House File 2716 H-8180 Amend House File 2716 as follows: 1 1. By striking everything after the enacting clause and 2 inserting: 3 < Section 1. NEW SECTION . 249P.1 Definitions. 4 As used in this chapter, unless the context otherwise 5 requires: 6 1. “Countable income” means the income of an individual when 7 the income is received and can be used to meet the individual’s 8 needs for food, clothing, and shelter. “Countable income” does 9 not include the income of another member of the individual’s 10 household, or certain receipts as described in 20 C.F.R. 11 §416.1103. 12 2. “Department” means the department of health and human 13 services. 14 3. “Disability” means a qualifying disability as determined 15 by the federal social security administration, or the 16 individual is determined by the department to have a physical 17 or mental impairment, or combination of impairments, that have 18 lasted or are expected to last for at least twelve months or 19 result in death. 20 4. “Long-term services and supports” means the broad 21 range of health, health-related, and personal care assistance 22 services and supports, provided in home and community-based 23 settings, necessary for persons with disabilities who 24 experience limitations in their capacity for self-care due to a 25 physical, cognitive, or mental disability or condition. 26 5. “Program” means the work without worry program 27 established in section 249P.3. 28 Sec. 2. NEW SECTION . 249P.2 Program —— intent. 29 It is the intent of the general assembly to remove barriers 30 to employment for individuals who, but for income and 31 resources, meet the definition of disability, by providing 32 medical assistance to employed individuals with disabilities 33 through a work without worry program in accordance with section 34 1902(a)(10)(A)(ii)(XIII) of the federal Social Security Act, 35 -1- HF 2716.3311 (1) 91 ak/ko 1/ 5 #1.

and Medicaid eligibility, using less restrictive income and 1 resource requirements through the application of section 2 1902(r)(2) of the federal Social Security Act, and cost-sharing 3 requirements established by the department and approved by the 4 centers for Medicare and Medicaid services of the United States 5 department of health and human services. 6 Sec. 3. NEW SECTION . 249P.3 Program —— established. 7 1. The work without worry program is established under the 8 medical assistance program and shall be administered by the 9 department to provide employed individuals with disabilities 10 access to health care coverage through the medical assistance 11 program. 12 2. Except as otherwise specified in this chapter, 13 provisions applicable to the medical assistance program 14 pursuant to chapter 249A shall be applicable to the program. 15 3. In addition to the benefits received under the program, 16 an individual shall have access to all traditional Medicaid 17 services under the medical assistance program, as well as 18 additional long-term services and supports and community-based 19 services, including waiver services, for which the individual 20 meets any applicable level of care requirements. 21 4. The department shall make every effort to coordinate 22 benefits with the health care coverage provided by an employer 23 of an employed individual with a disability receiving benefits 24 under this chapter. 25 Sec. 4. NEW SECTION . 249P.4 Program —— eligibility. 26 1. Except as otherwise provided in this chapter, an 27 individual may participate in the program if the individual 28 meets all of the following criteria: 29 a. The individual is eligible for the medical assistance 30 program under chapter 249A. 31 b. The individual is at least eighteen years of age. 32 c. The individual is less than sixty-five years of age. 33 d. The individual has a disability. 34 e. The individual is employed, earns income from employment 35 -2- HF 2716.3311 (1) 91 ak/ko 2/ 5

which may include self-employment, and works at least one hour 1 per month. 2 2. The department shall not adopt a rule for program 3 eligibility based upon any of the following: 4 a. An individual’s income or resources. 5 b. A resource test or limit. 6 c. An individual’s receipt of federal disability benefits. 7 3. An individual who receives supplemental security 8 income shall be automatically eligible for the program and may 9 participate the program. 10 4. An individual may be eligible for or receive other health 11 care coverage including through an employer, through Medicare, 12 through the medically needy program, the qualified Medicare 13 beneficiary program, or the specified low-income Medicare 14 beneficiary program. If the individual has such other coverage 15 and is subject to payment of copayments or premiums for that 16 coverage, notwithstanding the premium requirements under the 17 program to the contrary, the individual shall not be subject to 18 payment of premiums otherwise applicable under the program. 19 Sec. 5. NEW SECTION . 249P.5 Program —— premiums. 20 1. An individual’s monthly program premium amount shall 21 equal, rounded down to the nearest whole dollar, any of the 22 following: 23 a. If the individual’s verified countable income is less 24 than one hundred fifty percent of the federal poverty level 25 applicable to the individual’s household’s size, zero percent 26 of the individual’s verified countable income. 27 b. If the individual’s verified countable income is between 28 one hundred fifty percent and two hundred fifty percent of 29 the federal poverty level applicable to the individual’s 30 household’s size, three percent of the individual’s verified 31 countable income. 32 c. If the individual’s verified countable income is more 33 than two hundred fifty percent of the federal poverty level 34 applicable to the individual’s household’s size, six percent of 35 -3- HF 2716.3311 (1) 91 ak/ko 3/ 5

the individual’s verified countable income. 1 2. a. An individual shall report any change in the 2 individual’s countable income to the department. 3 b. The department shall utilize the individual’s verified 4 countable income until the individual reports a change in 5 countable income and the change is processed by the department, 6 unless there is good cause for the department’s delay in 7 verifying the change in the individual’s countable income. 8 c. A change in an individual’s program premium amount shall 9 be effective the month after the change in the individual’s 10 countable income is reported to and verified by the department. 11 3. An individual shall be covered under the program for 12 six consecutive months beginning the first day of the month in 13 which the department approves the individual’s application for 14 the program. 15 4. The department shall create a six-month grace period that 16 provides continuous program coverage to an individual following 17 the individual’s temporary loss of employment, or a health 18 crisis that temporarily prevents the individual from continuing 19 employment. The individual shall be required to continue to 20 pay the program premium based on the individual’s verified 21 countable income during the six-month grace period. 22 5. The department may terminate an individual’s program 23 coverage if the individual fails to pay four consecutive months 24 of program premiums. 25 6. An individual must pay a program premium in full for any 26 month that program coverage is provided, including a month when 27 a redetermination of coverage is made, a month when continued 28 coverage is requested, and during the period of an eligibility 29 determination appeal. 30 Sec. 6. NEW SECTION . 249P.6 Rules. 31 The department shall adopt rules pursuant to chapter 17A to 32 administer this chapter. 33 Sec. 7. WORK WITHOUT WORRY PROGRAM —— DEPARTMENT OF HEALTH 34 AND HUMAN SERVICES. 35 -4- HF 2716.3311 (1) 91 ak/ko 4/ 5

1. The department of health and human services shall submit 1 any waiver request or state plan amendment, or combination 2 thereof, to the centers for Medicare and Medicaid services of 3 the United States department of health and human services as 4 necessary to create a work without worry program in accordance 5 with this Act. 6 2. Any individual participating in the Medicaid for 7 employed persons with disabilities program when the work 8 without worry program is implemented shall be transferred to 9 and enrolled in the work without worry program. 10 Sec. 8. EFFECTIVE DATE. This Act, being deemed of immediate 11 importance, takes effect upon enactment. > 12 2. Title page, by striking lines 1 through 5 and inserting 13 < An Act relating to the establishment of the work without worry 14 program under the medical assistance program for employed 15 individuals with disabilities, and including effective date 16 provisions. > 17 ______________________________ SCHOLTEN of Woodbury -5- HF 2716.3311 (1) 91 ak/ko 5/ 5 #2.