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EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
SECOND REGULAR SESSION
SENATE BILL NO. 1708
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR MCCREERY .
7298S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal section 208.146, RSMo, and to enact in lieu thereof one new section relating to the ticket
to work health assurance program.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Section 208.146, RSMo, is repealed and one new 1
section enacted in lieu thereof, to be known as section 208.146, 2
to read as follows:3
208.146. 1. The program established under this 1
section shall be known as the "Ticket to Work Health 2
Assurance Program". Subject to appropriations and in 3
accordance with the federal Ticket to Work and Work 4
Incentives Improvement Act of 1999 (TWWIIA), Public Law 106- 5
170, the medical assistance provided for in section 208.151 6
may be paid for a person who is employed and who: 7
(1) Except for earnings, meets the definition of 8
disabled under the Supplemental Security Income Program or 9
meets the definition of an employed individual with a 10
medically improved disability under TWWIIA; 11
(2) Has earned income, as defined in subsection 2 of 12
this section; 13
(3) Meets the asset limits in subsection 3 of this 14
section; and 15
(4) Has income, as determined in subsection 3 of this 16
section, that does not exceed two hundred fifty percent of 17
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the federal poverty level, excluding any earned income of 18
the worker with a disability between two hundred fifty and 19
three hundred percent of the federal poverty level. 20
2. For income to be considered earned income for 21
purposes of this section, the department of social services 22
shall document that Medicare and Social Security taxes are 23
withheld from such income. Self-employed persons shall 24
provide proof of payment of Medicare and Social Security 25
taxes for income to be considered earned. 26
3. (1) For purposes of determining eligibility under 27
this section, the available asset limit and the definition 28
of available assets shall be the same as those used to 29
determine MO HealthNet eligibility for permanent and totally 30
disabled individuals under subdivision (24) of subsection 1 31
of section 208.151 except for: 32
(a) Medical savings accounts limited to deposits of 33
earned income and earnings on such income while a 34
participant in the program created under this section with a 35
value not to exceed five thousand dollars per year; 36
(b) Independent living accounts limited to deposits of 37
earned income and earnings on such income while a 38
participant in the program created under this section with a 39
value not to exceed five thousand dollars per year. For 40
purposes of this section, an "independent living account" 41
means an account established and maintained to provide 42
savings for transportation, housing, home modification, and 43
personal care services and assistive devices associated with 44
such person's disability; and 45
(c) Retirement accounts including, but not limited to, 46
individual accounts, 401(k) plans, 403(b) plans, Keogh 47
plans, and pension plans, provided that income from such 48
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accounts be calculated as income under subdivision (4) of 49
subsection 1 of this section. 50
(2) To determine income, the following shall be 51
disregarded: 52
(a) The first fifty thousand dollars of earned income 53
of the person's spouse; 54
(b) A twenty dollar standard deduction; 55
(c) Health insurance premiums; 56
(d) A seventy-five dollar a month standard deduction 57
for the disabled worker's dental and optical insurance when 58
the total dental and optical insurance premiums are less 59
than seventy-five dollars; 60
(e) All Supplemental Security Income payments, and the 61
first fifty dollars of SSDI payments; and 62
(f) A standard deduction for impairment-related 63
employment expenses equal to one-half of the disabled 64
worker's earned income. 65
4. Any person whose income exceeds one hundred percent 66
of the federal poverty level shall pay a premium for 67
participation in the medical assistance provided in this 68
section. Such premium shall be: 69
(1) For a person whose income is more than one hundred 70
percent but less than one hundred fifty percent of the 71
federal poverty level, four percent of income at one hundred 72
percent of the federal poverty level; 73
(2) For a person whose income equals or exceeds one 74
hundred fifty percent but is less than two hundred percent 75
of the federal poverty level, four percent of income at one 76
hundred fifty percent of the federal poverty level; 77
(3) For a person whose income equals or exceeds two 78
hundred percent but less than two hundred fifty percent of 79
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the federal poverty level, five percent of income at two 80
hundred percent of the federal poverty level; 81
(4) For a person whose income equals or exceeds two 82
hundred fifty percent up to and including three hundred 83
percent of the federal poverty level, six percent of income 84
at two hundred fifty percent of the federal poverty level. 85
5. Recipients of services through this program shall 86
report any change in income or household size within ten 87
days of the occurrence of such change. An increase in 88
premiums resulting from a reported change in income or 89
household size shall be effective with the next premium 90
invoice that is mailed to a person after due process 91
requirements have been met. A decrease in premiums shall be 92
effective the first day of the month immediately following 93
the month in which the change is reported. 94
6. If an eligible person's employer offers employer- 95
sponsored health insurance and the department of social 96
services determines that it is more cost effective, such 97
person shall participate in the employer-sponsored 98
insurance. The department shall pay such person's portion 99
of the premiums, co-payments, and any other costs associated 100
with participation in the employer-sponsored health 101
insurance. If the department elects to pay such person's 102
employer-sponsored insurance costs under this subsection, 103
the medical assistance provided under this section shall be 104
provided to an eligible person as a secondary or 105
supplemental policy for only personal care assistance 106
services, as defined in section 208.900, and related costs 107
and nonemergency medical transportation to any employer- 108
sponsored benefits that may be available to such person. 109
7. The department of social services shall provide to 110
the general assembly an annual report that identifies the 111
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number of participants in the program and describes the 112
outreach and education efforts to increase awareness and 113
enrollment in the program. 114
8. The department of social services shall submit such 115
state plan amendments and waivers to the Centers for 116
Medicare and Medicaid Services of the federal Department of 117
Health and Human Services as the department determines are 118
necessary to implement the provisions of this section. 119
[9. The provisions of this section shall expire August 120
28, 2025.] 121
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