Eligibility for Medicaid.

WORKING DRAFT
2013
STATE OF WYOMING
13LSO-0434.E1

SENATE FILE
NO.
SF0097

Eligibility for Medicaid.

Sponsored by:
Senator(s) Scott and Representative(s) Greene and Harvey

A BILL

for

AN ACT relating to Medicaid; providing eligibility categories and criteria for the Medicaid program; specifying income and resource limits; providing expanded eligibility as required by federal law; providing for continued eligibility of current Medicaid clients as specified; requiring reports; and providing for an effective date.

Be It Enacted by the Legislature of the State of Wyoming:

Section 1.

W.S. 42
‑
2
‑
406 is created to read:

42
‑
2
‑
406
.

Eligibility categories and criteria
; expansion of Medicaid prohibited
.

(a)

The department shall provide in the state Medicaid plan medical assistance and services to the following categories of eligible persons at the indicated income and asset limits:

(i)

Categories of mandatory coverage pursuant to
42 U.S.C.
§
1396a(a)(10)(A)(i)
:

(A)

Individuals receiving temporary assistance to needy families, as required by 42
C.F.R.
§ 435.110;

(B)

Families terminated from temporary assistance to needy families because of increased earnings or hours of employment, as required by 42 C.F.R. § 435.112, or because of increased child or spousal support, as required by 42 C.F.R. § 435.115;

(C)

Individuals who are ineligible for temporary assistance to needy families
solely because of policies requiring the deeming of income and resources
,

as required by 42 C.F.R. § 435.113;

(D)

Individuals who would be eligible for temporary assistance to needy families except for increased old age, survivors and disability insurance
,
as required by 42 C.F.R. § 435.114;

(E)

Individuals deemed to be receiving temporary assistance to needy families
,
as required by 42 C.F.R. § 435.115;

(F)

Qualified pregnant women
,
as required by 42 C.F.R. § 435.116;

(G)

Newborn children, including children of alien mothers, as required by 42 C.F.R. § 435.117;

(H)

Qualified family members, as required by 42 C.F.R. § 435.119. For purposes of this subparagraph, "qualified family member" means
any member of a family, including pregnant women and children eligible for Medicaid, who would be receiving
temporary assistance to needy families
cash benefits on the basis of the unemployment of the principal wage earner
;

(J)

Individuals receiving or deemed to be receiving supplemental security income, as required by 42 C.F.R. § 435.120;

(K)

Individuals who would be eligible for supplemental security income, as required by 42 C.F.R. § 435.122;

(M)

Individuals receiving mandatory state supplements to supplemental security income
,
as required by 42 C.F.R. § 435.130;

(N)

Individuals who would be eligible except for an increase in old age, survivors and disability insurance benefits
,
as required by 42 C.F.R. § 435.134;

(O)

Individuals who become ineligible for cash assistance as a result of old age, survivors and disability insurance cost-of-living increases received after April, 1977, as required by 42 C.F.R. § 435.135;

(P)

As required by 42 C.F.R. § 435.137, individuals who b
ecame ineligible for
supplemental security income
or a
s
tate supplement as a result of the elimination
of the additional reduction factor for disabled widows and widowers under age
sixty (
60
)

pursuant to
section 134 of P.L. 98-21
;

(Q)

Disabled widows and widowers aged
sixty (
60
)
through
sixty-four (
64
)
who would be eligible for
supplemental security income
except for early receipt of social security benefits
, as required by 42 C.F.R
.
§ 435.138;

(R)

A l
awful temporary resident
alien,
lawful permanent resident
alien and a nonqualified alien as defined in 8 U.S.C. § 1621, who would be eligible for Medicaid under this section if a citizen, shall receive emergency medical services only, as required by 42 C.F.R. § 435.139;

(S)

Children for whom adoption assistance or foster care maintenance payments are made
, as required by 42 C.F.R. § 435.145;

(T)

Pregnant women eligible for extended coverage, as required by 42 C.F.R. § 435.170.

(ii)

After December 31, 2013, the department shall provide in the state Medicaid plan for medical assistance and services to

infants and children under age nineteen (19), as required by 42 C.F.R. § 435.118;

(iii)

Categories of optional coverage pursuant to
42 U.S.C.
§
1396a(a)(10)(A)(ii)
:

(A)

Minors under age twenty-one (21) who are in foster care, in the custody of the department of family services, without regard to income or resources, pursuant to

42 U.S.C.
§
1396a(a)(10)(A)(ii)(VIII)(cc)
. Coverage under this subparagraph shall include twelve (12) months of full coverage for minors who were previously in foster care and for persons aged eighteen (18)
through
twenty (20) who were in the custody of the department of family services on their eighteenth birthday;

(B)

Minors under age twenty-one (21) who were adopted through a state subsidized adoption, pursuant to 42 C.F.R. § 435.227;

(C)

Minors under age twenty-one (21) who were previously in state foster care in the custody of the
department of family services, without regard to income or resources, pursuant to

42 U.S.C.
§
1396a(a)(10)(A)(ii)(VIII)(cc)
;

(D)

Women who have declared they are pregnant and who have applied for Medicaid shall be presumptively covered for outpatient Medicaid services pending an eligibility determination. Coverage under this subparagraph shall be limited to applicants with income less than or equal to one hundred thirty-three percent (133%) of the federal poverty level, without regard to other resources;

(E)

Minors who were previously receiving but are no longer eligible for supplemental security income payments shall receive full Medicaid coverage for twelve (12) months following termination of the supplemental security income;

(F)

Individuals in a nursing home because of medical necessity, having income less than or equal to three hundred percent (300%) of the supplemental security income payment standard and resources less than two thousand dollars ($2,000.00) for an individual and three
thousand dollars ($3,000.00) for a couple, subject to the community spouse resource allowance pursuant to 42 U.S.C. § 1396r–5;

(G)

Hospitalized individuals having income less than or equal to three hundred percent (300%) of the supplemental security income payment standard and resources less than two thousand dollars ($2,000.00) for an individual and three thousand dollars ($3,000.00) for a couple, subject to the community spouse resource allowance pursuant to 42 U.S.C. § 1396r–5;

(H)

Individuals in hospice care, having income less than or equal to three hundred percent (300%) of the supplemental security income payment standard and resources less than two thousand dollars ($2,000.00) for an individual and three thousand dollars ($3,000.00) for a couple, subject to the community spouse resource allowance pursuant to 42 U.S.C. § 1396r–5;

(J)

Individuals in an intermediate care facility for persons with intellectual disabilities, having income at or below three hundred percent (300%) of the supplemental security income payment standard and resources
less than two thousand dollars ($2,000.00) for an individual and three thousand dollars ($3,000.00) for a couple, subject to the community spouse resource allowance pursuant to 42 U.S.C. § 1396r–5;

(K)

Individuals aged sixty-five (65) or older residing at the Wyoming life resource center, having income at or below three hundred percent (300%) of the supplemental security income payment standard and resources less than two thousand dollars ($2,000.00) for an individual and three thousand dollars ($3,000.00) for a couple, subject to the community spouse resource allowance pursuant to 42 U.S.C. § 1396r–5;

(M)

Individuals aged twenty (20) or less with a developmental disability, having income less than or equal to three hundred percent (300%) of the supplemental security income payment standard and resources less than two thousand dollars ($2,000.00) for an individual and three thousand dollars ($3,000.00) for a couple, subject to the community spouse resource allowance pursuant to 42 U.S.C. § 1396r–5, and requiring services under this subparagraph by medical necessity;

(N)

Individuals under age nineteen (19) who were previously receiving but are no longer eligible for the children's developmental disability waiver pursuant to subparagraph (M) of this paragraph shall receive full Medicaid coverage for twelve (12) months following termination of their eligibility. Benefits under this subparagraph shall be limited to Medicaid medical benefits and shall not include other waiver services;

(O)

Adults age twenty-one (21) and older with a developmental disability, having income less than or equal to three hundred percent (300%) of the supplemental security income payment standard and resources less than two thousand dollars ($2,000.00) for an individual and three thousand dollars ($3,000.00) for a couple, and requiring services under this subparagraph by medical necessity;

(P)

Adults age twenty-one (21) and older with an acquired brain injury, having income less than or equal to three hundred percent (300%) of the supplemental security income payment standard and resources less than two thousand dollars ($2,000.00) for an individual and three thousand dollars ($3,000.00) for a couple, subject to
the community spouse resource allowance pursuant to 42 U.S.C. § 1396r–5, and requiring services under this subparagraph by medical necessity;

(Q)

Individuals requiring the services of an assisted living facility by medical necessity, having income less than or equal to three hundred percent (300%) of the supplemental security income payment standard and resources less than two thousand dollars ($2,000.00) for an individual and three thousand dollars ($3,000.00) for a couple, subject to the community spouse resource allowance pursuant to 42 U.S.C. § 1396r–5. Benefits under this subparagraph shall be limited to full medical benefits and waiver services but not room and board;

(R)

Individuals over age nineteen (19) requiring the services of a long term care facility by medical necessity, having income less than or equal to three hundred percent (300%) of the supplemental security income payment standard and resources less than two thousand dollars ($2,000.00) for an individual and three thousand dollars ($3,000.00) for a couple, subject to the community spouse resource allowance pursuant to 42 U.S.C. § 1396r–5;

(S)

Individuals aged four (4) through twenty (20) requiring mental health services by medical necessity, having income less than or equal to three hundred percent (300%) of the supplemental security income payment standard and resources less than two thousand dollars ($2,000.00) for an individual and three thousand dollars ($3,000.00) for a couple, subject to the community spouse resource allowance pursuant to 42 U.S.C. § 1396r–5. Upon termination of eligibility under this subparagraph, Medicaid medical benefits shall be provided for twelve (12) months following termination for an individual under nineteen (19) years of age;

(T)

Individuals without creditable insurance coverage who have been diagnosed with breast or cervical cancer, having income less than or equal to two hundred fifty percent (250%) of the federal poverty level, without regard to resources;

(U)

Individuals with a verified diagnosis of tuberculosis, having income less than one hundred percent (100%) of the supplemental security income payment standard and resources less than two thousand dollars
($2,000.00) for an individual and three thousand dollars ($3,000.00) for a couple,

subject to the community spouse resource allowance pursuant to 42 U.S.C. § 1396r–5, shall receive full Medicaid medical coverage but not inpatient services;

(W)

Employed individuals aged sixteen (16) through sixty-four (64) with disabilities, having unearned income less than or equal to three hundred percent (300%) of the supplemental security income payment standard without regard to resources. Individuals eligible pursuant to this subparagraph shall be required to pay
a premium equal to
seven and one-half percent (7 1/2%) of earned and unearned income per month, after disregarding the first fifty dollars ($50.00) of unearned income per month;

(Y)

Individuals under age nineteen (19) who were previously receiving but are no longer eligible pursuant to subparagraph (W) of this paragraph shall receive full Medicaid coverage for twelve (12) months following termination of their eligibility;

(Z)

Women who are pregnant, having income less than or equal to one hundred thirty-three percent
(133%) of the federal poverty level, without regard to resources. Services under this subparagraph shall be limited to family planning;

(AA)

Qualified Medicare beneficiaries entitled to Medicare part A and part B with income less than or equal to one hundred percent (100%) of the federal poverty level and resources that do not exceed two (2) times the limit for supplemental security income and who are not otherwise eligible for Medicaid. Services under this subparagraph shall be limited to payment of Medicare premiums, deductibles and coinsurance;

(BB)

Specified low income Medicare beneficiaries entitled to Medicare part A and part B with income between one hundred percent (100%) and one hundred thirty-five percent (135%) of the federal poverty level, having resources that do not exceed two (2) times the limit for supplemental security income and who are not otherwise eligible for Medicaid. Services under this subparagraph shall be limited to payment of Medicare part B premiums.

(iv)

Categories of individuals funded by the state without a federal medical assistance percentage:

(A)

Individuals under age twenty-one (21) in the custody of the department of family services and who are in basic foster care, institutional foster care or are pending foster care;

(B)

Individuals requiring nursing home care by medical necessity, having income above three hundred percent (300%) of the supplemental security income payment standard and resources less than two thousand dollars ($2,000.00) for an individual and three thousand dollars ($3,000.00) for a couple, subject to the community spouse resource allowance pursuant to 42 U.S.C. § 1396r–5, shall receive nursing home room and board. Services pursuant to this subparagraph shall be limited to one hundred twenty (120) days for those individuals who are in the process of setting up an income trust for their required contribution;

(C)

Individuals with income less than or equal to one hundred percent (100%) of the federal poverty level and resources less than two thousand five hundred dollars ($2,500.00), shall be eligible for the prescription drug assistance program pursuant to W.S. 42
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4
‑
118.

(b)

The department shall not expand or add to the categories of individuals eligible for Medicaid pursuant to this section.

This subsection shall not apply to any enacted legislation authorizing expansion of Medicaid pursuant to section 1902(a)(10)(A)(i)(VIII) of the Social Security Act, 42 U.S.C. § 1396a(a)(10)(A)(i)(VIII).

Section 2.

(a)

Notwithstanding W.S. 42
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2
‑
406 created by this act, if a group of individuals not identified in W.S. 42
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2
‑
406 was eligible under the Wyoming state Medicaid plan for any Medicaid service as of July 1, 2012, that group shall remain eligible for the same services and subject to the same eligibility criteria after July 1, 2013, subject however to subsection (b) of this section and until no later than July 1, 2017.

(
b
)

If the department of health or the department of family services, on or after
July
1, 201
3
and before July 1, 2016, discovers any group to which subsection (a) of this section should apply, the department shall report the facts related to the group and coverage to the joint labor, health and social services interim committee before October
1 following the discovery. Notwithstanding W.S. 42
‑
2
‑
406, any group reported by either department to the interim committee pursuant to this subsection shall remain eligible for the same services and subject to the same eligibility criteria until July 1 following the report to the interim committee.

Section 3.

This act is effective July 1, 2013.

(END)

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SF0097