00 SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 140 01 "An Act expanding medical assistance coverage for eligible children and pregnant 02 women; relating to the poverty guideline and cost sharing for certain recipients of 03 medical assistance; and 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 federal 29 poverty guideline for Alaska set by the United States Department of Health and 30 Human Services [OFFICIAL POVERTY LINE] applicable to a family of that size 31 [ACCORDING TO THE FEDERAL OFFICE OF MANAGEMENT AND 01 BUDGET], and who, but for earnings in excess of the limit established under 42 02 U.S.C. 1396d(q)(2)(B), would be considered to be individuals with respect to whom a 03 supplemental security income is being paid under 42 U.S.C. 1381 - 1383c; a person 04 eligible for assistance under this paragraph who is not eligible under another provision 05 of this section shall pay a premium or other cost-sharing charges according to a sliding 06 fee scale that is based on income as established by the department in regulations; 07 (13) persons under 19 years of age who are not covered under (a) of 08 this section and whose household income does not exceed 200 percent of the federal 09 poverty guideline for Alaska set by the United States Department of Health and 10 Human Services 11 [(A) $1,635 A MONTH IF THE HOUSEHOLD CONSISTS 12 OF ONE PERSON; 13 (B) $2,208 A MONTH IF THE HOUSEHOLD CONSISTS OF 14 TWO PERSONS; 15 (C) $2,782 A MONTH IF THE HOUSEHOLD CONSISTS OF 16 THREE PERSONS; 17 (D) $3,355 A MONTH IF THE HOUSEHOLD CONSISTS OF 18 FOUR PERSONS; 19 (E) $3,928 A MONTH IF THE HOUSEHOLD CONSISTS OF 20 FIVE PERSONS; 21 (F) $4,501 A MONTH IF THE HOUSEHOLD CONSISTS OF 22 SIX PERSONS; 23 (G) $5,074 A MONTH IF THE HOUSEHOLD CONSISTS OF 24 SEVEN PERSONS; 25 (H) $5,647 A MONTH IF THE HOUSEHOLD CONSISTS OF 26 EIGHT PERSONS; 27 (I) $5,647 A MONTH, PLUS AN ADDITIONAL $574 A 28 MONTH FOR EACH EXTRA PERSON ABOVE EIGHT PERSONS WHO 29 IS IN THE HOUSEHOLD IF THE HOUSEHOLD CONSISTS OF NINE 30 PERSONS OR MORE]; 31 (14) pregnant women who are not covered under (a) of this section and 01 whose household income does not exceed 200 percent of the federal poverty 02 guideline for Alaska set by the United States Department of Health and Human 03 Services 04 [(A) $2,208 A MONTH IF THE HOUSEHOLD CONSISTS 05 OF TWO PERSONS; 06 (B) $2,782 A MONTH IF THE HOUSEHOLD CONSISTS OF 07 THREE PERSONS; 08 (C) $3,355 A MONTH IF THE HOUSEHOLD CONSISTS OF 09 FOUR PERSONS; 10 (D) $3,928 A MONTH IF THE HOUSEHOLD CONSISTS OF 11 FIVE PERSONS; 12 (E) $4,501 A MONTH IF THE HOUSEHOLD CONSISTS OF 13 SIX PERSONS; 14 (F) $5,074 A MONTH IF THE HOUSEHOLD CONSISTS OF 15 SEVEN PERSONS; 16 (G) $5,647 A MONTH IF THE HOUSEHOLD CONSISTS OF 17 EIGHT PERSONS; 18 (H) $5,647 A MONTH, PLUS AN ADDITIONAL $574 A 19 MONTH FOR EACH EXTRA PERSON ABOVE EIGHT PERSONS WHO 20 IS IN THE HOUSEHOLD IF THE HOUSEHOLD CONSISTS OF NINE 21 PERSONS OR MORE]; 22 (15) persons who have been diagnosed with breast or cervical cancer 23 and who are eligible for coverage under 42 U.S.C. 1396a(a)(10)(A)(ii)(XVIII). 24 * Sec. 3. AS 47.07 is amended by adding a new section to read: 25 Sec. 47.07.022. Extended medical assistance coverage for children; costs. 26 (a) In addition to the persons specified in AS 47.07.020, a person who resides in the 27 state and who meets the criteria under (b) of this section is eligible for extended 28 medical assistance coverage equivalent to the mandatory and optional services 29 described under AS 47.07.030 if the person submits an annual application and 30 contribution as specified in (c) of this section. 31 (b) The department shall administer a program of extended medical assistance 01 coverage for a person 02 (1) who is under 19 years of age; 03 (2) whose household income is between 200 and 350 percent of the 04 federal poverty guideline for Alaska set by the United States Department of Health 05 and Human Services; and 06 (3) whose parent or legal guardian certifies that the person cannot 07 obtain coverage under a health insurance policy offered by an employer of the person's 08 parent or legal guardian. 09 (c) The program administered under this section must include an annual 10 application and sliding scale contribution, payable under terms specified in regulations 11 adopted by the department. The regulations must 12 (1) include the option of an assignment of an applicant's permanent 13 fund dividend and the permanent fund dividend of a parent, legal guardian, or other 14 authorized representative of an applicant; and 15 (2) set the contribution amount between $200 and $1,200, beginning 16 with $200 for a person whose household income is between 201 percent and 225 17 percent of the federal poverty guideline and increasing progressively based on the 18 person's household income. 19 (d) In addition to the annual contribution established under (c) of this section, 20 the department shall impose a copayment of 20 percent for medical services and 21 prescription drug costs covered under the program for a person whose household 22 income is between 250 and 350 percent of the federal poverty guideline. 23 * Sec. 4. AS 47.07.042(d) is amended to read: 24 (d) In addition to the requirements established under (a) and (b) of this section, 25 the department shall [MAY] require premiums or cost-sharing contributions from 26 recipients who are eligible for benefits under AS 47.07.022. The 27 [AS 47.07.020(b)(13) AND WHOSE HOUSEHOLD INCOME IS GREATER THAN 28 THE APPLICABLE AMOUNT SET OUT IN (f) OF THIS SECTION. IF THE 29 DEPARTMENT REQUIRES PREMIUMS OR COST-SHARING 30 CONTRIBUTIONS UNDER THIS SUBSECTION, THE] department 31 (1) shall adopt in regulation a sliding scale for those premiums or 01 contributions based on household income; 02 (2) may not exceed the maximums allowed under federal law; and 03 (3) shall implement a system by which the department or its designee 04 collects those premiums or contributions. 05 * Sec. 5. AS 47.07.042(f) is repealed. 06 * Sec. 6. The uncodified law of the State of Alaska is amended by adding a new section to 07 read: 08 TRANSITION: REGULATIONS. The Department of Health and Social Services may 09 proceed to adopt regulations necessary to implement the changes made by this Act. The 10 regulations take effect under AS 44.62 (Administrative Procedure Act), but not before the 11 effective date of secs. 1 - 5 of this Act. 12 * Sec. 7. Section 6 of this Act takes effect immediately under AS 01.10.070(c). 13 * Sec. 8. Except as provided in sec. 7 of this Act, this Act takes effect July 1, 2008.