00 HOUSE BILL NO. 367 01 "An Act relating to coverage of children and pregnant women under the medical 02 assistance program; and providing for an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. AS 47.07.020(b) is amended to read: 05 (b) In addition to the persons specified in (a) of this section, the following 06 optional groups of persons for whom the state may claim federal financial 07 participation are eligible for medical assistance: 08 (1) persons eligible for but not receiving assistance under any plan of 09 the state approved under 42 U.S.C. 1381 - 1383c (Title XVI, Social Security Act, 10 Supplemental Security Income) or a federal program designated as the successor to the 11 aid to families with dependent children program; 12 (2) persons in a general hospital, skilled nursing facility, or 13 intermediate care facility, who, if they left the facility, would be eligible for assistance 14 under one of the federal programs specified in (1) of this subsection; 01 (3) persons under age 21 who are under supervision of the department, 02 for whom maintenance is being paid in whole or in part from public funds, and who 03 are in foster homes or private child care [CHILD-CARE] institutions; 04 (4) aged, blind, or disabled persons, who, because they do not meet 05 income and resources requirements, do not receive supplemental security income 06 under 42 U.S.C. 1381 - 1383c (Title XVI, Social Security Act), and who do not 07 receive a mandatory state supplement, but who are eligible, or would be eligible if 08 they were not in a skilled nursing facility or intermediate care facility to receive an 09 optional state supplementary payment; 10 (5) persons under age 21 who are in an institution designated as an 11 intermediate care facility for the mentally retarded and who are financially eligible as 12 determined by the standards of the federal program designated as the successor to the 13 aid to families with dependent children program; 14 (6) persons in a medical or intermediate care facility whose income 15 while in the facility does not exceed 300 percent of the supplemental security income 16 benefit rate under 42 U.S.C. 1381 - 1383c (Title XVI, Social Security Act) but who 17 would not be eligible for an optional state supplementary payment if they left the 18 hospital or other facility; 19 (7) persons under age 21 who are receiving active treatment in a 20 psychiatric hospital and who are financially eligible as determined by the standards of 21 the federal program designated as the successor to the aid to families with dependent 22 children [AID TO FAMILIES WITH DEPENDENT CHILDREN] program; 23 (8) persons under age 21 and not covered under (a) of this section, who 24 would be eligible for benefits under the federal program designated as the successor to 25 the aid to families with dependent children program, except that they have the care and 26 support of both their natural and adoptive parents; 27 (9) pregnant women not covered under (a) of this section and who 28 meet the income and resource requirements of the federal program designated as the 29 successor to the aid to families with dependent children program; 30 (10) persons under age 21 not covered under (a) of this section who the 31 department has determined cannot be placed for adoption without medical assistance 01 because of a special need for medical or rehabilitative care and who the department 02 has determined are hard-to-place children eligible for subsidy under AS 25.23.190 - 03 25.23.220; 04 (11) persons who can be considered under 42 U.S.C. 1396a(e)(3) (Title 05 XIX, Social Security Act, Medical Assistance) to be individuals with respect to whom 06 a supplemental security income is being paid under 42 U.S.C. 1381 - 1383c (Title 07 XVI, Social Security Act) because they meet all of the following criteria: 08 (A) they are 18 years of age or younger and qualify as disabled 09 individuals under 42 U.S.C. 1382c(a) (Title XVI, Social Security Act); 10 (B) the department has determined that 11 (i) they require a level of care provided in a hospital, 12 nursing facility, or intermediate care facility for the mentally retarded; 13 (ii) it is appropriate to provide their care outside of an 14 institution; and 15 (iii) the estimated amount that would be spent for 16 medical assistance for their individual care outside an institution is not 17 greater than the estimated amount that would otherwise be expended 18 individually for medical assistance within an appropriate institution; 19 (C) if they were in a medical institution, they would be eligible 20 for medical assistance under other provisions of this chapter; and 21 (D) home and community-based services under a waiver 22 approved by the federal government are either not available to them under this 23 chapter or would be inappropriate for them; 24 (12) disabled persons, as described in 42 U.S.C. 25 1396a(a)(10)(A)(ii)(XIII), who are in families whose income, as determined under 26 applicable federal regulations or guidelines, is less than 250 percent of the official 27 poverty line applicable to a family of that size according to the federal Office of 28 Management and Budget, and who, but for earnings in excess of the limit established 29 under 42 U.S.C. 1396d(q)(2)(B), would be considered to be individuals with respect to 30 whom a supplemental security income is being paid under 42 U.S.C. 1381 - 1383c; a 31 person eligible for assistance under this paragraph who is not eligible under another 01 provision of this section shall pay a premium or other cost-sharing charges according 02 to a sliding fee scale that is based on income as established by the department in 03 regulations; 04 (13) persons under age 19 who are not covered under (a) of this section 05 and whose household income does not exceed 150 [200] percent of the federal poverty 06 guideline as defined by the federal office of management and budget and revised 07 under 42 U.S.C. 9902(2); 08 (14) pregnant women who are not covered under (a) of this section and 09 whose household income does not exceed 150 [200] percent of the federal poverty line 10 as defined by the federal office of management and budget and revised under 42 11 U.S.C. 9902(2). 12 * Sec. 2. AS 47.07.042(a) is amended to read: 13 (a) Except as provided in (b) and (c) [(b) - (d)] of this section, the state plan 14 developed under AS 47.07.040 shall impose deductible, coinsurance, and copayment 15 requirements on persons eligible for assistance under this chapter to the maximum 16 extent allowed under federal law and regulations. The plan must provide that health 17 care providers shall collect the allowable charge. The department shall reduce 18 payments to each provider by the amount of the allowable charge. A provider may not 19 deny services because a recipient is unable to share costs, but an inability to share 20 costs imposed under this section does not relieve the recipient of liability for the costs. 21 * Sec. 3. AS 47.07.042(d) is repealed. 22 * Sec. 4. This Act takes effect July 1, 2002.