Chapter

Chapter 354

2004 -- S 2280 SUBSTITUTE A AS AMENDED

Enacted 07/02/04

A N A C T

RELATING TO HUMAN SERVICES -- HEALTH CARE FOR WORKING PEOPLE FOR

WORKING PEOPLE WITH DISABILITIES

Introduced By: Senators Gibbs, Goodwin, Roberts, Parella, and Blais

Date Introduced: February 05, 2004

It is enacted by the General Assembly as follows:

SECTION 1. Title 40 of the General Laws entitled "Human services" is hereby amended

by adding thereto the following chapter:

CHAPTER 8.7

HEALTH CARE ASSISTANCE FOR WORKING PEOPLE WITH DISABILITIES

40-8.7-1. Short title. – This chapter shall be known and may be cited as “The Sherlock

Act.”

40-8.7-2. Medicaid buy-in program. – The department of human services is hereby

authorized to establish a Medicaid buy-in program pursuant to the "Balanced Budget Act of

1997" [42 U.S.C. section 1396a(a)(10)(ii)(XIII)].

40-8.7-3. Purpose. – The purpose of the Medicaid buy-in program is to:

(1) Enable individuals with disabilities to enter and reenter the work force as soon as

possible;

(2) Provide health care and social services to individuals with disabilities that will enable

those individuals to reduce their dependency on cash benefit programs;

(3) Allow individuals with disabilities the option to purchase Medicaid coverage that is

necessary to enable such individuals to obtain and/or maintain employment; and

(4) Authorize the department of human services to amend the state plan for personal care

services limited to employment-related personal care services for individuals with disabilities to

continue their employment activity.

40-8.7-4. Definitions. – As used in this chapter, the term:

(1) "Individual with a disability" means a person who has been designated, but without

regard to his or her ability to engage in substantial gainful activity, as specified in the social

security act [42 U.S.C. 423(d)(4)], as a totally and permanently disabled individual by the Social

Security Administration or the Rhode Island Medicaid program, pursuant to an application for

benefits under Title II, Title XVI or Title XIX of the social security act, regardless of current

receipt of cash benefits under the social security act.

(2) "Employed" means the individual with disabilities is engaged in a work effort that

meets substantial and reasonable threshold criteria for hours of work, wages, or other measures,

as defined by the department of human services and as permitted by federal law.

40-8.7-5. Authorization for the Medicaid buy-in program. – The department of human

services is hereby authorized and directed to amend its title XIX state plan to initiate a Medicaid

buy-in program for employed individuals with disabilities.

40-8.7-6. Eligibility. – To be eligible for benefits under the Medicaid buy-in program:

(1) The person shall be an individual with disabilities as defined in section 40-8.7-4, but

without regard to his or her ability to engage in substantial gainful activity, as specified in the

social security act [42 U.S.C. 423(d)(4)];

(2) The person shall be employed as defined in section 40-8.7-4;

(3) The person's net accountable income shall not exceed two hundred fifty percent

(250%) of the federal poverty level, taking into account the SSI program disregards and

impairment-related work expenses as defined in 42 U.S.C. Section 1396a(r)(2);

(4) A maximum of ten thousand dollars ($10,000) of available resources for an individual

and twenty thousand dollars ($20,000) for a couple shall be disregarded as shall any additional

resources held in a retirement account, in a medical savings account, or any other account, related

to enhancing the independence of the individual and approved under rules to be adopted by the

department; and

(5) The person shall be a current medical assistance recipient under section 40-8.5-1

[CNIL] or 40-8-3(v)[MNIL]; or shall meet income, assets, (except as modified by subsection (4)

above) and eligibility requirements for the medical assistance program under sections 40-8.5-1

[CNIL] or 40-8-3(v) [MNIL], as such requirements are modified and extended by this chapter.

40-8.7-7. Premiums and cost sharing. – (a) The department of humans services is

authorized and directed to promulgate such rules to establish the monthly premium payments for

employed individuals with disabilities who opt to participate directly in the Medicaid buy-in

program. To participate in the Medicaid buy-in program, the employed individual with

disabilities shall be required to make payment for coverage in accordance with a monthly

payment formula to be established by the department which shall count the individual's monthly-

unearned income in excess of the medically needy income limit [MNIL], and shall count a

portion of their earned income on a sliding scale basis, in accordance with rules to be established

by the department;

(b) The department is further authorized and directed to promulgate such rules to allow

employed individual with disabilities who have access to employer-based health insurance and

who are determined eligible by the department pursuant to this chapter, to either:

(1) Enroll themselves and/or their family in the employer-based health insurance plan as

a condition of participation in the Medicaid buy-in program under this chapter, provided this also

complies with the requirements of sections 40-5.1, 40-8.1, 40-8.4, 40-8.5, 42-12, 42-12.1, 42-12.2

and 42-12.3 as they relate to eligibility for the medical assistance program; and provided, further,

that enrollment in the employer-based health insurance plan is cost-effective and its benefits are

comparable to the benefits provided by the Medicaid program; or

(2) Enroll in the RI Medicaid buy-in program with employer/employee premium

payments for coverage under the medicaid buy-in program; provided, that these premium

payments are not greater than the employer's and employee's premiums in the existing employer-

based health insurance.

40-8.7-8. Work-related protections. – (a) Medicaid buy-in participants shall continue

on the medicaid buy-in program for up to four (4) months after loss of employment due to a

medical condition. If the loss of employment is not due to a medical condition, the individual

may continue to be eligible for up to four (4) months, but must pay a monthly premium equal to

their monthly-unearned income in excess of the medically needy income limit.

(b) Medicaid buy-in participants who return to other Medicaid eligibility categories shall

have their accrued savings in a retirement account and/or a medical savings account excluded

from countable assets.

related protections of this section.

40-8.7-9. Regulations and commencement of program. – The department of human

services shall promulgate the rules or regulations necessary to implement the provisions of this

act by January 1, 2005, and enrollment of individuals with disabilities in the Medicaid buy-in

program shall commence on January 1, 2006.

SECTION 2. This act shall take effect July 1, 2004.

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LC01305/SUB A

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