Additional Views

We support this legislation, which extends the sunset of transitional medical assistance (TMA) for an additional year. Our strong preference, however, is that Congress eliminate the sunset entirely, making the program more dependable for the beneficiaries who depend on it and the states that administer it. At a minimum, the Committee should have reauthorized TMA for five years, consistent with the reauthorization of Temporary Assistance for Needy Families (TANF).

Additionally, even though TMA is a vital route to coverage for parents leaving welfare for work, a significant number of parents miss out on TMA coverage. According to the latest Urban Institute data, two-thirds of parents lose Medicaid after leaving welfare, even though the vast majority are likely to be eligible for TMA, suggesting that simplifications to TMA are needed to assure that eligible families secure the coverage. In particular, there are four administrative simplifications that we wish to see enacted:

(1) A waiver of reporting requirements for families who qualify for TMA: Families can be eligible for TMA for up to 12 months; however, they must meet prescriptive reporting requirements to keep their eligibility. To receive the first six months of TMA, families must notify the state of their employment and income status (even though there is no income eligibility limit during this period). They then must report income to the state by the 21st day of the 4th month. In order to maintain eligibility for the second six months, the family must report again to the redetermination office after six months even if their income has not changed. In the second six months of TMA, families must report income to the state by the 21st day of the first and fourth month. A trip to the redetermination office can entail an entire day off from work, and if all paperwork is not correct, the family must make another trip. Often, a day off from work means a day of no pay. If the family does not show up as required, coverage is terminated.

(2) The elimination of TMA requirements for the subset of states that already provide health insurance to families at or above 185% of poverty. If states already meet TMA requirements through their regular Medicaid program, compliance with administrative rules of TMA is unnecessary and duplicative.

(3) A state option to waive requirement that families have been on Medicaid for three of the previous six months to qualify for TMA: Currently, in order to be eligible for TMA, a family must have had Medicaid coverage for three of the previous six months. This requirement excludes families who, for one reason or another, decided not to seek medical assistance even when they were eligible for it.

(4) A state option to expand TMA coverage above 185% of poverty: Currently, the income limit for TMA is 185% of poverty. Some states, however, would like the option to expand their TMA programs to individuals above that income level in order to make the transition from welfare to work rewarding.

While states could potentially use section 1115 of the Social Security Act to waive these administrative requirements, budget neutrality makes this an unattractive option for states, because they would be forced to reduce program spending in other areas, such as benefits or eligibility. We have long supported enacting these simplifications, and two of the four were included in H.R. 5291, the "Beneficiary Improvement and Protection Act of 2000," reported by the Committee in October of 2000.

In addition, we would like to see the Committee take action on the issue of health insurance coverage for pregnant women and children in Medicaid and the Children’s Health Insurance Program who are legal immigrants. Until the passage of the 1996 welfare reform law, legal immigrants were generally eligible for public benefits on the same basis as citizens. The welfare law eliminated the ability of most legal immigrants to receive any federal benefits, because it conditioned eligibility on citizenship status rather than legal status, extending to most legal immigrants the eligibility restrictions that had traditionally applied only to undocumented immigrants. Since passage of welfare reform, Congress has acted in some instances to reinstate eligibility for public benefits. In 1997, Congress restored Supplemental Security Income (SSI) to most immigrants who were already in the United States when the welfare law was enacted, and in 1998, it restored food stamp eligibility for immigrant children and for elderly and disabled persons who were here before August of 1996.

As a result, the eligibility of legal immigrants for public benefits varies among federal programs and depends on a variety of factors, including date of entry to the United States, type of immigration status, work history, age, and state of residence. Welfare reauthorization provides an opportunity to reconsider the restrictions and other immigrant provisions in the welfare law in a more comprehensive manner than has been undertaken to date. Therefore, we believe it would have been appropriate to address the issue of legal immigrants when the TANF was reauthorized.

There has been significant interest in giving states the option to provide Medicaid (and CHIP) coverage for legal immigrants and eliminating the five-year deeming requirement that accompanies the ban. Congressmen Diaz-Balart and Waxman are the lead sponsors of a bill, H.R. 1143, which would allow states to provide Medicaid coverage for legal immigrant children and pregnant women under Medicaid and CHIP and not require sponsor deeming for the first five years of residency. In 2000, the Committee reported out the Beneficiary Improvement and Protection Act (H.R. 5291) which allowed states the option to cover legal immigrant children and pregnant women under Medicaid and CHIP after they lawfully resided in the country for two years. This prohibition on coverage of legal immigrants is bad health policy as individuals who lack insurance tend to forgo or delay needed treatment and later on tax the health system as preventable illnesses turn into serious conditions requiring more expensive care. We believe the Committee should act to rectify this problem quickly.

John D. Dingell
Peter Deutsch
Edolphus Towns
Henry A. Waxman
Lois Capps
Karen McCarthy
Tom Sawyer
Frank Pallone, Jr.
Albert R. Wynn
Jane Harman
Sherrod Brown
Diana DeGette
Ted Strickland
Gene Green
Eliot L. Engel
Edward J. Markey
Bobby L. Rush