H.F. _____ 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 years of age or older. 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 1820YC (2) 90 pf/rh 1/ 4

H.F. _____ 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. 22 g. An individual may be eligible for or receive other health 23 care coverage including through an employer, through Medicare, 24 or through the medically needy program, the qualified Medicare 25 beneficiary program, or the specified low-income Medicare 26 beneficiary program. If the individual has such other coverage 27 and is subject to payment of copayments or premiums for that 28 coverage, notwithstanding the premium requirements under the 29 program to the contrary, the individual shall not be subject to 30 payment of premiums otherwise applicable under the program. 31 h. An individual with income at or above one hundred fifty 32 percent of the federal poverty level shall be subject to 33 payment of a premium not to exceed the limits established under 34 federal guidelines. 35 -2- LSB 1820YC (2) 90 pf/rh 2/ 4

H.F. _____ i. The program shall also provide that any individual 1 participating in the Medicaid for employed persons with 2 disabilities program when the work without worry program is 3 implemented shall be transferred to and enrolled in the work 4 without worry program. 5 3. The department of health and human services shall 6 implement a work without worry public awareness campaign to 7 ensure that consumer information and educational resources are 8 accessible to individuals with disabilities and the public. 9 The department shall also provide technical assistance to 10 individuals with disabilities in determining if the work 11 without worry program is the best option for coverage under 12 that individual’s particular circumstances and in applying for 13 and maintaining participation in the program. 14 EXPLANATION 15 The inclusion of this explanation does not constitute agreement with 16 the explanation’s substance by the members of the general assembly. 17 This bill creates the work without worry program for 18 employed individuals with disabilities 16 years of age and 19 older under the Medicaid program. 20 The bill directs the department of health and human services 21 (HHS) to submit any waiver request or state plan amendment, or 22 combination thereof, to the centers for Medicare and Medicaid 23 services of the United States department of health and human 24 services as necessary to create a work without worry program 25 for employed individuals with disabilities in accordance with 26 the bill. 27 Criteria for coverage under the program include that 28 the individual has a qualifying disability and although an 29 individual is not required to receive federal disability 30 benefits to participate in the program, an individual who 31 receives supplemental security income shall be automatically 32 eligible for coverage under the program; the individual is 33 16 years of age or older; the individual is employed and 34 has earned income from employment including self-employment; 35 -3- LSB 1820YC (2) 90 pf/rh 3/ 4

H.F. _____ the individual is not subject to any resource or asset test 1 or limit under the program with the exception of nonadapted 2 vehicles and a primary residence for which the assessed 3 value exceeds $400,000; the individual’s income is below 450 4 percent of the federal poverty level as adjusted by specified 5 deductions or disregards; the individual has access to all 6 traditional Medicaid services as well as additional long-term 7 services and supports and community-based services; the 8 individual may be eligible for or receive other coverage 9 including through an employer, through Medicare, through the 10 medically needy program, the qualified Medicare beneficiary 11 program, or the specified low-income Medicare beneficiary 12 program, and is not subject to otherwise applicable premiums 13 if the individual is subject to copayments or premiums for 14 the other coverage; the individual with income at or above 15 150 percent of the federal poverty level shall be subject to 16 payment of a premium not to exceed the limits established 17 under federal guidelines; and the program shall provide that 18 any individual participating in the Medicaid for employed 19 persons with disabilities program at the time the work without 20 worry program is implemented shall be transferred to and 21 enrolled in the work without worry program. The bill also 22 requires HHS to implement a work without worry public awareness 23 campaign to ensure that consumer information and educational 24 resources are accessible to individuals with disabilities and 25 the public, and to provide technical assistance to individuals 26 with disabilities in determining if the work without worry 27 program is the best option for coverage under the individual’s 28 particular circumstances and in applying for and maintaining 29 participation in the program. 30 -4- LSB 1820YC (2) 90 pf/rh 4/ 4