %all n apply
 to a transition individual if !        
individual t]m9ates enrollm5t "u ?is "p 
aft] ! end ( ! special enrollm5t p]iod  
"u p>agraph 7#a74  7#c7 ,transition     

individual def9$ ,9 ?is section1 ! t]m  
transition individual means an          
individual :o resides 9 ,pu]to ,rico &  
:o w\ld h be5 deem$ enroll$ "u ?is "p   
pursuant to section #ahcg7;f7 be=e !    
fir/ day ( ! effective mon? b = ! fact t
 ! individual 0 a resid5t ( ,pu]to      
,rico1 reg>dless ( :e!r ! individual is 
enroll$ "u ?is "p z ( su* fir/ day4  4