Bill Title: To require the Director of Job and Family Services to seek federal approval to create a premium assistance component of the Medicaid program.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2011-01-11 - To Health & Aging
[HB13 Detail]Download: Ohio-2011-HB13-Introduced.html
As Introduced
| 129th General Assembly | | Regular Session | | 2011-2012 |
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A BILL
| To enact section 5111.862 of the Revised Code to | 1 |
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require the Director of Job and Family Services to | 2 |
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seek federal approval to create a premium | 3 |
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assistance component of the Medicaid program. | 4 |
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
| Section 1. That section 5111.862 of the Revised Code be | 5 |
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enacted to read as follows: | 6 |
| Sec. 5111.862. (A) As used in this section: | 7 |
| "Assistance group" means a group of individuals treated as a | 8 |
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unit for purposes of determining eligibility for, and | 9 |
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participation in, the premium assistance component of the medicaid | 10 |
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program. | 11 |
| "Health benefit plan" has the same meaning as in section | 12 |
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3924.01 of the Revised Code. | 13 |
| "Plan of health coverage" has the same meaning as in section | 14 |
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3923.282 of the Revised Code. | 15 |
| "Federal poverty line" means the official poverty line as | 16 |
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established at least annually by the United States office of | 17 |
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management and budget pursuant to section 673(2) of the "Community | 18 |
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Services Block Grant Act," 95 Stat. 511 (1981), 42 U.S.C. 9902(2), | 19 |
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as amended. | 20 |
| (B) The director of job and family services shall submit to | 21 |
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the United States secretary of health and human services a request | 22 |
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for a medicaid waiver to create a premium assistance component of | 23 |
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the medicaid program. If the United States secretary grants the | 24 |
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waiver, the director shall establish the premium assistance | 25 |
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component in accordance with this section and the terms of the | 26 |
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waiver. | 27 |
| (C)(1) For an assistance group to qualify for the premium | 28 |
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assistance component, all of the following must apply: | 29 |
| (a) The assistance group must have countable income not | 30 |
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exceeding three hundred per cent of the federal poverty line. | 31 |
| (b) Each member of the assistance group, while participating | 32 |
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in the premium assistance component, must be enrolled in a health | 33 |
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benefit plan or plan of health coverage. | 34 |
| (c) If the health benefit plan or plan of health coverage in | 35 |
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which the assistance group is enrolled is sponsored by an employer | 36 |
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of a member of the assistance group, the employer must contribute | 37 |
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not less than fifty per cent of any premium charged for the | 38 |
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assistance group's enrollment. | 39 |
| (d) The assistance group must meet all other eligibility | 40 |
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requirements for the premium assistance component established in | 41 |
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rules adopted under section 5111.85 of the Revised Code. | 42 |
| (2) No assistance group shall be denied eligibility for the | 43 |
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premium assistance component due to either of the following: | 44 |
| (a) The amount of the assistance group's resources; | 45 |
| (b) That no member of the assistance group qualifies for any | 46 |
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other component of the medicaid program. | 47 |
| (D) The premium assistance component shall subsidize the | 48 |
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premium for enrollment in a health benefit plan or plan of health | 49 |
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coverage charged an assistance group participating in the | 50 |
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component. The subsidy shall range from twenty to eighty per cent | 51 |
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of the premium as determined using a sliding scale established in | 52 |
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rules adopted under section 5111.85 of the Revised Code. The | 53 |
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sliding scale shall be based on an assistance group's countable | 54 |
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income and the number of members of the assistance group. The | 55 |
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subsidy shall not cover any portion of the premium for which an | 56 |
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employer of a member of the assistance group is responsible. The | 57 |
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premium assistance component shall not pay the costs of any | 58 |
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deductibles, copayments, or other cost-sharing expenses, other | 59 |
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than the premium, for which the assistance group is responsible | 60 |
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under the health benefit plan or plan of health coverage. | 61 |
| (E) No member of an assistance group may participate in the | 62 |
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premium assistance component and another component of the medicaid | 63 |
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program contemporaneously. A member of an assistance group who | 64 |
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meets the eligibility requirements for the premium assistance | 65 |
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component and one or more other components of the medicaid program | 66 |
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shall choose whether to participate in the premium assistance | 67 |
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component or the other component or components for which the | 68 |
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member is eligible. The medicaid program shall not pay for the | 69 |
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costs of any medical assistance, other than the premium subsidy, | 70 |
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provided to a member of an assistance group participating in the | 71 |
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premium assistance component, including medical assistance that is | 72 |
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not covered by the health benefit plan or plan of coverage in | 73 |
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which the member is enrolled but is covered by another component | 74 |
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of the medicaid program in which the member could participate if | 75 |
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not for the member's participation in the premium assistance | 76 |
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component. | 77 |
