House File 424 - Introduced HOUSE FILE 424 BY TUREK A BILL FOR An Act relating to the establishment of the work without worry 1 program under the medical assistance program for employed 2 individuals with disabilities, and including effective date 3 provisions. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 2041YH (5) 91 lh/ko
H.F. 424 Section 1. NEW SECTION . 249O.1 Definitions. 1 As used in this chapter, unless the context otherwise 2 requires: 3 1. Countable income means the income of an individual when 4 the income is received and can be used to meet the individuals 5 needs for food, clothing, and shelter. Countable income does 6 not include the income of another member of the individuals 7 household, or certain receipts as described in 20 C.F.R. 8 416.1103. 9 2. Department means the department of health and human 10 services. 11 3. Disability means a qualifying disability as determined 12 by the federal social security administration, or the 13 individual is determined by the department to have a physical 14 or mental impairment, or combination of impairments, that have 15 lasted or are expected to last for at least twelve months or 16 result in death. 17 4. Long-term services and supports means the broad 18 range of health, health-related, and personal care assistance 19 services and supports, provided in home and community-based 20 settings, necessary for persons with disabilities who 21 experience limitations in their capacity for self-care due to a 22 physical, cognitive, or mental disability or condition. 23 5. Program means the work without worry program 24 established in section 249O.3. 25 Sec. 2. NEW SECTION . 249O.2 Program intent. 26 It is the intent of the general assembly to remove barriers 27 to employment for individuals who, but for income and 28 resources, meet the definition of disability, by providing 29 medical assistance to employed individuals with disabilities 30 through a work without worry program in accordance with section 31 1902(a)(10)(A)(ii)(XIII) of the federal Social Security Act, 32 and Medicaid eligibility, using less restrictive income and 33 resource requirements through the application of section 34 1902(r)(2) of the federal Social Security Act, and cost-sharing 35 -1- LSB 2041YH (5) 91 lh/ko 1/ 6
H.F. 424 requirements established by the department and approved by the 1 centers for Medicare and Medicaid services of the United States 2 department of health and human services. 3 Sec. 3. NEW SECTION . 249O.3 Program established. 4 1. The work without worry program is established under the 5 medical assistance program and shall be administered by the 6 department to provide employed individuals with disabilities 7 access to health care coverage through the medical assistance 8 program. 9 2. Except as otherwise specified in this chapter, 10 provisions applicable to the medical assistance program 11 pursuant to chapter 249A shall be applicable to the program. 12 3. In addition to the benefits received under the program, 13 an individual shall have access to all traditional Medicaid 14 services under the medical assistance program, as well as 15 additional long-term services and supports and community-based 16 services, including waiver services, for which the individual 17 meets any applicable level of care requirements. 18 4. The department shall make every effort to coordinate 19 benefits with the health care coverage provided by an employer 20 of an employed individual with a disability receiving benefits 21 under this chapter. 22 Sec. 4. NEW SECTION . 249O.4 Program eligibility. 23 1. Except as otherwise provided in this chapter, an 24 individual may participate in the program if the individual 25 meets all of the following criteria: 26 a. The individual is eligible for the medical assistance 27 program under chapter 249A. 28 b. The individual is at least eighteen years of age. 29 c. The individual is less than sixty-five years of age. 30 d. The individual has a disability. 31 e. The individual is employed and earns income from 32 employment, which may include self-employment. An individual 33 is employed if the individual receives earnings that are 34 subject to federal income tax, and unless the individual is 35 -2- LSB 2041YH (5) 91 lh/ko 2/ 6
H.F. 424 self-employed, has payroll taxes deducted from those earnings. 1 2. The department shall not adopt a rule for program 2 eligibility based upon any of the following: 3 a. An individuals income or resources. 4 b. A resource test or limit. 5 c. An individuals receipt of federal disability benefits. 6 3. An individual who receives supplemental security income 7 shall be automatically eligible for the program and shall not 8 be required to submit a separate application for the program. 9 4. An individual may be eligible for or receive other health 10 care coverage including through an employer, through Medicare, 11 or through the medically needy program, the qualified Medicare 12 beneficiary program, or the specified low-income Medicare 13 beneficiary program. If the individual has such other coverage 14 and is subject to payment of copayments or premiums for that 15 coverage, notwithstanding the premium requirements under the 16 program to the contrary, the individual shall not be subject to 17 payment of premiums otherwise applicable under the program. 18 Sec. 5. NEW SECTION . 249O.5 Program premiums. 19 1. An individuals monthly program premium amount shall 20 equal, rounded down to the nearest whole dollar, six percent of 21 the individuals verified countable income. 22 a. An individual shall report any change in the individuals 23 countable income to the department. 24 b. The department shall utilize the individuals verified 25 countable income until the individual reports a change in 26 countable income and the change is processed by the department, 27 unless there is good cause for the departments delay in 28 verifying the change in the individuals countable income. 29 c. A change in an individuals program premium amount shall 30 be effective the month after the change in the individuals 31 countable income is reported to and verified by the department. 32 2. An individual shall be covered under the program for 33 six consecutive months beginning the first day of the month in 34 which the department approves the individuals application for 35 -3- LSB 2041YH (5) 91 lh/ko 3/ 6
H.F. 424 the program. 1 3. The department shall create a six-month grace period that 2 provides continuous program coverage to an individual following 3 the individuals temporary loss of employment, or a health 4 crisis that temporarily prevents the individual from continuing 5 employment. The individual shall be required to continue to 6 pay the program premium based on the individuals verified 7 countable income during the six-month grace period. 8 4. The department may terminate an individuals program 9 coverage if the individual fails to pay four consecutive months 10 of program premiums. 11 5. An individual must pay a program premium in full for any 12 month that program coverage is provided, including a month when 13 a redetermination of coverage is made, a month when continued 14 coverage is requested, and during the period of an eligibility 15 determination appeal. 16 Sec. 6. NEW SECTION . 249O.6 Rules. 17 The department shall adopt rules pursuant to chapter 17A to 18 administer this chapter. 19 Sec. 7. WORK WITHOUT WORRY PROGRAM DEPARTMENT OF HEALTH 20 AND HUMAN SERVICES. 21 1. The department of health and human services shall submit 22 any waiver request or state plan amendment, or combination 23 thereof, to the centers for Medicare and Medicaid services of 24 the United States department of health and human services as 25 necessary to create a work without worry program in accordance 26 with this Act. 27 2. Any individual participating in the Medicaid for 28 employed persons with disabilities program when the work 29 without worry program is implemented shall be transferred to 30 and enrolled in the work without worry program. 31 Sec. 8. EFFECTIVE DATE. This Act, being deemed of immediate 32 importance, takes effect upon enactment. 33 EXPLANATION 34 The inclusion of this explanation does not constitute agreement with 35 -4- LSB 2041YH (5) 91 lh/ko 4/ 6
H.F. 424 the explanations substance by the members of the general assembly. 1 This bill relates to the work without worry program under 2 the medical assistance program for employed individuals with 3 disabilities. 4 The bill defines countable income (income) and 5 disability. 6 The bill establishes a work without worry program (program) 7 under the medical assistance program to be administered by the 8 department of health and human services (HHS). The program 9 shall provide employed individuals with disabilities access to 10 health care coverage under the medical assistance program as 11 well as long-term services and supports and community-based 12 services for which the individual qualifies. The bill requires 13 HHS to make every effort to coordinate benefits with health 14 care coverage provided by the employer of an individual 15 receiving program benefits. 16 Under current law, to be eligible for the Medicaid for 17 employed people with disabilities program (MEPD program), an 18 individual with disabilities must not exceed the individual or 19 couple resource limits, or the monthly household income limits. 20 The program eliminates these eligibility requirements. 21 The bill provides eligibility criteria for the program. The 22 bill prohibits HHS from adopting a rule for program eligiblity 23 based on an individuals income or resources, a resource test 24 or limit, or an individuals receipt of federal disability 25 benefits. An individual receiving supplemental security income 26 shall be automatically eligible for the program and is not 27 required to submit an application. An individual participating 28 in the program may be eligible for and receive other health 29 care coverage as described in the bill. If an individual 30 receives such coverage and pays a copayment or premium, the 31 individual does not have to pay a program premium (premium). 32 The bill requires that the monthly premium equal 6 percent 33 of an individuals verified income, rounded down to the 34 nearest whole dollar. An individual shall report any change 35 -5- LSB 2041YH (5) 91 lh/ko 5/ 6
H.F. 424 in the individuals income to HHS and shall pay a premium 1 any month program coverage is provided as detailed in the 2 bill. HHS shall create a six-month grace period to provide 3 continuous program coverage to an individual who temporarily 4 loses employment or suffers a health crisis that prevents 5 the individual from continuing employment. The individual 6 shall be required to continue to pay the premium during the 7 six-month grace period. HHS may terminate an individuals 8 program coverage for failure to pay four consecutive months of 9 premiums. 10 The bill requires HHS to adopt rules to administer the bill. 11 The bill requires HHS to submit any waiver request or state 12 plan amendment to the federal centers for Medicare and Medicaid 13 services as necessary to create the program. 14 The bill requires any individual participating in the MEPD 15 program to be transferred to and enrolled in the program. 16 The bill is effective upon enactment. 17 -6- LSB 2041YH (5) 91 lh/ko 6/ 6