Title 42 — The Public Health and WelfareRelease 119-73
§1396u–3 State coverage of medicare cost-sharing for additional low-income medicare beneficiaries
Title 42 › Chapter CHAPTER 7— - SOCIAL SECURITY › Subchapter SUBCHAPTER XIX— - GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS › § 1396u–3
Summary
States must change their Medicaid plans so Medicaid will pay Medicare deductibles and coinsurance for certain low-income Medicare people, called "qualifying individuals" (the people named in section 1396a(a)(10)(E)(iv)). States must let qualifying individuals apply any time during the year. States must pick applicants in the order they apply, but give first choice to people who got this help in the last month of the previous year and are still eligible. States must pick only as many people as the state’s yearly money allows. If someone is picked for any month, they get help for the rest of that calendar year if they stay eligible. Being picked one year does not guarantee help the next year. The law sets specific national dollar amounts to be split among states: fiscal year 1998 $200,000,000; 1999 $250,000,000; 2000 $300,000,000; 2001 $350,000,000; 2002 and 2003 $400,000,000 each. For 2008–2015 and later, the law lists these totals for each period: Jan 1–Sep 30, 2008 $315,000,000; Oct 1–Dec 31, 2008 $130,000,000; Jan 1–Sep 30, 2009 $350,000,000; Oct 1–Dec 31, 2009 $150,000,000; Jan 1–Sep 30, 2010 $462,500,000; Oct 1–Dec 31, 2010 $165,000,000; Jan 1–Sep 30, 2011 $720,000,000; Oct 1–Dec 31, 2011 $280,000,000; Jan 1–Sep 30, 2012 $450,000,000; Oct 1–Dec 31, 2012 $280,000,000; Jan 1–Sep 30, 2013 $485,000,000; Oct 1–Dec 31, 2013 $300,000,000; Jan 1–Sep 30, 2014 $485,000,000; Oct 1–Dec 31, 2014 $300,000,000; Jan 1–Mar 31, 2015 $250,000,000; Apr 1–Dec 31, 2015 $535,000,000; and 2016 and later years $980,000,000 (subject to a possible increase rule). The federal government divides each total among the states based on how many eligible people each state has. The federal share pays 100% of these costs up to a state's allocation and pays nothing for costs above it. The Medicare Supplementary Medical Insurance Trust Fund transfers money to cover these payments. The law does not create any other guaranteed right to this help.
Full Legal Text
Title 42, §1396u–3
The Public Health and Welfare — Source: USLM XML via OLRC
(a)A State plan under this subchapter shall provide, under section 1396a(a)(10)(E)(iv) of this title and subject to the succeeding provisions of this section and through a plan amendment, for medical assistance for payment of the cost of medicare cost-sharing described in such section on behalf of all individuals described in such section (in this section referred to as “qualifying individuals”) who are selected to receive such assistance under subsection (b).
(b)A State shall select qualifying individuals, and provide such individuals with assistance, under this section consistent with the following:
(1)The State shall permit all qualifying individuals to apply for assistance during a calendar year.
(2)(A)For each calendar year (beginning with 1998), from (and to the extent of) the amount of the allocation under subsection (c) for the State for the fiscal year ending in such calendar year, the State shall select qualifying individuals who apply for the assistance in the order in which they apply.
(B)For calendar years after 1998, the State shall give preference to individuals who were provided such assistance (or other assistance described in section 1396a(a)(10)(E) of this title) in the last month of the previous year and who continue to be (or become) qualifying individuals.
(3)The State shall limit the number of qualifying individuals selected with respect to assistance in a calendar year so that the aggregate amount of such assistance provided to such individuals in such year is estimated to be equal to (but not exceed) the State’s allocation under subsection (c) for the fiscal year ending in such calendar year.
(4)If a qualifying individual is selected to receive assistance under this section for a month in a year, the individual is entitled to receive such assistance for the remainder of the year if the individual continues to be a qualifying individual. The fact that an individual is selected to receive assistance under this section at any time during a year does not entitle the individual to continued assistance for any succeeding year.
(c)(1)The total amount available for allocation under this section for—
(A)fiscal year 1998 is $200,000,000;
(B)fiscal year 1999 is $250,000,000;
(C)fiscal year 2000 is $300,000,000;
(D)fiscal year 2001 is $350,000,000; and
(E)each of fiscal years 2002 and 2003 is $400,000,000.
(2)The Secretary shall provide for the allocation of the total amount described in paragraph (1) for a fiscal year, among the States that executed a plan amendment in accordance with subsection (a), based upon the Secretary’s estimate of the ratio of—
(A)an amount equal to the total number of individuals described in section 1396a(a)(10)(E)(iv) of this title in the State; to
(B)the sum of the amounts computed under subparagraph (A) for all eligible States.
(d)With respect to assistance described in section 1396a(a)(10)(E)(iv) of this title furnished in a State for calendar quarters in a calendar year—
(1)to the extent that such assistance does not exceed the State’s allocation under subsection (c) for the fiscal year ending in the calendar year, the Federal medical assistance percentage shall be equal to 100 percent; and
(2)to the extent that such assistance exceeds such allocation, the Federal medical assistance percentage is 0 percent.
(e)Except as specifically provided under this section, nothing in this subchapter shall be construed as establishing any entitlement of individuals described in section 1396a(a)(10)(E)(iv) of this title to assistance described in such section.
(f)For each fiscal year, the Secretary shall provide for the transfer from the Federal Supplementary Medical Insurance Trust Fund under section 1395t of this title to the appropriate account in the Treasury that provides for payments under section 1396b(a) of this title with respect to medical assistance provided under this section, of an amount equivalent to the total of the amount of payments made under such section that is attributable to this section and such transfer shall be treated as an expenditure from such Trust Fund for purposes of section 1395r of this title.
(g)(1)With respect to each period described in paragraph (2), a State shall select qualifying individuals, subject to paragraph (3), and provide such individuals with assistance, in accordance with the provisions of this section as in effect with respect to calendar year 2003, except that for such purpose—
(A)references in the preceding subsections of this section to a year, whether fiscal or calendar, shall be deemed to be references to such period; and
(B)the total allocation amount under subsection (c) for such period shall be the amount described in paragraph (2) for that period.
(2)For purposes of this subsection—
(A)for the period that begins on January 1, 2008, and ends on September 30, 2008, the total allocation amount is $315,000,000;
(B)for the period that begins on October 1, 2008, and ends on December 31, 2008, the total allocation amount is $130,000,000;
(C)for the period that begins on January 1, 2009, and ends on September 30, 2009, the total allocation amount is $350,000,000;
(D)for the period that begins on October 1, 2009, and ends on December 31, 2009, the total allocation amount is $150,000,000;
(E)for the period that begins on January 1, 2010, and ends on September 30, 2010, the total allocation amount is $462,500,000;
(F)for the period that begins on October 1, 2010, and ends on December 31, 2010, the total allocation amount is $165,000,000;
(G)for the period that begins on January 1, 2011, and ends on September 30, 2011, the total allocation amount is $720,000,000;
(H)for the period that begins on October 1, 2011, and ends on December 31, 2011, the total allocation amount is $280,000,000;
(I)for the period that begins on January 1, 2012, and ends on September 30, 2012, the total allocation amount is $450,000,000;
(J)for the period that begins on October 1, 2012, and ends on December 31, 2012, the total allocation amount is $280,000,000;
(K)for the period that begins on January 1, 2013, and ends on September 30, 2013, the total allocation amount is $485,000,000;
(L)for the period that begins on October 1, 2013, and ends on December 31, 2013, the total allocation amount is $300,000,000;
(M)for the period that begins on January 1, 2014, and ends on September 30, 2014, the total allocation amount is $485,000,000;
(N)for the period that begins on October 1, 2014, and ends on December 31, 2014, the total allocation amount is $300,000,000;
(O)for the period that begins on January 1, 2015, and ends on March 31, 2015, the total allocation amount is $250,000,000;
(P)for the period that begins on April 1, 2015, and ends on December 31, 2015, the total allocation amount is $535,000,000; and
(Q)for 2016 and, subject to paragraph (4), for each subsequent year, the total allocation amount is $980,000,000.
(3)For any specific period described in subparagraph (B), (D), (F), (H), (J), (L), (N), or (P) of paragraph (2), the following applies:
(A)The specific period shall be treated as a continuation of the immediately preceding period in that calendar year for purposes of applying subsection (b)(2) and qualifying individuals who received assistance in the last month of such immediately preceding period shall be deemed to be selected for the specific period (without the need to complete an application for assistance for such period).
(B)The limit to be applied under subsection (b)(3) for the specific period shall be the same as the limit applied under such subsection for the immediately preceding period.
(C)The ratio to be applied under subsection (c)(2) for the specific period shall be the same as the ratio applied under such subsection for the immediately preceding period.
(4)The Secretary may increase the allocation amount under paragraph (2)(Q) for a year (beginning with 2017) up to an amount that does not exceed the product of the following:
(A)In the case of 2017, the allocation amount for 2016, or in the case of a subsequent year, the maximum allocation amount allowed under this paragraph for the previous year.
(B)The monthly premium rate determined under section 1395r of this title for the year divided by the monthly premium rate determined under such section for the previous year.
(C)The average number of individuals (as estimated by the Chief Actuary of the Centers for Medicare & Medicaid Services in September of the previous year) to be enrolled under part B of subchapter XVIII for months in the year divided by the average number of such individuals (as so estimated) under this subparagraph with respect to enrollments in months in the previous year.
Legislative History
Notes & Related Subsidiaries
Editorial Notes
Prior Provisions
A prior section 1933 of act Aug. 14, 1935, was renumbered section 1939 and is classified to section 1396v of this title.
Amendments
2015—Subsec. (g)(2). Pub. L. 114–10, § 211(b)(1), redesignated subpars. (I) to (W) as (A) to (O), respectively, added subpars. (P) and (Q), and struck out former subpars. (A) to (H) which related to total allocation amounts for various periods beginning on
January 1, 2004, and ending on
December 31, 2007. Subsec. (g)(3). Pub. L. 114–10, § 211(b)(2), substituted “or (P)” for “(P), (R), (T), or (V)” in introductory provisions. Subsec. (g)(4). Pub. L. 114–10, § 211(b)(3), added par. (4). 2014—Subsec. (g)(2)(T). Pub. L. 113–93, § 201(b)(1)(A), struck out “and” at end. Subsec. (g)(2)(U). Pub. L. 113–93, § 201(b)(1)(B), substituted “
September 30, 2014” for “
March 31, 2014” and “$485,000,000;” for “$200,000,000.” Subsec. (g)(2)(V), (W). Pub. L. 113–93, § 201(b)(1)(C), added subpars. (V) and (W). Subsec. (g)(3). Pub. L. 113–93, § 201(b)(2), substituted “(T), or (V)” for “or (T)” in introductory provisions. 2013—Subsec. (g)(2)(S), (T). Pub. L. 112–240, § 621(b)(1), added subpars. (S) and (T). Subsec. (g)(2)(U). Pub. L. 113–67 added subpar. (U). Subsec. (g)(3). Pub. L. 112–240, § 621(b)(2), substituted “(R), or (T)” for “or (R)” in introductory provisions. 2012—Subsec. (g)(2)(Q), (R). Pub. L. 112–96, § 3101(b)(1), substituted “
September 30, 2012, the total allocation amount is $450,000,000; and” for “
February 29, 2012, the total allocation amount is $150,000,000.” in subpar. (Q) and added subpar. (R). Subsec. (g)(3). Pub. L. 112–96, § 3101(b)(2), substituted “(P), or (R)” for “or (P)” in introductory provisions. 2011—Subsec. (g)(2)(Q). Pub. L. 112–78 added subpar. (Q). 2010—Subsec. (g)(2)(M). Pub. L. 111–127, § 3(1), substituted “$462,500,000” for “$412,500,000”. Subsec. (g)(2)(N). Pub. L. 111–127, § 3(2), substituted “$165,000,000” for “$150,000,000”. Subsec. (g)(2)(O), (P). Pub. L. 111–309, § 110(b)(1), added subpars. (O) and (P). Subsec. (g)(3). Pub. L. 111–309, § 110(b)(2), substituted “(N), or (P)” for “or (N)” in introductory provisions. 2009—Subsec. (g)(2)(M), (N). Pub. L. 111–5, § 5005(b)(1), added subpars. (M) and (N). Subsec. (g)(3). Pub. L. 111–5, § 5005(b)(2), substituted “(L), or (N)” for “or (L)” in introductory provisions. 2008—Subsec. (g)(2)(I). Pub. L. 110–379, § 2(1), substituted “$315,000,000” for “$300,000,000”. Pub. L. 110–275, § 111(b)(1)(B)(i), (ii), substituted “September 30” for “June 30” and “$300,000,000” for “$200,000,000”. Subsec. (g)(2)(J). Pub. L. 110–379, § 2(2), substituted “$130,000,000” for “$100,000,000”. Pub. L. 110–275, § 111(b)(1)(A), (B)(iii), (C), added subpar. (J). Subsec. (g)(2)(K), (L). Pub. L. 110–275, § 111(b)(1)(C), added subpars. (K) and (L). Subsec. (g)(3). Pub. L. 110–275, § 111(b)(2), substituted “(H), (J), or (L)” for “or (H)” in introductory provisions. 2007—Subsec. (g)(2)(H). Pub. L. 110–90, § 3(b)(1), added subpar. (H). Subsec. (g)(2)(I). Pub. L. 110–173 added subpar. (I). Subsec. (g)(3). Pub. L. 110–90, § 3(b)(2), substituted “(F), or (H)” for “or (F)” in introductory provisions. 2005—Subsec. (g)(2)(D) to (G). Pub. L. 109–91, § 101(b)(1), added subpars. (D) to (G). Subsec. (g)(3). Pub. L. 109–91, § 101(b)(2), inserted “, (D), or (F)” after “subparagraph (B)” in introductory provisions. 2004—Subsec. (g). Pub. L. 108–448 amended heading and text of subsec. (g) generally. Prior to amendment, text read as follows: “With respect to the period that begins on
January 1, 2004, and ends on
September 30, 2004, a State shall select qualifying individuals, and provide such individuals with assistance, in accordance with the provisions of this section as in effect with respect to calendar year 2003, except that for such purpose— “(1) references in the preceding subsections of this section to ‘fiscal year’ and ‘calendar year’ shall be deemed to be references to such period; and “(2) the total allocation amount under subsection (c) of this section for such period shall be $300,000,000.” 2003—Subsec. (c)(1)(E). Pub. L. 108–89, § 401(b)(1), substituted “each of fiscal years 2002 and 2003” for “fiscal year 2002”. Subsec. (c)(2)(A). Pub. L. 108–89, § 401(b)(2), substituted “the total number of individuals described in section 1396a(a)(10)(E)(iv) of this title in the State; to” for “the sum of— “(i) twice the total number of individuals described in section 1396a(a)(10)(E)(iv)(I) of this title in the State, and “(ii) the total number of individuals described in section 1396a(a)(10)(E)(iv)(II) of this title in the State; to”. Subsec. (g). Pub. L. 108–173, § 103(f)(2)(A), substituted “
September 30, 2004” for “
March 31, 2004” in introductory provisions. Pub. L. 108–89, § 401(c), added subsec. (g). Subsec. (g)(2). Pub. L. 108–173, § 103(f)(2)(B), substituted “$300,000,000” for “$100,000,000”. 1999—Subsec. (b)(4). Pub. L. 106–113 inserted “a” after “for a month in”.
Statutory Notes and Related Subsidiaries
Effective Date
of 2007 AmendmentAmendment by Pub. L. 110–90 effective as of Sept. 30, 2007, see section 3(c) of Pub. L. 110–90, set out as a note under section 1396a of this title.
Effective Date
of 2005 AmendmentAmendment by Pub. L. 109–91 effective Sept. 30, 2005, see section 101(c) of Pub. L. 109–91, set out as a note under section 1396a of this title.
Effective Date
of 2003 AmendmentAmendment by Pub. L. 108–173 applicable to calendar quarters beginning on or after Apr. 1, 2004, see section 103(f)(3) of Pub. L. 108–173, set out as a note under section 1396a of this title.
Reference
Citations & Metadata
Citation
42 U.S.C. § 1396u–3
Title 42 — The Public Health and Welfare
Last Updated
Apr 6, 2026
Release point: 119-73