1.1 	A bill for an act
1.2 	relating to human services; establishing eligibility
1.3 	requirements related to nonuse of tobacco products and
1.4 	tobacco use cessation for state health care programs
1.5 	and MFIP; amending Minnesota Statutes 2004, sections
1.6 	256D.03, subdivision 3; 256L.07, by adding a
1.7 	subdivision; proposing coding for new law in Minnesota
1.8 	Statutes, chapters 256B; 256J.
1.9 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.10 	Section 1. [256B.0565] ELIGIBILITY; TOBACCO USE
1.11 	CESSATION.
1.12 		Subdivision 1.Requirement for adult recipients. In
1.13 	order to be eligible for medical assistance, an adult recipient,
1.14 	within 30 days of initial enrollment, must sign a statement
1.15 	developed by the commissioner that states that the recipient:
1.16 	(1) does not use tobacco products; or 
1.17 	(2) is currently enrolled in a tobacco use cessation
1.18 	program approved by the commissioner, or agrees to enroll in and
1.19 	complete a tobacco use cessation program that is approved by the
1.20 	commissioner.
1.21 	If the recipient under clause (2) does not complete a tobacco
1.22 	use cessation program within six months of initial enrollment,
1.23 	the recipient is subject to twice the level of cost-sharing
1.24 	required under section 256B.0631, and a $40 per month maximum
1.25 	for prescription drug co-payments, until the recipient completes
1.26 	the program.  For purposes of this higher cost-sharing
1.27 	requirement, the exemption for pregnant women under section
2.1 	256B.0631, subdivision 2, clause (2), does not apply.
2.2 		Subd. 2.Renewal of eligibility. The commissioner shall
2.3 	apply the requirements of subdivision 1 to randomly selected
2.4 	adult recipients who renew their eligibility for medical
2.5 	assistance.  The commissioner shall apply all requirements of
2.6 	subdivision 1 to the selected recipients, with the timeline for
2.7 	compliance beginning with the date of renewal of eligibility
2.8 	rather than the date of initial enrollment.
2.9 		Subd. 3.Coordination. The commissioner shall coordinate
2.10 	the approval of tobacco use cessation programs with the
2.11 	commissioner of health, the Minnesota Partnership for Action
2.12 	Against Tobacco, and other public and private sector entities
2.13 	and partnerships, in order to ensure the availability of
2.14 	effective and affordable programs and minimize state medical
2.15 	assistance costs.  The commissioner shall only approve tobacco
2.16 	use cessation programs that participate in the medical
2.17 	assistance program or that offer services without charge to
2.18 	medical assistance recipients.
2.19 		Subd. 4.Federal approval; other law. The commissioner
2.20 	shall seek any federal waivers and law changes necessary to
2.21 	implement this section.  The commissioner shall implement this
2.22 	section notwithstanding any state law to the contrary.
2.23 	
EFFECTIVE DATE. This section is effective July 1, 2005,
2.24 	or upon receipt of any necessary federal approvals, whichever is
2.25 	later, and applies to initial applications and renewals
2.26 	submitted on or after that date.

2.27 	Sec. 2. Minnesota Statutes 2004, section 256D.03,
2.28 	subdivision 3, is amended to read:
2.29 		Subd. 3.General assistance medical care; eligibility.
 2.30 	(a) General assistance medical care may be paid for any person
2.31 	who is not eligible for medical assistance under chapter 256B,
2.32 	including eligibility for medical assistance based on a
2.33 	spenddown of excess income according to section 256B.056,
2.34 	subdivision 5, or MinnesotaCare as defined in paragraph (b),
2.35 	except as provided in paragraph (c), is in compliance with
2.36 	paragraph (m),and:
3.1 	(1) who is receiving assistance under section 256D.05,
3.2 	except for families with children who are eligible under
3.3 	Minnesota family investment program (MFIP), or who is having a
3.4 	payment made on the person's behalf under sections 256I.01 to
3.5 	256I.06; or
3.6 	(2) who is a resident of Minnesota; and
3.7 	(i) who has gross countable income not in excess of 75
3.8 	percent of the federal poverty guidelines for the family size,
3.9 	using a six-month budget period and whose equity in assets is
3.10 	not in excess of $1,000 per assistance unit.  Exempt assets, the
3.11 	reduction of excess assets, and the waiver of excess assets must
3.12 	conform to the medical assistance program in section 256B.056,
3.13 	subdivision 3, with the following exception:  the maximum amount
3.14 	of undistributed funds in a trust that could be distributed to
3.15 	or on behalf of the beneficiary by the trustee, assuming the
3.16 	full exercise of the trustee's discretion under the terms of the
3.17 	trust, must be applied toward the asset maximum; or
3.18 	(ii) who has gross countable income above 75 percent of the
3.19 	federal poverty guidelines but not in excess of 175 percent of
3.20 	the federal poverty guidelines for the family size, using a
3.21 	six-month budget period, whose equity in assets is not in excess
3.22 	of the limits in section 256B.056, subdivision 3c, and who
3.23 	applies during an inpatient hospitalization.
3.24 	(b) General assistance medical care may not be paid for
3.25 	applicants or recipients who meet all eligibility requirements
3.26 	of MinnesotaCare as defined in sections 256L.01 to 256L.16, and
3.27 	are adults with dependent children under 21 whose gross family
3.28 	income is equal to or less than 275 percent of the federal
3.29 	poverty guidelines.
3.30 	(c) For applications received on or after October 1, 2003,
3.31 	eligibility may begin no earlier than the date of application.
3.32 	For individuals eligible under paragraph (a), clause (2), item
3.33 	(i), a redetermination of eligibility must occur every 12
3.34 	months.  Individuals are eligible under paragraph (a), clause
3.35 	(2), item (ii), only during inpatient hospitalization but may
3.36 	reapply if there is a subsequent period of inpatient
4.1 	hospitalization.  Beginning January 1, 2000, Minnesota health
4.2 	care program applications completed by recipients and applicants
4.3 	who are persons described in paragraph (b), may be returned to
4.4 	the county agency to be forwarded to the Department of Human
4.5 	Services or sent directly to the Department of Human Services
4.6 	for enrollment in MinnesotaCare.  If all other eligibility
4.7 	requirements of this subdivision are met, eligibility for
4.8 	general assistance medical care shall be available in any month
4.9 	during which a MinnesotaCare eligibility determination and
4.10 	enrollment are pending.  Upon notification of eligibility for
4.11 	MinnesotaCare, notice of termination for eligibility for general
4.12 	assistance medical care shall be sent to an applicant or
4.13 	recipient.  If all other eligibility requirements of this
4.14 	subdivision are met, eligibility for general assistance medical
4.15 	care shall be available until enrollment in MinnesotaCare
4.16 	subject to the provisions of paragraph (e).
4.17 	(d) The date of an initial Minnesota health care program
4.18 	application necessary to begin a determination of eligibility
4.19 	shall be the date the applicant has provided a name, address,
4.20 	and Social Security number, signed and dated, to the county
4.21 	agency or the Department of Human Services.  If the applicant is
4.22 	unable to provide a name, address, Social Security number, and
4.23 	signature when health care is delivered due to a medical
4.24 	condition or disability, a health care provider may act on an
4.25 	applicant's behalf to establish the date of an initial Minnesota
4.26 	health care program application by providing the county agency
4.27 	or Department of Human Services with provider identification and
4.28 	a temporary unique identifier for the applicant.  The applicant
4.29 	must complete the remainder of the application and provide
4.30 	necessary verification before eligibility can be determined.
4.31 	The county agency must assist the applicant in obtaining
4.32 	verification if necessary.
4.33 	(e) County agencies are authorized to use all automated
4.34 	databases containing information regarding recipients' or
4.35 	applicants' income in order to determine eligibility for general
4.36 	assistance medical care or MinnesotaCare.  Such use shall be
5.1 	considered sufficient in order to determine eligibility and
5.2 	premium payments by the county agency.
5.3 	(f) General assistance medical care is not available for a
5.4 	person in a correctional facility unless the person is detained
5.5 	by law for less than one year in a county correctional or
5.6 	detention facility as a person accused or convicted of a crime,
5.7 	or admitted as an inpatient to a hospital on a criminal hold
5.8 	order, and the person is a recipient of general assistance
5.9 	medical care at the time the person is detained by law or
5.10 	admitted on a criminal hold order and as long as the person
5.11 	continues to meet other eligibility requirements of this
5.12 	subdivision.
5.13 	(g) General assistance medical care is not available for
5.14 	applicants or recipients who do not cooperate with the county
5.15 	agency to meet the requirements of medical assistance.
5.16 	(h) In determining the amount of assets of an individual
5.17 	eligible under paragraph (a), clause (2), item (i), there shall
5.18 	be included any asset or interest in an asset, including an
5.19 	asset excluded under paragraph (a), that was given away, sold,
5.20 	or disposed of for less than fair market value within the 60
5.21 	months preceding application for general assistance medical care
5.22 	or during the period of eligibility.  Any transfer described in
5.23 	this paragraph shall be presumed to have been for the purpose of
5.24 	establishing eligibility for general assistance medical care,
5.25 	unless the individual furnishes convincing evidence to establish
5.26 	that the transaction was exclusively for another purpose.  For
5.27 	purposes of this paragraph, the value of the asset or interest
5.28 	shall be the fair market value at the time it was given away,
5.29 	sold, or disposed of, less the amount of compensation received.
5.30 	For any uncompensated transfer, the number of months of
5.31 	ineligibility, including partial months, shall be calculated by
5.32 	dividing the uncompensated transfer amount by the average
5.33 	monthly per person payment made by the medical assistance
5.34 	program to skilled nursing facilities for the previous calendar
5.35 	year.  The individual shall remain ineligible until this fixed
5.36 	period has expired.  The period of ineligibility may exceed 30
6.1 	months, and a reapplication for benefits after 30 months from
6.2 	the date of the transfer shall not result in eligibility unless
6.3 	and until the period of ineligibility has expired.  The period
6.4 	of ineligibility begins in the month the transfer was reported
6.5 	to the county agency, or if the transfer was not reported, the
6.6 	month in which the county agency discovered the transfer,
6.7 	whichever comes first.  For applicants, the period of
6.8 	ineligibility begins on the date of the first approved
6.9 	application.
6.10 	(i) When determining eligibility for any state benefits
6.11 	under this subdivision, the income and resources of all
6.12 	noncitizens shall be deemed to include their sponsor's income
6.13 	and resources as defined in the Personal Responsibility and Work
6.14 	Opportunity Reconciliation Act of 1996, title IV, Public Law
6.15 	104-193, sections 421 and 422, and subsequently set out in
6.16 	federal rules.
6.17 	(j) Undocumented noncitizens and nonimmigrants are
6.18 	ineligible for general assistance medical care.  For purposes of
6.19 	this subdivision, a nonimmigrant is an individual in one or more
6.20 	of the classes listed in United States Code, title 8, section
6.21 	1101(a)(15), and an undocumented noncitizen is an individual who
6.22 	resides in the United States without the approval or
6.23 	acquiescence of the Immigration and Naturalization Service.
6.24 	(k) Notwithstanding any other provision of law, a
6.25 	noncitizen who is ineligible for medical assistance due to the
6.26 	deeming of a sponsor's income and resources, is ineligible for
6.27 	general assistance medical care.
6.28 	(l) Effective July 1, 2003, general assistance medical care
6.29 	emergency services end.
6.30 	(m) In order to be eligible for general assistance medical
6.31 	care, an adult recipient, within 30 days of initial enrollment,
6.32 	must sign a statement developed by the commissioner that states
6.33 	that the recipient:
6.34 	(1) does not use tobacco products; or 
6.35 	(2) is currently enrolled in a tobacco use cessation
6.36 	program approved by the commissioner, or agrees to enroll in and
7.1 	complete a tobacco use cessation program approved by the
7.2 	commissioner.
7.3 	If the recipient under clause (2) does not complete a tobacco
7.4 	use cessation program within six months of initial enrollment,
7.5 	the recipient is subject to twice the level of cost-sharing
7.6 	required under subdivision 4, paragraph (d), clauses (1) to (5),
7.7 	and a $40 per month maximum for prescription drug co-payments,
7.8 	until the recipient completes the program.  The commissioner
7.9 	shall apply the requirements of this paragraph to randomly
7.10 	selected adult recipients who renew their eligibility for
7.11 	general assistance medical care.  The commissioner shall apply
7.12 	all requirements of this paragraph to the selected recipients,
7.13 	with the timeline for compliance beginning with the date of
7.14 	renewal of eligibility rather than the date of initial
7.15 	enrollment.  The commissioner shall coordinate the approval of
7.16 	tobacco use cessation programs with the commissioner of health,
7.17 	the Minnesota Partnership for Action Against Tobacco, and other
7.18 	public and private sector entities and partnerships in order to
7.19 	ensure the availability of effective and affordable programs and
7.20 	minimize general assistance medical care costs.  The
7.21 	commissioner shall only approve tobacco use cessation programs
7.22 	that participate in the general assistance medical care program
7.23 	or that offer services without charge to general assistance
7.24 	medical care recipients.  Notwithstanding any state law to the
7.25 	contrary, the commissioner shall implement this paragraph.
7.26 	
EFFECTIVE DATE. This section is effective July 1, 2005,
7.27 	and applies to initial applications and renewals submitted on or
7.28 	after that date.

7.29 	Sec. 3. [256J.145] ELIGIBILITY; TOBACCO USE CESSATION.
7.30 		Subdivision 1.Requirement. In order to be eligible for
7.31 	MFIP, an adult recipient, within 30 days of initial enrollment,
7.32 	must sign a statement developed by the commissioner that states
7.33 	that the recipient:
7.34 	(1) does not use tobacco products; or 
7.35 	(2) is currently enrolled in a tobacco use cessation
7.36 	program approved by the commissioner or agrees to enroll in and
8.1 	complete a tobacco use cessation program that is approved by the
8.2 	commissioner.
8.3 	If the recipient under clause (2) does not complete a tobacco
8.4 	use cessation program within six months of initial enrollment,
8.5 	the commissioner shall reduce the recipient's MFIP grant amount
8.6 	by ten percent until the recipient completes the program.
8.7 		Subd. 2.Renewal of eligibility. The commissioner shall
8.8 	apply the requirements of subdivision 1 to randomly selected
8.9 	adult recipients who renew their eligibility for MFIP.  The
8.10 	commissioner shall apply all requirements of subdivision 1 to
8.11 	the selected recipients, with the timeline for compliance
8.12 	beginning with the date of renewal of eligibility rather than
8.13 	the date of initial enrollment.
8.14 		Subd. 3.Coordination. The commissioner shall coordinate
8.15 	the approval of tobacco use cessation programs with the
8.16 	commissioner of health, the Minnesota Partnership for Action
8.17 	Against Tobacco, and other public and private sector entities
8.18 	and partnerships in order to ensure the availability of
8.19 	effective and affordable programs and minimize state health care
8.20 	program costs.  The commissioner shall only approve tobacco use
8.21 	cessation programs that participate in the medical assistance
8.22 	program or that offer services without charge to MFIP enrollees.
8.23 		Subd. 4.Federal approval. The commissioner shall seek
8.24 	any federal waivers and law changes necessary to implement this
8.25 	section.
8.26 	
EFFECTIVE DATE. This section is effective July 1, 2005,
8.27 	or upon receipt of any necessary federal approvals, whichever is
8.28 	later, and applies to initial applications and renewals
8.29 	submitted on or after that date.

8.30 	Sec. 4. Minnesota Statutes 2004, section 256L.07, is
8.31 	amended by adding a subdivision to read:
8.32 		Subd. 5.Tobacco use cessation required for adult
8.33 	enrollees. (a) In order to be eligible for MinnesotaCare, an
8.34 	adult enrollee, within 30 days of initial enrollment, must sign
8.35 	a statement developed by the commissioner that states that the
8.36 	enrollee:
9.1 	(1) does not use tobacco products; or 
9.2 	(2) is currently enrolled in a tobacco use cessation
9.3 	program approved by the commissioner, or agrees to enroll in and
9.4 	complete a tobacco use cessation program that is approved by the
9.5 	commissioner.
9.6 	If the enrollee under clause (2) does not complete a tobacco use
9.7 	cessation program within six months of initial enrollment, the
9.8 	enrollee is subject to twice the level of cost-sharing required
9.9 	under section 256L.03, subdivision 5, paragraph (a), clauses (1)
9.10 	to (4), and double the out-of-pocket maximums for inpatient
9.11 	hospital services, or if applicable, twice the level of
9.12 	cost-sharing required under section 256L.035 and a $2,000
9.13 	out-of-pocket maximum for inpatient hospital services and a $40
9.14 	per month maximum for prescription drug co-payments until the
9.15 	enrollee completes the program.  For purposes of this higher
9.16 	cost-sharing requirement, the exemptions for parents, relative
9.17 	caretakers, and pregnant women under section 256L.03,
9.18 	subdivision 5, paragraphs (b) and (c), do not apply.
9.19 	(b) The commissioner shall apply the requirements of
9.20 	paragraph (a) to randomly selected adult enrollees who renew
9.21 	their eligibility for MinnesotaCare.  The commissioner shall
9.22 	apply all requirements of paragraph (a) to the selected
9.23 	enrollees with the timeline for compliance beginning with the
9.24 	date of renewal of eligibility rather than the date of initial
9.25 	enrollment.
9.26 	(c) The commissioner shall coordinate the approval of
9.27 	tobacco use cessation programs with the commissioner of health,
9.28 	the Minnesota Partnership for Action Against Tobacco, and other
9.29 	public and private sector entities and partnerships in order to
9.30 	ensure the availability of effective and affordable programs and
9.31 	minimize state MinnesotaCare costs.  The commissioner shall only
9.32 	approve tobacco use cessation programs that participate in the
9.33 	MinnesotaCare program or that offer services without charge to
9.34 	MinnesotaCare enrollees.
9.35 	(d) The commissioner shall seek any federal waivers and law
9.36 	changes necessary to implement this subdivision.
10.1 	Notwithstanding any state law to the contrary, the commissioner
10.2 	shall implement this subdivision for all enrollees for whom
10.3 	federal approval is not necessary.
10.4 	
EFFECTIVE DATE. This section is effective July 1, 2005,
10.5 	for all enrollees for whom federal approval is not necessary,
10.6 	and is effective July 1, 2005, or upon receipt of any necessary
10.7 	federal approvals, whichever is later, for all enrollees for
10.8 	whom federal approval is necessary, and applies to initial
10.9 	applications and renewals submitted on or after those dates.