SF 368 (LSB 1820XS (2) 90)

SENATE FILE 368

BY  ZAUN

A BILL FOR

An Act relating to the work without worry program for employed individuals with disabilities under the Medicaid program.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  WORK WITHOUT WORRY PROGRAM —— MEDICAID FOR EMPLOYED INDIVIDUALS WITH DISABILITIES.
   1.  The department of health and human services shall submit any waiver request or state plan amendment, or combination thereof, to the centers for Medicare and Medicaid services of the United States department of health and human services as necessary to create a work without worry program for employed individuals with disabilities in accordance with this section.
   2.  The program shall provide Medicaid coverage based on the following criteria:
   a.  The individual has a qualifying disability as determined by the social security administration or the individual is determined by the department of health and human services to have a physical or mental impairment or combination of impairments that have lasted or are expected to last for at least twelve months or result in death. An individual shall not be required to receive federal disability benefits to participate in the program. An individual who receives supplemental security income shall be automatically eligible for coverage under the program and shall not be required to submit a separate application for the program.
   b.  The individual is sixteen years of age or older.
   c.  The individual is employed and has earned income from employment including self-employment. The employment requirement shall not be limited by the number of hours or amount of income, but the individual shall verify employment through evidence of pay stubs or a self-employment ledger. The program shall allow for continuation of coverage for a participating individual for six months following loss of employment if there is an intent on the part of the individual to return to employment.
   d.  The individual is not subject to any resource or asset test or limit under the program, with the exception of the following:
   (1)  Any vehicle owned by the individual that is not adapted for the individual, used primarily by or for the individual, and used for transporting the individual to medical appointments.
   (2)  The primary residence owned and occupied by the individual if the assessed value of the residence exceeds four hundred thousand dollars.
   e.  The individual’s income is below four hundred fifty percent of the federal poverty level. Income is based only on the individual’s net earned and unearned income as a household of one as that income is adjusted by the following deductions or disregards:
   (1)  A twenty dollar general disregard from unearned income that is not from employment.
   (2)  A disregard of sixty-five dollars plus one-half of the individual’s earned income from employment.
   (3)  A deduction of impairment-related work expenses.
   (4)  A deduction of work expenses for the blind.
   f.  An individual shall have access to all traditional Medicaid services under the Medicaid state plan as well as additional long-term services and supports and community-based services, including waiver services, for which the individual meets any applicable level of care requirements.
   g.  An individual may be eligible for or receive other health care coverage including through an employer, through Medicare, or through the medically needy program, the qualified Medicare beneficiary program, or the specified low-income Medicare beneficiary program. If the individual has such other coverage and is subject to payment of copayments or premiums for that coverage, notwithstanding the premium requirements under the program to the contrary, the individual shall not be subject to payment of premiums otherwise applicable under the program.
   h.  An individual with income at or above one hundred fifty percent of the federal poverty level shall be subject to payment of a premium not to exceed the limits established under federal guidelines.
   i.  The program shall also provide that any individual participating in the Medicaid for employed persons with disabilities program when the work without worry program is implemented shall be transferred to and enrolled in the work without worry program.
   3.  The department of health and human services shall implement a work without worry public awareness campaign to ensure that consumer information and educational resources are accessible to individuals with disabilities and the public. The department shall also provide technical assistance to individuals with disabilities in determining if the work without worry program is the best option for coverage under that individual’s particular circumstances and in applying for and maintaining participation in the program.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill creates the work without worry program for employed individuals with disabilities 16 years of age and older under the Medicaid program.
   The bill directs the department of health and human services (HHS) to submit any waiver request or state plan amendment, or combination thereof, to the centers for Medicare and Medicaid services of the United States department of health and human services as necessary to create a work without worry program for employed individuals with disabilities in accordance with the bill.
   Criteria for coverage under the program include that the individual has a qualifying disability and although an individual is not required to receive federal disability benefits to participate in the program, an individual who receives supplemental security income shall be automatically eligible for coverage under the program; the individual is 16 years of age or older; the individual is employed and has earned income from employment including self-employment; the individual is not subject to any resource or asset test or limit under the program with the exception of nonadapted vehicles and a primary residence for which the assessed value exceeds $400,000; the individual’s income is below 450 percent of the federal poverty level as adjusted by specified deductions or disregards; the individual has access to all traditional Medicaid services as well as additional long-term services and supports and community-based services; the individual may be eligible for or receive other coverage including through an employer, through Medicare, through the medically needy program, the qualified Medicare beneficiary program, or the specified low-income Medicare beneficiary program, and is not subject to otherwise applicable premiums if the individual is subject to copayments or premiums for the other coverage; the individual with income at or above 150 percent of the federal poverty level shall be subject to payment of a premium not to exceed the limits established under federal guidelines; and the program shall provide that any individual participating in the Medicaid for employed persons with disabilities program at the time the work without worry program is implemented shall be transferred to and enrolled in the work without worry program. The bill also requires HHS to implement a work without worry public awareness campaign to ensure that consumer information and educational resources are accessible to individuals with disabilities and the public, and to provide technical assistance to individuals with disabilities in determining if the work without worry program is the best option for coverage under the individual’s particular circumstances and in applying for and maintaining participation in the program.