Enrolled SB 105: Relating to eligibility requirements for medical assistance for certain children, pregnant women, and persons in a medical or intermediate care facility.
00Enrolled SB 105 01 Relating to eligibility requirements for medical assistance for certain children, pregnant 02 women, and persons in a medical or intermediate care facility. 03 _______________ 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 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 $1,656 a month [300 PERCENT OF THE 16 SUPPLEMENTAL SECURITY INCOME BENEFIT RATE UNDER 42 U.S.C. 1381 17 - 1383c (TITLE XVI, SOCIAL SECURITY ACT)] but who would not be eligible for 18 an optional state supplementary payment if they left the 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 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 06 (A) $1,635 a month if the household consists of one person; 07 (B) $2,208 a month if the household consists of two persons; 08 (C) $2,782 a month if the household consists of three 09 persons; 10 (D) $3,355 a month if the household consists of four 11 persons; 12 (E) $3,928 a month if the household consists of five persons; 13 (F) $4,501 a month if the household consists of six persons; 14 (G) $5,074 a month if the household consists of seven 15 persons; 16 (H) $5,647 a month if the household consists of eight 17 persons; 18 (I) $5,647 a month, plus an additional $574 a month for 19 each extra person above eight persons who is in the household if the 20 household consists of nine persons or more [200 PERCENT OF THE 21 FEDERAL POVERTY GUIDELINE AS DEFINED BY THE FEDERAL 22 OFFICE OF MANAGEMENT AND BUDGET AND REVISED UNDER 42 23 U.S.C. 9902(2)]; 24 (14) pregnant women who are not covered under (a) of this section and 25 whose household income does not exceed 26 (A) $2,208 a month if the household consists of two persons; 27 (B) $2,782 a month if the household consists of three 28 persons; 29 (C) $3,355 a month if the household consists of four 30 persons; 31 (D) $3,928 a month if the household consists of five persons;
01 (E) $4,501 a month if the household consists of six persons; 02 (F) $5,074 a month if the household consists of seven 03 persons; 04 (G) $5,647 a month if the household consists of eight 05 persons; 06 (H) $5,647 a month, plus an additional $574 a month for 07 each extra person above eight persons who is in the household if the 08 household consists of nine persons or more [200 PERCENT OF THE 09 FEDERAL POVERTY LINE AS DEFINED BY THE FEDERAL OFFICE OF 10 MANAGEMENT AND BUDGET AND REVISED UNDER 42 U.S.C. 11 9902(2)]. 12 * Sec. 2. AS 47.07.042(d) is amended to read: 13 (d) In addition to the requirements established under (a) and (b) of this section, 14 the department may require premiums or cost-sharing contributions from recipients 15 who are eligible for benefits under AS 47.07.020(b)(13) and whose household income 16 is greater than the applicable amount set out in (e) of this section [BETWEEN 150 17 AND 200 PERCENT OF THE FEDERAL POVERTY GUIDELINE]. If the 18 department requires premiums or cost-sharing contributions under this subsection, the 19 department 20 (1) shall adopt in regulation a sliding scale for those premiums or 21 contributions based on household income; 22 (2) may not exceed the maximums allowed under federal law; and 23 (3) shall implement a system by which the department or its designee 24 collects those premiums or contributions. 25 * Sec. 3. AS 47.07.042 is amended by adding a new subsection to read: 26 (e) In (d) of this section, the term "applicable amount" means 27 (1) $1,385 a month if the household consists of one person; 28 (2) $1,867 a month if the household consists of two persons; 29 (3) $2,348 a month if the household consists of three persons; 30 (4) $2,829 a month if the household consists of four persons; 31 (5) $3,310 a month if the household consists of five persons;
01 (6) $3,792 a month if the household consists of six persons; 02 (7) $4,273 a month if the household consists of seven persons; 03 (8) $4,754 a month if the household consists of eight persons; 04 (9) $4,754 a month, plus an additional $482 a month for each extra 05 person above eight persons who is in the household if the household consists of nine 06 persons or more.