Senate Study Bill 1135 

                                       SENATE/HOUSE FILE       
                                       BY  (PROPOSED DEPARTMENT OF
                                            HUMAN SERVICES BILL)

    Passed Senate, Date               Passed House,  Date             
    Vote:  Ayes        Nays           Vote:  Ayes        Nays         

                                      A BILL FOR

  1 An Act relating to the expenditures allowable from medical
  2    assistance income trusts.
  4 TLSB 1238DP 82
  5 pf/sh/8


  1  1    Section 1.  Section 633C.3, subsection 1, Code 2007, is
  1  2 amended to read as follows:
  1  3    1.  Regardless of the terms of a medical assistance income
  1  4 trust, if the beneficiary's total monthly income is less than
  1  5 the average statewide charge for nursing facility services to
  1  6 a private pay resident of a nursing facility, then, during the
  1  7 life of the beneficiary, any property received or held by the
  1  8 trust shall be expended only as follows, as applicable, and in
  1  9 the following order of priority:
  1 10    a.  A reasonable amount may be paid or set aside each month
  1 11 for necessary expenses of the trust, not to exceed ten dollars
  1 12 per month without court approval.
  1 13    b.  From the remaining principal or income of the trust, an
  1 14 amount sufficient to bring the beneficiary's available income
  1 15 up to three hundred percent of the benefit for an individual
  1 16 under the federal supplemental security income program shall
  1 17 be paid to or otherwise made available to the beneficiary on a
  1 18 monthly basis, to be counted as income or a resource in
  1 19 determining eligibility for medical assistance under chapter
  1 20 249A amounts may be paid for expenses that qualify as required
  1 21 deductions from income pursuant to 42 C.F.R. } 435.725(c) or
  1 22 435.726(c) for purposes of determining the amount by which
  1 23 medical assistance payments under chapter 249A for
  1 24 institutional services or for home and community=based
  1 25 services provided under a federal waiver will be reduced based
  1 26 on the beneficiary's income.
  1 27    c.  If the beneficiary is an institutionalized individual
  1 28 or receiving home and community=based services provided under
  1 29 a federal waiver, the remaining principal or income of the
  1 30 trust shall be paid directly to the provider of institutional
  1 31 care or home and community=based services, on a monthly basis,
  1 32 for any cost not paid by the beneficiary from the
  1 33 beneficiary's available income under paragraph "b", to reduce
  1 34 any amount paid as medical assistance under chapter 249A.
  1 35    d.  Any remaining principal or income of the trust may, at
  2  1 the trustee's discretion or as directed by the terms of the
  2  2 trust, be paid directly to providers of other medical care or
  2  3 services that would otherwise be covered by medical
  2  4 assistance, paid to the state as reimbursement for medical
  2  5 assistance paid on behalf of the beneficiary, or retained by
  2  6 the trust.
  2  7                           EXPLANATION
  2  8    This bill relates to the allowable expenditures from
  2  9 medical assistance income trusts.  The bill eliminates the
  2 10 limit on the amount of income that is available to individuals
  2 11 under medical assistance income trusts and special needs
  2 12 trusts while retaining their eligibility for medical
  2 13 assistance, if the individual's total monthly income is less
  2 14 than the average statewide charge for the type of care the
  2 15 individual requires.  The levels of care to which the bill
  2 16 applies, including home and community=based services, are
  2 17 nursing facility care including specialized services, care
  2 18 provided through an intermediate care facility for persons
  2 19 with mental retardation, care provided through a psychiatric
  2 20 medical institution for children, and care provided in a state
  2 21 mental health institute.
  2 22    Current law limits the disbursement to the individual as
  2 23 income to an amount sufficient to bring the individual's
  2 24 available income up to three hundred percent of the benefit
  2 25 for an individual under the federal supplemental security
  2 26 income program.  Under the bill, the individual would have
  2 27 access to all of the individual's income for the purpose of
  2 28 allowable expenses, which are expenses that are allowed as
  2 29 deductions in determining client participation such as the
  2 30 personal needs allowance, spousal and dependent allowances,
  2 31 and unmet medical expenses.  Any excess income above the
  2 32 allowable expenses would then be applied toward payment of
  2 33 providers of facility or home and community=based services,
  2 34 toward payment of other providers of medical care or services
  2 35 that would otherwise be covered by medical assistance, toward
  3  1 payment to the state for reimbursement for medical assistance
  3  2 paid on behalf of the individual, or would be retained by the
  3  3 trust.
  3  4 LSB 1238DP 82
  3  5 pf:nh/sh/8