SB 232

Currently, the Department of Health Services (DHS) administers the Medical

Assistance (MA) program, which is a joint federal and state program that provides

health services to individuals who have limited resources. Some services are

provided through programs that operated under a waiver of federal Medicaid laws

(MA waiver programs). Current law requires DHS to study potential changes to the

MA state plan and to waivers of federal Medicaid law for certain purposes, including

increasing the cost effectiveness and efficiency of care for the MA program and MA

waiver programs and improving the health status of individuals who receive benefits

under the MA program or an MA waiver program. If DHS determines that revision

of existing statutes or rules would be necessary to advance any of the purposes for

which the study was conducted, DHS may propose a policy to do any of the following:

require cost sharing from program benefit recipients up to the maximum allowed by

the federal government; authorize providers to deny care or services if a program

benefit recipient is unable to share costs; modify existing benefits or establish

various benefits packages and offer different packages to different groups of

recipients; revise provider reimbursement models for particular services; mandate

that program benefit recipients enroll in managed care; restrict or eliminate

presumptive eligibility; impose restrictions on providing benefits to individuals who

are not citizens of the United States; set standards for establishing and verifying

eligibility requirements; develop standards and methodologies to assure accurate

eligibility determinations and redetermine continuing eligibility; and reduce income

levels for purposes of determining eligibility. Before implementing a policy that

conflicts with a state statute, DHS must submit to the Joint Committee on Finance

under the committee's passive review process the proposed amendment to the state

MA plan or proposed waiver of federal Medicaid law and estimates of the projected

cost savings associated with the amendment or waiver request. If the proposed state

MA plan amendment or waiver request is not rejected by the committee, DHS must

submit to the federal government the amendment or waiver request, if necessary, to

the extent necessary to implement its policy. If the federal government does not allow

the amendment or does not grant the waiver, DHS may not implement the policy.

Current law also requires DHS to request a waiver from the federal government

to allow the department to implement eligibility standards, methodologies, and

procedures under the state MA plan or federal Medicaid law waivers that are more

restrictive than those in place on March 23, 2010. If the federal government does not

approve the waiver request before December 31, 2011, DHS must reduce, on July 1,

2012, following the procedures under federal law, income levels to 133 percent of the

federal poverty line for adults who are not pregnant or disabled for the purposes of

determining eligibility, to the extent permitted under federal law.

This bill eliminates the requirement for DHS to conduct the study. DHS is not

authorized, under the bill, to create a policy that would override elements of the MA