As Introduced

127th General Assembly
Regular Session
2007-2008
H. B. No. 106


Representatives Peterson, Stewart, D. 

Cosponsors: Representatives Stewart, J., Flowers, Carano, McGregor, J., Stebelton, Yuko, Seitz, Evans, Skindell, Chandler, Combs, Bacon, Hottinger, Setzer, White, Wagoner, Sykes, Strahorn, Wolpert 

A BILL
To amend sections 5111.011, 5111.0118, and 5111.851 1
and to enact sections 5111.182, 5111.70, 5111.701, 2
5111.702, 5111.703, 5111.704, 5111.705, 5111.706, 3
5111.707, 5111.708, 5111.709, and 5111.7010 of the 4
Revised Code to establish the Medicaid Buy-In for 5
Workers with Disabilities Program and a Medicaid 6
program for individuals who exhaust benefits under 7
a qualified long-term care insurance policy.8


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

       Section 1. That sections 5111.011, 5111.0118, and 5111.851 be 9
amended and sections 5111.182, 5111.70, 5111.701, 5111.702, 10
5111.703, 5111.704, 5111.705, 5111.706, 5111.707, 5111.708, 11
5111.709, and 5111.7010 of the Revised Code be enacted to read as 12
follows:13

       Sec. 5111.011. (A) The director of job and family services 14
shall adopt rules establishing eligibility requirements for the 15
medicaid program. The rules shall be adopted pursuant to section 16
111.15 of the Revised Code and shall be consistent with federal 17
and state law. The rules shall include rules that do all of the 18
following:19

       (1) Establish standards consistent with federal law for 20
allocating income and resources as income and resources of the 21
spouse, children, parents, or stepparents of a recipient of or 22
applicant for medicaid;23

       (2) Define the term "resources" as used in division (A)(1) of 24
this section;25

       (3) Specify the number of months that is to be used for the 26
purpose of the term "look-back date" used in section 5111.0116 of 27
the Revised Code;28

       (4) Establish processes to be used to determine both of the 29
following:30

       (a) The date an institutionalized individual's ineligibility 31
for services under section 5111.0116 of the Revised Code is to 32
begin;33

       (b) The number of months an institutionalized individual's 34
ineligibility for such services is to continue.35

       (5) Establish exceptions to the period of ineligibility that 36
an institutionalized individual would otherwise be subject to 37
under section 5111.0116 of the Revised Code;38

       (6) Define the term "other medicaid-funded long-term care 39
services" as used in sections 5111.0117 and, 5111.0118, and 40
5111.182 of the Revised Code;41

       (7) For the purpose of division (C)(2)(c) of section 42
5111.0117 of the Revised Code, establish the process to determine 43
whether the child of an aged, blind, or disabled individual is 44
financially dependent on the individual for housing.45

       (B) Notwithstanding any provision of state law, including 46
statutes, administrative rules, common law, and court rules, 47
regarding real or personal property or domestic relations, but 48
excluding sections 5111.0118 and 5111.182 of the Revised Code, the 49
standards established under rules adopted under division (A)(1) of 50
this section shall be used to determine eligibility for medicaid.51

       Sec. 5111.0118.  (A) Except as otherwise provided by this 52
section, no individual shall qualify for nursing facility services 53
or other medicaid-funded long-term care services if the 54
individual's equity interest in the individual's home exceeds five 55
hundred thousand dollars or, if the individual participates in the 56
program established under section 5111.182 of the Revised Code, 57
seven hundred fifty thousand dollars. The director of job and 58
family services shall increase this amountthese amounts effective 59
January 1, 2011, and the first day of each year thereafter, by the 60
percentage increase in the consumer price index for all urban 61
consumers (all items; United States city average), rounded to the 62
nearest one thousand dollars.63

       (B) This section does not apply to an individual if either of 64
the following applies:65

       (1) Either of the following lawfully reside in the 66
individual's home:67

       (a) The individual's spouse;68

       (b) The individual's child if the child is under twenty-one 69
years of age or, under 42 U.S.C. 1382c, considered blind or 70
disabled.71

       (2) The individual qualifies, pursuant to the process 72
established under division (C) of this section, for a waiver of 73
this section due to a demonstrated hardship.74

       (C) The director shall establish a process by which 75
individuals may obtain a waiver of this section due to a 76
demonstrated hardship. The process shall be consistent with the 77
process for such waivers established by the United States 78
secretary of health and human services under 42 U.S.C. 79
1396p(f)(4).80

       (D) Nothing in this section shall be construed as preventing 81
an individual from using a reverse mortgage or home equity loan to 82
reduce the individual's total equity interest in the home.83

       Sec. 5111.182.  (A) As used in this section:84

       (1) "Nursing facility services" means nursing facility 85
services covered by the medicaid program that a nursing facility, 86
as defined in section 5111.20 of the Revised Code, provides to a 87
resident of the nursing facility who is a medicaid recipient 88
eligible for medicaid-covered nursing facility services.89

       (2) "Other medicaid-funded long-term care services" has the 90
meaning specified in rules adopted under section 5111.011 of the 91
Revised Code.92

       (3) "Qualified long-term care insurance policy" means an 93
insurance policy that meets both of the following requirements:94

       (a) The insurance policy provides coverage for long-term care 95
services for at least three years that are comparable, as 96
determined by the director of job and family services, to nursing 97
facility services and other medicaid-funded long-term care 98
services.99

       (b) The insurance policy meets all the requirements that a 100
long-term care insurance policy must meet for the qualified state 101
long-term care insurance partnership program established under 102
section 5111.18 of the Revised Code.103

       (4) "Resources" has the meaning established in rules adopted 104
under section 5111.011 of the Revised Code.105

       (B) The director of job and family services shall establish a 106
program that enables an individual who exhausts the benefits 107
payable under a qualified long-term care insurance policy to 108
qualify for nursing facility services or other medicaid-funded 109
long-term care services without regard, except as provided in 110
section 5111.0118 of the Revised Code, to the value of the 111
individual's resources if the individual meets all other 112
eligibility requirements for, as applicable, nursing facility 113
services or other medicaid-funded long-term care services. The 114
program shall cover nursing facility services and other 115
medicaid-funded long-term care services, but an individual 116
participating in the program shall choose, subject to the 117
individual's eligibility for the services and the availability of 118
the other medicaid-funded long-term care services, whether to 119
receive nursing facility services or other medicaid-funded 120
long-term care services.121

       The director of job and family services may adopt rules in 122
accordance with Chapter 119. of the Revised Code as necessary to 123
implement this section.124

       Sec. 5111.70.  (A) As used in sections 5111.70 to 5111.7010 125
of the Revised Code:126

       (1) "Applicant" means an individual who applies to 127
participate in the medicaid buy-in for workers with disabilities 128
program.129

       (2) "Earned income" has the meaning established by rules 130
adopted under section 5111.707 of the Revised Code.131

       (3) "Employed individual with a medically improved 132
disability" has the same meaning as in 42 U.S.C. 1396d(v).133

       (4) "Family" means an applicant or participant and the spouse 134
and dependent children of the applicant or participant. If an 135
applicant or participant is under eighteen years of age, "family" 136
also means the parents of the applicant or participant.137

       (5) "Federal poverty guidelines" has the same meaning as in 138
section 5101.46 of the Revised Code.139

       (6) "Income" means earned income and unearned income.140

       (7) "Participant" means an individual who has been determined 141
eligible for the medicaid buy-in for workers with disabilities 142
program and is participating in the program.143

       (8) "Supplemental security income program" means the program 144
established under Title XVI of the "Social Security Act," 86 Stat. 145
1329 (1972), 42 U.S.C. 1381, as amended.146

       (9) "Medicaid buy-in for workers with disabilities program" 147
means the component of the medicaid program established under 148
sections 5111.70 to 5111.7010 of the Revised Code.149

       (10) "Unearned income" has the meaning established by rules 150
adopted under section 5111.707 of the Revised Code.151

       (B) Not later than ninety days after the effective date of 152
this section, the director of job and family services shall submit 153
to the United States secretary of health and human services an 154
amendment to the state medicaid plan and any federal waiver 155
necessary to establish the medicaid buy-in for workers with 156
disabilities program in accordance with 42 U.S.C. 1396a 157
(10)(A)(ii)(XV) and (XVI) and sections 5111.70 to 5111.7010 of the 158
Revised Code. The director shall implement sections 5111.701 to 159
5111.7010 of the Revised Code if the amendment and, if needed, 160
federal waiver are approved.161

       Sec. 5111.701.  Under the medicaid buy-in for workers with 162
disabilities program, an individual who does all of the following 163
in accordance with rules adopted under section 5111.707 of the 164
Revised Code qualifies for medical assistance under the medicaid 165
program:166

       (A) Applies for the medicaid buy-in for workers with 167
disabilities program;168

       (B) Provides satisfactory evidence of all of the following:169

       (1) That the individual is at least sixteen years of age and 170
under sixty-five years of age;171

       (2) Except as provided in section 5111.706 of the Revised 172
Code, that one of the following applies to the individual:173

       (a) The individual is considered disabled for the purpose of 174
the supplemental security income program, regardless of whether 175
the individual receives supplemental security income benefits.176

       (b) The individual is an employed individual with a medically 177
improved disability.178

       (3) That the value of the assets of the individual's family, 179
less assets and asset value disregarded pursuant to rules adopted 180
under section 5111.707 of the Revised Code, does not exceed the 181
amount provided for by section 5111.702 of the Revised Code;182

       (4) That the income of the individual's family, less amounts 183
disregarded pursuant to section 5111.703 of the Revised Code, does 184
not exceed two hundred fifty per cent of the federal poverty 185
guidelines;186

       (5) That the individual meets the additional eligibility 187
requirements for the medicaid buy-in for workers with disabilities 188
program that the director of job and family services establishes 189
in rules adopted under section 5111.707 of the Revised Code.190

       (C) To the extent required by section 5111.704 of the Revised 191
Code, pays the premium established under that section.192

       Sec. 5111.702.  (A) Except as provided in division (B) of 193
this section, the maximum value of assets, less assets and asset 194
value disregarded pursuant to rules adopted under section 5111.707 195
of the Revised Code, that an individual's family may have without 196
the individual exceeding the asset eligibility limit for the 197
medicaid buy-in for workers with disabilities program shall not 198
exceed ten thousand dollars.199

       (B) Each calendar year, the director of job and family 200
services shall adjust the asset eligibility limit specified in 201
division (A) of this section by the change in the consumer price 202
index for all items for all urban consumers for the previous 203
calendar year, as published by the United States bureau of labor 204
statistics. The annual adjustment shall go into effect on the 205
earliest date possible.206

       Sec. 5111.703.  For the purpose of determining whether an 207
individual is within the eligibility limit for the medicaid buy-in 208
for workers with disabilities program, all of the following apply:209

       (A) The first twenty thousand dollars of the individual's 210
earned income shall be disregarded.211

       (B) No amount that an employer of a member of the 212
individual's family pays to obtain health insurance for one or 213
more members of the family, including any amount of a premium 214
established under section 5111.704 of the Revised Code that the 215
employer pays, shall be treated as the income of the individual's 216
family.217

       (C) All other amounts disregarded pursuant to rules adopted 218
under section 5111.707 of the Revised Code shall be applied to the 219
income of the individual's family.220

       Sec. 5111.704.  (A) An individual whose family's income 221
exceeds one hundred fifty per cent of the federal poverty 222
guidelines shall pay an annual premium as a condition of 223
qualifying for the medicaid buy-in for workers with disabilities 224
program. The amount of the premium shall be determined as follows:225

       (1) Subtract one hundred fifty per cent of the federal 226
poverty guidelines, as applicable for a family size equal to the 227
size of the individual's family, from the amount of the income of 228
the individual's family;229

       (2) Subtract any amount a member of the individual's family 230
pays, whether by payroll deduction or otherwise, for other health 231
insurance for one or more members of the family from the 232
difference determined under division (A)(1) of this section;233

       (3) Multiply the difference determined under division (A)(2) 234
of this section by one tenth.235

       (B) No amount that an employer of a member of an individual's 236
family pays to obtain health insurance for one or more members of 237
the individual's family, including any amount of a premium 238
established under this section that the employer pays, shall be 239
treated as the income of the individual's family for the purpose 240
of this section.241

       Sec. 5111.705. No individual shall be denied eligibility for 242
the medicaid buy-in for workers with disabilities program on the 243
basis that the individual receives services under a home and 244
community-based services medicaid waiver component as defined in 245
section 5111.851 of the Revised Code.246

       Sec. 5111.706. An individual who had been participating in 247
the medicaid buy-in for workers with disabilities program as an 248
employed individual with a medically improved disability may 249
continue to participate in the program for up to six months even 250
though the individual ceases to be an employed individual with a 251
medically improved disability due to ceasing to be employed if the 252
individual continues to meet all other eligibility requirements 253
for the program.254

       Sec. 5111.707.  The director of job and family services shall 255
adopt rules in accordance with Chapter 119. of the Revised Code as 256
necessary to implement the medicaid buy-in for workers with 257
disabilities program. The rules shall do all of the following:258

       (A) Specify assets, asset values, and amounts to be 259
disregarded in determining asset and income eligibility limits for 260
the program;261

       (B) Establish meanings for the terms "earned income" and 262
"unearned income";263

       (C) Establish additional eligibility requirements for the 264
program that must be established for the United States secretary 265
of health and human services to approve the program.266

       Sec. 5111.708. (A) There is hereby created the medicaid 267
buy-in advisory council. The council shall consist of the 268
following members:269

       (1) The executive director of assistive technology of Ohio or 270
the executive director's designee;271

       (2) The director of the axis center for public awareness of 272
people with disabilities or the director's designee;273

       (3) The executive director of the cerebral palsy association 274
of Ohio or the executive director's designee;275

       (4) The chief executive officer of Ohio advocates for mental 276
health or the chief executive officer's designee;277

       (5) The state director of the Ohio chapter of the American 278
association of retired persons or the state director's designee;279

       (6) The director of the Ohio developmental disabilities 280
council created under section 5123.35 of the Revised Code or the 281
director's designee;282

       (7) The executive director of the governor's council on 283
people with disabilities created under section 3303.41 of the 284
Revised Code or the executive director's designee;285

       (8) The administrator of the legal rights service created 286
under section 5123.60 of the Revised Code or the administrator's 287
designee;288

       (9) The chairperson of the Ohio Olmstead task force or the 289
chairperson's designee;290

       (10) The executive director of the Ohio statewide independent 291
living council or the executive director's designee;292

       (11) The president of the Ohio chapter of the national 293
multiple sclerosis society or the president's designee;294

       (12) The executive director of the arc of Ohio or the 295
executive director's designee.296

       (B) All members of the medicaid buy-in advisory council shall 297
serve without compensation or reimbursement, except as serving on 298
the council is considered part of their usual job duties.299

       (C) The members of the medicaid buy-in advisory council shall 300
elect one of the members of the council to serve as the council's 301
chairperson for a two-year term. The chairperson may be re-elected 302
to successive terms. 303

       (D) The department of job and family services shall provide 304
the Ohio medicaid buy-in advisory council with accommodations for 305
the council to hold its meetings and shall provide the council 306
with other administrative assistance the council needs to perform 307
its duties.308

       Sec. 5111.709.  The director of job and family services or 309
the director's designee shall consult with the medicaid buy-in 310
advisory council before adopting, amending, or rescinding any 311
rules under section 5111.707 of the Revised Code governing the 312
medicaid buy-in for workers with disabilities program.313

        The director or designee shall meet quarterly with the 314
council to discuss the program. At the meetings, the council may 315
provide the director or designee with suggestions for improving 316
the program and the director or designee shall provide the council 317
with all of the following information:318

       (A) The number of individuals who participated in the program 319
the previous quarter;320

       (B) The cost of the program the previous quarter;321

       (C) The amount of revenue generated the previous quarter by 322
premiums that participants pay under section 5111.704 of the 323
Revised Code;324

       (D) The average amount of earned income of participants' 325
families;326

       (E) The average amount of time participants have participated 327
in the program;328

       (F) The types of other health insurance participants have 329
been able to obtain.330

       Sec. 5111.7010.  Not less than once each year, the director 331
of job and family services shall submit a report on the medicaid 332
buy-in for workers with disabilities program to the governor, 333
speaker and minority leader of the house of representatives, 334
president and minority leader of the senate, and chairpersons of 335
the house and senate committees to which the biennial operating 336
budget bill is referred. The report shall include all of the 337
following information:338

       (A) The number of individuals who participated in the 339
medicaid buy-in for workers with disabilities program;340

       (B) The cost of the program;341

       (C) The amount of revenue generated by premiums that 342
participants pay under section 5111.704 of the Revised Code;343

       (D) The average amount of earned income of participants' 344
families;345

       (E) The average amount of time participants have participated 346
in the program;347

       (F) The types of other health insurance participants have 348
been able to obtain.349

       Sec. 5111.851.  (A) As used in sections 5111.851 to 5111.855 350
of the Revised Code:351

       "Administrative agency" means, with respect to a home and 352
community-based services medicaid waiver component, the department 353
of job and family services or, if a state agency or political 354
subdivision contracts with the department under section 5111.91 of 355
the Revised Code to administer the component, that state agency or 356
political subdivision.357

        "Home and community-based services medicaid waiver component" 358
means a medicaid waiver component under which home and 359
community-based services are provided as an alternative to 360
hospital, nursing facility, or intermediate care facility for the 361
mentally retarded services.362

        "Hospital" has the same meaning as in section 3727.01 of the 363
Revised Code.364

        "Intermediate care facility for the mentally retarded" has 365
the same meaning as in section 5111.20 of the Revised Code.366

        "Level of care determination" means a determination of 367
whether an individual needs the level of care provided by a 368
hospital, nursing facility, or intermediate care facility for the 369
mentally retarded and whether the individual, if determined to 370
need that level of care, would receive hospital, nursing facility, 371
or intermediate care facility for the mentally retarded services 372
if not for a home and community-based services medicaid waiver 373
component.374

       "Medicaid buy-in for workers with disabilities program" means 375
the component of the medicaid program established under sections 376
5111.70 to 5111.7010 of the Revised Code.377

        "Nursing facility" has the same meaning as in section 5111.20 378
of the Revised Code.379

       "Patient liability" means the cost-sharing expenses for which 380
an individual receiving services under a home and community-based 381
services medicaid waiver component is responsible.382

        "Skilled nursing facility" means a facility certified as a 383
skilled nursing facility under Title XVIII of the "Social Security 384
Act," 79 Stat. 286 (1965), 42 U.S.C. 1395, as amended.385

        (B) The following requirements apply to each home and 386
community-based services medicaid waiver component:387

        (1) Only an individual who qualifies for a component shall 388
receive that component's services.389

        (2) A level of care determination shall be made as part of 390
the process of determining whether an individual qualifies for a 391
component and shall be made each year after the initial 392
determination if, during such a subsequent year, the 393
administrative agency determines there is a reasonable indication 394
that the individual's needs have changed.395

        (3) A written plan of care or individual service plan based 396
on an individual assessment of the services that an individual 397
needs to avoid needing admission to a hospital, nursing facility, 398
or intermediate care facility for the mentally retarded shall be 399
created for each individual determined eligible for a component.400

        (4) Each individual determined eligible for a component shall 401
receive that component's services in accordance with the 402
individual's level of care determination and written plan of care 403
or individual service plan.404

        (5) No individual may receive services under a component 405
while the individual is a hospital inpatient or resident of a 406
skilled nursing facility, nursing facility, or intermediate care 407
facility for the mentally retarded.408

        (6) No individual may receive prevocational, educational, or 409
supported employment services under a component if the individual 410
is eligible for such services that are funded with federal funds 411
provided under 29 U.S.C. 730 or the "Individuals with Disabilities 412
Education Act," 111 Stat. 37 (1997), 20 U.S.C. 1400, as amended.413

        (7) Safeguards shall be taken to protect the health and 414
welfare of individuals receiving services under a component, 415
including safeguards established in rules adopted under section 416
5111.85 of the Revised Code and safeguards established by 417
licensing and certification requirements that are applicable to 418
the providers of that component's services.419

        (8) No services may be provided under a component by a 420
provider that is subject to standards that 42 U.S.C. 1382e(e)(1) 421
requires be established if the provider fails to comply with the 422
standards applicable to the provider.423

        (9) Individuals determined to be eligible for a component, or 424
such individuals' representatives, shall be informed of that 425
component's services, including any choices that the individual or 426
representative may make regarding the component's services, and 427
given the choice of either receiving services under that component 428
or, as appropriate, hospital, nursing facility, or intermediate 429
care facility for the mentally retarded services.430

       (10) No individual shall lose eligibility for services under 431
a component on the basis that the individual also receives 432
services under the medicaid buy-in for workers with disabilities 433
program.434

       (11) No individual shall lose eligibility for services under 435
a component on the basis that the individual's income or assets 436
increase to an amount above the eligibility limit for the 437
component if the individual is participating in the medicaid 438
buy-in for workers with disabilities program and the amount of the 439
individual's income or assets does not exceed the eligibility 440
limit for the medicaid buy-in for workers with disabilities 441
program.442

       (12) No individual receiving services under a component shall 443
have any patient liability for the services for any period during 444
which the individual also participates in the medicaid buy-in for 445
workers with disabilities program.446

       Section 2. That existing sections 5111.011, 5111.0118, and 447
5111.851 of the Revised Code are hereby repealed.448

       Section 3. The Director of Job and Family Services shall call 449
the Medicaid Buy-In Advisory Council established under section 450
5111.708 of the Revised Code to meet for the first time not later 451
than sixty days after the effective date of this section.452