Bill > S1621

Introduced Session

This bill increases the income eligibility threshold and eliminates the asset test for the Qualified Medicare Beneficiary (QMB) Program, the Specified Low-Income Medicare Beneficiary (SLMB) Program, and the Qualifying Individual (QI) Program. The bill also appropriates from the General Fund to the Department of Human Services (DHS) such an amount as is necessary to carry out these provisions. Generally, these programs are referred to as Medicare Savings Programs, which are federal programs administered by each individual state Medicaid agency and provide people with limited income and resources assistance in paying their Medicare cost sharing obligations. The QMB program pays for eligible individuals Medicare Part A and B premiums, copayments, coinsurances, and deductibles. The SLMB and QI programs pay for eligible individuals Medicare Part B premiums. Currently, New Jersey implements the federal income - between 100 percent and 135 percent of the federal poverty level (FPL) - and asset cap - $9,090 for individuals and $13,630 for married couples - to determine eligibility for these Medicare Savings Programs. States, however, have the option of modifying federal income and asset eligibility criteria, pursuant to Section 1902(r)(2) of the Social Security Act, by increasing income and asset disregards. Using this authority, the bill directs the Commissioner of Human Services to implement a State Medicaid benefit, that maximizes federal funding available under the QMB, SLMB, and QI programs, to provide State residents enrolled in the Medicare program, whose incomes are equal to or less than 200 percent of the FPL, or $29,160 for singles and $39,440 for married couples in 2023, and without regard to resident's assets, with assistance in the payment of all medicare cost-sharing. Under the bill, medicare cost-sharing includes Medicare Part A and B premiums, copayments, coinsurances, and deductibles. To the extent that federal law and regulation do not permit the provision of assistance in the payment all medicare cost-sharing under the SLMB and QI programs, the bill directs the DHS to provide such assistance via a separate subprogram using State funds only. Furthermore, the bill authorizes the Commissioner of Human Services to establish alternative income eligibility standards to the standard described under the bill in order to comply with federal law and regulations and to maximize federal funding available under the SLMB and QI programs, provided that the alternative income eligibility standards are no higher than 230 percent of the FPL. The bill explicitly states that its provisions are in no way to be construed to permit the Commissioner of Human Services to alter the federal requirements for the QMB, SLMB, and QI programs beyond the flexibilities provided to the State by the federal government regarding income and asset eligibility.

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Vin Gopal (D)*,  Andrew Zwicker (D)*, 

Introduced in the Senate, Referred to Senate Budget and Appropriations Committee (on 01/13/2026)

Official Document