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

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.