Medicaid-expansion alternative.

2015
STATE OF WYOMING
15LSO-0011
Numbered
2.1

SENATE FILE

NO.
SF0066

Medicaid-expansion alternative.

Sponsored by:
Joint Labor, Health & Social Services Interim Committee

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 an appropriation; 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
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4
‑
40
4
are created to read:

ARTICLE 4
MEDICAID EXPANSION

42
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4
‑
40
1
.

Definitions.

(a)

As used in this article:

(
i
)

"Basic benefit plan" means a plan of limited health and wellness benefits, as specified in the state Medicaid coverage
negotiated pursuant to W.S. 42
‑
4
‑
403(a), for those beneficiaries who have failed to contribute as required to a PHWA;

(ii)

"Cost sharing" means any premiums charged for coverage, any required contributions to the PHWA and any copayments paid directly by an individual;

(iii)

"Expanded benefit plan" means a plan of health and wellness benefits, as specified in the state Medicaid coverage
negotiated pursuant to W.S. 42
‑
4
‑
403(a), for those beneficiaries who have contributed as required to a PHWA;
(i
v
)

"Personal health and wellness account" or "PHWA" means an account similar to a health savings account, administered by the department or the department's agent, that includes a beneficiary's contributions and
state contributions on behalf of the beneficiary, and used for the beneficiary's health related cost
‑
sharing expenses as required under this article;

(v)

"Rollover" means to transfer to an employer sponsored or individually managed health coverage or similar account when an individual leaves the Medicaid program.

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4
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40
2
.

Medicaid expansion.

(a)

The director of the department, the insurance commissioner and the governor shall negotiate with the center
s
for Medicare and Medicaid services of the United States department of health and human services for a demonstration waiver, state plan amendment, or a combination of both, to provide Medicaid coverage effective
as soon as practicable after
completion of the negotiations pursuant to this section
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
five
(
5
) years without additional legislative authorization;

(ii)

The plan shall have two (2) levels of alternative benefits available, a basic level and an expanded level;

(iii)

Nondisabled adults with incomes up to one hundred thirty
‑
three
percent (13
3
%) of the federal poverty level
, as defined in 42 U.S.C. 1396(e)(14)(I)(
i
),
shall be required to contribute to a personal health and wellness account, modeled after a health savings account, in
amounts as provided in W.S. 42
‑
4
‑
405;

(i
v
)

Individuals who make required contributions to a PHWA shall be eligible, beginning the first of the month after a beneficiary's first contribution to the PHWA, for the expanded level of Medicaid benefits with no cost

sharing
except for copayments made from the PHWA
;

(v)

Individuals with incomes between one hundred percent (100%) and
one hundred thirty
‑
three percent (133%) of the federal poverty level, as defined in 42 U.S.C. 1396(e)(14)(I)(i),
who fail to make required contributions to a PHWA shall be disenrolled from coverage
under the expanded benefit plan, moved to the basic benefit plan
and barred from reenrolling
in the expanded benefit plan
for six (6) months
. If an individual
fails to make a contribution to the PWHA, the person shall be notified and given thirty (30) days from the time the notification is sent to make the contribution before the sanction in this paragraph is implemented
;

(v
i
)

Individuals with incomes up to one hundred percent (100%) of the federal poverty level who fail to make required contributions to a PHWA shall be enrolled in the basic level of Medicaid benefits with cost sharing, which may exceed monthly PHWA contributions, and shall
be barred from reenrolling in the expanded benefit plan for six (6) months
;

(v
ii)

Participants who are able to work and who are not full
‑
time students shall be enrolled in a work assistance benefit at the time of application. The goal shall be to enable as many participants as possible to be employed at least twenty (20) hours per week.
Work assistance may include but is not limited to access to job search facilities, resume assistance, skills
‑
to
‑
job matching services, job training, vocational rehabilitation and employment referral;

(vii
i
)

For beneficiaries with employer sponsored insurance, the program shall provide a defined contribution to the PHWA which may be used to cover the cost of the beneficiary's premium and any cost sharing under the employer plan, including deductibles and copayments;

(i
x
)

Total cost sharing shall be limited to five percent (5%) of household income;

(x)

Provision of wellness benefits with incentives
, which may include additional PHWA contributions by Medicaid,
for those beneficiaries completing preventive services
recommended by the beneficiary's primary care
provider
or for completing healthy behaviors
specified in the Medicaid coverage
negotiated pursuant to W.S. 42
‑
4
‑
403(a)
, such as completing a smoking cessation program
;

(xi)

Administration of the expanded Medicaid program negotiated pursuant to this section shall be the responsibility of the department. The department shall carry out this responsibility through contracts with private insurance carriers or third party administration, subject to the following:

(A)

Contracts shall be awarded pursuant to requests for proposals, following to the extent practical the normal state contracting processes;

(B)

The bidders may be limited to those companies, or a subset of those companies, offering a qualified health plan pursuant to 42 U.S.C.
section 18031
in Wyoming to individuals or small groups;

(C)

Contracts may be awarded to multiple bidders and the department is encouraged to award multiple contracts to give Medicaid clients a choice;

(D)

Contracts shall include the administration of the PHWA accounts;

(E)

Contracts shall include provisions for financial reporting and payment of contractors as the federal government may reasonably require in the Medicaid coverage agreement negotiated pursuant to this section;

(F)

Contracts may include risk sharing provisions.

(
c
)

Any negotiations for expansion of Medicaid pursuant to this section may include the following provisions:

(
i
)

Differential cost sharing, for emergent and nonemergent use of an emergency room;

(ii)

Programs to increase access to transportation
;

(iii)

Optional Medicaid premium assistance for adults with employer sponsored insurance and for children to be covered through their parents' employer sponsored insurance or exchange qualified health plan;

(iv)

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 defi
ciencies in immunization status
.

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40
3
.

Medicaid expansion; federal funding contingency.

The program created by
this article
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%).

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4
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40
4
.

Personal health and wellness accounts; contributions; copayments; state funding.

(a)

Personal health and wellness accounts required pursuant to this article shall be subject to the following:

(
i
)

A sliding scale for monthly contribution based on
a beneficiary's income as a
percent of federal poverty level;

(ii)

Expanded benefit level beneficiaries contributing consistently to their PHWA shall be eligible to roll

over unused account balances;

(iii)

The PHWA for each beneficiary shall be in the amount of two thousand five hundred dollars ($2,500.00) with appropriated Medicaid funds used to fund the difference between beneficiary contributio
ns and the full account balance;

(iv)

The Medicaid contribution to each PHWA may be made over a period of time provided at least five hundred dollars ($500.00) is made at enrollment and may be in part conditioned on health and wellness a
ctions taken by the beneficiary;

(v)

If the PHWA has insufficient funds to pay owed copayments, Medicaid shall pay the copayments and the individual's contributions to the PHWA shall be increased by fifty percent (50%) for each one thousand dollars ($1,000.00) or fraction thereof that Medicaid pays, provided the increase shall be limited by the cost sharing limits provided in this article.

(b)

Copayments under the basic level of health benefits shall be
developed to encourage use of preventive care services, outpatient services and preferred drugs, and to discourage use of inpatient services, nonpreferred drugs and nonemergency visits to emergency rooms.

Section 2
.

There is appropriated five dollars ($5.00) from the general fund to the department of health. This appropriation shall be
for the period beginning with the
effective date of this act and ending June 30, 2016.

This appropriation shall only be expended to provide for administration of expanded Medicaid benefits as provided in this act. Notwithstanding any other provision of law, this appropriation shall not be transferred or expended for any other purpose and any unexpended, unobligated funds remaining from this appropriation shall revert as provided by law on June 30, 2016.

Section 3
.

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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SF0066