H.F. 2276 Section 1. Section 249J.5, subsection 1, Code 2009, is 1 amended to read as follows: 2 1. Except as otherwise provided in this chapter, an 3 individual nineteen through sixty-four years of age shall 4 be eligible solely for the expansion population benefits 5 described in this chapter when provided through the expansion 6 population provider network as described in this chapter, if 7 the individual meets all of the following conditions: 8 a. The individual is not eligible for coverage under the 9 medical assistance program in effect on or after April 1, 2005. 10 b. The individual has a family income at or below two 11 hundred percent of the federal poverty level as defined by the 12 most recently revised poverty income guidelines published by 13 the United States department of health and human services. 14 c. The individual fulfills asset test requirements 15 established by the department consistent with the medical 16 assistance program. 17 d. The individual is a resident of Iowa. 18 c. e. The individual fulfills all other conditions of 19 participation for the expansion population described in this 20 chapter, including requirements relating to personal financial 21 responsibility. 22 Sec. 2. Section 249J.8, subsection 1, Code 2009, is amended 23 to read as follows: 24 1. Each expansion population member whose family income 25 exceeds one hundred percent of the federal poverty level as 26 defined by the most recently revised poverty income guidelines 27 published by the United States department of health and human 28 services shall pay a monthly premium not to exceed one-twelfth 29 of five percent of the member’s annual family income based on 30 a sliding fee scale . Each expansion population member whose 31 family income is equal to or less than one hundred percent 32 of the federal poverty level as defined by the most recently 33 revised poverty income guidelines published by the United 34 States department of health and human services shall not be 35 -1- LSB 5982YH (4) 83 pf/nh 1/ 4

H.F. 2276 subject to payment of a monthly premium. All premiums shall be 1 paid on the last day of the month of coverage. The department 2 shall deduct the amount of any monthly premiums paid by an 3 expansion population member for benefits under the healthy and 4 well kids in Iowa program when computing the amount of monthly 5 premiums owed under this subsection. An expansion population 6 member shall pay the monthly premium during the entire period 7 of the member’s enrollment. Regardless of the length of 8 enrollment, the member is subject to payment of the premium for 9 a minimum of four consecutive months. However, an expansion 10 population member who complies with the requirement of payment 11 of the premium for a minimum of four consecutive months during 12 a consecutive twelve-month period of enrollment shall be deemed 13 to have complied with this requirement for the subsequent 14 consecutive twelve-month period of enrollment and shall only be 15 subject to payment of the monthly premium on a month-by-month 16 basis. Timely payment of premiums, including any arrearages 17 accrued from prior enrollment, is a condition of receiving any 18 expansion population services. The payment to and acceptance 19 by an automated case management system or the department 20 of the premium required under this subsection shall not 21 automatically confer initial or continuing program eligibility 22 on an individual. A premium paid to and accepted by the 23 department’s premium payment process that is subsequently 24 determined to be untimely or to have been paid on behalf of 25 an individual ineligible for the program shall be refunded 26 to the remitter in accordance with rules adopted by the 27 department. Premiums collected under this subsection shall be 28 deposited in the premiums subaccount of the account for health 29 care transformation created pursuant to section 249J.23. An 30 expansion population member shall also pay the same copayments 31 required of other adult recipients of medical assistance. 32 Sec. 3. Section 514I.4, subsection 5, paragraph b, 33 subparagraph (2), Code Supplement 2009, is amended to read as 34 follows: 35 -2- LSB 5982YH (4) 83 pf/nh 2/ 4

H.F. 2276 (2) Establish for children of families with incomes 1 exceeding two hundred percent but not exceeding three hundred 2 percent of the federal poverty level, family cost sharing 3 amounts, and graduated premiums based on a rationally developed 4 sliding fee schedule, that are distinctly different from those 5 for families with incomes of one hundred fifty percent or more 6 but not exceeding two hundred percent of the federal poverty 7 level, in accordance with federal law, with the approval of the 8 board. 9 Sec. 4. Section 514I.5, subsection 8, paragraph h, Code 10 Supplement 2009, is amended to read as follows: 11 h. The amount of any cost sharing under the program which 12 shall be assessed based on family income and which complies 13 with federal law. The rules shall provide that for children 14 of families with incomes exceeding two hundred percent but not 15 exceeding three hundred percent of the federal poverty level, 16 the family cost-sharing amounts, and graduated premiums based 17 on a rationally developed sliding fee schedule, are distinctly 18 different from those for families with incomes of one hundred 19 fifty percent or more but not exceeding two hundred percent of 20 the federal poverty level, in accordance with federal law. 21 EXPLANATION 22 This bill relates to the requirements for the hawk-i 23 program and the IowaCare program, both under the purview 24 of the department of human services (DHS). With regard to 25 the IowaCare program, the bill establishes as eligibility 26 requirements that an individual fulfills asset testing 27 requirements established by DHS consistent with the medical 28 assistance program and that the individual is a resident of the 29 state. Additionally, the bill requires that monthly premiums 30 for an individual whose family income exceeds 100 percent of 31 the federal poverty level be based on a sliding fee scale 32 rather than a premium that does not exceed one-twelfth of five 33 percent of the member’s annual family income. 34 With regard to the hawk-i program, the bill directs the 35 -3- LSB 5982YH (4) 83 pf/nh 3/ 4

H.F. 2276 hawk-i board and DHS to establish and adopt by rule premiums 1 for children of families with incomes exceeding 200 percent but 2 not exceeding 300 percent of the federal poverty level that are 3 based on a rationally developed sliding fee schedule and that 4 are distinctly different from those for families with incomes 5 of 150 percent or more but not exceeding 200 percent of the 6 federal poverty level. 7 -4- LSB 5982YH (4) 83 pf/nh 4/ 4