HLS 181ES-65 ORIGINAL
2018 First Extraordinary Session
HOUSE BILL NO. 3
BY REPRESENTATIVE HOFFMANN
MEDICAID: Provides for a work and community engagement initiative within the
Medicaid program (Item #13)
1 AN ACT
2To enact Part XIV of Chapter 3 of Title 46 of the Louisiana Revised Statutes of 1950, to be
3 comprised of R.S. 46:460.101 through 460.106, relative to the medical assistance
4 program of this state known as Medicaid; to establish a work and community
5 engagement initiative within the state Medicaid program; to establish participation
6 in an approved work, education, or other community engagement activity as a
7 condition of Medicaid eligibility for certain adult enrollees; to provide for
8 applicability of and exemptions from Medicaid work and community engagement
9 requirements; to provide for duties of the secretary of the Louisiana Department of
10 Health in administering the Medicaid work and community engagement initiative;
11 to require submission to the federal Medicaid agency of an application to administer
12 the initiative; to provide for administrative rulemaking; and to provide for related
13 matters.
14Be it enacted by the Legislature of Louisiana:
15 Section 1. Part XIV of Chapter 3 of Title 46 of the Louisiana Revised Statutes of
161950, comprised of R.S. 46:460.101 through 460.106, is hereby enacted to read as follows:
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1 PART XIV. LOUISIANA MEDICAID - PROMOTION OF WORK
2 AND COMMUNITY ENGAGEMENT
3 §460.101. Short title
4 This Part shall be known and may be cited as the "Promotion of Work and
5 Community Engagement in Medicaid Law".
6 §460.102. Definitions
7 As used in this Part, the following terms have the meaning ascribed in this
8 Section:
9 (1) "Able-bodied adult" means an adult without a disability who is nineteen
10 to sixty-four years of age.
11 (2) "Affordable Care Act" means the following acts of congress, collectively:
12 (a) The Patient Protection and Affordable Care Act, Public Law 111-148.
13 (b) The Health Care and Education Reconciliation Act, Public Law 111-152.
14 (3) "Centers for Medicare and Medicaid Services" and "CMS" mean the
15 division of the United States Department of Health and Human Services which
16 administers and regulates the medical assistance program provided for in Title XIX
17 of the Social Security Act commonly known as the Medicaid program.
18 (4) "Department" means the Louisiana Department of Health.
19 (5) "Medicaid" and "medical assistance program" mean the medical
20 assistance program provided for in Title XIX of the Social Security Act.
21 (6) "Secretary" means the secretary of the Louisiana Department of Health.
22 (7) "Section 1115 waiver application" means an application to the secretary
23 of the United States Department of Health and Human Services for certain provisions
24 of Title XIX of the Social Security Act to be waived, as authorized in section 1115
25 of the act, in order to provide a state Medicaid program with the flexibility to
26 implement an experimental, pilot, or demonstration project that promotes the
27 objectives of the Medicaid program.
28 §460.103. Legislative findings; declaration
29 A. The Legislature of Louisiana hereby finds and affirms the following:
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1 (1) As reported by the department in December, 2017, over four hundred
2 fifty-three thousand adults are newly enrolled in Louisiana's Medicaid program
3 pursuant to expansion of the program's income eligibility standards, as authorized
4 in the Affordable Care Act, in 2016. Within this Medicaid expansion population,
5 fewer than two hundred eighty-four thousand persons, or sixty-two and one-half
6 percent of new adult enrollees, have earned income.
7 (2) A broad range of social, economic, and behavioral factors can have major
8 effects on an individual's health and wellness, and a growing body of evidence
9 suggests that targeting certain health determinants, including productive work and
10 community engagement, may improve health outcomes.
11 (3) Studies have found strong evidence that unemployment can be harmful
12 to health and is associated with higher mortality, poorer general health, poorer
13 mental health, and higher medical consultation and hospital admission rates.
14 (4) It is widely recognized that education can lead to improved health by
15 facilitating gains in health knowledge and raising awareness of healthy behaviors.
16 (5) Community engagement activities such as volunteering are associated
17 with improved health outcomes and can lead to paid employment.
18 B. The legislature hereby declares that it is the policy of this state to
19 encourage self-sufficiency so that Louisianians may reduce dependence on public
20 benefits to meet basic needs and become economically self-reliant. Therefore,
21 promoting work and community engagement among able-bodied adult Medicaid
22 enrollees is a public policy priority of this state.
23 §460.104. Work and other community engagement; requirement
24 Except as provided in R.S. 46:460.105, no able-bodied adult without a
25 dependent shall be eligible for Medicaid benefits unless he meets one or more of the
26 following criteria:
27 (1) Is working twenty hours or more per week, averaged monthly.
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1 (2) Is participating in and complying with the requirements of a work
2 readiness program for twenty hours or more per week, as determined in accordance
3 with rules and regulations of the department.
4 (3) Is participating in an approved educational activity or program, as
5 determined in accordance with rules and regulations of the department.
6 (4) Is volunteering for twenty hours or more per week, as determined in
7 accordance with rules and regulations of the department.
8 (5) Is meeting any combination of working, participating in an approved
9 work program, and participating in an approved educational activity or program for
10 a total of twenty hours or more per week.
11 §460.105. Exemptions
12 The prohibition on Medicaid eligibility provided in R.S. 46:460.104 shall not
13 apply to any individual if he or she meets any of the following criteria:
14 (1) Is medically certified as physically or mentally unfit for employment.
15 (2) Is pregnant.
16 (3) Is a parent or caretaker responsible for the care of a dependent child
17 under the age of one year.
18 (4) Is a parent or caretaker personally providing the care for a dependent
19 child with serious medical conditions or with a disability, as determined in
20 accordance with rules and regulations of the department.
21 (5) Is receiving unemployment compensation and complying with applicable
22 work requirements of the Louisiana Employment Security Law, R.S. 23:1471 et seq.
23 (6) Is participating in an approved program of rehabilitation or other
24 treatment for a substance use disorder as defined in R.S. 28:2, as determined in
25 accordance with rules and regulations of the department.
26 §460.106. Section 1115 waiver application; administrative rulemaking
27 A. The secretary shall prepare and submit to CMS a section 1115 waiver
28 application providing for the program of work and other community engagement
29 created by the provisions of this Part.
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1 B. The secretary shall promulgate all rules and regulations in accordance
2 with the Administrative Procedure Act as are necessary to institute the program of
3 work and other community engagement created by the provisions of this Part.
4 Section 2. The secretary of the Louisiana Department of Health shall take such
5actions as are necessary to cause the section 1115 waiver application required by R.S.
646:460.106, as enacted by Section 1 of this Act, to be submitted to the Centers for Medicare
7and Medicaid Services on or before January 1, 2019.
8 Section 3. This Act shall become effective upon signature by the governor or, if not
9signed by the governor, upon expiration of the time for bills to become law without signature
10by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
11vetoed by the governor and subsequently approved by the legislature, this Act shall become
12effective on the day following such approval.
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 3 Original 2018 First Extraordinary Session Hoffmann
Abstract: Establishes participation in a work, educational, or other community engagement
activity as a condition of Medicaid eligibility for able-bodied adult enrollees without
dependents.
Proposed law provides legislative findings and a declaration concerning health effects
associated with productive work and community engagement.
Proposed law defines "able-bodied adult" as an adult without a disability who is 19 to 64
years of age.
Proposed law establishes a work and community engagement initiative within the Medicaid
program. Requires participation in a work or community engagement activity specified in
proposed law as a condition of Medicaid eligibility for able-bodied adult enrollees without
dependents. Provides for duties of the secretary of the La. Department of Health (LDH) in
administering the work and community engagement initiative established by proposed law.
Proposed law stipulates that, subject to certain exemptions provided therein, no able-bodied
adult without a dependent shall be eligible for Medicaid benefits unless he meets one or
more of the following criteria:
(1)Is working 20 hours or more per week, averaged monthly.
(2)Is participating in and complying with the requirements of a work program for 20
hours or more per week.
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(3)Is participating in an approved educational activity or program.
(4)Is volunteering for 20 hours or more per week.
(5)Is meeting any combination of working, participating in an approved work program,
and participating in an approved educational activity or program for a total of 20
hours or more per week.
Proposed law provides that the work and community engagement requirements created by
proposed law shall not apply to any individual if he or she meets any of the following
criteria:
(1)Is medically certified as physically or mentally unfit for employment.
(2)Is pregnant.
(3)Is a parent or caretaker responsible for the care of a dependent child under the age
of one year.
(4)Is a parent or caretaker personally providing care for a dependent child with a
disability or serious medical condition.
(5)Is receiving unemployment compensation and complying with applicable work
requirements of present law relative to employment security (R.S. 23:1471 et seq.).
(6)Is participating in an LDH-approved program of rehabilitation or other treatment for
a substance use disorder as defined in present law (R.S. 28:2).
Proposed law requires the secretary of LDH to prepare and submit to the federal Medicaid
agency on or before Jan. 1, 2019, the application necessary to institute the program provided
for in proposed law. Further requires the secretary to promulgate all rules and regulations
in accordance with the Administrative Procedure Act as are necessary to institute the
program.
Proposed law provides that it shall be known as the "Promotion of Work and Community
Engagement in Medicaid Law".
Effective upon signature of governor or lapse of time for gubernatorial action.
(Adds R.S. 46:460.101-460.106)
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