Print Friendly SENATE BILL NO. 1143 – Disabled workers, medicaid buy-in
SENATE BILL NO. 1143
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S1143.................................................by HEALTH AND WELFARE
MEDICAID - Adds to existing law to provide a Medicaid buy-in for workers
02/14 Senate intro - 1st rdg - to printing
02/15 Rpt prt - to Health/Wel
02/25 Rpt out - rec d/p - to 2nd rdg
02/28 2nd rdg - to 3rd rdg
03/02 3rd rdg - PASSED - 19-15-1
AYES -- Andreason, Broadsword, Bunderson, Burkett, Coiner, Compton,
Corder, Darrington, Gannon, Kelly, Keough, Langhorst, Malepeai,
Marley, McGee, Schroeder, Stegner, Stennett, Werk
NAYS -- Brandt, Burtenshaw, Cameron, Davis, Goedde, Hill, Jorgenson,
Little, Lodge, McKenzie, Noble, Pearce, Richardson, Sweet, Williams
Absent and excused -- Geddes
Floor Sponsors - Compton & Keough
Title apvd - to House
03/03 House intro - 1st rdg - to W/M
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-eighth Legislature First Regular Session - 2005
IN THE SENATE
SENATE BILL NO. 1143
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO MEDICAL ASSISTANCE; AMENDING CHAPTER 2, TITLE 56, IDAHO CODE, BY
3 THE ADDITION OF A NEW SECTION 56-209n, IDAHO CODE, TO PROVIDE A MEDICAID
4 BUY-IN FOR WORKERS WITH DISABILITIES, TO PROVIDE REQUIREMENTS, TO PROVIDE
5 ELIGIBILITY REQUIREMENTS AND TO PROVIDE FOR PREMIUMS.
6 Be It Enacted by the Legislature of the State of Idaho:
7 SECTION 1. That Chapter 2, Title 56, Idaho Code, be, and the same is
8 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
9 ignated as Section 56-209n, Idaho Code, and to read as follows:
10 56-209n. MEDICAID BUY-IN FOR WORKERS WITH DISABILITIES -- BASIC GROUP.
11 (1) An employed person with a disability is eligible for medicaid if he meets
12 the eligibility requirements of this section. He may be required to pay a pre-
13 mium for his medicaid coverage depending upon his income level. The partici-
14 pant has a disability if he meets the definition of blindness or disability
15 used by the social security administration for supplemental security income
16 benefits. The participant must meet the aid to aged, blind and disabled (AABD)
17 nonfinancial eligibility requirements as provided in rules of the department.
18 The participant shall also cooperate to secure medical support as provided in
19 rules of the department. The participant shall also meet the requirement to
20 enroll in a cost-effective employer group health plan as provided in rules of
21 the department. The participant shall be at least age sixteen (16) years and
22 less than age sixty-five (65) years.
23 (2) A participant shall be employed, including self-employed, and provide
24 written proof of employment. Hourly wage and work hours are not used to
25 determine employment. This definition of employment shall apply to the basic
26 coverage group only. Income of the participant and the participant's spouse,
27 after exclusions and disregards, must not exceed two hundred fifty percent
28 (250%) of the official poverty guideline published by the federal office of
29 management and budget for the participant's family size if the participant is
30 not to pay a premium, and must not exceed five hundred percent (500%) of the
31 official poverty guideline published by the federal office of management and
32 budget for the participant's family size if the participant is to be eligible
33 for the program. The participant's family includes the participant, his spouse
34 and any minor or dependent child, dependent parent or dependent sibling of
35 either spouse. A dependent shall be any individual who is or who could be
36 claimed as a dependent of the participant or spouse on the federal income tax
37 return of either spouse.
38 (3) The participant must continue to have a severe medical impairment as
39 determined by the social security administration. If a participant has a medi-
40 cal improvement, he shall be ineligible for the program provided in this sec-
41 tion. A participant has a medical improvement if the social security adminis-
42 tration finds, at the time of a regularly scheduled continuing disability
43 review, that he has a medical improvement and does not meet the disability
1 requirement for supplemental security income benefits or social security dis-
3 (4) A participant with gross earned income less than two hundred fifty
4 percent (250%) of the official poverty guideline provided in subsection (2) of
5 this section before the earned income disregards are subtracted, shall not pay
6 a premium for his medicaid benefits. A participant with gross earned income
7 equal to or more than two hundred fifty percent (250%) of the official poverty
8 guideline enumerated in subsection (2) of this section shall pay a monthly
9 premium as a condition of eligibility for medicaid.
10 (5) The monthly premium shall be calculated by multiplying seven and one-
11 half percent (7.5%) by the amount of the eligible participant's income above
12 two hundred fifty percent (250%) of the federal poverty guideline.
13 (6) The premium for the initial six (6) months shall be calculated based
14 on the projected average gross earned income and nonexcluded unearned income
15 for the initial month and the following five (5) months. All premiums col-
16 lected shall be placed in the state medical assistance fund.
STATEMENT OF PURPOSE
This legislation would create a Medicaid Buy-In program for Idahoans with disabilities who are working. Medicaid Buy-
In is a program that helps transition people to work by permitting them to "buy into" Medicaid while working. For
people currently on Medicaid, there is no incentive to work more than part-time since if they earn even one dollar too
much, they lose their Medicaid coverage. That coverage pays for the supports and services that people with disabilities
need to go to work. With Medicaid Buy-In, when the eligible person goes to work, they pay a premium, based on a
sliding scale, which enables them to retain their coverage. The program encourages self-sufficiency and independence
instead of trapping people in dependence and poverty.
Many people on Medicaid want to work and recognize that employment is the way to end dependence. But because of
the cost of their support needs and the fact that most employers provide no insurance coverage for those supports, they
must curtail their work hours to keep their Medicaid card. Medicaid Buy-In helps them gradually leave or lessen their
reliance on Medicaid while increasing their work hours and income. The program enables people with disabilities to be
contributing, tax-paying citizens.
Eligible individuals would be those individuals between the ages of 16 and 64 who meet the SSI definition of disability
and who are working and earning up to 250% of the Federal Poverty Guidelines or FPG (for FY 2004 $23,275/year) or
who have unearned income up to 2 times the SSI limit ($552 x 2 = $ 1,104/month), and whose work expenses related to
the disability are not paid for by private insurance, Medicaid or Medicare. Once a person is determined eligible, s/he
will be required to pay a premium based on a sliding scale that is based on the person's gross earned income.
A great deal of planning and thought has gone into the design of a Medicaid Buy-In program for Idaho.
In 1996, Governor Batt's Medicaid Reform Advisory Council recommended that the Department of Health and Welfare
request a federal waiver to establish a Medicaid buy-in program with a sliding fee scale for Idahoans with disabilities that
would allow recipients who return to the work force to keep their Medicaid intact until they were able to obtain insurance
that provides the necessary coverage.
In 1999, the federal Ticket to Work and Work Incentives Improvement Act was passed allowing states the option of
offering a Medicaid Buy-In program to working individuals who would be Medicaid eligible if it were not for their
increased income. As a result, 27 states started offering this program.
In 2001, the legislature directed the Department of Health and Welfare to collaborate with stakeholders to develop this
program that would transition people back into the work force while receiving needed health care coverage on a sliding
scale. Idaho received a $2.1 million grant to analyze and design an Idaho Medicaid Buy-In initiative. Although the design
was completed, legislative approval was not sought because the downturn in the economy made it difficult to find the
needed state match.
In 2003, Governor Kempthorne's Blue Ribbon, 2020 Task Force recommended that the state implement a Medicaid Buy-
In Program so that individuals with disabilities could continue to receive Medicaid benefits and share in the cost of those
benefits after obtaining employment.
The Department of Health and Welfare has estimated that the 2006 general fund impact would be $430,308.
For information, contact:
Idaho State Independent Living Council
Phone: 208-334-3800 S 1143