Bills · 2013-2014 Regular Session
Relating to: eligibility for and premiums under the Medical Assistance purchase plan and disregarding assets in an independence account and retirement benefits for purposes of determining eligibility and cost-sharing requirements under a number of Medical Assistance and long-term care programs. (FE)
Health services, department of — Health Medical assistance Poor Public assistance Retirement — Private plans
- Introduced, stopped here
- Passes Assembly, not reached
- Passes Senate, not reached
- Governor signs, not reached
- Law, not reached
Unfamiliar terms? Glossary
What this bill does
Plain-language analysis by the nonpartisan Legislative Reference Bureau
Under current law, an individual who would be eligible for the Medical
Assistance (MA) program based on eligibility for supplemental security income
(SSI), but who is not eligible for SSI because he or she is employed and has too much
earned and unearned income to be eligible, may pay premiums for coverage under
MA if his or her family's net income is less than 250 percent of the poverty line and
his or her assets do not exceed $15,000, excluding certain assets. This program is
known as the MA purchase plan (MAPP). When determining the value of the
individual's assets for continued eligibility under MAPP, the Department of Health
Services (DHS) excludes amounts in a DHS-approved account that consists solely
of savings from the individual's employment after the individual's coverage under
MAPP began. These accounts are known as "independence accounts."
This bill makes changes to the eligibility and premium requirements under
MAPP. Under current law, when determining whether an individual's net income is
less than 250 percent of the poverty line, certain disregards are deducted from the
individual's and his or her spouse's total earned income, then the individual's and his
or her spouse's total unearned income is added, and then another general disregard
is deducted. Under the bill, an individual's net income is determined by subtracting
the same disregards as under current law from the individual's total earned and
unearned income alone, then the individual's out-of-pocket medical and remedial
expenses and long-term care costs, if any, are deducted. In addition, the bill provides
that if an individual whose income is equal to or greater than 250 percent of the
poverty line satisfies all of the other eligibility requirements, he or she is eligible for
MAPP if DHS determines that his or her earnings are insufficient to replace all of
the publicly funded benefits that he or she would actually receive in the absence of
those earnings. The bill also requires DHS, when determining eligibility for MAPP,
to exclude from assets, to the extent approved by the federal government, income or
assets from retirement benefits that accumulated or were earned from employment
income or employer contributions while the individual was employed and receiving
MA coverage under MAPP.
Premiums for MA coverage under MAPP currently are calculated for an
individual by adding together all of the individual's unearned income, after certain
specified amounts are deducted, and then adding, in practice, 3 percent of the
individual's earned income, although the statutes provide that 3.5 percent of the
individual's earned income is to be added. DHS may waive any premiums that are
calculated to be below $10 per month, although, in practice, DHS waives any
premiums below $25 per month. In addition, the statutes prohibit DHS from
assessing a premium to an individual whose earned and unearned income is below
150 percent of the poverty line. Under the bill, an individual whose total earned and
unearned income is at least 150 percent of the poverty line for an individual is
required to pay a monthly premium equal to 3 percent of the individual's total earned