CSSB 366(FIN) AM(EFD FLD): "An Act relating to medical support and health insurance coverage for children; allowing a member of the teachers' retirement system or the public employees' retirement system to assign to a Medicaid-qualifying trust the member's right to receive a monetary benefit from the system; relating to the effect of a Medicaid-qualifying trust on the eligibility of a person for Medicaid; relating to the recovery of certain Medicaid payments from estates and trusts; requiring persons who receive Medicaid services to be liable for sharing in the cost of those services to the extent allowed under federal law and regulations."
00CS FOR SENATE BILL NO. 366(FIN) am(efd fld) 01 "An Act relating to medical support and health insurance coverage for children; 02 allowing a member of the teachers' retirement system or the public employees' 03 retirement system to assign to a Medicaid-qualifying trust the member's right to 04 receive a monetary benefit from the system; relating to the effect of a Medicaid-qualifying trust on 05 the eligibility of a person for Medicaid; relating to the 06 recovery of certain Medicaid payments from estates and trusts; requiring persons 07 who receive Medicaid services to be liable for sharing in the cost of those 08 services to the extent allowed under federal law and regulations." 09 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 10 * Section 1. PURPOSES. The purposes of this Act are to 11 (1) bring the state into compliance with federal law with respect to the recovery of 12 Medicaid payments from the estates and trusts of individuals under certain circumstances and 13 with respect to the establishment of medical support orders for children; 14 (2) allow diversion of certain employee pension payments into Medicaid-qualifying
01 trusts if the trusts provide that Medicaid payments made on behalf of the individual may be 02 recovered from the trust after the individual's death. 03 * Sec. 2. AS 14.25.200(a) is amended to read: 04 (a) Except as provided in AS 29.45.030(a)(1), member contributions and other 05 amounts held in the system on behalf of a member or other person who is or may 06 become eligible for benefits under the system are exempt from Alaska state and 07 municipal taxes and are not subject to anticipation, alienation, sale, transfer, 08 assignment, pledge, encumbrance, or charge of any kind, either voluntary or 09 involuntary, before they are received by the person entitled to the amount under the 10 terms of the system, and any attempt to anticipate, alienate, sell, transfer, assign, 11 pledge, encumber, charge, or otherwise dispose of any right to amounts accrued in the 12 system is void. However, a member's right to receive benefits may be assigned 13 (1) under a qualified domestic relations order; or 14 (2) to a trust or similar legal device that meets the requirements for 15 a Medicaid-qualifying trust under AS 47.07.020(f) and 42 U.S.C. 1396p(d)(4). 16 * Sec. 3. AS 21.36 is amended by adding a new section to read: 17 Sec. 21.36.095. COVERAGE OF CHILDREN. (a) An insurer may not deny 18 enrollment of a child under the health care insurance of the child's parent on the 19 ground that the child 20 (1) was born out of wedlock; 21 (2) is not claimed as a dependent on the parent's federal income tax 22 return; 23 (3) does not reside with the parent; or 24 (4) does not reside in the insurer's service area. 25 (b) If a parent is required under AS 25.27.020(a)(9) or 25.27.060(c) to provide 26 medical support for a child and the parent is eligible for family health coverage 27 through an insurer, the parent's insurer 28 (1) shall allow the parent to enroll the child under the family coverage 29 without regard to restrictions relating to enrollment periods if the child is otherwise 30 eligible; 31 (2) shall, if the parent fails to apply for enrollment of a child under (1)
01 of this subsection, enroll the child under the parent's family coverage upon application 02 by the child's other parent or custodian, the child support enforcement agency, or the 03 Department of Health and Social Services; and 04 (3) may not disenroll or eliminate coverage of the child unless the 05 insurer has received written evidence that 06 (A) the parent with the insurance coverage is no longer required 07 by court order or administrative order to provide the child's medical support; 08 or 09 (B) the child is or will be enrolled in comparable health 10 coverage through another insurer that will take effect not later than the 11 effective date of the disenrollment or elimination of coverage. 12 (c) An insurer who provides health coverage of a child through family health 13 coverage of a parent who does not have sole physical custody of the child shall 14 (1) provide to the child's other parent or custodian the information that 15 may be necessary for the child to obtain benefits through the family health coverage; 16 (2) allow the child's other parent or custodian, or the child's health care 17 provider with the parent's or custodian's approval, to submit claims for covered 18 services without the approval of the parent whose insurance covers the child; and 19 (3) make payment on claims submitted under (2) of this subsection 20 directly to the child's other parent or custodian, the health care provider, or a state 21 agency to which the child's medical support rights have been assigned under 22 AS 25.27.120 or AS 47.07.025. 23 (d) If an individual is covered for health benefits from an insurer, the insurer 24 may not impose requirements on a state agency to which the rights of the individual 25 under AS 25.27.120 or AS 47.07.025 have been assigned that are different from 26 requirements applicable to an agent or assignee of other individuals covered by the 27 insurer. 28 (e) In this section, "insurer" includes 29 (1) an insurer, as defined in AS 21.90.900; 30 (2) a group health plan, as defined in 29 U.S.C. 1167(l) (Employee 31 Retirement Income Security Act of 1974);
01 (3) a health maintenance organization, as defined in AS 21.86.900; 02 (4) hospital service corporation or medical service corporation, as 03 defined in AS 21.87.330; 04 (5) a writing carrier, as defined in AS 21.55.500; and 05 (6) an entity offering a service benefit plan, as referred to in 42 U.S.C. 06 1396g. 07 * Sec. 4. AS 25.27.020(a) is amended to read: 08 (a) The agency shall 09 (1) seek enforcement of child support orders of the superior courts of 10 the state in other jurisdictions and shall obtain, enforce, and administer the orders in 11 this state; 12 (2) adopt regulations to carry out the purposes of this chapter, including 13 regulations that establish 14 (A) schedules for determining the amount an obligor is liable 15 to contribute toward the support of an obligee under this chapter and under 42 16 U.S.C. 651 - 669 (Title IV-D, Social Security Act); 17 (B) procedures for hearings conducted under AS 25.27.170; and 18 (C) subject to AS 25.27.025 and to federal law, a uniform rate 19 of interest on arrearages of support that shall be charged the obligor upon 20 notice if child support payments are 10 or more days overdue or if payment is 21 made by a check backed by insufficient funds; however, an obligor may not be 22 charged interest on late payment of a child support obligation, other than a 23 payment on arrearages, if the obligor is 24 (i) employed and income is being withheld from the 25 obligor's wages under an income withholding order; 26 (ii) receiving unemployment compensation and child 27 support obligations are being withheld from the obligor's unemployment 28 payments under AS 23.20.401; or 29 (iii) receiving compensation for disabilities under 30 AS 23.30 and child support obligations are being withheld from the 31 obligor's compensation payments;
01 (3) administer and enforce AS 25.25 (Uniform Reciprocal Enforcement 02 of Support Act); 03 (4) establish, enforce, and administer child support obligations 04 administratively under this chapter; 05 (5) administer the state plan required under 42 U.S.C. 651 - 669 (Title 06 IV-D, Social Security Act) as amended; 07 (6) disburse support payments collected by the agency to the obligee, 08 together with interest charged under (2)(C) of this subsection; 09 (7) establish and enforce administratively under this chapter, or through 10 the superior courts of the state, child support orders from other jurisdictions pertaining 11 to obligors within the state; 12 (8) enforce and administer spousal support orders if a spousal support 13 obligation has been established with respect to the spouse and if the support obligation 14 established with respect to the child of that spouse is also being administered; [AND] 15 (9) obtain a medical support order as part of a child support order if 16 health care coverage is available to the obligor at a reasonable cost; the medical 17 support order must meet the requirements of AS 25.27.063; and 18 (10) act on behalf of the Department of Health and Social Services 19 in the enforcement of AS 47.07.025(b). 20 * Sec. 5. AS 25.27.060(c) is amended to read: 21 (c) In a court proceeding where the support of a minor child is at issue, the 22 court may order either or both parents to pay the amount necessary for support, 23 maintenance, nurture, and education of the child. The court shall issue a medical 24 support order as part of a child support order if health care coverage is available to the 25 obligor at a reasonable cost. The medical support order must meet the 26 requirements of AS 25.27.063. Upon a showing of good cause the court may order 27 the parents required to pay support to give reasonable security for payments. 28 * Sec. 6. AS 25.27.062(i) is amended to read: 29 (i) An employer shall, to the extent permitted under 15 U.S.C. 1673(b), 30 withhold the current support obligation from an obligor's wages, including the 31 obligor's share, if any, of the premium for health coverage required to be
01 withheld under AS 25.27.063(c)(4). An employer shall withhold additional income, 02 to the extent permitted under 15 U.S.C. 1673(b), from an obligor's wages for any 03 support arrearage. 04 * Sec. 7. AS 25.27 is amended by adding a new section to read: 05 Sec. 25.27.063. MEDICAL SUPPORT ORDER. (a) A medical support order 06 issued under AS 25.27.020(a)(9) or 25.27.060(c) must require that the obligor provide 07 health care coverage for the child to whom the duty of support is owed. 08 (b) If an obligor who is required to provide health care coverage under a 09 medical support order is eligible for family health coverage through an employer doing 10 business in the state, the court or agency issuing the medical support order shall send 11 a copy of the medical support order to the employer. 12 (c) An employer who receives a copy of a medical support order under (b) of 13 this section 14 (1) shall allow the employee named in the order to enroll the child 15 under the family coverage without regard to restrictions relating to enrollment periods 16 if the child is otherwise eligible and is not already enrolled under the family coverage; 17 (2) shall, if the employee fails to apply for enrollment of a child under 18 (1) of this subsection, enroll the child under the employee's family coverage upon 19 application by the child's other parent or custodian, the child support enforcement 20 agency, or the Department of Health and Social Services; 21 (3) may not disenroll or eliminate coverage of the child while the 22 employee is still employed by the employer unless the employer has eliminated family 23 health coverage for all of its employees or has received written evidence that 24 (A) the employee is no longer required by court order or 25 administrative order to provide the child's insurance coverage; or 26 (B) the child is or will be enrolled in comparable health 27 coverage through another insurer that will take effect not later than the 28 effective date of the disenrollment or elimination of coverage; and 29 (4) shall withhold from the employee's compensation the employee's 30 share, if any, of premiums for health coverage to the extent permitted under 15 U.S.C. 31 1673(b) (Consumer Credit Protection Act) and pay the withheld amount to the
01 appropriate insurer; if federal regulations allow the employer to withhold less than the 02 employee's share of the insurance premium, the employer may withhold the lesser 03 amount and pay it to the appropriate insurer. 04 * Sec. 8. AS 25.27.065(b) is amended to read: 05 (b) When the right to receive child support has been assigned to a 06 governmental entity, an agreement under (a) of this section that has not been adopted 07 as an administrative order of the agency is not effective during a period when the 08 obligee is receiving [PUBLIC] assistance under AS 47.07 or AS 47.25.310 - 09 47.25.420. 10 * Sec. 9. AS 25.27.120(a) is amended to read: 11 (a) An obligor is liable to the state in the amount of assistance granted under 12 AS 47.07 and AS 47.25.310 - 47.25.420 to a child to whom the obligor owes a duty 13 of support except that, if a support order has been entered, the liability of the obligor 14 for assistance granted under AS 47.25.310 - 47.25.420 may not exceed the amount 15 of support provided for in the support order, and, if a medical order of support has 16 been entered, the liability of the obligor for assistance granted under AS 47.07 17 may not exceed the amount of support provided for in the medical order of 18 support. 19 * Sec. 10. AS 25.27.120(d) is amended to read: 20 (d) If the agency fails to comply with (c) of this section, interest does not 21 accrue on the liability to the state unless a support order or medical support order, 22 as applicable, has been entered. 23 * Sec. 11. AS 25.27.130(b) is amended to read: 24 (b) To establish or enforce an order of support, including, if applicable, a 25 medical support order, based on the subrogation of the state, the agency is not 26 limited to the amount of assistance being granted to the child. 27 * Sec. 12. AS 25.27.130(c) is amended to read: 28 (c) The recovery of any amount for which the obligor is liable that exceeds the 29 total assistance granted under AS 47.07 and AS 47.25.310 - 47.25.420 shall be paid 30 to the obligee. 31 * Sec. 13. AS 25.27.130(d) is amended to read:
01 (d) Except as provided in (f) of this section, if the obligee is not receiving 02 assistance under AS 47.07 or AS 47.25.310 - 47.25.420 at the time the state recovers 03 money in an action under this section, the recovery of any amount for which the 04 obligor is liable shall be distributed to the obligee for support payments, including 05 medical support payments, that have become due and unpaid since the termination 06 of assistance under AS 47.07 or AS 47.25.310 - 47.25.420 under a support order in 07 favor of the obligee. 08 * Sec. 14. AS 25.27.130(e) is amended to read: 09 (e) After payment to the obligee under (d) of this section, the state may retain 10 an amount not to exceed the total unreimbursed assistance paid on behalf of the 11 obligee under AS 47.07 or AS 47.25.310 - 47.25.420. 12 * Sec. 15. AS 25.27.130(f) is amended to read: 13 (f) Notwithstanding (d) of this section, the state shall, if required under federal 14 law or regulations, distribute amounts recovered through offset of the obligor's federal 15 tax refund as past due support with first distribution to the state for unpaid support 16 assigned to the state under AS 47.07.025 and AS 47.25.345. 17 * Sec. 16. AS 39.35.500 is amended to read: 18 Sec. 39.35.500. SAFEGUARD OF EMPLOYEE FUNDS HELD BY THE 19 SYSTEM. Except as provided in AS 29.45.030(a)(1), employee contributions and 20 other amounts held in the system are exempt from Alaska state and local taxes. 21 Amounts held on behalf of, or payable to, any employee or other person who is or 22 may become eligible for benefits under the system are not subject to anticipation, 23 alienation, sale, transfer, assignment, pledge, encumbrance, or charge of any kind, 24 either voluntary or involuntary, before being received by the person entitled to the 25 amount under the terms of the system. An attempt to anticipate, alienate, sell, transfer, 26 assign, pledge, encumber, charge, or otherwise dispose of a right to amounts held 27 under the system is void. However, an employee's right to receive benefits may be 28 assigned 29 (1) under a qualified domestic relations order; or 30 (2) to a trust or similar legal device that meets the requirements for 31 a Medicaid-qualifying trust under AS 47.07.020(f) and 42 U.S.C. 1396p(d)(4).
01 * Sec. 17. AS 47.07.020 is amended by adding new subsections to read: 02 (f) A person may not be denied eligibility for medical assistance under this 03 chapter on the basis of a diversion of income, whether by assignment or after receipt 04 of the income, into a Medicaid-qualifying trust that, according to a determination made 05 by the department, 06 (1) has provisions that require that the state will receive all of the trust 07 assets remaining at the death of the individual, subject to a maximum amount that 08 equals the total medical assistance paid on behalf of the individual; and 09 (2) otherwise meets the requirements of 42 U.S.C. 1396p(d)(4). 10 (g) A person's eligibility for medical assistance under this chapter may not be 11 denied or delayed on the basis of a transfer of assets for less than fair market value 12 if the person establishes to the satisfaction of the department that the denial or delay 13 would work an undue hardship on the person as determined on the basis of criteria in 14 applicable federal regulations. 15 * Sec. 18. AS 47.07 is amended by adding a new section to read: 16 Sec. 47.07.025. ASSIGNMENT OF MEDICAL SUPPORT RIGHTS. (a) An 17 applicant for or recipient of assistance under this chapter is considered to have 18 assigned to the state, through the department and the child support enforcement 19 agency, all rights to accrued and continuing medical support that the applicant and 20 other persons for whom assistance is sought may have from all sources. The 21 assignment takes effect upon a determination that the applicant is eligible for assistance 22 under this chapter. Except with respect to the amount of any unpaid medical support 23 obligation accrued under the assignment, the assignment under this section terminates 24 when the applicant ceases to receive assistance under this chapter. 25 (b) Through the child support enforcement agency or on its own behalf, the 26 department may garnish the wages, salary, or other employment income of a person 27 who 28 (1) is required by a medical support order under AS 25.27.063 to 29 provide coverage of the costs of medical care to a child who is eligible for medical 30 assistance under this chapter; 31 (2) has received payment from a third party for the costs of the
01 services; and 02 (3) has not used the payments to reimburse, as appropriate, the other 03 parent or custodian of the child, the provider of the services, or the department. 04 (c) Garnishment under (b) of this section is limited to the amount necessary 05 to reimburse the department for expenditures for the child under this chapter. Claims 06 for current support or support arrearages take priority over claims under this section. 07 * Sec. 19. AS 47.07.030 is amended by adding a new subsection to read: 08 (d) The department may use a case management system under which certain 09 eligible individuals are required to seek approval from the case manager before 10 receiving some services under this chapter and under which certain services may be 11 denied eligibility under this chapter if the case manager does not approve provision of 12 the service. A case manager may approve coverage of an optional service listed in 13 AS 47.07.035, notwithstanding that coverage of that service may have been eliminated 14 under AS 47.07.035. 15 * Sec. 20. AS 47.07 is amended by adding a new section to read: 16 Sec. 47.07.042. RECIPIENT COST-SHARING. (a) Except as provided in (b) 17 of this section, the state plan developed under AS 47.07.040 shall impose deductible, 18 coinsurance, and copayment requirements or similar charges on persons eligible for 19 assistance under this chapter to the maximum extent allowed under federal law and 20 regulations. The plan must provide that health care providers shall collect the 21 allowable charge. The department shall reduce payments to each provider by the 22 amount of the allowable charge. A provider may not deny services because a recipient 23 is unable to share costs, but an inability to share costs imposed under this section does 24 not relieve the recipient of liability for the costs. 25 (b) The state plan developed under AS 47.07.040 shall impose a copayment 26 requirement for inpatient hospital services in an amount that is the lesser of 27 (1) $50 a day, up to a maximum of $200 per discharge; or 28 (2) the maximum allowed under federal law and regulations. 29 (c) The department shall seek waivers from the federal government to allow 30 the department to impose copayments that are higher than those set out in federal 31 regulations at 42 C.F.R. Chapter IV.
01 * Sec. 21. AS 47.07 is amended by adding a new section to read: 02 Sec. 47.07.055. RECOVERY OF MEDICAL ASSISTANCE FROM 03 ESTATES. (a) The estate of an individual who received medical assistance payments 04 is subject to a claim for recovery of the medical assistance after the individual's death 05 that, except as provided in (b) of this section, may be secured by a lien filed against 06 the individual's real property during the individual's lifetime if the 07 (1) individual was an inpatient in a nursing facility, intermediate care 08 facility for the mentally retarded, or other medical institution; 09 (2) department required the individual, as a condition of receiving 10 medical assistance under this chapter, to spend for medical expenses all but a minimal 11 amount of that individual's income; and 12 (3) department determined during the individual's lifetime, after notice 13 and opportunity for hearing, that the individual could not reasonably be expected to 14 be discharged from the institution and to return home. 15 (b) A lien may not be filed under (a) of this section against an individual's 16 home if the home is lawfully occupied by the individual's 17 (1) spouse; 18 (2) child under age 21; 19 (3) blind or disabled child as described in AS 47.25.615(3) or (5) or 20 42 U.S.C. 1382(c); or 21 (4) sibling, if the sibling has an equity interest in the home and was 22 residing in the home for at least one year before the date of the individual's admission 23 to the institution. 24 (c) The state may not recover the costs of medical assistance under a lien on 25 a home under (a) of this section until after the death of the individual's surviving 26 spouse, if any, and only at a time when neither of the following is lawfully residing 27 in the home: 28 (1) a sibling of the individual who was residing in the individual's 29 home for a period of at least one year immediately preceding the date of the 30 individual's institutionalization and who has continuously resided in the home since 31 the institutionalization began; or
01 (2) a son or daughter of the individual who 02 (A) resided in the home for at least two years immediately 03 preceding the date of the individual's institutionalization; 04 (B) has continuously resided in the home since the 05 institutionalization began; and 06 (C) establishes to the department's satisfaction that the son or 07 daughter provided care to the individual that allowed the individual to reside 08 in the home rather than in an institution. 09 (d) A lien and claim authorized under (a) of this section are extinguished if, 10 during the individual's lifetime, the individual is discharged from the institution and 11 returns home. However, a new lien and claim are authorized for subsequent expenses 12 if the circumstances described in (a) of this section occur after the individual returns 13 home. 14 (e) In addition to recovery of medical assistance upon sale of property subject 15 to a lien authorized under (a) - (d) of this section, after an individual's death, the 16 individual's estate is subject to a claim for reimbursement for medical assistance 17 payments made on behalf of the individual under this chapter for the following 18 services to the extent that those services were provided when the individual was 55 19 years of age or older: 20 (1) services received while an inpatient in a nursing facility, 21 intermediate care facility for the mentally retarded, or other medical institutions; and 22 (2) home and community-based services provided through a waiver 23 received from the federal government that allows home and community-based services 24 to be covered under this chapter for persons who are eligible for coverage under this 25 chapter while in an institution but who are able to avoid institutionalization because 26 of the provision of home and community-based services. 27 (f) Other than a recovery upon sale of a home, a claim under this section may 28 be made only after the death of the individual's surviving spouse, if any, and only at 29 a time when the individual has no surviving child under age 21 and no surviving child 30 who is blind or totally and permanently disabled. 31 (g) For purposes of AS 13.16.470, the claims authorized under this section are
01 debts with preference under the laws of the state. 02 * Sec. 22. APPLICABILITY. The charges provided for under AS 47.07.042, added by 03 sec. 20 of this Act, apply to services performed on or after July 1, 1994.