HF 4032

as introduced - 91st Legislature (2019 - 2020) Posted on 03/02/2020 02:04pm

A bill for an act
relating to human services; eliminating medical assistance asset limits for people
with disabilities; amending Minnesota Statutes 2018, sections 256B.055,
subdivisions 7, 15, by adding a subdivision; 256B.056, subdivisions 1a, 1b, 4;
256B.057, subdivisions 3, 4, 9; Minnesota Statutes 2019 Supplement, section
256B.056, subdivision 3.

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

Section 1.

Minnesota Statutes 2018, section 256B.055, subdivision 7, is amended to read:

Subd. 7.

deleted text begin Aged or blind persons or deleted text end Persons deleted text begin with disabilities deleted text end new text begin age 65 or older new text end .

deleted text begin (a) deleted text end
Medical assistance may be paid for a person who meets the categorical eligibility
requirements of the Supplemental Security Income program new text begin based on an age of 65 or more
years, new text end or deleted text begin , deleted text end who would meet those requirements except for excess income or assets, and who
meets the other eligibility requirements of this section.

deleted text begin (b) Following a determination that the applicant is not aged or blind and does not meet
any other category of eligibility for medical assistance and has not been determined disabled
by the Social Security Administration, applicants under this subdivision shall be referred
to the commissioner's state medical review team for a determination of disability.
deleted text end

Sec. 2.

Minnesota Statutes 2018, section 256B.055, is amended by adding a subdivision
to read:

new text begin Subd. 7b. new text end

new text begin Persons who are blind or who have been determined to have a disability. new text end

new text begin (a)
Medical assistance may be paid for a person who meets the categorical eligibility
requirements of the Supplemental Security Income program based on blindness or disability,
or who would meet those requirements except for excess income or assets, and who meets
the other eligibility requirements of this section.
new text end

new text begin (b) Following a determination that the applicant is not blind, does not meet any other
category of eligibility requirements for medical assistance, and has not been determined
disabled by the Social Security Administration, an applicant under this subdivision shall be
referred to the commissioner's state medical review team for a determination of disability.
new text end

Sec. 3.

Minnesota Statutes 2018, section 256B.055, subdivision 15, is amended to read:

Subd. 15.

Adults without children.

Medical assistance may be paid for a person who
is:

(1) at least age 21 and under age 65;

(2) not pregnant;

(3) not entitled to Medicare Part A or enrolled in Medicare Part B under Title XVIII of
the Social Security Act;

(4) not otherwise eligible under subdivision deleted text begin 7 deleted text end new text begin 7b new text end as a person who meets the categorical
eligibility requirements of the Supplemental Security Income program;

(5) not enrolled under subdivision deleted text begin 7 deleted text end new text begin 7b new text end as a person who would meet the categorical
eligibility requirements of the Supplemental Security Income program except for excess
income or assets; and

(6) not described in another subdivision of this section.

Sec. 4.

Minnesota Statutes 2018, section 256B.056, subdivision 1a, is amended to read:

Subd. 1a.

Income and assets generally.

(a)(1) Unless specifically required by state law
or rule or federal law or regulation, the methodologies used in counting income deleted text begin and assets deleted text end
to determine eligibility for medical assistance for persons whose eligibility category is based
on blindness, disability, or age of 65 or more years, the methodologies for the Supplemental
Security Income program shall be used deleted text begin , except as provided under subdivision 3, paragraph
(a), clause (6) deleted text end .

(2) 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. Effective upon federal
approval, for children eligible under section 256B.055, subdivision 12, or for home and
community-based waiver services whose eligibility for medical assistance is determined
without regard to parental income, child support payments, including any payments made
by an obligor in satisfaction of or in addition to a temporary or permanent order for child
support, and Social Security payments are not counted as income.

(b)(1) The modified adjusted gross income methodology as defined in the Affordable
Care Act shall be used for eligibility categories based on:

(i) children under age 19 and their parents and relative caretakers as defined in section
256B.055, subdivision 3a;

(ii) children ages 19 to 20 as defined in section 256B.055, subdivision 16;

(iii) pregnant women as defined in section 256B.055, subdivision 6;

(iv) infants as defined in sections 256B.055, subdivision 10, and 256B.057, subdivision
8; and

(v) adults without children as defined in section 256B.055, subdivision 15.

For these purposes, a "methodology" does not include an asset or income standard, or
accounting method, or method of determining effective dates.

(2) For individuals whose income eligibility is determined using the modified adjusted
gross income methodology in clause (1), the commissioner shall subtract from the individual's
modified adjusted gross income an amount equivalent to five percent of the federal poverty
guidelines.

new text begin (c) Unless specifically required by state law or rule or federal law or regulation, the
methodologies used in counting assets to determine eligibility for medical assistance for
persons whose eligibility is based on an age of 65 or more years, the methodologies for the
Supplemental Security Income program shall be used, except as provided under subdivision
3, paragraph (a), clause (6).
new text end

Sec. 5.

Minnesota Statutes 2018, section 256B.056, subdivision 1b, is amended to read:

Subd. 1b.

Aged, blind, and disabled income methodology.

The $20 general income
disregard allowed under the Supplemental Security Income program is included in the
standard and shall not be allowed as a deduction from income for a person eligible under
section 256B.055, subdivisions 7, 7a, new text begin 7b, new text end and 12.

Sec. 6.

Minnesota Statutes 2019 Supplement, 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 deleted text begin for aged, blind, and disabled persons deleted text end , 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;

deleted text begin (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);
deleted text end

deleted text begin (6) deleted text end new text begin (5) new text end 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

deleted text begin (7) deleted text end new text begin (6) new text end 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 section 256B.055, subdivision
15.

new text begin (c) No asset limit shall apply to persons eligible under section 256B.055, subdivision
7b.
new text end

Sec. 7.

Minnesota Statutes 2018, section 256B.056, subdivision 4, is amended to read:

Subd. 4.

Income.

(a) To be eligible for medical assistance, a person eligible under section
256B.055, subdivisions 7, 7a, new text begin 7b, new text end and 12, may have income up to 100 percent of the federal
poverty guidelines. Effective January 1, 2000, and each successive January, recipients of
Supplemental Security Income may have an income up to the Supplemental Security Income
standard in effect on that date.

(b) Effective January 1, 2014, to be eligible for medical assistance, under section
256B.055, subdivision 3a, a parent or caretaker relative may have an income up to 133
percent of the federal poverty guidelines for the household size.

(c) To be eligible for medical assistance under section 256B.055, subdivision 15, a
person may have an income up to 133 percent of federal poverty guidelines for the household
size.

(d) To be eligible for medical assistance under section 256B.055, subdivision 16, a child
age 19 to 20 may have an income up to 133 percent of the federal poverty guidelines for
the household size.

(e) To be eligible for medical assistance under section 256B.055, subdivision 3a, a child
under age 19 may have income up to 275 percent of the federal poverty guidelines for the
household size or an equivalent standard when converted using modified adjusted gross
income methodology as required under the Affordable Care Act. Children who are enrolled
in medical assistance as of December 31, 2013, and are determined ineligible for medical
assistance because of the elimination of income disregards under modified adjusted gross
income methodology as defined in subdivision 1a remain eligible for medical assistance
under the Children's Health Insurance Program Reauthorization Act of 2009, Public Law
111-3, until the date of their next regularly scheduled eligibility redetermination as required
in subdivision 7a.

(f) In computing income to determine eligibility of persons under paragraphs (a) to (e)
who are not residents of long-term care facilities, the commissioner shall disregard increases
in income as required by Public Laws 94-566, section 503; 99-272; and 99-509. For persons
eligible under paragraph (a), veteran aid and attendance benefits and Veterans Administration
unusual medical expense payments are considered income to the recipient.

Sec. 8.

Minnesota Statutes 2018, section 256B.057, subdivision 3, is amended to read:

Subd. 3.

Qualified Medicare beneficiaries.

deleted text begin A person who is entitled to Part A Medicare
benefits, whose income is equal to or less than 100 percent of the federal poverty guidelines,
and whose assets are no more than $10,000 for a single individual and $18,000 for a married
couple or family of two or more, is eligible for medical assistance reimbursement of Part
A and Part B premiums, Part A and Part B coinsurance and deductibles, and cost-effective
premiums for enrollment with a health maintenance organization or a competitive medical
plan under section 1876 of the Social Security Act. deleted text end new text begin (a) A person is eligible for medical
assistance reimbursement of Part A and Part B premiums, Part A and Part B coinsurance
and deductibles, and cost-effective premiums for enrollment with a health maintenance
organization or a competitive medical plan under section 1876 of the Social Security Act
if:
new text end

new text begin (1) the person is entitled to Part A Medicare;
new text end

new text begin (2) the person's income is equal to or less than 100 percent of the federal poverty
guidelines; and
new text end

new text begin (3) for a person 65 years of age or older, the person's assets do not exceed $10,000 for
a single individual and $18,000 for a married couple or family of two or more.
new text end

new text begin (b) new text end 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 were a medical assistance recipient with
Medicare coverage. 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.
new text begin new text end

Sec. 9.

Minnesota Statutes 2018, section 256B.057, subdivision 4, is amended to read:

Subd. 4.

Qualified working adults with disabilities.

deleted text begin A person who is entitled to
Medicare Part A benefits under section 1818A of the Social Security Act; whose income
does not exceed 200 percent of the federal poverty guidelines for the applicable family size;
whose nonexempt assets do not exceed twice the maximum amount allowable under the
Supplemental Security Income program, according deleted text end deleted text begin to family size; and who is not otherwise
eligible for medical assistance, is eligible for medical assistance reimbursement of the
Medicare Part A premium. deleted text end new text begin A person is eligible for medical assistance reimbursement if:
new text end

new text begin (1) the person is entitled to Medicare Part A benefits under section 1818A of the Social
Security Act;
new text end

new text begin (2) the person's income does not exceed 200 percent of the federal poverty guidelines
for the applicable family size;
new text end

new text begin (3) for a person 65 years of age or older, the person's nonexempt assets do not exceed
twice the maximum amount allowable under the Supplemental Security Income program
according to family size; and
new text end

new text begin (4) the person is not otherwise eligible for medical assistance.
new text end

Sec. 10.

Minnesota Statutes 2018, 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 deleted text begin , deleted text end 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 (5).

(1) An enrollee must pay the greater of a $35 premium or the premium calculated based
on the person's gross earned and unearned income and the applicable family size 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.

(2) 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.

(3) 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 (5).

(4) 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.

(5) 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 six-month 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 six-month 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.

deleted text begin (i) deleted text end new text begin (h) new text end Nonpayment of the premium 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.

deleted text begin (j) deleted text end new text begin (i) new text end For enrollees whose income does not exceed 200 percent of the federal poverty
guidelines and who are also enrolled in Medicare, the commissioner shall reimburse the
enrollee for Medicare part B premiums under section 256B.0625, subdivision 15, paragraph
(a).