House File 948 H-1192 Amend House File 948 as follows: 1 1. Page 3, line 31, by striking < MEDICAID FOR EMPLOYED 2 PEOPLE WITH DISABILITIES > and inserting < WORK WITHOUT WORRY > 3 2. By striking page 3, line 32, through page 4, line 32, and 4 inserting: 5 < Sec. ___. NEW SECTION . 249O.1 Definitions. 6 As used in this chapter, unless the context otherwise 7 requires: 8 1. “Countable income” means the income of an individual when 9 the income is received and can be used to meet the individual’s 10 needs for food, clothing, and shelter. “Countable income” does 11 not include the income of another member of the individual’s 12 household, or certain receipts as described in 20 C.F.R. 13 §416.1103. 14 2. “Department” means the department of health and human 15 services. 16 3. “Disability” means a qualifying disability as determined 17 by the federal social security administration, or the 18 individual is determined by the department to have a physical 19 or mental impairment, or combination of impairments, that have 20 lasted or are expected to last for at least twelve months or 21 result in death. 22 4. “Long-term services and supports” means the broad 23 range of health, health-related, and personal care assistance 24 services and supports, provided in home and community-based 25 settings, necessary for persons with disabilities who 26 experience limitations in their capacity for self-care due to a 27 physical, cognitive, or mental disability or condition. 28 5. “Program” means the work without worry program 29 established in section 249O.3. 30 Sec. ___. NEW SECTION . 249O.2 Program —— intent. 31 It is the intent of the general assembly to remove barriers 32 to employment for individuals who, but for income and 33 resources, meet the definition of disability, by providing 34 medical assistance to employed individuals with disabilities 35 -1- HF 948.1255 (1) 91 lh/ko 1/ 5 #1. #2.

through a work without worry program in accordance with section 1 1902(a)(10)(A)(ii)(XIII) of the federal Social Security Act, 2 and Medicaid eligibility, using less restrictive income and 3 resource requirements through the application of section 4 1902(r)(2) of the federal Social Security Act, and cost-sharing 5 requirements established by the department and approved by the 6 centers for Medicare and Medicaid services of the United States 7 department of health and human services. 8 Sec. ___. NEW SECTION . 249O.3 Program —— established. 9 1. The work without worry program is established under the 10 medical assistance program and shall be administered by the 11 department to provide employed individuals with disabilities 12 access to health care coverage through the medical assistance 13 program. 14 2. Except as otherwise specified in this chapter, 15 provisions applicable to the medical assistance program 16 pursuant to chapter 249A shall be applicable to the program. 17 3. In addition to the benefits received under the program, 18 an individual shall have access to all traditional Medicaid 19 services under the medical assistance program, as well as 20 additional long-term services and supports and community-based 21 services, including waiver services, for which the individual 22 meets any applicable level of care requirements. 23 4. The department shall make every effort to coordinate 24 benefits with the health care coverage provided by an employer 25 of an employed individual with a disability receiving benefits 26 under this chapter. 27 Sec. ___. NEW SECTION . 249O.4 Program —— eligibility. 28 1. Except as otherwise provided in this chapter, an 29 individual may participate in the program if the individual 30 meets all of the following criteria: 31 a. The individual is eligible for the medical assistance 32 program under chapter 249A. 33 b. The individual is at least eighteen years of age. 34 c. The individual is less than sixty-five years of age. 35 -2- HF 948.1255 (1) 91 lh/ko 2/ 5

d. The individual has a disability. 1 e. The individual is employed, earns income from employment 2 which may include self-employment, and works at least one hour 3 per month. 4 2. The department shall not adopt a rule for program 5 eligibility based upon any of the following: 6 a. An individual’s income or resources. 7 b. A resource test or limit. 8 c. An individual’s receipt of federal disability benefits. 9 3. An individual who receives supplemental security 10 income shall be automatically eligible for the program and may 11 participate in the program. 12 4. An individual may be eligible for or receive other health 13 care coverage including through an employer, through Medicare, 14 or through the medically needy program, the qualified Medicare 15 beneficiary program, or the specified low-income Medicare 16 beneficiary program. If the individual has such other coverage 17 and is subject to payment of copayments or premiums for that 18 coverage, notwithstanding the premium requirements under the 19 program to the contrary, the individual shall not be subject to 20 payment of premiums otherwise applicable under the program. 21 Sec. ___. NEW SECTION . 249O.5 Program —— premiums. 22 1. An individual’s monthly program premium amount shall 23 equal, rounded down to the nearest whole dollar, any of the 24 following: 25 a. If the individual’s verified countable income is less 26 than one hundred fifty percent of the federal poverty level 27 applicable to the individual’s household’s size, zero percent 28 of the individual’s verified countable income. 29 b. If the individual’s verified countable income is between 30 one hundred fifty percent and two hundred fifty percent of 31 the federal poverty level applicable to the individual’s 32 household’s size, three percent of the individual’s verified 33 countable income. 34 c. If the individual’s verified countable income is more 35 -3- HF 948.1255 (1) 91 lh/ko 3/ 5

than two hundred fifty percent of the federal poverty level 1 applicable to the individual’s household’s size, six percent of 2 the individual’s verified countable income. 3 2. a. An individual shall report any change in the 4 individual’s countable income to the department. 5 b. The department shall utilize the individual’s verified 6 countable income until the individual reports a change in 7 countable income and the change is processed by the department, 8 unless there is good cause for the department’s delay in 9 verifying the change in the individual’s countable income. 10 c. A change in an individual’s program premium amount shall 11 be effective the month after the change in the individual’s 12 countable income is reported to and verified by the department. 13 3. An individual shall be covered under the program for 14 six consecutive months beginning the first day of the month in 15 which the department approves the individual’s application for 16 the program. 17 4. The department shall create a six-month grace period that 18 provides continuous program coverage to an individual following 19 the individual’s temporary loss of employment, or a health 20 crisis that temporarily prevents the individual from continuing 21 employment. The individual shall be required to continue to 22 pay the program premium based on the individual’s verified 23 countable income during the six-month grace period. 24 5. The department may terminate an individual’s program 25 coverage if the individual fails to pay four consecutive months 26 of program premiums. 27 6. An individual must pay a program premium in full for any 28 month that program coverage is provided, including a month when 29 a redetermination of coverage is made, a month when continued 30 coverage is requested, and during the period of an eligibility 31 determination appeal. 32 Sec. ___. NEW SECTION . 249O.6 Rules. 33 The department shall adopt rules pursuant to chapter 17A to 34 administer this chapter. 35 -4- HF 948.1255 (1) 91 lh/ko 4/ 5

Sec. ___. WORK WITHOUT WORRY PROGRAM —— DEPARTMENT OF HEALTH 1 AND HUMAN SERVICES. 2 1. The department of health and human services shall submit 3 any waiver request or state plan amendment, or combination 4 thereof, to the centers for Medicare and Medicaid services of 5 the United States department of health and human services as 6 necessary to create a work without worry program in accordance 7 with this Act. 8 2. Any individual participating in the Medicaid for 9 employed persons with disabilities program when the work 10 without worry program is implemented shall be transferred to 11 and enrolled in the work without worry program. 12 Sec. ___. EFFECTIVE DATE. This division of this Act, being 13 deemed of immediate importance, takes effect upon enactment. > 14 3. Title page, by striking lines 4 and 5 and inserting 15 < modernization fund, and the work without worry program, and 16 including effective date provisions. > 17 4. By renumbering as necessary. 18 ______________________________ TUREK of Pottawattamie -5- HF 948.1255 (1) 91 lh/ko 5/ 5 #3. #4.