H.F. 2589 Section 1. WORK WITHOUT WORRY PROGRAM —— MEDICAID FOR 1 EMPLOYED INDIVIDUALS WITH DISABILITIES. 2 1. The department of health and human services shall submit 3 any waiver request or state plan amendment, or combination 4 thereof, to the centers for Medicare and Medicaid services of 5 the United States department of health and human services as 6 necessary to create a work without worry program for employed 7 individuals with disabilities in accordance with this section. 8 2. The program shall provide Medicaid coverage based on the 9 following criteria: 10 a. The individual has a qualifying disability as determined 11 by the social security administration or the individual is 12 determined by the department of health and human services 13 to have a physical or mental impairment or combination of 14 impairments that have lasted or are expected to last for 15 at least twelve months or result in death. An individual 16 shall not be required to receive federal disability benefits 17 to participate in the program. An individual who receives 18 supplemental security income shall be automatically eligible 19 for coverage under the program and shall not be required to 20 submit a separate application for the program. 21 b. The individual is sixteen to sixty-five years of age. 22 c. The individual is employed and has earned income 23 from employment including self-employment. The employment 24 requirement shall not be limited by the number of hours or 25 amount of income, but the individual shall verify employment 26 through evidence of pay stubs or a self-employment ledger. 27 The program shall allow for continuation of coverage for a 28 participating individual for six months following loss of 29 employment if there is an intent on the part of the individual 30 to return to employment. 31 d. The individual is not subject to any resource or asset 32 test or limit under the program, with the exception of the 33 following: 34 (1) Any vehicle owned by the individual that is not 35 -1- LSB 1820HV (3) 90 pf/ko 1/ 5

H.F. 2589 adapted for the individual, used primarily by or for the 1 individual, and used for transporting the individual to medical 2 appointments. 3 (2) The primary residence owned and occupied by the 4 individual if the assessed value of the residence exceeds four 5 hundred thousand dollars. 6 e. The individual’s income is below four hundred fifty 7 percent of the federal poverty level. Income is based only on 8 the individual’s net earned and unearned income as a household 9 of one as that income is adjusted by the following deductions 10 or disregards: 11 (1) A twenty dollar general disregard from unearned income 12 that is not from employment. 13 (2) A disregard of sixty-five dollars plus one-half of the 14 individual’s earned income from employment. 15 (3) A deduction of impairment-related work expenses. 16 (4) A deduction of work expenses for the blind. 17 f. An individual shall have access to all traditional 18 Medicaid services under the Medicaid state plan as well as 19 additional long-term services and supports and community-based 20 services, including waiver services, for which the individual 21 meets any applicable level of care requirements subject to any 22 waiting list or availability of openings for the service and 23 support. 24 g. An individual may be eligible for or receive other health 25 care coverage including through an employer, through Medicare, 26 or through the medically needy program, the qualified Medicare 27 beneficiary program, or the specified low-income Medicare 28 beneficiary program. If the individual has such other coverage 29 and is subject to payment of copayments or premiums for that 30 coverage, notwithstanding the premium requirements under the 31 program to the contrary, the individual shall not be subject to 32 payment of premiums otherwise applicable under the program. 33 h. An individual with income at or above one hundred fifty 34 percent of the federal poverty level shall be subject to 35 -2- LSB 1820HV (3) 90 pf/ko 2/ 5

H.F. 2589 payment of a premium not to exceed the limits established under 1 federal guidelines. 2 i. The program shall also provide that any individual 3 participating in the Medicaid for employed persons with 4 disabilities program when the work without worry program is 5 implemented shall be transferred to and enrolled in the work 6 without worry program. 7 3. The department of health and human services shall 8 implement a work without worry public awareness campaign to 9 ensure that consumer information and educational resources are 10 accessible to individuals with disabilities and the public. 11 The department shall also provide technical assistance to 12 individuals with disabilities in determining if the work 13 without worry program is the best option for coverage under 14 that individual’s particular circumstances and in applying for 15 and maintaining participation in the program. 16 Sec. 2. MEDICAID —— REIMBURSEMENT FOR THE REPAIR OF COMPLEX 17 REHABILITATION TECHNOLOGY. Under both Medicaid managed care 18 and fee-for-service administration of the Medicaid program, the 19 department of health and human services shall not require a 20 prescription for reimbursement of a provider for the repair of 21 complex rehabilitation equipment, if the complex rehabilitation 22 technology was previously prescribed and reimbursed under 23 the Medicaid program. For the purposes of this section, 24 “complex rehabilitation technology” means items classified 25 under the Medicare program as durable medical equipment that 26 is individually configured for individuals to meet their 27 specific and unique medical, physical, and functional needs 28 and capacities for basic activities of daily living and 29 instrumental activities of daily living identified as medically 30 necessary. 31 EXPLANATION 32 The inclusion of this explanation does not constitute agreement with 33 the explanation’s substance by the members of the general assembly. 34 This bill relates to programs and services under the 35 -3- LSB 1820HV (3) 90 pf/ko 3/ 5

H.F. 2589 Medicaid program. The bill creates the work without worry 1 program for employed individuals with disabilities 16 to 65 2 years of age under the Medicaid program. The bill directs the 3 department of health and human services (HHS) to submit any 4 waiver request or state plan amendment, or combination thereof, 5 to the centers for Medicare and Medicaid services of the United 6 States department of health and human services as necessary to 7 create a work without worry program for employed individuals 8 with disabilities in accordance with the bill. Criteria for 9 coverage under the program include that the individual has 10 a qualifying disability and although an individual is not 11 required to receive federal disability benefits to participate 12 in the program, an individual who receives supplemental 13 security income shall be automatically eligible for coverage 14 under the program; the individual is 16 to 65 years of age; the 15 individual is employed and has earned income from employment 16 including self-employment; the individual is not subject to 17 any resource or asset test or limit under the program with the 18 exception of nonadapted vehicles and a primary residence for 19 which the assessed value exceeds $400,000; the individual’s 20 income is below 450 percent of the federal poverty level as 21 adjusted by specified deductions or disregards; the individual 22 has access to all traditional Medicaid services as well as 23 additional long-term services and supports and community-based 24 services subject to waiting lists and availability of openings; 25 the individual may be eligible for or receive other coverage 26 including through an employer, through Medicare, through the 27 medically needy program, the qualified Medicare beneficiary 28 program, or the specified low-income Medicare beneficiary 29 program, and is not subject to otherwise applicable premiums 30 if the individual is subject to copayments or premiums for 31 the other coverage; the individual with income at or above 32 150 percent of the federal poverty level shall be subject to 33 payment of a premium not to exceed the limits established 34 under federal guidelines; and the program shall provide that 35 -4- LSB 1820HV (3) 90 pf/ko 4/ 5

H.F. 2589 any individual participating in the Medicaid for employed 1 persons with disabilities program at the time the work without 2 worry program is implemented shall be transferred to and 3 enrolled in the work without worry program. The bill also 4 requires HHS to implement a work without worry public awareness 5 campaign to ensure that consumer information and educational 6 resources are accessible to individuals with disabilities and 7 the public, and to provide technical assistance to individuals 8 with disabilities in determining if the work without worry 9 program is the best option for coverage under the individual’s 10 particular circumstances and in applying for and maintaining 11 participation in the program. 12 The bill also provides that under both Medicaid managed care 13 and fee-for-service administration of the Medicaid program, 14 HHS shall not require a prescription for reimbursement of a 15 provider for the repair of complex rehabilitation technology, 16 if the complex rehabilitation technology was previously 17 prescribed and reimbursed under the Medicaid program. The bill 18 defines complex rehabilitation technology. 19 -5- LSB 1820HV (3) 90 pf/ko 5/ 5