Bill Summary – FastDemocracy

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68th Legislature 2023                                                                                             LC 1508
                                       _____________ BILL NO. _____________
                   INTRODUCED BY _________________________________________________
                                            (Primary Sponsor)
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  A BILL FOR AN ACT ENTITLED: “AN ACT INCREASING THE ELIGIBILITY STANDARD FOR PREGNANT
  WOMEN UNDER THE MEDICAID PROGRAM; AMENDING SECTIONS 53-4-1110 AND 53-6-131, MCA; AND
  PROVIDING AN EFFECTIVE DATE.”
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  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
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          Section 1. Section 53-4-1110, MCA, is amended to read:
          "53-4-1110. (Temporary) Exemption from resource test. An otherwise applicable eligibility
  resource test provided for in 53-6-113(6) and 53-6-131(9) does not apply to plan applicants. (Terminates June
  30, 2025, on occurrence of contingency--sec. 48, Ch. 415, L. 2019.)
          53-4-1110. (Effective on occurrence of contingency) Exemption from resource test. An
  otherwise applicable eligibility resource test provided for in 53-6-113(6) and 53-6-131(8) does not apply to plan
  applicants."
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          Section 2. Section 53-6-131, MCA, is amended to read:
          "53-6-131. (Temporary) Eligibility requirements. (1) Medical assistance under the Montana
  medicaid program may be granted to a U.S. citizen or a qualified alien as defined in 8 U.S.C. 1641 who is
  determined by the department of public health and human services to be a Montana resident and, in its
  discretion, to be eligible as follows:
          (a)      The person receives or is considered to be receiving supplemental security income benefits
  under Title XVI of the Social Security Act, 42 U.S.C. 1381, et seq., and does not have income or resources in
  excess of the applicable medical assistance limits.
          (b)      The person would be eligible for assistance under the program described in subsection (1)(a) if
  that person were to apply for that assistance.
          (c)      The person is in a medical facility that is a medicaid provider and, but for residence in the
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68th Legislature 2023                                                                                               LC 1508
  facility, the person would be receiving assistance under the program in subsection (1)(a).
          (d)      The person is:
          (i)      under 21 years of age and in foster care under the supervision of the state or was in foster care
  under the supervision of the state and has been adopted as a child with special needs; or
          (ii)     under 18 years of age and is in a guardianship subsidized by the department pursuant to 41-3-
  444.
          (e)      The person meets the nonfinancial criteria of the categories in subsections (1)(a) through (1)(d)
  and:
          (i)      the person's income does not exceed the income level specified for federally aided categories
  of assistance and the person's resources are within the resource standards of the federal supplemental security
  income program; or
          (ii)     the person, while having income greater than the medically needy income level specified for
  federally aided categories of assistance:
          (A)      has an adjusted income level, after incurring medical expenses, that does not exceed the
  medically needy income level specified for federally aided categories of assistance or, alternatively, has paid in
  cash to the department the amount by which the person's income exceeds the medically needy income level
  specified for federally aided categories of assistance; and
          (B)      (I) in the case of a person who meets the nonfinancial criteria for medical assistance because
  the person is aged, blind, or disabled, has resources that do not exceed the resource standards of the federal
  supplemental security income program; or
          (II)     in the case of a person who meets the nonfinancial criteria for medical assistance because the
  person is pregnant, is an infant or child, or is the caretaker of an infant or child, has resources that do not
  exceed the resource standards adopted by the department.
          (f)      The person is a qualified pregnant woman or a child as defined in 42 U.S.C. 1396d(n).
          (g)      The person is under 19 years of age and lives with a family having a combined income that
  does not exceed 185% of the federal poverty level. The department may establish lower income levels to the
  extent necessary to maximize federal matching funds provided for in 53-4-1104.
          (2)      The department shall require an applicant to provide proof of the applicant's residency in this
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68th Legislature 2023                                                                                                LC 1508
  state.
            (3)       (a) The department may establish income and resource limitations. Limitations of income and
  resources must be within the amounts permitted by federal law for the medicaid program. Any otherwise
  applicable eligibility resource test prescribed by the department does not apply to enrollees in the healthy
  Montana kids plan provided for in 53-4-1104.
            (b)       The department may not count as a resource an individual retirement account that was
  established by a person participating in the medicaid program for workers with disabilities provided for in 53-6-
  195 if:
            (i)       the person is no longer eligible for coverage under 53-6-195; and
            (ii)      the individual retirement account was established during the time the person was receiving
  benefits through the medicaid program for workers with disabilities.
            (4)       (a) The department may not require a person who is eligible for medicaid under subsection
  (1)(e)(ii)(A) to:
            (i)       make only a cash payment to qualify for medicaid under that subsection; or
            (ii)      only incur medical expenses as a means of qualifying for medicaid under that subsection.
            (b)       If a person eligible for medicaid under subsection (1)(e)(ii)(A) is participating in a home and
  community-based services waiver, the department shall count as an eligible medical expense any medical
  service or item that a nonwaiver medicaid applicant is allowed to count as a medical expense to qualify for
  medicaid under subsection (1)(e)(ii)(A).
            (c)       Nothing in this subsection (4) may be construed as preventing a person from making only a
  cash payment to qualify for medicaid pursuant to subsection (1)(e)(ii)(A).
            (5)       The Montana medicaid program shall pay, as required by federal law, the premiums necessary
  for medicaid-eligible persons participating in the medicare program and may, within the discretion of the
  department, pay all or a portion of the medicare premiums, deductibles, and coinsurance for a qualified
  medicare-eligible person or for a qualified disabled and working individual, as defined in section 6408(d)(2) of
  the federal Omnibus Budget Reconciliation Act of 1989, Public Law 101-239, who:
            (a)       has income that does not exceed income standards as may be required by the Social Security
  Act; and
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68th Legislature 2023                                                                                                LC 1508
          (b)      has resources that do not exceed standards that the department determines reasonable for
  purposes of the program.
          (6)      The department may pay a medicaid-eligible person's expenses for premiums, coinsurance,
  and similar costs for health insurance or other available health coverage, as provided in 42 U.S.C. 1396b(a)(1).
          (7)      In accordance with waivers of federal law that are granted by the secretary of the U.S.
  department of health and human services, the department of public health and human services may grant
  eligibility for basic medicaid benefits as described in 53-6-101 to an individual receiving section 1931 medicaid
  benefits, as defined in 53-4-602, as the specified caretaker relative of a dependent child under the section 1931
  medicaid program. A recipient who is pregnant, meets the criteria for disability provided in Title II of the Social
  Security Act, 42 U.S.C. 416, et seq., or is less than 21 years of age is entitled to full medicaid coverage, as
  provided in 53-6-101.
          (8)      The department, under the Montana medicaid program, may provide, if a waiver is not
  available from the federal government, medicaid and other assistance mandated by Title XIX of the Social
  Security Act, 42 U.S.C. 1396, et seq., as may be amended, and not specifically listed in this part to categories
  of persons that may be designated by the act for receipt of assistance.
          (9)      Notwithstanding any other provision of this chapter, medical assistance must be provided to
  infants and pregnant women whose family income does not exceed income standards adopted by the
  department that comply with the requirements of 42 U.S.C. 1396a(l)(2)(A)(i) and whose family resources do not
  exceed standards that the department determines reasonable for purposes of the program 185% of the federal
  poverty level.
          (10)     Subject to appropriations, the department may cooperate with and make grants to a nonprofit
  corporation that uses donated funds to provide basic preventive and primary health care medical benefits to
  children whose families are ineligible for the Montana medicaid program and who are ineligible for any other
  health care coverage, are under 19 years of age, and are enrolled in school if of school age.
          (11)     A person described in subsection (9) must be provided continuous eligibility for medical
  assistance, as authorized in 42 U.S.C. 1396a(e)(5) through (e)(7).
          (12)     Full medical assistance under the Montana medicaid program may be granted to an individual
  during the period in which the individual requires treatment of breast or cervical cancer, or both, or of a
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68th Legislature 2023                                                                                                LC 1508
  precancerous condition of the breast or cervix, if the individual:
          (a)         has been screened for breast and cervical cancer under the Montana breast and cervical
  health program funded by the centers for disease control and prevention program established under Title XV of
  the Public Health Service Act, 42 U.S.C. 300k, or in accordance with federal requirements;
          (b)         needs treatment for breast or cervical cancer, or both, or a precancerous condition of the
  breast or cervix;
          (c)         is not otherwise covered under creditable coverage, as provided by federal law or regulation;
          (d)         is not eligible for medical assistance under any mandatory categorically needy eligibility group;
  and
          (e)         has not attained 65 years of age.
          (13)        Subject to the limitation in 53-6-195, the department shall provide medicaid coverage to
  workers with disabilities as provided in 53-6-195 and in accordance with 42 U.S.C. 1396a(a)(10)(A)(ii)(XIII) and
  (r)(2) and 42 U.S.C. 1396o.
          (14)        Nothing in subsection (1) may be construed as allowing the department to deny enrollment for
  a reason that is impermissible under federal law or regulation. (Terminates June 30, 2025, on occurrence of
  contingency--sec. 48, Ch. 415, L. 2019.)
          53-6-131. (Effective on occurrence of contingency) Eligibility requirements. (1) Medical
  assistance under the Montana medicaid program may be granted to a person who is determined by the
  department of public health and human services, in its discretion, to be eligible as follows:
          (a)         The person receives or is considered to be receiving supplemental security income benefits
  under Title XVI of the Social Security Act, 42 U.S.C. 1381, et seq., and does not have income or resources in
  excess of the applicable medical assistance limits.
          (b)         The person would be eligible for assistance under the program described in subsection (1)(a) if
  that person were to apply for that assistance.
          (c)         The person is in a medical facility that is a medicaid provider and, but for residence in the
  facility, the person would be receiving assistance under the program in subsection (1)(a).
          (d)         The person is:
          (i)         under 21 years of age and in foster care under the supervision of the state or was in foster care
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68th Legislature 2023                                                                                               LC 1508
  under the supervision of the state and has been adopted as a child with special needs; or
          (ii)     under 18 years of age and is in a guardianship subsidized by the department pursuant to 41-3-
  444.
          (e)      The person meets the nonfinancial criteria of the categories in subsections (1)(a) through (1)(d)
  and:
          (i)      the person's income does not exceed the income level specified for federally aided categories
  of assistance and the person's resources are within the resource standards of the federal supplemental security
  income program; or
          (ii)     the person, while having income greater than the medically needy income level specified for
  federally aided categories of assistance:
          (A)      has an adjusted income level, after incurring medical expenses, that does not exceed the
  medically needy income level specified for federally aided categories of assistance or, alternatively, has paid in
  cash to the department the amount by which the person's income exceeds the medically needy income level
  specified for federally aided categories of assistance; and
          (B)      (I) in the case of a person who meets the nonfinancial criteria for medical assistance because
  the person is aged, blind, or disabled, has resources that do not exceed the resource standards of the federal
  supplemental security income program; or
          (II)     in the case of a person who meets the nonfinancial criteria for medical assistance because the
  person is pregnant, is an infant or child, or is the caretaker of an infant or child, has resources that do not
  exceed the resource standards adopted by the department.
          (f)      The person is a qualified pregnant woman or a child as defined in 42 U.S.C. 1396d(n).
          (g)      The person is under 19 years of age and lives with a family having a combined income that
  does not exceed 185% of the federal poverty level. The department may establish lower income levels to the
  extent necessary to maximize federal matching funds provided for in 53-4-1104.
          (2)      (a) The department may establish income and resource limitations. Limitations of income and
  resources must be within the amounts permitted by federal law for the medicaid program. Any otherwise
  applicable eligibility resource test prescribed by the department does not apply to enrollees in the healthy
  Montana kids plan provided for in 53-4-1104.
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68th Legislature 2023                                                                                                LC 1508
            (b)       The department may not count as a resource an individual retirement account that was
  established by a person participating in the medicaid program for workers with disabilities provided for in 53-6-
  195 if:
            (i)       the person is no longer eligible for coverage under 53-6-195; and
            (ii)      the individual retirement account was established during the time the person was receiving
  benefits through the medicaid program for workers with disabilities.
            (3)       The Montana medicaid program shall pay, as required by federal law, the premiums necessary
  for medicaid-eligible persons participating in the medicare program and may, within the discretion of the
  department, pay all or a portion of the medicare premiums, deductibles, and coinsurance for a qualified
  medicare-eligible person or for a qualified disabled and working individual, as defined in section 6408(d)(2) of
  the federal Omnibus Budget Reconciliation Act of 1989, Public Law 101-239, who:
            (a)       has income that does not exceed income standards as may be required by the Social Security
  Act; and
            (b)       has resources that do not exceed standards that the department determines reasonable for
  purposes of the program.
            (4)       (a) The department may not require a person who is eligible for medicaid under subsection
  (1)(e)(ii)(A) to:
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