Medicaid-staged expansion.

WORKING DRAFT
2014
STATE OF
WYOMING
14LSO-0374

SENATE FILE
NO.
SF0118

Medicaid-staged expansion.

Sponsored by:
Senator(s)
Rothfuss
, Craft, Emerich, Esquibel, F., Hastert, Johnson, Schiffer and Von Flatern and Representative(s) Barlow,
B
yrd,
C
onnolly, Filer, Greene,
Petroff,
Throne and Zwonitzer, Dn.

A BILL

for

AN ACT relating to Medicaid; providing for expansion of coverage to low income persons as specified; authorizing a Medicaid demonstration waiver; providing waiver requirements as
specified; creating the health
care reserve account; providing for transfer of appropriated funds as specified; and providing for an effective date.

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

Section 1.

W.S. 42
‑
4
‑
401 through 42
‑
4
‑
404 are created to read:

ARTICLE 4
MEDICAID EXPANSION

42
‑
4
‑
401.

Temporary Medicaid expansion.

(a)

Commencing as practicable after March 15, 2014, the department shall provide for all p
ersons described under section 1902(a)(10)(A)(i)(VIII) of the Social Security Act, 42 U.S.C. § 1396a(a)(10)(A)(i)(VIII), to be eligible for services under this chapter. However, this subsection shall not apply if the federal medical assistance percentage, pursuant to 42 U.S.C. § 1396d(y), is less than ninety percent (90%).

(b)

This section is repealed effective March 30, 2015.

42
‑
4
‑
402.

Medicaid expansion.

(a)

The director of the department
, the insurance commissioner
and
the
governor shall negotiate with the center for Medicare and Medicaid services of the United States department of health and human services for a demonstration waiver to provide Medicaid coverage effective April 1, 2015, for all persons described under section 1902(a)(10)(A)(i)(VIII) of the Social Security Act, 42 U.S.C. § 1396a(a)(10)(A)(i)(VIII).

(b)

Any expansion of Medicaid pursuant to this section shall be subject to the following:

(i)

The waiver shall be limited to a maximum period of three (3) years without additional legislative authorization;

(ii)

The program shall include premium assistance for eligible higher income individuals to enable their enrollment in a qualified health plan through the health insurance exchange or through an employer sponsored group plan;

(iii)

The program shall include for eligible moderate income individuals cost sharing as authorized under federal law and regulations;

(iv)

The program shall include for eligible lower income individuals the same benefits with the same restrictions as provided those persons who would be eligible for Medicaid without regard to the expansion of eligibility authorized by the Patient Protection and Affordable Care Act, P.L. 111-148;

(v)

The program shall provide for state general fund cost neutrality, which for purposes of this paragraph means that the average cost of care for recipients under this article is reasonably estimated to not exceed the average cost of care provided to similar recipients under the traditional Medicaid program and provides the maximum realized financial benefit to the state;

(vi)

Premiums shall not exceed two percent (2%) of annual income for beneficiaries whose income is less than or equal to one hundred percent (100%) of the federal poverty level;

(vii)

Maximum annual out-of-pocket expense shall not exceed limits applicable to health insurance policies obtained through the federally operated health insurance exchange in Wyoming by individuals whose income is greater than one hundred percent (100%) of the federal poverty level and less than or equal to one hundred thirty-three percent (133%) of the federal poverty level, calculated as provided in the Patient Protection and Affordable Care Act, P.L. 111-148;

(viii)

Initial and continuing income eligibility standards shall be structured to avoid creating a disincentive for a beneficiary to increase that beneficiary's household income.

(c)

In negotiating the waiver pursuant to this section, the department and the governor shall consider whether the waiver shall include:

(i)

Provision of wellness benefits;

(ii)

Waiver of any co-pay or deductible provisions for wellness benefits;

(iii)

Reductions in cost sharing obligations for beneficiaries who attain or maintain specified uniform standards of healthy behaviors. Uniform standards shall include, at a minimum, completion of an approved annual health risk assessment to identify unhealthy characteristics, including alcohol use, substance use disorders, tobacco use, obesity and deficiencies in immunization status;

(iv)

An
individual financing structure that allows nonaged, nondisabled eligible beneficiaries to enroll in a program that will create and utilize accounts that operate similar to a health savings account or medical savings account. The accounts shall

allow a participant to purchase cost effective high deductible health insurance and

promote independence and self-sufficiency;

(v)

An option for beneficiaries to remain in the program with the same benefit and financing structure even if the beneficiary's household income drops below one hundred percent (100%) of the federal poverty level.

42
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4
‑
403.

Medicaid expansion; federal funding contingency.

The program created by W.S. 42
‑
4
‑
401 and 42
‑
4
‑
404 shall not be administered during any time period in which the federal medical assistance percentage, as currently provided pursuant to 42 U.S.C. § 1396d(y), is less than ninety percent (90%).

42
‑
4
‑
404.

Health
care reserve account.

(a)

The healthcare reserve account is created.

(b)

The account shall consist of monies appropriated to but unspent as a result of Medicaid expansion under this article and identified by the director of the department of health and the directors of other affected agencies.

(c
)

Funds identified by the directors of the various departments as required by this article shall be transferred to the healthcare reserve account pursuant to the governor's authority under W.S. 9
‑
2
‑
1005(b)(i).

(
d
)

Funds in the healthcare reserve account shall not be expended without further legislative enactment.

Section 2.

This act is effective immediately upon completion of all acts necessary for a bill to become law as provided by Article 4, Section 8 of the Wyoming Constitution.

(END)

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SF0118