HF 2276 (LSB 5982YH (4) 83)

HOUSE FILE 2276

BY  UPMEYER and HUSER

A BILL FOR

An Act relating to program criteria for the hawk-i and IowaCare programs under the purview of the department of human services.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 249J.5, subsection 1, Code 2009, is amended to read as follows:
   1.  Except as otherwise provided in this chapter, an individual nineteen through sixty-four years of age shall be eligible solely for the expansion population benefits described in this chapter when provided through the expansion population provider network as described in this chapter, if the individual meets all of the following conditions:
   a.  The individual is not eligible for coverage under the medical assistance program in effect on or after April 1, 2005.
   b.  The individual has a family income at or below two hundred percent of the federal poverty level as defined by the most recently revised poverty income guidelines published by the United States department of health and human services.
   c.  The individual fulfills asset test requirements established by the department consistent with the medical assistance program.
   d.  The individual is a resident of Iowa.
   c.  e.  The individual fulfills all other conditions of participation for the expansion population described in this chapter, including requirements relating to personal financial responsibility.
    Sec. 2.  Section 249J.8, subsection 1, Code 2009, is amended to read as follows:
   1.  Each expansion population member whose family income exceeds one hundred percent of the federal poverty level as defined by the most recently revised poverty income guidelines published by the United States department of health and human services shall pay a monthly premium not to exceed one-twelfth of five percent of the member’s annual family income based on a sliding fee scale. Each expansion population member whose family income is equal to or less than one hundred percent of the federal poverty level as defined by the most recently revised poverty income guidelines published by the United States department of health and human services shall not be subject to payment of a monthly premium. All premiums shall be paid on the last day of the month of coverage. The department shall deduct the amount of any monthly premiums paid by an expansion population member for benefits under the healthy and well kids in Iowa program when computing the amount of monthly premiums owed under this subsection. An expansion population member shall pay the monthly premium during the entire period of the member’s enrollment. Regardless of the length of enrollment, the member is subject to payment of the premium for a minimum of four consecutive months. However, an expansion population member who complies with the requirement of payment of the premium for a minimum of four consecutive months during a consecutive twelve-month period of enrollment shall be deemed to have complied with this requirement for the subsequent consecutive twelve-month period of enrollment and shall only be subject to payment of the monthly premium on a month-by-month basis. Timely payment of premiums, including any arrearages accrued from prior enrollment, is a condition of receiving any expansion population services. The payment to and acceptance by an automated case management system or the department of the premium required under this subsection shall not automatically confer initial or continuing program eligibility on an individual. A premium paid to and accepted by the department’s premium payment process that is subsequently determined to be untimely or to have been paid on behalf of an individual ineligible for the program shall be refunded to the remitter in accordance with rules adopted by the department. Premiums collected under this subsection shall be deposited in the premiums subaccount of the account for health care transformation created pursuant to section 249J.23. An expansion population member shall also pay the same copayments required of other adult recipients of medical assistance.
    Sec. 3.  Section 514I.4, subsection 5, paragraph b, subparagraph (2), Code Supplement 2009, is amended to read as follows:
   (2)  Establish for children of families with incomes exceeding two hundred percent but not exceeding three hundred percent of the federal poverty level, family cost sharing amounts, and graduated premiums based on a rationally developed sliding fee schedule, that are distinctly different from those for families with incomes of one hundred fifty percent or more but not exceeding two hundred percent of the federal poverty level, in accordance with federal law, with the approval of the board.
    Sec. 4.  Section 514I.5, subsection 8, paragraph h, Code Supplement 2009, is amended to read as follows:
   h.  The amount of any cost sharing under the program which shall be assessed based on family income and which complies with federal law.  The rules shall provide that for children of families with incomes exceeding two hundred percent but not exceeding three hundred percent of the federal poverty level, the family cost-sharing amounts, and graduated premiums based on a rationally developed sliding fee schedule, are distinctly different from those for families with incomes of one hundred fifty percent or more but not exceeding two hundred percent of the federal poverty level, in accordance with federal law.
EXPLANATION
   This bill relates to the requirements for the hawk-i program and the IowaCare program, both under the purview of the department of human services (DHS). With regard to the IowaCare program, the bill establishes as eligibility requirements that an individual fulfills asset testing requirements established by DHS consistent with the medical assistance program and that the individual is a resident of the state. Additionally, the bill requires that monthly premiums for an individual whose family income exceeds 100 percent of the federal poverty level be based on a sliding fee scale rather than a premium that does not exceed one-twelfth of five percent of the member’s annual family income.
   With regard to the hawk-i program, the bill directs the hawk-i board and DHS to establish and adopt by rule premiums for children of families with incomes exceeding 200 percent but not exceeding 300 percent of the federal poverty level that are based on a rationally developed sliding fee schedule and that are distinctly different from those for families with incomes of 150 percent or more but not exceeding 200 percent of the federal poverty level.