Bill Text: OH HB13 | 2011-2012 | 129th General Assembly | Introduced

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Bill Title: To require the Director of Job and Family Services to seek federal approval to create a premium assistance component of the Medicaid program.

Sponsorship: Partisan Bill (Republican 1)

Status: (Introduced - Dead) 2011-01-11 - To Health & Aging [HB13 Detail]

Download: Ohio-2011-HB13-Introduced.html

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As Introduced

129th General Assembly Regular Session 2011-2012

H. B. No. 13

Representative Sears 

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A BILL

To enact section 5111.862 of the Revised Code to

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require the Director of Job and Family Services to

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seek federal approval to create a premium

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assistance component of the Medicaid program.

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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That section 5111.862 of the Revised Code be	5
enacted to read as follows:	6

Sec. 5111.862.  (A) As used in this section:

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"Assistance group" means a group of individuals treated as a	8
unit for purposes of determining eligibility for, and	9
participation in, the premium assistance component of the medicaid	10
program.	11

"Health benefit plan" has the same meaning as in section	12
3924.01 of the Revised Code.	13

"Plan of health coverage" has the same meaning as in section	14
3923.282 of the Revised Code.	15

"Federal poverty line" means the official poverty line as	16
established at least annually by the United States office of	17
management and budget pursuant to section 673(2) of the "Community	18
Services Block Grant Act," 95 Stat. 511 (1981), 42 U.S.C. 9902(2),	19
as amended.	20

(B) The director of job and family services shall submit to	21
the United States secretary of health and human services a request	22
for a medicaid waiver to create a premium assistance component of	23
the medicaid program. If the United States secretary grants the	24
waiver, the director shall establish the premium assistance	25
component in accordance with this section and the terms of the	26
waiver.	27

(C)(1) For an assistance group to qualify for the premium	28
assistance component, all of the following must apply:	29

(a) The assistance group must have countable income not	30
exceeding three hundred per cent of the federal poverty line.	31

(b) Each member of the assistance group, while participating	32
in the premium assistance component, must be enrolled in a health	33
benefit plan or plan of health coverage.	34

(c) If the health benefit plan or plan of health coverage in	35
which the assistance group is enrolled is sponsored by an employer	36
of a member of the assistance group, the employer must contribute	37
not less than fifty per cent of any premium charged for the	38
assistance group's enrollment.	39

(d) The assistance group must meet all other eligibility	40
requirements for the premium assistance component established in	41
rules adopted under section 5111.85 of the Revised Code.	42

(2) No assistance group shall be denied eligibility for the	43
premium assistance component due to either of the following:	44

(a) The amount of the assistance group's resources;

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(b) That no member of the assistance group qualifies for any	46
other component of the medicaid program.	47

(D) The premium assistance component shall subsidize the	48
premium for enrollment in a health benefit plan or plan of health	49
coverage charged an assistance group participating in the	50
component. The subsidy shall range from twenty to eighty per cent	51
of the premium as determined using a sliding scale established in	52
rules adopted under section 5111.85 of the Revised Code. The	53
sliding scale shall be based on an assistance group's countable	54
income and the number of members of the assistance group. The	55
subsidy shall not cover any portion of the premium for which an	56
employer of a member of the assistance group is responsible. The	57
premium assistance component shall not pay the costs of any	58
deductibles, copayments, or other cost-sharing expenses, other	59
than the premium, for which the assistance group is responsible	60
under the health benefit plan or plan of health coverage.	61

(E) No member of an assistance group may participate in the	62
premium assistance component and another component of the medicaid	63
program contemporaneously. A member of an assistance group who	64
meets the eligibility requirements for the premium assistance	65
component and one or more other components of the medicaid program	66
shall choose whether to participate in the premium assistance	67
component or the other component or components for which the	68
member is eligible. The medicaid program shall not pay for the	69
costs of any medical assistance, other than the premium subsidy,	70
provided to a member of an assistance group participating in the	71
premium assistance component, including medical assistance that is	72
not covered by the health benefit plan or plan of coverage in	73
which the member is enrolled but is covered by another component	74
of the medicaid program in which the member could participate if	75
not for the member's participation in the premium assistance	76
component.	77