Fact Sheet

Reforms to Permanently Fund World Trade Center Health Program


House Energy and Commerce Committee Chairman Fred Upton (R-MI) today called for permanent reauthorization of the World Trade Center Health Program. Upton also outlined six permanent entitlement reforms totaling more than $4 billion to pay for permanent extension of the important program.

Require millionaires to pay their fair share of Medicare Part B and D premiums
Since 2007, Medicare beneficiaries with higher incomes have paid higher Part B monthly premiums.  These income-related monthly adjustment amounts affect fewer than 5 percent of people with Medicare. Congress increased cost-sharing for Medicare beneficiaries subject to income-related premiums in Medicare Parts B or D in the ACA, MACRA, and the Bipartisan Budget Act of 2015. This policy would require individuals with an annual income at or above $1 million (or joint filers at or above $1.5 million) to pay the full share of their Medicare premium. To put it in perspective, this policy change would mean millionaire Medicare beneficiaries would only pay approximately $70 more each month.
SAVINGS: $1.9 billion

Closing a Medicaid loophole for community spouse annuities
Medicaid’s treatment of married couples’ income and resources has resulted in a loophole in Medicaid eligibility that allows married individuals to increase the amount of assets the community spouse is able to retain above State and Federal maximums. GAO reported on cases in which the community spouses of Medicaid beneficiaries receiving long-term care had annuities worth more than $1 million. This policy would make half of the income generated from an annuity purchased by a community spouse within the 60 month Medicaid lookback period countable towards the institutionalized spouse’s financial eligibility for Medicaid – thus ensuring that Medicaid coverage is for those who cannot afford to finance their own care.
SAVINGS: $900 million

Updating Medicaid’s maximum allowable home equity allowance
This policy will establish a federal cap on the home equity allowance consistent with the current federal default of $552,000 in 2015 that is indexed to grow with inflation. Under this policy, more than $552,000 in home equity would still be sheltered if a spouse, child under age 21, or child who is considered blind or disabled lives in the home. If enacted, individuals who have home equity levels above the allowed threshold could use such equity to help cover the cost of their care until they bring the equity interest in their home below the federal standard (capitalized?), at which point they could obtain Medicaid long-term care coverage if they are otherwise eligible. Individuals could access the equity interest in their home through a variety of legal means, such as a reverse mortgage, home equity loan, or other financial vehicles.
SAVINGS: $430 million

Closing a loophole that allows multi-millionaire lottery winners to retain Medicaid
States are required to use Modified Adjusted Gross Income (MAGI) for determining what income to include or disregard in determining Medicaid eligibility for most non-elderly and non-disabled individuals. Under Medicaid regulations, income received as a lump sum, such as lottery winnings, is counted as income only in the month received. As a result, States are not allowed to disenroll multi-million dollar lottery winners from Medicaid, thus allowing these individuals to keep taxpayer financed Medicaid coverage. This policy would close this loophole by requiring states, for purposes of determining MAGI for Medicaid and CHIP eligibility, to count monetary winnings from lotteries, gambling winnings, or inheritances, of $60,000 or more as if they were obtained over multiple months, even if obtained in a single month.
SAVINGS: $400 million

Ensuring federal Medicaid coverage is not granted to individuals who are not legal immigrants
Generally, Medicaid coverage is only available for individuals who are U.S. citizens or have legal immigration status.  However, under a small exception, States are required to provide temporary Medicaid coverage to individuals who have not provided documentation of their citizenship or satisfactory immigration status. This policy would close the loophole in current practice by ensuring that federal taxpayer dollars in the Medicaid program only go to individuals who have proven they are citizens or are here legally in the U.S.
SAVINGS: $865 million

Protecting vulnerable patients through Medicaid Electronic Verification of in-home care
Work from Office of Inspector General at the U.S. Department of Health and Human Services (OIG) has demonstrated that existing program safeguards intended to ensure medical necessity, patient safety, and quality of home-based services and prevent improper payments were often ineffective. Electronic visit verification (EVV) systems offer a way to reduce the level of fraud and improper payments, while protecting some of the most vulnerable Medicaid beneficiaries and ensuring that they receive the care they need. This policy would incentivize State Medicaid programs to adopt EVV for personal care and home health services by implementing a modest reduction in the Federal matching rate for those services in 2019 for states that fail to implement an EVV system.
SAVINGS: $300 million


Fact Sheet