This bill clarifies that the intent of the general assembly by this bill is to remove barriers to employment for individuals who, but for income and resources, meet the federal Social Security definition of having a disability, by providing medical assistance to working individuals with disabilities through a buy-in program in accordance with federal law and Medicaid eligibility, including using less-restrictive income and resource requirements through the application of the Social Security Act and cost-sharing requirements established by the bureau and approved by the federal centers for medicare and medicaid services.
ESTABLISHMENT OF PROGRAM
This bill requires the bureau of TennCare ("bureau") to establish a buy-in program ("program") on or before January 1, 2025, for working individuals with disabilities that enables those individuals to access health insurance coverage through the medical assistance program, including as a supplement to employer-sponsored coverage. In establishing the program, the bureau:
(1) Must establish cost-sharing requirements for the program in accordance with federal law and this bill;
(2) Must establish and modify eligibility and cost-sharing requirements in order to administer the program within available funds;
(3) Must not establish eligibility restrictions for the program based upon a person's income, resources, or maximum age;
(4) May consider, when applicable, a person's income, excluding spousal income or assets, when establishing cost-sharing requirements;
(5) Must include a grace period that provides continuous coverage for an individual who experiences a temporary interruption of employment; and
(6) Must make every effort to coordinate benefits with employer-sponsored coverage available to the working individuals with disabilities receiving benefits under this state's law relative to programs and services for poor persons or other applicable law.
In establishing the buy-in program, this bill requires the bureau to utilize savings realized from the TennCare block grant funding agreement entered into with the federal government pursuant to state law.
This bill requires the bureau to seek federal approval to exclude resources accumulated in a separate account that result from earnings during an individual's enrollment in the program, including IRS-approved retirement accounts, when determining the individual's subsequent eligibility for another medical assistance program. This bill authorizes the director of TennCare ("director") to seek any federal waiver the director deems necessary to effectuate this bill.
PROGRAM DESCRIPTION
This bill requires the director to ensure that the program (i) provides categorically needy scope of care; (ii) provides home- and community-based long-term services and supports for an enrollee who meets the functional requirements for those programs, is approved for those services, and chooses to enroll in the program; (iii) approves coverage for six months effective the first of the month in which a person applies and meets program requirements; (iv) allows a person who is eligible for another TennCare program to choose not to participate in the program; and (v) deems a person ineligible for buy-in program coverage for a month in which the person received TennCare benefits under the medically needy program.
INDIVIDUAL ELIGIBILITY REQUIREMENTS
This bill requires the director to ensure that in order for a person to qualify for the program, the person must have residence in this state; have citizenship or immigration status in the United States; possess a valid social security account number; assign medical support rights to this state; be at least 18; meet federal disability requirements; and be employed full or part time, including self-employment.
This bill also requires the director to ensure that the program (i) does not require a resource test; (ii) requires that an enrollee comply with cost-sharing provisions; and (iii) allows a person who, once approved for the program, experiences a job loss to choose to continue program coverage through the original six months of eligibility, if the job loss results from an involuntary dismissal or health crisis, and the person continues to pay the monthly premium based on the person's income.
EMPLOYMENT REQUIREMENTS
For the purpose of the program, this bill requires the director to ensure that a person is considered to be employed if the person gets paid for working; has earnings that are subject to federal income tax; and, unless the person is self-employed, has payroll taxes deducted from earnings received.
PREMIUM PAYMENTS
When determining the premium amount a person must pay for participation in the buy-in program, this bill requires the director to ensure the following:
(1) The bureau counts only the income of the person approved for the program, and does not count the income of another household member;
(2) For purposes of determining countable income to be used in the premium calculation, the bureau applies the following rules: (i) income is considered available and owned when it is received and can be used to meet the person's needs for food, clothing, and shelter; and (ii) certain receipts are not income as described in federal rules;
(3) The program premium amount equals, rounded down to the nearest whole dollar, 5 percent of countable income described in (2) above, including both earned and unearned income;
(4) When determining the premium amount, the bureau uses the verified income amount until a change in income is reported and processed, unless good cause for delay in verifying changes exists; and
(5) A change in the premium amount is effective the month after the change in income is reported to and processed by the bureau.
When billing for and processing payments of buy-in program premiums, this bill requires the director to ensure the following:
(1) For current and ongoing coverage, the bureau bills for program premiums during the month following the benefit month;
(2) The first monthly premium begins the first full month of coverage;
(3) The bureau may terminate program coverage if premiums are not paid in full for four consecutive months;
(4) The person must pay the monthly premium in full to avoid losing program coverage and, if a person makes a partial payment, the payment does not count as a full payment toward the premium;
(5) Payments received are applied to premiums owed in the following order: (i) past due months, beginning with the most delinquent month; and (ii) the current coverage month that has been invoiced; and
(6) A person must pay a premium for any month that program coverage is provided, including months when a redetermination of coverage is made, months when continued coverage is requested, and during the period of an aid-pending eligibility appeal.