HOUSE BILL NO. 1382 103RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE PRICE.
2830H.01I JOSEPH ENGLER, Chief Clerk
AN ACT To repeal section 208.151, RSMo, and to enact in lieu thereof one new section relating to MO HealthNet benefits.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Section 208.151, RSMo, is repealed and one new section enacted in lieu 2 thereof, to be known as section 208.151, to read as follows: 208.151. 1. Medical assistance on behalf of needy persons shall be known as "MO 2 HealthNet". For the purpose of paying MO HealthNet benefits and to comply with Title XIX, 3 Public Law 89-97, 1965 amendments to the federal Social Security Act (42 U.S.C. Section 4 301, et seq.) as amended, the following needy persons shall be eligible to receive MO 5 HealthNet benefits to the extent and in the manner hereinafter provided: 6 (1) All participants receiving state supplemental payments for the aged, blind and 7 disabled; 8 (2) All participants receiving aid to families with dependent children benefits, 9 including all persons under nineteen years of age who would be classified as dependent 10 children except for the requirements of subdivision (1) of subsection 1 of section 208.040. 11 Participants eligible under this subdivision who are participating in treatment court, as 12 defined in section 478.001, shall have their eligibility automatically extended sixty days from 13 the time their dependent child is removed from the custody of the participant, subject to 14 approval of the Centers for Medicare and Medicaid Services; 15 (3) All participants receiving blind pension benefits; 16 (4) All persons who would be determined to be eligible for old age assistance 17 benefits, permanent and total disability benefits, or aid to the blind benefits under the
EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language. HB 1382 2
18 eligibility standards in effect December 31, 1973, or less restrictive standards as established 19 by rule of the family support division, who are sixty-five years of age or over and are patients 20 in state institutions for mental diseases or tuberculosis; 21 (5) All persons under the age of twenty-one years who would be eligible for aid to 22 families with dependent children except for the requirements of subdivision (2) of subsection 23 1 of section 208.040, and who are residing in an intermediate care facility, or receiving active 24 treatment as inpatients in psychiatric facilities or programs, as defined in 42 U.S.C. Section 25 1396d, as amended; 26 (6) All persons under the age of twenty-one years who would be eligible for aid to 27 families with dependent children benefits except for the requirement of deprivation of 28 parental support as provided for in subdivision (2) of subsection 1 of section 208.040; 29 (7) All persons eligible to receive nursing care benefits; 30 (8) All participants receiving family foster home or nonprofit private child-care 31 institution care, subsidized adoption benefits and parental school care wherein state funds are 32 used as partial or full payment for such care; 33 (9) All persons who were participants receiving old age assistance benefits, aid to the 34 permanently and totally disabled, or aid to the blind benefits on December 31, 1973, and who 35 continue to meet the eligibility requirements, except income, for these assistance categories, 36 but who are no longer receiving such benefits because of the implementation of Title XVI of 37 the federal Social Security Act, as amended; 38 (10) Pregnant women who meet the requirements for aid to families with dependent 39 children, except for the existence of a dependent child in the home; 40 (11) Pregnant women who meet the requirements for aid to families with dependent 41 children, except for the existence of a dependent child who is deprived of parental support as 42 provided for in subdivision (2) of subsection 1 of section 208.040; 43 (12) Pregnant women or infants under one year of age, or both, whose family income 44 does not exceed an income eligibility standard equal to one hundred eighty-five percent of the 45 federal poverty level as established and amended by the federal Department of Health and 46 Human Services, or its successor agency; 47 (13) Children who have attained one year of age but have not attained six years of age 48 who are eligible for medical assistance under Section 6401 of P.L. 101-239 (Omnibus Budget 49 Reconciliation Act of 1989) (42 U.S.C. Sections 1396a to 1396b). The family support 50 division shall use an income eligibility standard equal to one hundred thirty-three percent of 51 the federal poverty level established by the Department of Health and Human Services, or its 52 successor agency; 53 (14) Children who have attained six years of age but have not attained nineteen years 54 of age. For children who have attained six years of age but have not attained nineteen years HB 1382 3
55 of age, the family support division shall use an income assessment methodology which 56 provides for eligibility when family income is equal to or less than equal to one hundred 57 percent of the federal poverty level established by the Department of Health and Human 58 Services, or its successor agency. As necessary to provide MO HealthNet coverage under this 59 subdivision, the department of social services may revise the state MO HealthNet plan to 60 extend coverage under 42 U.S.C. Section 1396a(a)(10)(A)(i)(III) to children who have 61 attained six years of age but have not attained nineteen years of age as permitted by paragraph 62 (2) of subsection (n) of 42 U.S.C. Section 1396d using a more liberal income assessment 63 methodology as authorized by paragraph (2) of subsection (r) of 42 U.S.C. Section 1396a; 64 (15) The family support division shall not establish a resource eligibility standard in 65 assessing eligibility for persons under subdivision (12), (13) or (14) of this subsection. The 66 MO HealthNet division shall define the amount and scope of benefits which are available to 67 individuals eligible under each of the subdivisions (12), (13), and (14) of this subsection, in 68 accordance with the requirements of federal law and regulations promulgated thereunder; 69 (16) Notwithstanding any other provisions of law to the contrary, ambulatory prenatal 70 care shall be made available to pregnant women during a period of presumptive eligibility 71 pursuant to 42 U.S.C. Section 1396r-1, as amended; 72 (17) A child born to a woman eligible for and receiving MO HealthNet benefits under 73 this section on the date of the child's birth shall be deemed to have applied for MO HealthNet 74 benefits and to have been found eligible for such assistance under such plan on the date of 75 such birth and to remain eligible for such assistance for a period of time determined in 76 accordance with applicable federal and state law and regulations so long as the child is a 77 member of the woman's household and either the woman remains eligible for such assistance 78 or for children born on or after January 1, 1991, the woman would remain eligible for such 79 assistance if she were still pregnant. Upon notification of such child's birth, the family 80 support division shall assign a MO HealthNet eligibility identification number to the child so 81 that claims may be submitted and paid under such child's identification number; 82 (18) Pregnant women and children eligible for MO HealthNet benefits pursuant to 83 subdivision (12), (13) or (14) of this subsection shall not as a condition of eligibility for MO 84 HealthNet benefits be required to apply for aid to families with dependent children. The 85 family support division shall utilize an application for eligibility for such persons which 86 eliminates information requirements other than those necessary to apply for MO HealthNet 87 benefits. The division shall provide such application forms to applicants whose preliminary 88 income information indicates that they are ineligible for aid to families with dependent 89 children. Applicants for MO HealthNet benefits under subdivision (12), (13) or (14) of this 90 subsection shall be informed of the aid to families with dependent children program and that HB 1382 4
91 they are entitled to apply for such benefits. Any forms utilized by the family support division 92 for assessing eligibility under this chapter shall be as simple as practicable; 93 (19) Subject to appropriations necessary to recruit and train such staff, the family 94 support division shall provide one or more full-time, permanent eligibility specialists to 95 process applications for MO HealthNet benefits at the site of a health care provider, if the 96 health care provider requests the placement of such eligibility specialists and reimburses the 97 division for the expenses including but not limited to salaries, benefits, travel, training, 98 telephone, supplies, and equipment of such eligibility specialists. The division may provide a 99 health care provider with a part-time or temporary eligibility specialist at the site of a health 100 care provider if the health care provider requests the placement of such an eligibility specialist 101 and reimburses the division for the expenses, including but not limited to the salary, benefits, 102 travel, training, telephone, supplies, and equipment, of such an eligibility specialist. The 103 division may seek to employ such eligibility specialists who are otherwise qualified for such 104 positions and who are current or former welfare participants. The division may consider 105 training such current or former welfare participants as eligibility specialists for this program; 106 (20) Pregnant women who are eligible for, have applied for and have received MO 107 HealthNet benefits under subdivision (2), (10), (11) or (12) of this subsection shall continue 108 to be considered eligible for all pregnancy-related and postpartum MO HealthNet benefits 109 provided under section 208.152 until the end of the sixty-day period beginning on the last day 110 of their pregnancy. Pregnant women receiving mental health treatment for postpartum 111 depression or related mental health conditions within sixty days of giving birth shall, subject 112 to appropriations and any necessary federal approval, be eligible for MO HealthNet benefits 113 for mental health services for the treatment of postpartum depression and related mental 114 health conditions for up to twelve additional months. Pregnant women receiving substance 115 abuse treatment within sixty days of giving birth shall, subject to appropriations and any 116 necessary federal approval, be eligible for MO HealthNet benefits for substance abuse 117 treatment and mental health services for the treatment of substance abuse for no more than 118 twelve additional months, as long as the woman remains adherent with treatment. The 119 department of mental health and the department of social services shall seek any necessary 120 waivers or state plan amendments from the Centers for Medicare and Medicaid Services and 121 shall develop rules relating to treatment plan adherence. No later than fifteen months after 122 receiving any necessary waiver, the department of mental health and the department of social 123 services shall report to the house of representatives budget committee and the senate 124 appropriations committee on the compliance with federal cost neutrality requirements; 125 (21) Case management services for pregnant women and young children at risk shall 126 be a covered service. To the greatest extent possible, and in compliance with federal law and 127 regulations, the department of health and senior services shall provide case management HB 1382 5
128 services to pregnant women by contract or agreement with the department of social services 129 through local health departments organized under the provisions of chapter 192 or chapter 130 205 or a city health department operated under a city charter or a combined city-county health 131 department or other department of health and senior services designees. To the greatest extent 132 possible the department of social services and the department of health and senior services 133 shall mutually coordinate all services for pregnant women and children with the [crippled] 134 children's [program] special health care needs service, the prevention of intellectual 135 disability and developmental disability program and the prenatal care program administered 136 by the department of health and senior services. The department of social services shall by 137 regulation establish the methodology for reimbursement for case management services 138 provided by the department of health and senior services. For purposes of this section, the 139 term "case management" shall mean those activities of local public health personnel to 140 identify prospective MO HealthNet-eligible high-risk mothers and enroll them in the state's 141 MO HealthNet program, refer them to local physicians or local health departments who 142 provide prenatal care under physician protocol and who participate in the MO HealthNet 143 program for prenatal care and to ensure that said high-risk mothers receive support from all 144 private and public programs for which they are eligible and shall not include involvement in 145 any MO HealthNet prepaid, case-managed programs; 146 (22) By January 1, 1988, the department of social services and the department of 147 health and senior services shall study all significant aspects of presumptive eligibility for 148 pregnant women and submit a joint report on the subject, including projected costs and the 149 time needed for implementation, to the general assembly. The department of social services, 150 at the direction of the general assembly, may implement presumptive eligibility by regulation 151 promulgated pursuant to chapter 207; 152 (23) All participants who would be eligible for aid to families with dependent 153 children benefits except for the requirements of paragraph (d) of subdivision (1) of section 154 208.150; 155 (24) (a) All persons who would be determined to be eligible for old age assistance 156 benefits under the eligibility standards in effect December 31, 1973, as authorized by 42 157 U.S.C. Section 1396a(f), or less restrictive methodologies as contained in the MO HealthNet 158 state plan as of January 1, 2005; except that, on or after July 1, 2005, less restrictive income 159 methodologies, as authorized in 42 U.S.C. Section 1396a(r)(2), may be used to change the 160 income limit if authorized by annual appropriation; 161 (b) All persons who would be determined to be eligible for aid to the blind benefits 162 under the eligibility standards in effect December 31, 1973, as authorized by 42 U.S.C. 163 Section 1396a(f), or less restrictive methodologies as contained in the MO HealthNet state 164 plan as of January 1, 2005, except that less restrictive income methodologies, as authorized in HB 1382 6
165 42 U.S.C. Section 1396a(r)(2), shall be used to raise the income limit to one hundred percent 166 of the federal poverty level; 167 (c) All persons who would be determined to be eligible for permanent and total 168 disability benefits under the eligibility standards in effect December 31, 1973, as authorized 169 by 42 U.S.C. Section 1396a(f); or less restrictive methodologies as contained in the MO 170 HealthNet state plan as of January 1, 2005; except that, on or after July 1, 2005, less 171 restrictive income methodologies, as authorized in 42 U.S.C. Section 1396a(r)(2), may be 172 used to change the income limit if authorized by annual appropriations. Eligibility standards 173 for permanent and total disability benefits shall not be limited by age; 174 (25) Persons who have been diagnosed with breast or cervical cancer and who are 175 eligible for coverage pursuant to 42 U.S.C. Section 1396a(a)(10)(A)(ii)(XVIII). Such 176 persons shall be eligible during a period of presumptive eligibility in accordance with 42 177 U.S.C. Section 1396r-1. A person who receives a breast or cervical cancer screening service 178 of a type that is within the scope of screening services under Title XV of the Public Health 179 Service Act (42 U.S.C. Section 300k et seq.) and who otherwise meets the eligibility 180 requirements for medical assistance for treatment of breast or cervical cancer as provided 181 under this subdivision is eligible for medical assistance under this subdivision regardless of 182 whether the screening service was provided by a provider who receives or uses funds under 183 that title; 184 (26) Persons who are in foster care under the responsibility of the state of Missouri on 185 the date such persons attained the age of eighteen years, or at any time during the thirty-day 186 period preceding their eighteenth birthday, or persons who received foster care for at least six 187 months in another state, are residing in Missouri, and are at least eighteen years of age, 188 without regard to income or assets, if such persons: 189 (a) Are under twenty-six years of age; 190 (b) Are not eligible for coverage under another mandatory coverage group; and 191 (c) Were covered by Medicaid while they were in foster care; 192 (27) Any homeless child or homeless youth, as those terms are defined in section 193 167.020, subject to approval of a state plan amendment by the Centers for Medicare and 194 Medicaid Services; and 195 (28) (a) Subject to approval of any necessary state plan amendments or waivers, 196 beginning on July 6, 2023, pregnant women who are eligible for, have applied for, and have 197 received MO HealthNet benefits under subdivision (2), (10), (11), or (12) of this subsection 198 shall be eligible for medical assistance during the pregnancy and during the twelve-month 199 period that begins on the last day of the woman's pregnancy and ends on the last day of the 200 month in which such twelve-month period ends, consistent with the provisions of 42 U.S.C. 201 Section 1396a(e)(16). The department shall submit a state plan amendment to the Centers for HB 1382 7
202 Medicare and Medicaid Services when the number of ineligible MO HealthNet participants 203 removed from the program in 2023 pursuant to section 208.239 exceeds the projected number 204 of beneficiaries likely to enroll in benefits in 2023 under this subdivision and subdivision (2) 205 of subsection 6 of section 208.