HSB 241 (LSB 2914YC (1) 91)

HOUSE FILE _____ 

BY  (PROPOSED COMMITTEE ON HEALTH AND HUMAN SERVICES BILL BY CHAIRPERSON NORDMAN)

A BILL FOR

An Act relating to the establishment of the work without worry program under the medical assistance program for employed individuals with disabilities, and including effective date provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  249O.1  Definitions.
   As used in this chapter, unless the context otherwise requires:
   1.  “Countable income” means the income of an individual when the income is received and can be used to meet the individual’s needs for food, clothing, and shelter. “Countable income” does not include the income of another member of the individual’s household, or certain receipts as described in 20 C.F.R. §416.1103.
   2.  “Department” means the department of health and human services.
   3.  “Disability” means a qualifying disability as determined by the federal social security administration, or the individual is determined by the department 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.
   4.  “Long-term services and supports” means the broad range of health, health-related, and personal care assistance services and supports, provided in home and community-based settings, necessary for persons with disabilities who experience limitations in their capacity for self-care due to a physical, cognitive, or mental disability or condition.
   5.  “Program” means the work without worry program established in section 249O.3.
    Sec. 2.  NEW SECTION.  249O.2  Program —— intent.
   It is the intent of the general assembly to remove barriers to employment for individuals who, but for income and resources, meet the definition of disability, by providing medical assistance to employed individuals with disabilities through a work without worry program in accordance with section 1902(a)(10)(A)(ii)(XIII) of the federal Social Security Act, and Medicaid eligibility, using less restrictive income and resource requirements through the application of section 1902(r)(2) of the federal Social Security Act, and cost-sharing requirements established by the department and approved by the centers for Medicare and Medicaid services of the United States department of health and human services.
    Sec. 3.  NEW SECTION.  249O.3  Program —— established.
   1.  The work without worry program is established under the medical assistance program and shall be administered by the department to provide employed individuals with disabilities access to health care coverage through the medical assistance program.
   2.  Except as otherwise specified in this chapter, provisions applicable to the medical assistance program pursuant to chapter 249A shall be applicable to the program.
   3.  In addition to the benefits received under the program, an individual shall have access to all traditional Medicaid services under the medical assistance program, 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.
   4.  The department shall make every effort to coordinate benefits with the health care coverage provided by an employer of an employed individual with a disability receiving benefits under this chapter.
    Sec. 4.  NEW SECTION.  249O.4  Program —— eligibility.
   1.  Except as otherwise provided in this chapter, an individual may participate in the program if the individual meets all of the following criteria:
   a.  The individual is eligible for the medical assistance program under chapter 249A.
   b.  The individual is at least eighteen years of age.
   c.  The individual is less than sixty-five years of age.
   d.  The individual has a disability.
   e.  The individual is employed and earns income from employment, which may include self-employment. An individual is employed if the individual receives earnings that are subject to federal income tax, and unless the individual is self-employed, has payroll taxes deducted from those earnings.
   2.  The department shall not adopt a rule for program eligibility based upon any of the following:
   a.  An individual’s income or resources.
   b.  A resource test or limit.
   c.  An individual’s receipt of federal disability benefits.
   3.  An individual who receives supplemental security income shall be automatically eligible for the program and shall not be required to submit a separate application for the program.
   4.  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.
    Sec. 5.  NEW SECTION.  249O.5  Program —— premiums.
   1.  An individual’s monthly program premium amount shall equal, rounded down to the nearest whole dollar, six percent of the individual’s verified countable income.
   a.  An individual shall report any change in the individual’s countable income to the department.
   b.  The department shall utilize the individual’s verified countable income until the individual reports a change in countable income and the change is processed by the department, unless there is good cause for the department’s delay in verifying the change in the individual’s countable income.
   c.  A change in an individual’s program premium amount shall be effective the month after the change in the individual’s countable income is reported to and verified by the department.
   2.  An individual shall be covered under the program for six consecutive months beginning the first day of the month in which the department approves the individual’s application for the program.
   3.  The department shall create a six-month grace period that provides continuous program coverage to an individual following the individual’s temporary loss of employment, or a health crisis that temporarily prevents the individual from continuing employment. The individual shall be required to continue to pay the program premium based on the individual’s verified countable income during the six-month grace period.
   4.  The department may terminate an individual’s program coverage if the individual fails to pay four consecutive months of program premiums.
   5.  An individual must pay a program premium in full for any month that program coverage is provided, including a month when a redetermination of coverage is made, a month when continued coverage is requested, and during the period of an eligibility determination appeal.
    Sec. 6.  NEW SECTION.  249O.6  Rules.
   The department shall adopt rules pursuant to chapter 17A to administer this chapter.
    Sec. 7.  WORK WITHOUT WORRY PROGRAM —— DEPARTMENT OF HEALTH AND HUMAN SERVICES.
   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 in accordance with this Act.
   2.  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.
    Sec. 8.  EFFECTIVE DATE.  This Act, being deemed of immediate importance, takes effect upon enactment.
EXPLANATION
The inclusion of this explanation does not constitute agreement with

the explanation’s substance by the members of the general assembly.
   This bill relates to the work without worry program under the medical assistance program for employed individuals with disabilities.
   The bill defines “countable income” (income) and “disability”.
   The bill establishes a work without worry program (program) under the medical assistance program to be administered by the department of health and human services (HHS). The program shall provide employed individuals with disabilities access to health care coverage under the medical assistance program as well as long-term services and supports and community-based services for which the individual qualifies. The bill requires HHS to make every effort to coordinate benefits with health care coverage provided by the employer of an individual receiving program benefits.
   Under current law, to be eligible for the Medicaid for employed people with disabilities program (MEPD program), an individual with disabilities must not exceed the individual or couple resource limits, or the monthly household income limits. The program eliminates these eligibility requirements.
   The bill provides eligibility criteria for the program. The bill prohibits HHS from adopting a rule for program eligiblity based on an individual’s income or resources, a resource test or limit, or an individual’s receipt of federal disability benefits. An individual receiving supplemental security income shall be automatically eligible for the program and is not required to submit an application. An individual participating in the program may be eligible for and receive other health care coverage as described in the bill. If an individual receives such coverage and pays a copayment or premium, the individual does not have to pay a program premium (premium).
   The bill requires that the monthly premium equal 6 percent of an individual’s verified income, rounded down to the nearest whole dollar. An individual shall report any change in the individual’s income to HHS and shall pay a premium any month program coverage is provided as detailed in the bill. HHS shall create a six-month grace period to provide continuous program coverage to an individual who temporarily loses employment or suffers a health crisis that prevents the individual from continuing employment. The individual shall be required to continue to pay the premium during the six-month grace period. HHS may terminate an individual’s program coverage for failure to pay four consecutive months of premiums.
   The bill requires HHS to adopt rules to administer the bill.
   The bill requires HHS to submit any waiver request or state plan amendment to the federal centers for Medicare and Medicaid services as necessary to create the program.
   The bill requires any individual participating in the MEPD program to be transferred to and enrolled in the program.
   The bill is effective upon enactment.