Senate File 615 H-1200 Amend the amendment, H-1198, to Senate File 615, as passed by 1 the Senate, as follows: 2 1. Page 1, after line 8 by inserting: 3 < ___. Page 3, line 28, before < MEDICAID > by inserting < WORK 4 WITHOUT WORRY PROGRAM AND >> 5 2. Page 1, after line 9 by inserting: 6 << Sec. ___. NEW SECTION . 249O.1 Definitions. 7 As used in this chapter, unless the context otherwise 8 requires: 9 1. “Countable income” means the income of an individual when 10 the income is received and can be used to meet the individual’s 11 needs for food, clothing, and shelter. “Countable income” does 12 not include the income of another member of the individual’s 13 household, or certain receipts as described in 20 C.F.R. 14 §416.1103. 15 2. “Department” means the department of health and human 16 services. 17 3. “Disability” means a qualifying disability as determined 18 by the federal social security administration, or the 19 individual is determined by the department to have a physical 20 or mental impairment, or combination of impairments, that have 21 lasted or are expected to last for at least twelve months or 22 result in death. 23 4. “Long-term services and supports” means the broad 24 range of health, health-related, and personal care assistance 25 services and supports, provided in home and community-based 26 settings, necessary for persons with disabilities who 27 experience limitations in their capacity for self-care due to a 28 physical, cognitive, or mental disability or condition. 29 5. “Program” means the work without worry program 30 established in section 249O.3. 31 Sec. ___. NEW SECTION . 249O.2 Program —— intent. 32 It is the intent of the general assembly to remove barriers 33 to employment for individuals who, but for income and 34 resources, meet the definition of disability, by providing 35 -1- H 1198.1280 (2) 91 lh/ko 1/ 5 #1. #2.

medical assistance to employed individuals with disabilities 1 through a work without worry program in accordance with section 2 1902(a)(10)(A)(ii)(XIII) of the federal Social Security Act, 3 and Medicaid eligibility, using less restrictive income and 4 resource requirements through the application of section 5 1902(r)(2) of the federal Social Security Act, and cost-sharing 6 requirements established by the department and approved by the 7 centers for Medicare and Medicaid services of the United States 8 department of health and human services. 9 Sec. ___. NEW SECTION . 249O.3 Program —— established. 10 1. The work without worry program is established under the 11 medical assistance program and shall be administered by the 12 department to provide employed individuals with disabilities 13 access to health care coverage through the medical assistance 14 program. 15 2. Except as otherwise specified in this chapter, 16 provisions applicable to the medical assistance program 17 pursuant to chapter 249A shall be applicable to the program. 18 3. In addition to the benefits received under the program, 19 an individual shall have access to all traditional Medicaid 20 services under the medical assistance program, as well as 21 additional long-term services and supports and community-based 22 services, including waiver services, for which the individual 23 meets any applicable level of care requirements. 24 4. The department shall make every effort to coordinate 25 benefits with the health care coverage provided by an employer 26 of an employed individual with a disability receiving benefits 27 under this chapter. 28 Sec. ___. NEW SECTION . 249O.4 Program —— eligibility. 29 1. Except as otherwise provided in this chapter, an 30 individual may participate in the program if the individual 31 meets all of the following criteria: 32 a. The individual is eligible for the medical assistance 33 program under chapter 249A. 34 b. The individual is at least eighteen years of age. 35 -2- H 1198.1280 (2) 91 lh/ko 2/ 5

c. The individual is less than sixty-five years of age. 1 d. The individual has a disability. 2 e. The individual is employed, earns income from employment 3 which may include self-employment, and works at least one hour 4 per month. 5 2. The department shall not adopt a rule for program 6 eligibility based upon any of the following: 7 a. An individual’s income or resources. 8 b. A resource test or limit. 9 c. An individual’s receipt of federal disability benefits. 10 3. An individual who receives supplemental security 11 income shall be automatically eligible for the program and may 12 participate in the program. 13 4. An individual may be eligible for or receive other health 14 care coverage including through an employer, through Medicare, 15 or through the medically needy program, the qualified Medicare 16 beneficiary program, or the specified low-income Medicare 17 beneficiary program. If the individual has such other coverage 18 and is subject to payment of copayments or premiums for that 19 coverage, notwithstanding the premium requirements under the 20 program to the contrary, the individual shall not be subject to 21 payment of premiums otherwise applicable under the program. 22 Sec. ___. NEW SECTION . 249O.5 Program —— premiums. 23 1. An individual’s monthly program premium amount shall 24 equal, rounded down to the nearest whole dollar, any of the 25 following: 26 a. If the individual’s verified countable income is less 27 than one hundred fifty percent of the federal poverty level 28 applicable to the individual’s household’s size, zero percent 29 of the individual’s verified countable income. 30 b. If the individual’s verified countable income is between 31 one hundred fifty percent and two hundred fifty percent of 32 the federal poverty level applicable to the individual’s 33 household’s size, three percent of the individual’s verified 34 countable income. 35 -3- H 1198.1280 (2) 91 lh/ko 3/ 5

c. If the individual’s verified countable income is more 1 than two hundred fifty percent of the federal poverty level 2 applicable to the individual’s household’s size, six percent of 3 the individual’s verified countable income. 4 2. a. An individual shall report any change in the 5 individual’s countable income to the department. 6 b. The department shall utilize the individual’s verified 7 countable income until the individual reports a change in 8 countable income and the change is processed by the department, 9 unless there is good cause for the department’s delay in 10 verifying the change in the individual’s countable income. 11 c. A change in an individual’s program premium amount shall 12 be effective the month after the change in the individual’s 13 countable income is reported to and verified by the department. 14 3. An individual shall be covered under the program for 15 six consecutive months beginning the first day of the month in 16 which the department approves the individual’s application for 17 the program. 18 4. The department shall create a six-month grace period that 19 provides continuous program coverage to an individual following 20 the individual’s temporary loss of employment, or a health 21 crisis that temporarily prevents the individual from continuing 22 employment. The individual shall be required to continue to 23 pay the program premium based on the individual’s verified 24 countable income during the six-month grace period. 25 5. The department may terminate an individual’s program 26 coverage if the individual fails to pay four consecutive months 27 of program premiums. 28 6. An individual must pay a program premium in full for any 29 month that program coverage is provided, including a month when 30 a redetermination of coverage is made, a month when continued 31 coverage is requested, and during the period of an eligibility 32 determination appeal. 33 Sec. ___. NEW SECTION . 249O.6 Rules. 34 The department shall adopt rules pursuant to chapter 17A to 35 -4- H 1198.1280 (2) 91 lh/ko 4/ 5

administer this chapter. 1 Sec. ___. WORK WITHOUT WORRY PROGRAM —— DEPARTMENT OF HEALTH 2 AND HUMAN SERVICES. 3 1. The department of health and human services shall submit 4 any waiver request or state plan amendment, or combination 5 thereof, to the centers for Medicare and Medicaid services of 6 the United States department of health and human services as 7 necessary to create a work without worry program in accordance 8 with this Act. 9 2. Any individual participating in the Medicaid for 10 employed persons with disabilities program when the work 11 without worry program is implemented shall be transferred to 12 and enrolled in the work without worry program. >> 13 3. Page 1, after line 22 by inserting: 14 << Sec. ___. EFFECTIVE DATE. This division of this Act, 15 being deemed of immediate importance, takes effect upon 16 enactment. >> 17 4. By renumbering as necessary. 18 ______________________________ TUREK of Pottawattamie -5- H 1198.1280 (2) 91 lh/ko 5/ 5 #3. #4.