Senate File 2315 - Introduced SENATE FILE 2315 BY GUTH A BILL FOR An Act relating to eligibility for the Medicaid for employed 1 persons with disabilities program. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 6851XS (1) 91 ak/ko

S.F. 2315 Section 1. Section 249A.3, subsection 2, paragraph a, 1 subparagraph (1), Code 2026, is amended to read as follows: 2 (1) (a) As allowed under 42 U.S.C. 3 §1396a(a)(10)(A)(ii)(XIII), individuals with disabilities, 4 who are less than sixty-five years of age, who are members of 5 families whose income is less than two hundred fifty three 6 hundred percent of the most recently revised official poverty 7 guidelines published by the United States department of health 8 and human services for the family, who have earned income 9 and who are eligible for mandatory medical assistance or 10 optional medical assistance under this section if earnings are 11 disregarded. As allowed by 42 U.S.C. §1396a(r)(2), unearned 12 income shall also be disregarded in determining whether an 13 individual is eligible for assistance under this subparagraph. 14 For the purposes of determining the amount of an individual’s 15 resources under this subparagraph and as allowed by 42 U.S.C. 16 §1396a(r)(2), a maximum of ten thousand dollars of available 17 resources for an individual and twenty-one thousand dollars 18 of available resources for a couple shall be disregarded, and 19 any additional resources held in a retirement account, in a 20 pension account, in a medical savings account, or in any other 21 account approved under rules adopted by the department shall 22 also be disregarded. 23 (b) Individuals eligible for assistance under this 24 subparagraph, whose individual income exceeds one hundred 25 fifty percent of the official poverty guidelines published 26 by the United States department of health and human services 27 for an individual, shall pay a premium. The amount of the 28 premium shall be based on a sliding fee schedule adopted by 29 rule of the department and shall be based on a percentage of 30 the individual’s income. The maximum premium payable by an 31 individual whose income exceeds one hundred fifty percent of 32 the official poverty guidelines shall be commensurate with 33 the cost of state employees’ group health insurance in this 34 state. The payment to and acceptance by an automated case 35 -1- LSB 6851XS (1) 91 ak/ko 1/ 2

S.F. 2315 management system or the department of the premium required 1 under this subparagraph shall not automatically confer initial 2 or continuing program eligibility on an individual. The 3 department shall maintain a page on the department’s internet 4 site where individuals can electronically pay any premium owed 5 by an individual to the department. A premium paid to and 6 accepted by the department’s premium payment process that is 7 subsequently determined to be untimely or to have been paid on 8 behalf of an individual ineligible for the program shall be 9 refunded to the remitter in accordance with rules adopted by 10 the department. Any unpaid premium shall be a debt owed to the 11 department. 12 EXPLANATION 13 The inclusion of this explanation does not constitute agreement with 14 the explanation’s substance by the members of the general assembly. 15 This bill relates to eligibility for the Medicaid for 16 employed persons with disabilities program (MEPD). 17 Code section 249A.3 sets forth program eligibility criteria 18 for MEPD pursuant to 42 U.S.C. §1396a. The bill amends current 19 eligibility provisions requiring the department to cap premiums 20 for individuals whose income falls below 250 percent of the 21 federal poverty level (FPL), and that any acceptance by the 22 department of the payment of a premium does not automatically 23 confer initial or continuing MEPD eligibility on an individual. 24 Code section 249A.3 also requires HHS to not consider certain 25 assets when determining asset eligibility under MEPD. 26 The bill requires that HHS extend MEPD eligibility to those 27 with household incomes up to 300 percent of the FPL. Moneys in 28 a pension fund are not to be considered by HHS for purposes of 29 determining asset eligibility under MEPD. The bill provides 30 that HHS must allow for the electronic payment of MEPD premiums 31 through a page maintained on the department’s internet site. 32 -2- LSB 6851XS (1) 91 ak/ko 2/ 2