Enrolled SB 13: Relating to eligibility requirements for medical assistance for certain children and pregnant women; and providing for an effective date.
00Enrolled SB 13 01 Relating to eligibility requirements for medical assistance for certain children and pregnant 02 women; and providing for an effective date. 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 21 years of age who are under supervision of the 02 department, for whom maintenance is being paid in whole or in part from public 03 funds, and who 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 21 years of age who are in an institution designated 11 as an intermediate care facility for the mentally retarded and who are financially 12 eligible as determined by the standards of the federal program designated as the 13 successor to the 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 but who would not be eligible for 16 an optional state supplementary payment if they left the hospital or other facility; 17 (7) persons under 21 years of age who are receiving active treatment in 18 a psychiatric hospital and who are financially eligible as determined by the standards 19 of the federal program designated as the successor to the aid to families with 20 dependent children program; 21 (8) persons under 21 years of age and not covered under (a) of this 22 section, who would be eligible for benefits under the federal program designated as 23 the successor to the aid to families with dependent children program, except that they 24 have the care and support of both their natural and adoptive parents; 25 (9) pregnant women not covered under (a) of this section and who 26 meet the income and resource requirements of the federal program designated as the 27 successor to the aid to families with dependent children program; 28 (10) persons under 21 years of age not covered under (a) of this section 29 who the department has determined cannot be placed for adoption without medical 30 assistance because of a special need for medical or rehabilitative care and who the 31 department has determined are hard-to-place children eligible for subsidy under
01 AS 25.23.190 - 25.23.210; 02 (11) persons who can be considered under 42 U.S.C. 1396a(e)(3) (Title 03 XIX, Social Security Act, Medical Assistance) to be individuals with respect to whom 04 a supplemental security income is being paid under 42 U.S.C. 1381 - 1383c (Title 05 XVI, Social Security Act) because they meet all of the following criteria: 06 (A) they are 18 years of age or younger and qualify as disabled 07 individuals under 42 U.S.C. 1382c(a) (Title XVI, Social Security Act); 08 (B) the department has determined that 09 (i) they require a level of care provided in a hospital, 10 nursing facility, or intermediate care facility for the mentally retarded; 11 (ii) it is appropriate to provide their care outside of an 12 institution; and 13 (iii) the estimated amount that would be spent for 14 medical assistance for their individual care outside an institution is not 15 greater than the estimated amount that would otherwise be expended 16 individually for medical assistance within an appropriate institution; 17 (C) if they were in a medical institution, they would be eligible 18 for medical assistance under other provisions of this chapter; and 19 (D) home and community-based services under a waiver 20 approved by the federal government are either not available to them under this 21 chapter or would be inappropriate for them; 22 (12) disabled persons, as described in 42 U.S.C. 23 1396a(a)(10)(A)(ii)(XIII), who are in families whose income, as determined under 24 applicable federal regulations or guidelines, is less than 250 percent of the official 25 poverty line applicable to a family of that size according to the United States 26 Department of Health and Human Services, and who, but for earnings in excess of the 27 limit established under 42 U.S.C. 1396d(q)(2)(B), would be considered to be 28 individuals with respect to whom a supplemental security income is being paid under 29 42 U.S.C. 1381 - 1383c; a person eligible for assistance under this paragraph who is 30 not eligible under another provision of this section shall pay a premium or other cost- 31 sharing charges according to a sliding fee scale that is based on income as established
01 by the department in regulations; 02 (13) persons under 19 years of age who are not covered under (a) of 03 this section and whose household income does not exceed 200 [175] percent of the 04 federal poverty line as defined by the United States Department of Health and Human 05 Services and revised under 42 U.S.C. 9902(2); 06 (14) pregnant women who are not covered under (a) of this section and 07 whose household income does not exceed 200 [175] percent of the federal poverty line 08 as defined by the United States Department of Health and Human Services and revised 09 under 42 U.S.C. 9902(2); 10 (15) persons who have been diagnosed with breast or cervical cancer 11 and who are eligible for coverage under 42 U.S.C. 1396a(a)(10)(A)(ii)(XVIII). 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 between 150 and 200 [175] percent of the federal poverty line. If the department 17 requires premiums or cost-sharing contributions under this subsection, the department 18 (1) shall adopt in regulation a sliding scale for those premiums or 19 contributions based on household income; 20 (2) may not exceed the maximums allowed under federal law; and 21 (3) shall implement a system by which the department or its designee 22 collects those premiums or contributions. 23 * Sec. 3. This Act takes effect immediately under AS 01.10.070(c).