Senate Bill No. 317
Introduced By eck, cobb, waterman, carey
A Bill for an Act entitled: "An Act providing for the expansion of medicaid services to certain low-income
children; requiring AUTHORIZING the department of public health and human services to EXPAND MEDICAID
ELIGIBILITY OR PURCHASE HEALTH INSURANCE IF THE FEDERAL GOVERNMENT OFFERS THE STATE
THE OPTION AND TO adopt rules providing for monthly fees to be paid by new CERTAIN medicaid recipients;
53-6-131, MCA; and providing an effective date."
Be it enacted by the Legislature of the State of Montana:
Section 1. Section 53-6-131, MCA, is amended to read:
"53-6-131. Eligibility requirements. (1) Medical assistance under the Montana medicaid program may be granted to a person who is determined by the department of public health and human services, in its discretion, to be eligible as follows:
(a) The person receives or is considered to be receiving supplemental security income benefits under Title XVI of the federal Social Security Act, 42 U.S.C. 1381, et seq., or aid to families with dependent children under Title IV of the federal Social Security Act, 42 U.S.C. 601, et seq.
(b) The person would be eligible for assistance under a program described in subsection (1)(a) if that person were to apply for that assistance.
(c) The person is in a medical facility that is a medicaid provider and, but for residence in the facility, the person would be receiving assistance under one of the programs in subsection (1)(a).
(d) The person is under 19 years of age and meets the conditions of eligibility in the state plan for aid to families with dependent children, other than with respect to school attendance.
(e) The person is under 21 years of age and in foster care under the supervision of the state or was in foster care under the supervision of the state and has been adopted as a hard-to-place child.
(f) The person meets the nonfinancial criteria of the categories in subsections (1)(a) through (1)(e) and:
(i) the person's income does not exceed the income level specified for federally aided categories of assistance and the person's resources are within the resource standards of the federal supplemental security income program; or
(ii) the person, while having income greater than the medically needy income level specified for federally aided categories of assistance:
(A) has an adjusted income level, after incurring medical expenses, that does not exceed the medically needy income level specified for federally aided categories of assistance or, alternatively, has paid in cash to the department the amount by which the person's income exceeds the medically needy income level specified for federally aided categories of assistance; and
(B) has resources that are within the resource standards of the federal supplemental security income program.
(g) The person is a qualified pregnant woman or child as defined in 42 U.S.C. 1396d(n).
(2) The department may establish income and resource limitations. Limitations of income and resources must be within the amounts permitted by federal law for the medicaid program.
(3) The Montana medicaid program shall pay, as required by federal law, the premiums necessary for medicaid-eligible persons participating in the medicare program and may, within the discretion of the department, pay all or a portion of the medicare premiums, deductibles, and coinsurance for a qualified medicare-eligible person or for a qualified disabled and working individual, as defined in section 6408(d)(2) of the federal Omnibus Budget Reconciliation Act of 1989, Public Law 101-239, who:
(a) has income that does not exceed income standards as may be required by the federal Social Security Act; and
(b) has resources that do not exceed standards that the department determines reasonable for purposes of the program.
(4) The department may pay a medicaid-eligible person's expenses for premiums, coinsurance, and similar costs for health insurance or other available health coverage, as provided in 42 U.S.C. 1396b(a)(1).
(5) If waivers of federal law are granted by the secretary of the U.S. department of health and human services, the department of public health and human services may grant eligibility for basic medicaid benefits as described in 53-6-101 to an individual receiving aid to families with dependent children as the specified caretaker relative of a dependent child under the FAIM project and to all adult recipients of medical assistance only who are covered under a group related to aid to families with dependent children. A recipient who is pregnant is entitled to full medicaid coverage as provided in 53-6-101.
(6) The department, under the Montana medicaid program, may provide, if a waiver is not available from the federal government, medicaid and other assistance mandated by Title XIX of the federal Social Security Act, 42 U.S.C. 1396, et seq., as may be amended, and not specifically listed in this part to categories of persons that may be designated by the act for receipt of assistance.
(7) (a) Notwithstanding any other provision of this chapter, medical assistance must be provided to:
(i) infants and pregnant women whose family income does not exceed
133% 185% 133% of the federal poverty threshold,
as provided in 42 U.S.C. 1396a(a)(10)(A)(ii)(IX) and 42 U.S.C. 1396a(l)(2)(A)(i), and whose family resources do not
exceed standards that the department determines reasonable for purposes of the program; and
(ii) subject to appropriations
, all children under 19 years of age, other than those referred to in subsection (7)(a)(i), whose
family income does not exceed 185% of the federal poverty threshold and whose family resources do not exceed standards
that the department determines reasonable for purposes of the program . AND ANY NECESSARY WAIVERS, ALL
CHILDREN WHO ARE 14 TO 18 YEARS OF AGE AND WHOSE FAMILY INCOME DOES NOT EXCEED 100% OF
THE FEDERAL POVERTY THRESHOLD.
The department shall establish by rule a range of monthly fees to be paid for medicaid benefits by medicaid recipients
designated in subsection (7)(a)(i) whose family income is between 133% and 185% of the federal poverty threshold and by
medicaid recipients designated in subsection (7)(a)(ii) if those monthly payments are allowed by federal waiver. IF THE
FEDERAL GOVERNMENT OFFERS THE STATE AN OPTION EITHER TO EXPAND MEDICAID ELIGIBILITY OR
TO BUY HEALTH INSURANCE, THE DEPARTMENT MAY BY RULE ESTABLISH ELIGIBILITY
REQUIREMENTS AND A RANGE OF MONTHLY FEES TO BE PAID. The rules adopted by the department must
provide for a sliding scale of payments to be made to the department by each recipient as required by this subsection and as
permitted by federal waiver based upon the number of medicaid recipients per family and the family's income. The
department shall work with local health departments to control the cost of benefits provided pursuant to subsections
(7)(a)(i) and (7)(a)(ii).
(8) Subject to appropriations, the department may cooperate with and make grants to a
nonprofit corporation that uses
donated funds to provide basic preventive and primary health care medical benefits to children whose families are ineligible
for the Montana medicaid program and who are ineligible for any other health care coverage, are under 19 years of age, and
are enrolled in school if of school age.
A Any person described in subsection (7)(a) must be provided continuous eligibility for medical assistance, as
authorized in 42 U.S.C. 1396a(e)(5) through a(e)(7).
(10) The department may establish resource and income standards of eligibility for mental health services that are more liberal than the resource and income standards of eligibility for physical health services. The standards for eligibility for mental health services may provide for eligibility for households with family income that does not exceed 200% of the federal poverty threshold or that does not exceed a lesser amount determined in the discretion of the department. The department may by rule specify under what circumstances deductions for medical expenses should be used to reduce countable family income in determining eligibility. The department may also adopt rules establishing fees to be charged recipients for services. The fees may vary according to family income."
NEW SECTION. Section 2. Contingent effectiveness. [Section 1] is only effective if funding for the expansion of medicaid as provided in that section is not appropriated by the 55th legislature.
NEW SECTION. Section 3. Effective date. Subject to [section 2], [this act] is effective July 1, 1997.