Bill Text: IA SSB1174 | 2025-2026 | 91st General Assembly | Introduced
Bill Title: A bill for an act relating to the establishment of the work without worry program under the medical assistance program for employed individuals with disabilities, and including effective date provisions.
Spectrum: Committee Bill
Status: (Introduced) 2025-02-25 - Subcommittee recommends amendment and passage. [SSB1174 Detail]
Download: Iowa-2025-SSB1174-Introduced.html
Senate
Study
Bill
1174
-
Introduced
SENATE
FILE
_____
BY
(PROPOSED
COMMITTEE
ON
HEALTH
AND
HUMAN
SERVICES
BILL
BY
CHAIRPERSON
KLIMESH)
A
BILL
FOR
An
Act
relating
to
the
establishment
of
the
work
without
worry
1
program
under
the
medical
assistance
program
for
employed
2
individuals
with
disabilities,
and
including
effective
date
3
provisions.
4
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
5
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Section
1.
NEW
SECTION
.
249O.1
Definitions.
1
As
used
in
this
chapter,
unless
the
context
otherwise
2
requires:
3
1.
“Countable
income”
means
the
income
of
an
individual
when
4
the
income
is
received
and
can
be
used
to
meet
the
individual’s
5
needs
for
food,
clothing,
and
shelter.
“Countable
income”
does
6
not
include
the
income
of
another
member
of
the
individual’s
7
household,
or
certain
receipts
as
described
in
20
C.F.R.
8
§416.1103.
9
2.
“Department”
means
the
department
of
health
and
human
10
services.
11
3.
“Disability”
means
a
qualifying
disability
as
determined
12
by
the
federal
social
security
administration,
or
the
13
individual
is
determined
by
the
department
to
have
a
physical
14
or
mental
impairment,
or
combination
of
impairments,
that
have
15
lasted
or
are
expected
to
last
for
at
least
twelve
months
or
16
result
in
death.
17
4.
“Long-term
services
and
supports”
means
the
broad
18
range
of
health,
health-related,
and
personal
care
assistance
19
services
and
supports,
provided
in
home
and
community-based
20
settings,
necessary
for
persons
with
disabilities
who
21
experience
limitations
in
their
capacity
for
self-care
due
to
a
22
physical,
cognitive,
or
mental
disability
or
condition.
23
5.
“Program”
means
the
work
without
worry
program
24
established
in
section
249O.3.
25
Sec.
2.
NEW
SECTION
.
249O.2
Program
——
intent.
26
It
is
the
intent
of
the
general
assembly
to
remove
barriers
27
to
employment
for
individuals
who,
but
for
income
and
28
resources,
meet
the
definition
of
disability,
by
providing
29
medical
assistance
to
employed
individuals
with
disabilities
30
through
a
work
without
worry
program
in
accordance
with
section
31
1902(a)(10)(A)(ii)(XIII)
of
the
federal
Social
Security
Act,
32
and
Medicaid
eligibility,
using
less
restrictive
income
and
33
resource
requirements
through
the
application
of
section
34
1902(r)(2)
of
the
federal
Social
Security
Act,
and
cost-sharing
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requirements
established
by
the
department
and
approved
by
the
1
centers
for
Medicare
and
Medicaid
services
of
the
United
States
2
department
of
health
and
human
services.
3
Sec.
3.
NEW
SECTION
.
249O.3
Program
——
established.
4
1.
The
work
without
worry
program
is
established
under
the
5
medical
assistance
program
and
shall
be
administered
by
the
6
department
to
provide
employed
individuals
with
disabilities
7
access
to
health
care
coverage
through
the
medical
assistance
8
program.
9
2.
Except
as
otherwise
specified
in
this
chapter,
10
provisions
applicable
to
the
medical
assistance
program
11
pursuant
to
chapter
249A
shall
be
applicable
to
the
program.
12
3.
In
addition
to
the
benefits
received
under
the
program,
13
an
individual
shall
have
access
to
all
traditional
Medicaid
14
services
under
the
medical
assistance
program,
as
well
as
15
additional
long-term
services
and
supports
and
community-based
16
services,
including
waiver
services,
for
which
the
individual
17
meets
any
applicable
level
of
care
requirements.
18
4.
The
department
shall
make
every
effort
to
coordinate
19
benefits
with
the
health
care
coverage
provided
by
an
employer
20
of
an
employed
individual
with
a
disability
receiving
benefits
21
under
this
chapter.
22
Sec.
4.
NEW
SECTION
.
249O.4
Program
——
eligibility.
23
1.
Except
as
otherwise
provided
in
this
chapter,
an
24
individual
may
participate
in
the
program
if
the
individual
25
meets
all
of
the
following
criteria:
26
a.
The
individual
is
eligible
for
the
medical
assistance
27
program
under
chapter
249A.
28
b.
The
individual
is
at
least
eighteen
years
of
age.
29
c.
The
individual
is
less
than
sixty-five
years
of
age.
30
d.
The
individual
has
a
disability.
31
e.
The
individual
is
employed
and
earns
income
from
32
employment,
which
may
include
self-employment.
An
individual
33
is
employed
if
the
individual
receives
earnings
that
are
34
subject
to
federal
income
tax,
and
unless
the
individual
is
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self-employed,
has
payroll
taxes
deducted
from
those
earnings.
1
2.
The
department
shall
not
adopt
a
rule
for
program
2
eligibility
based
upon
any
of
the
following:
3
a.
An
individual’s
income
or
resources.
4
b.
A
resource
test
or
limit.
5
c.
An
individual’s
receipt
of
federal
disability
benefits.
6
3.
An
individual
who
receives
supplemental
security
income
7
shall
be
automatically
eligible
for
the
program
and
shall
not
8
be
required
to
submit
a
separate
application
for
the
program.
9
4.
An
individual
may
be
eligible
for
or
receive
other
health
10
care
coverage
including
through
an
employer,
through
Medicare,
11
or
through
the
medically
needy
program,
the
qualified
Medicare
12
beneficiary
program,
or
the
specified
low-income
Medicare
13
beneficiary
program.
If
the
individual
has
such
other
coverage
14
and
is
subject
to
payment
of
copayments
or
premiums
for
that
15
coverage,
notwithstanding
the
premium
requirements
under
the
16
program
to
the
contrary,
the
individual
shall
not
be
subject
to
17
payment
of
premiums
otherwise
applicable
under
the
program.
18
Sec.
5.
NEW
SECTION
.
249O.5
Program
——
premiums.
19
1.
An
individual’s
monthly
program
premium
amount
shall
20
equal,
rounded
down
to
the
nearest
whole
dollar,
six
percent
of
21
the
individual’s
verified
countable
income.
22
a.
An
individual
shall
report
any
change
in
the
individual’s
23
countable
income
to
the
department.
24
b.
The
department
shall
utilize
the
individual’s
verified
25
countable
income
until
the
individual
reports
a
change
in
26
countable
income
and
the
change
is
processed
by
the
department,
27
unless
there
is
good
cause
for
the
department’s
delay
in
28
verifying
the
change
in
the
individual’s
countable
income.
29
c.
A
change
in
an
individual’s
program
premium
amount
shall
30
be
effective
the
month
after
the
change
in
the
individual’s
31
countable
income
is
reported
to
and
verified
by
the
department.
32
2.
An
individual
shall
be
covered
under
the
program
for
33
six
consecutive
months
beginning
the
first
day
of
the
month
in
34
which
the
department
approves
the
individual’s
application
for
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the
program.
1
3.
The
department
shall
create
a
six-month
grace
period
that
2
provides
continuous
program
coverage
to
an
individual
following
3
the
individual’s
temporary
loss
of
employment,
or
a
health
4
crisis
that
temporarily
prevents
the
individual
from
continuing
5
employment.
The
individual
shall
be
required
to
continue
to
6
pay
the
program
premium
based
on
the
individual’s
verified
7
countable
income
during
the
six-month
grace
period.
8
4.
The
department
may
terminate
an
individual’s
program
9
coverage
if
the
individual
fails
to
pay
four
consecutive
months
10
of
program
premiums.
11
5.
An
individual
must
pay
a
program
premium
in
full
for
any
12
month
that
program
coverage
is
provided,
including
a
month
when
13
a
redetermination
of
coverage
is
made,
a
month
when
continued
14
coverage
is
requested,
and
during
the
period
of
an
eligibility
15
determination
appeal.
16
Sec.
6.
NEW
SECTION
.
249O.6
Rules.
17
The
department
shall
adopt
rules
pursuant
to
chapter
17A
to
18
administer
this
chapter.
19
Sec.
7.
WORK
WITHOUT
WORRY
PROGRAM
——
DEPARTMENT
OF
HEALTH
20
AND
HUMAN
SERVICES.
21
1.
The
department
of
health
and
human
services
shall
submit
22
any
waiver
request
or
state
plan
amendment,
or
combination
23
thereof,
to
the
centers
for
Medicare
and
Medicaid
services
of
24
the
United
States
department
of
health
and
human
services
as
25
necessary
to
create
a
work
without
worry
program
in
accordance
26
with
this
Act.
27
2.
Any
individual
participating
in
the
Medicaid
for
28
employed
persons
with
disabilities
program
when
the
work
29
without
worry
program
is
implemented
shall
be
transferred
to
30
and
enrolled
in
the
work
without
worry
program.
31
Sec.
8.
EFFECTIVE
DATE.
This
Act,
being
deemed
of
immediate
32
importance,
takes
effect
upon
enactment.
33
EXPLANATION
34
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
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the
explanation’s
substance
by
the
members
of
the
general
assembly.
1
This
bill
relates
to
the
work
without
worry
program
under
2
the
medical
assistance
program
for
employed
individuals
with
3
disabilities.
4
The
bill
defines
“countable
income”
(income)
and
5
“disability”.
6
The
bill
establishes
a
work
without
worry
program
(program)
7
under
the
medical
assistance
program
to
be
administered
by
the
8
department
of
health
and
human
services
(HHS).
The
program
9
shall
provide
employed
individuals
with
disabilities
access
to
10
health
care
coverage
under
the
medical
assistance
program
as
11
well
as
long-term
services
and
supports
and
community-based
12
services
for
which
the
individual
qualifies.
The
bill
requires
13
HHS
to
make
every
effort
to
coordinate
benefits
with
health
14
care
coverage
provided
by
the
employer
of
an
individual
15
receiving
program
benefits.
16
Under
current
law,
to
be
eligible
for
the
Medicaid
for
17
employed
people
with
disabilities
program
(MEPD
program),
an
18
individual
with
disabilities
must
not
exceed
the
individual
or
19
couple
resource
limits,
or
the
monthly
household
income
limits.
20
The
program
eliminates
these
eligibility
requirements.
21
The
bill
provides
eligibility
criteria
for
the
program.
The
22
bill
prohibits
HHS
from
adopting
a
rule
for
program
eligiblity
23
based
on
an
individual’s
income
or
resources,
a
resource
test
24
or
limit,
or
an
individual’s
receipt
of
federal
disability
25
benefits.
An
individual
receiving
supplemental
security
income
26
shall
be
automatically
eligible
for
the
program
and
is
not
27
required
to
submit
an
application.
An
individual
participating
28
in
the
program
may
be
eligible
for
and
receive
other
health
29
care
coverage
as
described
in
the
bill.
If
an
individual
30
receives
such
coverage
and
pays
a
copayment
or
premium,
the
31
individual
does
not
have
to
pay
a
program
premium
(premium).
32
The
bill
requires
that
the
monthly
premium
equal
6
percent
33
of
an
individual’s
verified
income,
rounded
down
to
the
34
nearest
whole
dollar.
An
individual
shall
report
any
change
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in
the
individual’s
income
to
HHS
and
shall
pay
a
premium
1
any
month
program
coverage
is
provided
as
detailed
in
the
2
bill.
HHS
shall
create
a
six-month
grace
period
to
provide
3
continuous
program
coverage
to
an
individual
who
temporarily
4
loses
employment
or
suffers
a
health
crisis
that
prevents
5
the
individual
from
continuing
employment.
The
individual
6
shall
be
required
to
continue
to
pay
the
premium
during
the
7
six-month
grace
period.
HHS
may
terminate
an
individual’s
8
program
coverage
for
failure
to
pay
four
consecutive
months
of
9
premiums.
10
The
bill
requires
HHS
to
adopt
rules
to
administer
the
bill.
11
The
bill
requires
HHS
to
submit
any
waiver
request
or
state
12
plan
amendment
to
the
federal
centers
for
Medicare
and
Medicaid
13
services
as
necessary
to
create
the
program.
14
The
bill
requires
any
individual
participating
in
the
MEPD
15
program
to
be
transferred
to
and
enrolled
in
the
program.
16
The
bill
is
effective
upon
enactment.
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