HF 1384

as introduced - 93rd Legislature (2023 - 2024) Posted on 02/27/2023 04:51pm

A bill for an act
relating to human services; requiring notice of the medical assistance program for
employed persons with disabilities; modifying medical assistance eligibility
requirements for employed persons with disabilities; amending Minnesota Statutes
2022, sections 256B.04, by adding a subdivision; 256B.056, subdivision 3;
256B.057, subdivision 9.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2022, section 256B.04, is amended by adding a subdivision
to read:

new text begin Subd. 26. new text end

new text begin Notice of employed persons with disabilities program. new text end

new text begin The commissioner
shall provide information on the medical assistance program for employed persons with
disabilities under section 256B.057, subdivision 9, to all medical assistance enrollees at the
time of initial enrollment and at least annually thereafter.
new text end

Sec. 2.

Minnesota Statutes 2022, section 256B.056, subdivision 3, is amended to read:

Subd. 3.

Asset limitations for certain individuals.

(a) To be eligible for medical
assistance, a person must not individually own more than $3,000 in assets, or if a member
of a household with two family members, husband and wife, or parent and child, the
household must not own more than $6,000 in assets, plus $200 for each additional legal
dependent. In addition to these maximum amounts, an eligible individual or family may
accrue interest on these amounts, but they must be reduced to the maximum at the time of
an eligibility redetermination. The accumulation of the clothing and personal needs allowance
according to section 256B.35 must also be reduced to the maximum at the time of the
eligibility redetermination. The value of assets that are not considered in determining
eligibility for medical assistance is the value of those assets excluded under the Supplemental
Security Income program for aged, blind, and disabled persons, with the following
exceptions:

(1) household goods and personal effects are not considered;

(2) capital and operating assets of a trade or business that the local agency determines
are necessary to the person's ability to earn an income are not considered;

(3) motor vehicles are excluded to the same extent excluded by the Supplemental Security
Income program;

(4) assets designated as burial expenses are excluded to the same extent excluded by the
Supplemental Security Income program. Burial expenses funded by annuity contracts or
life insurance policies must irrevocably designate the individual's estate as contingent
beneficiary to the extent proceeds are not used for payment of selected burial expenses;

(5) for a person who no longer qualifies as an employed person with a disability due to
loss of earnings, assets allowed while eligible for medical assistance under section 256B.057,
subdivision 9, are not considered for 12 months, beginning with the first month of ineligibility
as an employed person with a disability, to the extent that the person's total assets remain
within the allowed limits of section 256B.057, subdivision 9, paragraph (d);

(6) a designated employment incentives asset account is disregarded when determining
eligibility for medical assistance for a person age 65 years or older under section 256B.055,
subdivision 7. An employment incentives asset account must only be designated by a person
who has been enrolled in medical assistance under section 256B.057, subdivision 9, for a
24-consecutive-month period. A designated employment incentives asset account contains
qualified assets owned by the person and the person's spouse in the last month of enrollment
in medical assistance under section 256B.057, subdivision 9. Qualified assets include
retirement and pension accounts, medical expense accounts, and up to $17,000 of the person's
other nonexcluded assets. An employment incentives asset account is no longer designated
when a person loses medical assistance eligibility for a calendar month or more before
turning age 65. A person who loses medical assistance eligibility before age 65 can establish
a new designated employment incentives asset account by establishing a new
24-consecutive-month period of enrollment under section 256B.057, subdivision 9. The
income of a spouse of a person enrolled in medical assistance under section 256B.057,
subdivision 9, during each of the 24 consecutive months before the person's 65th birthday
must be disregarded when determining eligibility for medical assistance under section
256B.055, subdivision 7. Persons eligible under this clause are not subject to the provisions
in section 256B.059; and

(7) effective July 1, 2009, certain assets owned by American Indians are excluded as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section 447.50.

(b) No asset limit shall apply to persons eligible under deleted text begin section deleted text end new text begin sections new text end 256B.055,
subdivision 15 new text begin , and 256B.057, subdivision 9 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever occurs later. The commissioner of human services shall notify the revisor of
statutes when federal approval is obtained.
new text end

Sec. 3.

Minnesota Statutes 2022, section 256B.057, subdivision 9, is amended to read:

Subd. 9.

Employed persons with disabilities.

(a) Medical assistance may be paid for
a person who is employed and who:

(1) but for excess earnings or assets, meets the definition of disabled under the
Supplemental Security Income program; new text begin and
new text end

deleted text begin (2) meets the asset limits in paragraph (d); and
deleted text end

deleted text begin (3) deleted text end new text begin (2) new text end pays a premium and other obligations under paragraph deleted text begin (e) deleted text end new text begin (d) new text end .

(b) For purposes of eligibility, there is a $65 earned income disregard. To be eligible
for medical assistance under this subdivision, a person must have more than $65 of earned
income. Earned income must have Medicare, Social Security, and applicable state and
federal taxes withheld. The person must document earned income tax withholding. Any
spousal income or assets shall be disregarded for purposes of eligibility and premium
determinations.

(c) After the month of enrollment, a person enrolled in medical assistance under this
subdivision who:

(1) is temporarily unable to work and without receipt of earned income due to a medical
condition, as verified by a physician, advanced practice registered nurse, or physician
assistant; or

(2) loses employment for reasons not attributable to the enrollee, and is without receipt
of earned income may retain eligibility for up to four consecutive months after the month
of job loss. To receive a four-month extension, enrollees must verify the medical condition
or provide notification of job loss. All other eligibility requirements must be met and the
enrollee must pay all calculated premium costs for continued eligibility.

deleted text begin (d) For purposes of determining eligibility under this subdivision, a person's assets must
not exceed $20,000, excluding:
deleted text end

deleted text begin (1) all assets excluded under section 256B.056;
deleted text end

deleted text begin (2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans, Keogh
plans, and pension plans;
deleted text end

deleted text begin (3) medical expense accounts set up through the person's employer; and
deleted text end

deleted text begin (4) spousal assets, including spouse's share of jointly held assets.
deleted text end

deleted text begin (e) deleted text end new text begin (d) new text end All enrollees must pay a premium to be eligible for medical assistance under this
subdivision, except as provided under clause deleted text begin (5) deleted text end new text begin new text end new text begin (6) new text end .

(1) An enrollee must pay the greater of a $35 premium or the premium calculated deleted text begin based
on deleted text end new text begin by applying the following sliding premium fee scale to new text end the person's gross earned and
unearned income and the applicable family size deleted text begin using a sliding fee scale established by the
commissioner, which begins at one percent of income at 100 percent of the federal poverty
guidelines and increases to 7.5 percent of income for those with incomes at or above 300
percent of the federal poverty guidelines. deleted text end new text begin :
new text end

new text begin (i) for households with income less than 250 percent of the federal poverty guidelines,
the premium is zero percent of income;
new text end

new text begin (ii) for households with income equal to or greater than 250 percent of the federal poverty
guidelines and less than 300 percent of the federal poverty guidelines, the sliding premium
fee scale begins at zero percent of income at 250 percent of the federal poverty guidelines
and increases to 2.5 percent of income for households with income up to 300 percent of the
federal poverty guidelines;
new text end

new text begin (iii) for households with income equal to or greater than 300 percent of the federal
poverty guidelines and less than 400 percent of the federal poverty guidelines, the sliding
premium fee scale begins at 2.5 percent of income at 300 percent of the federal poverty
guidelines and increases to four percent of income for households with income up to 400
percent of the federal poverty guidelines;
new text end

new text begin (iv) for households with income equal to or greater than 400 percent of the federal
poverty guidelines and less than 500 percent of the federal poverty guidelines, the sliding
premium fee scale begins at four percent of income at 400 percent of the federal poverty
guidelines and increases to 5.5 percent of income for households with income up to 500
percent of the federal poverty guidelines; and
new text end

new text begin (v) for households with income equal to or greater than 500 percent of the federal poverty
guidelines, the premium is equal to 5.5 percent of income.
new text end

new text begin (2) Prior to determining an enrollee's income for the purposes of determining the premium
amount, the lead agency must subtract the value of any Medicare premiums, coinsurance,
and deductibles not reimbursed under this chapter.
new text end

deleted text begin (2) deleted text end new text begin (3) new text end Annual adjustments in the premium schedule based upon changes in the federal
poverty guidelines shall be effective for premiums due in July of each year.

deleted text begin (3) deleted text end new text begin (4) new text end All enrollees who receive unearned income must pay one-half of one percent of
unearned income in addition to the premium amount, except as provided under clause deleted text begin (5) deleted text end new text begin
new text end new text begin (6) new text end .

deleted text begin (4) deleted text end new text begin (5) new text end Increases in benefits under title II of the Social Security Act shall not be counted
as income for purposes of this subdivision until July 1 of each year.

deleted text begin (5) deleted text end new text begin (6) new text end Effective July 1, 2009, American Indians are exempt from paying premiums as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section 447.50.

deleted text begin (f) deleted text end new text begin (e) new text end A person's eligibility and premium shall be determined by the local county agency.
Premiums must be paid to the commissioner. All premiums are dedicated to the
commissioner.

deleted text begin (g) deleted text end new text begin (f) new text end Any required premium shall be determined at application and redetermined at the
enrollee's deleted text begin six-month deleted text end new text begin annual new text end income review or when a change in income or household size
is reported. Enrollees must report any change in income or household size within ten days
of when the change occurs. A decreased premium resulting from a reported change in income
or household size shall be effective the first day of the next available billing month after
the change is reported. Except for changes occurring from annual cost-of-living increases,
a change resulting in an increased premium shall not affect the premium amount until the
next deleted text begin six-month deleted text end new text begin annual new text end review.

deleted text begin (h) deleted text end new text begin (g) new text end Premium payment is due upon notification from the commissioner of the premium
amount required. Premiums may be paid in installments at the discretion of the commissioner. new text begin
Enrollees who fail to pay a premium must be: (1) contacted directly by letter and by preferred
contact method, if known, by the lead agency within 30 calendar days following each past
due date; (2) notified of the enrollee's past due premium payments; and (3) offered either a
repayment plan or an alternative medical assistance coverage option for which the enrollee
is eligible. A past due notice must not include a threat of termination of medical assistance
unless the commissioner provides the notice more than 120 calendar days after the initial
past due notice.
new text end

new text begin (h) The commissioner has the authority to enter into repayment plans with enrollees
who have past due premiums. If an enrollee requests or agrees to a repayment plan, the
commissioner shall negotiate terms of a repayment plan with the enrollee for any amount
of past due premiums to be repaid over a period of months agreed to by the commissioner
and the enrollee, not to exceed a period of 48 months. Repayment plan terms must be tailored
to the individualized needs of the enrollee. An enrollee's coverage must not be closed due
to past due premiums while the enrollee is participating in a repayment plan. Participation
in a repayment plan includes making payments pursuant to the agreed upon repayment plan.
Repayment plans must also be available upon reapplication by an enrollee whose employed
persons with disabilities coverage has been closed and a past due premium applies.
new text end

(i) Nonpayment of the premium new text begin after 180 calendar days new text end shall result in denial or
termination of medical assistance unless the person demonstrates good cause for nonpayment.
"Good cause" means an excuse for the enrollee's failure to pay the required premium when
due because the circumstances were beyond the enrollee's control or not reasonably
foreseeable. The commissioner shall determine whether good cause exists based on the
weight of the supporting evidence submitted by the enrollee to demonstrate good cause.
Except when an installment agreement is accepted by the commissioner, all persons
disenrolled for nonpayment of a premium must pay any past due premiums as well as current
premiums due prior to being reenrolled. Nonpayment shall include payment with a returned,
refused, or dishonored instrument. The commissioner may require a guaranteed form of
payment as the only means to replace a returned, refused, or dishonored instrument.

(j) For enrollees deleted text begin whose income does not exceed 200 percent of the federal poverty
guidelines deleted text end new text begin who are: (1) eligible under this subdivision new text end and deleted text begin who are deleted text end also enrolled in Medicare deleted text begin , deleted text end new text begin ; new text end
new text begin and (2) not eligible for medical assistance reimbursement of Medicare premiums under
subdivisions 3, 3a, 3b, or 4, new text end the commissioner shall reimburse the enrollee for Medicare new text begin
part A and Medicare new text end part B premiums deleted text begin under section 256B.0625, subdivision 15, paragraph
(a). deleted text end new text begin and part A and part B coinsurance and deductibles. Reimbursement of the Medicare
coinsurance and deductibles, when added to the amount paid by Medicare, must not exceed
the total rate the provider would have received for the same service or services if the person
was receiving benefits as a qualified Medicare beneficiary. Increases in benefits under Title
II of the Social Security Act must not be counted as income for purposes of this subdivision
until July 1 of each year.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever occurs later. The commissioner of human services shall notify the revisor of
statutes when federal approval is obtained.
new text end