Citations Affected:
IC 4-22-2-37.1
;
IC 12-7-2
; IC 12-15.
Synopsis: Medicaid buy-in program for the working disabled.
Establishes a Medicaid buy-in program to provide Medicaid coverage
to certain working individuals with disabilities as authorized by federal
law. Establishes the Medicaid work incentives council to assist the
office of Medicaid policy and planning (OMPP) in developing the
Medicaid buy-in program. Specifies eligibility requirements for the
buy-in program. Requires an annual review of the Medicaid buy-in
program by OMPP and the Medicaid work incentives council. Requires
OMPP to apply for certain federal grants. Allows OMPP to apply for
a federal grant to implement a demonstration project to provide
Medicaid coverage to certain individuals.
Effective: Upon passage; July 1, 2001.
January 17, 2001, read first time and referred to Committee on Ways and Means.
A BILL FOR AN ACT to amend the Indiana Code concerning
Medicaid.
and declared necessary to meet an emergency.
(6) A rule required under
IC 24-4.5-1-106
that is adopted by the
department of financial institutions and declared necessary to
meet an emergency under
IC 24-4.5-6-107.
(7) A rule adopted by the Indiana utility regulatory commission to
address an emergency under
IC 8-1-2-113.
(8) An emergency rule jointly adopted by the water pollution
control board and the budget agency under
IC 13-18-13-18.
(9) An emergency rule adopted by the state lottery commission
under
IC 4-30-3-9.
(10) A rule adopted under
IC 16-19-3-5
that the executive board
of the state department of health declares is necessary to meet an
emergency.
(11) An emergency rule adopted by the Indiana transportation
finance authority under
IC 8-21-12.
(12) An emergency rule adopted by the insurance commissioner
under
IC 27-1-23-7.
(13) An emergency rule adopted by the Indiana horse racing
commission under
IC 4-31-3-9.
(14) An emergency rule adopted by the air pollution control
board, the solid waste management board, or the water pollution
control board under
IC 13-15-4-10
(4) or to comply with a
deadline required by federal law, provided:
(A) the variance procedures are included in the rules; and
(B) permits or licenses granted during the period the
emergency rule is in effect are reviewed after the emergency
rule expires.
(15) An emergency rule adopted by the Indiana election
commission under
IC 3-6-4.1-14.
(16) An emergency rule adopted by the department of natural
resources under
IC 14-10-2-5.
(17) An emergency rule adopted by the Indiana gaming
commission under
IC 4-33-4-2
,
IC 4-33-4-3
, or
IC 4-33-4-14.
(18) An emergency rule adopted by the alcoholic beverage
commission under
IC 7.1-3-17.5
,
IC 7.1-3-17.7
, or
IC 7.1-3-20-24.4.
(19) An emergency rule adopted by the department of financial
institutions under
IC 28-15-11.
(20) An emergency rule adopted by the office of the secretary of
family and social services under
IC 12-8-1-12.
(21) An emergency rule adopted by the office of the children's
health insurance program under
IC 12-17.6-2-11.
cash, other liquid assets, real property, and personal property
owned by a recipient of Medicaid under this chapter, or the spouse
of a recipient, that could be converted to cash to be used for
support or maintenance, except the following:
(1) All resources excluded under the federal Supplemental
Security Income program (42 U.S.C. 1382b), including the
following:
(A) A plan to achieve self-sufficiency (PASS).
(B) Property essential to self-support (PESS).
(2) Retirement and medical savings accounts established
under 26 U.S.C. 220 and held by either the recipient or the
recipient's spouse.
(3) Subject to approval by the office, not more than twenty
thousand dollars ($20,000) in accounts held by the recipient
for the sole purpose of purchasing goods or services, including
assistive technology and personal assistance, that:
(A) will increase the employability or independence of the
applicant or recipient; and
(B) are not services to which the recipient is entitled under
Medicaid or any other publicly funded program.
In determining the types of accounts to be approved under
this subdivision, the office shall consider any
recommendations made by the Medicaid work incentives
council established by
IC 12-15-42-1.
(4) Any other assets disregarded by the office under this
article for the purpose of determining eligibility for Medicaid.
Sec. 3. The Medicaid buy-in program for working individuals
with disabilities is established to provide, beginning January 1,
2002, Medicaid to individuals who are disabled and regularly
employed, as authorized under Section 201 of the federal Ticket to
Work and Work Incentives Improvement Act of 1999 (P.L.
106-170, 42 U.S.C. 1396 et seq.).
Sec. 4. (a) To enroll in the buy-in program beginning January
1, 2002, an individual must meet the eligibility requirements under
IC 12-15-2-6
, except as follows:
(1) The individual's disability is not required to be so severe
as to substantially impair the individual's ability to perform
labor or services or to engage in a useful occupation.
(2) The individual must be at least eighteen (18) years of age
but not more than sixty-four (64) years of age.
(3) The individual must be engaged in a substantial and
reasonable work effort as determined by the office and as
permitted by federal law.
(b) In determining an individual's eligibility for the buy-in
program, the office may not consider the following resources:
(1) Any resource excluded under the federal Supplemental
Security Income program (42 U.S.C. 1382b), including the
following:
(A) A plan to achieve self-sufficiency (PASS).
(B) Property essential to self-support (PESS).
(2) A retirement or medical savings account established under
26 U.S.C. 220 and held by the applicant's spouse.
(3) Any other assets disregarded by the office under this
article for the purpose of determining eligibility for Medicaid.
Sec. 5. An individual who is enrolled in the buy-in program
continues to be eligible for Medicaid coverage under the buy-in
program if the individual meets the following requirements:
(1) The individual's annual gross income does not exceed four
hundred fifty percent (450%) of the federal income poverty
level for an individual. In determining an individual's income
under this subdivision, the office may not consider the
following:
(A) The income of the individual's spouse.
(B) Income disregarded under the federal Supplemental
Security Income program (42 U.S.C. 1382b) as either of the
following:
(i) Impairment related work expenses (IRWE).
(ii) Student earned income exclusion.
(2) The individual does not have countable resources that
exceed the resource limits for the federal Supplemental
Security Income program (42 U.S.C. 1382).
(3) The individual is less than sixty-five (65) years of age.
(4) The individual meets all other eligibility requirements
under this chapter.
Sec. 6. An individual who is enrolled in the buy-in program and
who becomes ineligible to receive monthly disability assistance
payments under the federal Supplemental Security Income
program or the federal Social Security Disability Insurance
program due to an improvement in the individual's medical
condition continues to be eligible for Medicaid coverage under the
buy-in program if the individual meets the following requirements:
(1) The individual continues to have a severe medically
determinable impairment, as determined by the office.
(2) The individual is employed and earning a monthly wage
that is not less than the federal minimum hourly wage times
forty (40).
(3) The individual does not have income or countable
resources in excess of the limits established under section 5 of
this chapter.
(4) The individual is less than sixty-five (65) years of age.
(5) The individual pays any premiums or other cost sharing
required under this chapter.
(6) The individual meets all other eligibility requirements
under this chapter.
Sec. 7. (a) An individual who is enrolled in the buy-in program
and who is unable to maintain employment for involuntary
reasons, including temporary leave due to a health problem or
involuntary termination, continues to be eligible for Medicaid
coverage under the buy-in program if the individual meets the
following requirements:
(1) Within sixty (60) days after the date on which the
individual becomes unemployed, the individual, or an
authorized representative of the individual, submits a written
request to the office that the individual's Medicaid coverage
be continued.
(2) The individual maintains a connection to the workforce
during the individual's continued eligibility period by
participating in at least one (1) of the following activities:
(A) Enrollment in a state or federal vocational
rehabilitation program.
(B) Enrollment or registration with the office of workforce
development.
(C) Participation in a transition from school to work
program.
(D) Participation with an approved provider of
employment services.
(E) Provision of documentation from the individual's
employer that the individual is on temporary involuntary
leave.
(F) Provision of documentation of a bona fide effort to seek
employment.
(3) The individual does not have income or countable
resources in excess of the limits established under section 5 of
this chapter.
(4) The individual is less than sixty-five (65) years of age.
(5) The individual pays any premiums or other cost sharing
required under this chapter.
(6) The individual meets all other eligibility requirements
under this chapter.
(b) The office shall continue Medicaid coverage under the
buy-in program for an individual described in subsection (a) for
the lesser of the following periods:
(1) The length of time requested by the individual.
(2) Twelve (12) months from the date of the individual's
involuntary loss of employment.
(c) If an individual is ineligible for continued coverage under the
buy-in program because the individual:
(1) fails to meet the requirements of subsection (a); or
(2) has already met twelve (12) months of continuing
eligibility under this section;
the individual must meet the eligibility requirements of
IC 12-15-2-6
to continue to be eligible for Medicaid.
(d) In determining the eligibility of an individual described in
subsection (c) for Medicaid under
IC 12-15-2-6
, the office shall
disregard any assets accumulated by the individual while
participating in the buy-in program.
Sec. 8. (a) The office shall develop a sliding scale of premiums
for individuals participating in the buy-in program.
(b) The sliding scale of premiums required under subsection (a)
must:
(1) be based on the annual gross income of the individual and,
if married, the individual's spouse; and
(2) provide for a minimum monthly premium of twenty-five
dollars ($25) and a maximum monthly premium of two
hundred seventy-five dollars ($275).
(c) Subject to the minimum and maximum amounts described
in subsection (b), the office may annually adjust the scale of
premiums adopted under this section.
Sec. 9. (a) An individual whose gross annual income, including
the gross annual income of the individual's spouse, if married, is
less than one hundred fifty percent (150%) of the federal income
poverty level for the size of the individual's or couple's family may
not be required to pay a premium to participate in the buy-in
program.
(b) An individual whose gross annual income, including the
gross annual income of the individual's spouse, if married, is at
least one hundred fifty percent (150%) but not more than four
hundred fifty percent (450%) of the federal income poverty level
for the size of the individual's or couple's family, must pay a
monthly premium in an amount equal to:
(1) the lesser of:
(A) the amount prescribed by the sliding scale developed
by the office under section 8 of this chapter; or
(B) seven and one-half percent (7 1/2%) of the individual's
or couple's gross annual income divided by twelve (12);
minus
(2) the monthly amount of any premium paid by the
individual, the individual's spouse, or the individual's parent
for health insurance that covers the individual.
Sec. 10. (a) The office shall annually review the amount of the
premium that an individual is required to pay under section 9 of
this chapter.
(b) The office may increase the premium required under section
9 of this chapter only after conducting an annual review under
subsection (a).
(c) The office shall decrease the premium that an individual is
required to pay under section 9 of this chapter if:
(1) the individual notifies the office of a change in income or
family size; and
(2) the sliding scale adopted under section 8 of this chapter
applied to the individual's changed circumstances prescribes
a premium for the individual that is lower than the premium
the individual is paying.
Sec. 11. To the greatest extent possible, the office shall use the
same administrative procedure regarding premiums for the buy-in
program as are used for the children's health insurance program
established under IC 12-17.6, including:
(1) the effect of nonpayment of a premium; and
(2) the collection of premiums.
Sec. 12. (a) The office shall establish criteria to base the annual
redetermination of disability required under 405 IAC 2-2-3(b) for
an individual participating in the buy-in program on the
individual's medical evidence, including evidence of physical or
mental impairment.
(b) In conducting the annual redetermination described in
subsection (a), the office may not determine that an individual
participating in the buy-in program is no longer disabled based
solely on the individual's:
(1) participation in employment;
(2) earned income; or
no longer dependent on, or who have reduced dependence on,
public benefits or services, other than Medicaid or the
children's health insurance program, due to income or
support services received through participation in the buy-in
program or work initiatives created through Section 1619 of
the federal Social Security Act (42 U.S.C. 1382h).
(8) The change in the number of buy-in program participants
or participants in work initiatives created through Section
1619 of the federal Social Security Act (42 U.S.C. 1382h) who
have health care needs and related services covered though
employer based benefit programs.
(c) In evaluating the effectiveness of the state's work incentive
initiatives for individuals with disabilities, the office:
(1) shall collaborate with other state agencies on data
collection; and
(2) may consult with an independent contractor to collect data
on the criteria listed under subsection (b).
(d) The office shall provide an annual report of its evaluation
under this section to the council not later than October 1 each year,
beginning in 2002.
Sec. 15. Funding for the buy-in program shall be from funds
appropriated by the general assembly, premiums paid, and any
federal matching funds available to the program.
Sec. 16. (a) The office shall adopt rules under
IC 4-22-2
to
implement this chapter.
(b) The office may adopt emergency rules under
IC 4-22-2-37.1
to implement this chapter on an emergency basis.
(c) In adopting rules under this section, the office shall:
(1) submit proposed rules to the council; and
(2) consider any recommendations of the council before
adopting final rules.
(IC 2-5-23) not later than December 31 each year, beginning in
2002.
(b) The report required under this section must include the
following:
(1) The evaluation made by the office under
IC 12-15-41-14
and any comments the council has regarding the evaluation.
(2) Recommendations for any necessary legislation or rules.
States Department of Health and Human Services for approval of
the necessary waiver amendment under the federal Home and
Community Based Services program (42 U.S.C. 1396 et seq.) to
amend the following Medicaid waivers to allow an individual who
is participating in the Medicaid buy-in program established by
IC 12-15-41-3
, as added by this act, for working individuals with
disabilities to receive waiver services regardless of whether the
individual's income exceeds the income limit for the waiver:
(1) ICF/MR waiver.
(2) Aged and disabled waiver.
(3) Medically fragile children's waiver.
(4) Autism waiver.
(5) Traumatic brain injury waiver.
(6) Adult foster care, adult day care, and assisted living
waiver.
(c) Before submitting the waiver amendment request required
under this SECTION, the office shall submit the proposed waiver
amendment request to the Medicaid work incentives council
established by
IC 12-15-42-1
, as added by this act, for review. The
office shall consider including any changes to the proposed waiver
amendment request recommended by the council.
(d) The office may not implement the waiver amendment until
the office files an affidavit with the governor attesting that the
federal waiver amendment applied for under this SECTION is in
effect. The office shall file the affidavit under this subsection not
later than five (5) days after the office is notified that the waiver
amendment is approved.
(e) If the office receives a waiver amendment under this
SECTION from the United States Department of Health and
Human Services and the governor receives the affidavit filed under
subsection (d), the office shall implement the waiver amendment
not more than sixty (60) days after the governor receives the
affidavit.
(f) The office may adopt rules under
IC 4-22-2
to implement this
SECTION. Before adopting final rules under this section, the office
shall:
(1) submit the proposed rules to the Medicaid work incentives
council; and
(2) consider any recommendations made by the council
regarding the proposed rules.
(g) This SECTION expires January 1, 2007.
SECTION, "office" refers to the office of Medicaid policy and
planning established by
IC 12-8-6-1.
(b) The office may apply to the Secretary of the United States
Department of Health and Human Services for a grant under
Section 204 of the federal Ticket to Work and Work Incentives
Improvement Act of 1999 (P.L. 106-170, 42 U.S.C. 1396a) to
establish a demonstration project to provide Medicaid coverage to
individuals described in Section 204(b) of the federal Ticket to
Work and Work Incentives Improvement Act of 1999 (P.L.
106-170, 42 U.S.C. 1396a).
(c) If the office establishes a demonstration project under this
SECTION, the office may adopt rules under
IC 4-22-2
to
implement the demonstration project.
(d) This SECTION expires June 30, 2006.