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SB 87: "An Act expanding medical assistance coverage for eligible children and pregnant women; relating to cost sharing for certain recipients of medical assistance; and providing for an effective date."

00                             SENATE BILL NO. 87                                                                          
01 "An Act expanding medical assistance coverage for eligible children and pregnant                                        
02 women; relating to cost sharing for certain recipients of medical assistance; and                                       
03 providing for an effective date."                                                                                       
04 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                                
05    * Section 1. The uncodified law of the State of Alaska is amended by adding a new section                          
06 to read:                                                                                                                
07       SHORT TITLE. This Act may be known as the No Child Left Uninsured Act.                                            
08    * Sec. 2. AS 47.07.020(b) is amended to read:                                                                      
09            (b)  In addition to the persons specified in (a) of this section, the following                              
10       optional groups of persons for whom the state may claim federal financial                                         
11       participation are eligible for medical assistance:                                                                
12                 (1)  persons eligible for but not receiving assistance under any plan of                                
13       the state approved under 42 U.S.C. 1381 - 1383c (Title XVI, Social Security Act,                                  
14       Supplemental Security Income) or a federal program designated as the successor to the                             
01       aid to families with dependent children program;                                                                  
02                 (2)  persons in a general hospital, skilled nursing facility, or                                        
03       intermediate care facility, who, if they left the facility, would be eligible for assistance                      
04       under one of the federal programs specified in (1) of this subsection;                                            
05                 (3)  persons under 21 years of age who are under supervision of the                                     
06       department, for whom maintenance is being paid in whole or in part from public                                    
07       funds, and who are in foster homes or private child-care institutions;                                            
08                 (4)  aged, blind, or disabled persons, who, because they do not meet                                    
09       income and resources requirements, do not receive supplemental security income                                    
10       under 42 U.S.C. 1381 - 1383c (Title XVI, Social Security Act), and who do not                                     
11       receive a mandatory state supplement, but who are eligible, or would be eligible if                               
12       they were not in a skilled nursing facility or intermediate care facility to receive an                           
13       optional state supplementary payment;                                                                             
14                 (5)  persons under 21 years of age who are in an institution designated                                 
15       as an intermediate care facility for the mentally retarded and who are financially                                
16       eligible as determined by the standards of the federal program designated as the                                  
17       successor to the aid to families with dependent children program;                                                 
18                 (6)  persons in a medical or intermediate care facility whose income                                    
19       while in the facility does not exceed $1,656 a month but who would not be eligible for                            
20       an optional state supplementary payment if they left the hospital or other facility;                              
21                 (7)  persons under 21 years of age who are receiving active treatment in                                
22       a psychiatric hospital and who are financially eligible as determined by the standards                            
23       of the federal program designated as the successor to the aid to families with                                    
24       dependent children program;                                                                                       
25                 (8)  persons under 21 years of age and not covered under (a) of this                                    
26       section, who would be eligible for benefits under the federal program designated as                               
27       the successor to the aid to families with dependent children program, except that they                            
28       have the care and support of both their natural and adoptive parents;                                             
29                 (9)  pregnant women not covered under (a) of this section and who                                       
30       meet the income and resource requirements of the federal program designated as the                                
31       successor to the aid to families with dependent children program;                                                 
01                 (10)  persons under 21 years of age not covered under (a) of this section                               
02       who the department has determined cannot be placed for adoption without medical                                   
03       assistance because of a special need for medical or rehabilitative care and who the                               
04       department has determined are hard-to-place children eligible for subsidy under                                   
05       AS 25.23.190 - 25.23.210;                                                                                         
06                 (11)  persons who can be considered under 42 U.S.C. 1396a(e)(3) (Title                                  
07       XIX, Social Security Act, Medical Assistance) to be individuals with respect to whom                              
08       a supplemental security income is being paid under 42 U.S.C. 1381 - 1383c (Title                                  
09       XVI, Social Security Act) because they meet all of the following criteria:                                        
10                      (A)  they are 18 years of age or younger and qualify as disabled                                   
11            individuals under 42 U.S.C. 1382c(a) (Title XVI, Social Security Act);                                       
12                      (B)  the department has determined that                                                            
13                           (i)  they require a level of care provided in a hospital,                                     
14                 nursing facility, or intermediate care facility for the mentally retarded;                              
15                           (ii)  it is appropriate to provide their care outside of an                                   
16                 institution; and                                                                                        
17                           (iii)  the estimated amount that would be spent for                                           
18                 medical assistance for their individual care outside an institution is not                              
19                 greater than the estimated amount that would otherwise be expended                                      
20                 individually for medical assistance within an appropriate institution;                                  
21                      (C)  if they were in a medical institution, they would be eligible                                 
22            for medical assistance under other provisions of this chapter; and                                           
23                      (D)  home and community-based services under a waiver                                              
24            approved by the federal government are either not available to them under this                               
25            chapter or would be inappropriate for them;                                                                  
26                 (12)  disabled persons, as described in 42 U.S.C.                                                       
27       1396a(a)(10)(A)(ii)(XIII), who are in families whose income, as determined under                                  
28       applicable federal regulations or guidelines, is less than 250 percent of the official                            
29       poverty line applicable to a family of that size according to the United States                                   
30       Department of Health and Human Services, and who, but for earnings in excess of the                               
31       limit established under 42 U.S.C. 1396d(q)(2)(B), would be considered to be                                       
01       individuals with respect to whom a supplemental security income is being paid under                               
02       42 U.S.C. 1381 - 1383c; a person eligible for assistance under this paragraph who is                              
03       not eligible under another provision of this section shall pay a premium or other cost-                           
04       sharing charges according to a sliding fee scale that is based on income as established                           
05       by the department in regulations;                                                                                 
06                 (13)  persons under 19 years of age who are not covered under (a) of                                    
07       this section and whose household income does not exceed 200 [175] percent of the                              
08       federal poverty line as defined by the United States Department of Health and Human                               
09       Services and revised under 42 U.S.C. 9902(2);                                                                     
10                 (14)  pregnant women who are not covered under (a) of this section and                                  
11       whose household income does not exceed 200 [175] percent of the federal poverty line                          
12       as defined by the United States Department of Health and Human Services and revised                               
13       under 42 U.S.C. 9902(2);                                                                                          
14                 (15)  persons who have been diagnosed with breast or cervical cancer                                    
15       and who are eligible for coverage under 42 U.S.C. 1396a(a)(10)(A)(ii)(XVIII).                                     
16    * Sec. 3. AS 47.07 is amended by adding a new section to read:                                                     
17            Sec. 47.07.022. Extended medical assistance coverage for children; costs.                                  
18       (a) In addition to the persons specified in AS 47.07.020, a person who resides in the                             
19       state and who meets the criteria under (b) of this section is eligible for extended                               
20       medical assistance coverage equivalent to the mandatory and optional services                                     
21       described under AS 47.07.030 if the person submits an annual application and                                      
22       contribution as specified in (c) of this section.                                                                 
23            (b)  The department shall administer a program of extended medical assistance                                
24       coverage for a person                                                                                             
25                 (1)  who is under 19 years of age;                                                                      
26                 (2)  whose household income is between 200 and 300 percent of the                                       
27       federal poverty guideline as defined by the United States Department of Health and                                
28       Human Services and revised under 42 U.S.C. 9902(2); and                                                           
29                 (3)  whose parent or legal guardian certifies that the person is not                                    
30       covered under a health insurance policy.                                                                          
31            (c)  The program administered under this section must include an annual                                      
01       application and sliding scale contribution, payable under terms specified in regulations                          
02       adopted by the department. The regulations must                                                                   
03                 (1)  include the option of an assignment of an applicant's permanent                                    
04       fund dividend and the permanent fund dividend of a parent, legal guardian, or other                               
05       authorized representative of an applicant; and                                                                    
06                 (2)  set the annual contribution amount between $240 and $1,200,                                        
07       beginning with $240 for a person whose household income is between 201 percent and                                
08       225 percent of the federal poverty guideline and increasing progressively based on the                            
09       person's household income.                                                                                        
10            (d)  In addition to the annual contribution established under (c) of this section,                           
11       the department shall impose a copayment of 20 percent for medical services and                                    
12       prescription drug costs covered under the program for a person whose household                                    
13       income is between 250 and 300 percent of the federal poverty guideline.                                           
14    * Sec. 4. AS 47.07.042(d) is amended to read:                                                                      
15            (d)  In addition to the requirements established under (a) and (b) of this section,                          
16       the department shall [MAY] require premiums or cost-sharing contributions from                                
17       recipients who are eligible for benefits under AS 47.07.022. The                                              
18       [AS 47.07.020(b)(13) AND WHOSE HOUSEHOLD INCOME IS BETWEEN 150                                                    
19       AND 175 PERCENT OF THE FEDERAL POVERTY LINE. IF THE                                                               
20       DEPARTMENT     REQUIRES    PREMIUMS     OR    COST-SHARING                                                        
21       CONTRIBUTIONS UNDER THIS SUBSECTION, THE] department                                                              
22                 (1)  shall adopt in regulation a sliding scale for those premiums or                                    
23       contributions based on household income;                                                                          
24                 (2)  may not exceed the maximums allowed under federal law; and                                         
25                 (3)  shall implement a system by which the department or its designee                                   
26       collects those premiums or contributions.                                                                         
27    * Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to                          
28 read:                                                                                                                   
29       TRANSITION: REGULATIONS. The Department of Health and Social Services may                                         
30 proceed to adopt regulations necessary to implement the changes made by this Act. The                                   
31 regulations take effect under AS 44.62 (Administrative Procedure Act), but not before the                               
01 effective date of secs. 1 - 4 of this Act.                                                                              
02    * Sec. 6. Section 5 of this Act takes effect immediately under AS 01.10.070(c).                                    
03    * Sec. 7. Except as provided in sec. 6 of this Act, this Act takes effect July 1, 2010.