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| To enact sections 5111.0126, 5111.0127, and 5111.0128 | 1 |
| of the Revised Code to permit the Medicaid program | 2 |
| to cover the eligibility expansion group | 3 |
| authorized by the Patient Protection and | 4 |
| Affordable Care Act and to make an appropriation. | 5 |
| Section 1. That sections 5111.0126, 5111.0127, and 5111.0128 | 6 |
| of the Revised Code be enacted to read as follows: | 7 |
| Sec. 5111.0126. Subject to section 5111.0127 of the Revised | 8 |
| Code, the medicaid program may cover the group, or one or more | 9 |
| subgroups of the group, described in the "Social Security Act," | 10 |
| section 1902(a)(10)(A)(i)(VIII), 42 U.S.C. | 11 |
| 1396a(a)(10)(A)(i)(VIII), if the federal medical assistance | 12 |
| percentage for expenditures for medicaid services provided to the | 13 |
| group or subgroup is at least the amount specified in the "Social | 14 |
| Security Act," section 1905(y), 42 U.S.C. 1396d(y), as of March | 15 |
| 30, 2010. | 16 |
| Sec. 5111.0127. (A) The medicaid program shall cease to | 17 |
| cover the group, and any subgroup of the group, specified in | 18 |
| section 5111.0126 of the Revised Code if the federal medical | 19 |
| assistance percentage for expenditures for medicaid services | 20 |
| provided to the group or subgroup is lowered to an amount below | 21 |
| the amount specified in the "Social Security Act," section | 22 |
| 1905(y), 42 U.S.C. 1396d(y), as of March 30, 2010. If the medicaid | 23 |
| program ceases to cover the group, or any subgroup of the group | 24 |
| pursuant to this division, each individual enrolled in medicaid as | 25 |
| part of the group or subgroup shall be disenrolled from medicaid | 26 |
| on the first day of the month following the effective date of the | 27 |
| federal medical assistance percentage's reduction unless the | 28 |
| individual meets the eligibility requirements for another | 29 |
| eligibility group or subgroup. | 30 |
| (B)(1) If federal law or the United States department of | 31 |
| health and human services requires the state to reduce or | 32 |
| eliminate any tax, the medical assistance director may do either | 33 |
| of the following regarding the eligibility group, and any subgroup | 34 |
| of the group, specified in section 5111.0126 of the Revised Code: | 35 |
| (a) Terminate the medicaid program's coverage of the | 36 |
| eligibility group or subgroup; | 37 |
| (b) Alter the eligibility requirements for the group or | 38 |
| subgroup in a manner that causes fewer individuals to meet the | 39 |
| eligibility requirements. | 40 |
| (2) If the medical assistance director terminates the | 41 |
| medicaid program's coverage of the group or subgroup pursuant to | 42 |
| division (B)(1)(a) of this section, each individual enrolled in | 43 |
| medicaid as part of the group or subgroup shall be disenrolled | 44 |
| from medicaid on a date the director specifies unless the | 45 |
| individual meets the eligibility requirements for another | 46 |
| eligibility group or subgroup. | 47 |
| (3) If the medical assistance director alters the group's or | 48 |
| subgroup's eligibility requirements pursuant to division (B)(1)(b) | 49 |
| of this section, each individual enrolled in medicaid as part of | 50 |
| the group or subgroup shall be disenrolled from medicaid on a date | 51 |
| the director specifies unless the individual meets the altered | 52 |
| eligibility requirements or meets the eligibility requirements for | 53 |
| another eligibility group or subgroup. | 54 |
| (C) Notwithstanding section 5101.35 of the Revised Code, an | 55 |
| individual's disenrollment from medicaid pursuant to this section | 56 |
| is not subject to appeal under that section. | 57 |
| Sec. 5111.0128. (A) If the medicaid program covers the | 58 |
| group, or any subgroup of the group, specified in section | 59 |
| 5111.0126 of the Revised Code, the cost-sharing requirements | 60 |
| instituted under section 5111.0112 of the Revised Code do not | 61 |
| apply to any member of the group or subgroup who has countable | 62 |
| income exceeding one hundred per cent of the federal poverty line. | 63 |
| Instead, the office of medical assistance shall institute | 64 |
| cost-sharing requirements for such members of the group or | 65 |
| subgroup in accordance with this section. | 66 |
| (B) In instituting cost-sharing requirements under this | 67 |
| section, all of the following apply: | 68 |
| (1) The requirements shall not apply to any individual exempt | 69 |
| from the requirements pursuant to the "Social Security Act," | 70 |
| sections 1916 and 1916A, 42 U.S.C. 1396o and 1396o-1. | 71 |
| (2) The copayment amounts for drugs shall be not less than | 72 |
| the copayment amounts for drugs established under the cost-sharing | 73 |
| requirements instituted under section 5111.0112 of the Revised | 74 |
| Code. | 75 |
| (3) The copayment amount for nonemergency emergency | 76 |
| department services shall be higher than the copayment amount for | 77 |
| nonemergency emergency department services established under the | 78 |
| cost-sharing requirements instituted under section 5111.0112 of | 79 |
| the Revised Code. | 80 |
| (4) Copayments shall be established for at least all other | 81 |
| types of medicaid services that are subject to copayments included | 82 |
| in the cost-sharing requirements instituted under section | 83 |
| 5111.0112 of the Revised Code, and the copayment amounts for those | 84 |
| services may be higher than the copayment amounts for those | 85 |
| services under the cost-sharing requirements established under | 86 |
| that section. | 87 |
| (C) All of the following apply to the cost-sharing | 88 |
| requirements instituted under this section: | 89 |
| (1) Subject to division (C)(2) of this section, a medicaid | 90 |
| provider may refuse to provide a medicaid service to a medicaid | 91 |
| recipient who fails to pay the copayment for the service if the | 92 |
| recipient is subject to the copayment requirement. | 93 |
| (2) Before refusing to provide a medicaid service under | 94 |
| division (C)(1) of this section, a medicaid provider shall inform | 95 |
| the medicaid recipient whether an alternative medicaid service for | 96 |
| which there is no copayment is available. | 97 |
| (3) A medicaid provider may attempt to collect unpaid | 98 |
| copayments. | 99 |
| (4) A medicaid provider shall not waive a medicaid | 100 |
| recipient's obligation to pay a copayment. | 101 |
| (5) In the case of a medicaid provider that is a hospital, | 102 |
| the provider may take action to collect a copayment by providing, | 103 |
| at the time the provider provides hospital services to a medicaid | 104 |
| recipient subject to the copayment requirement, notice that a | 105 |
| copayment may be owed. | 106 |
| Section 2. All items in this section are hereby appropriated | 107 |
| as designated out of any moneys in the state treasury to the | 108 |
| credit of the designated fund. For all appropriations made in this | 109 |
| act, those in the first column are for fiscal year 2014 and those | 110 |
| in the second column are for fiscal year 2015. The appropriations | 111 |
| made in this act are in addition to any other appropriations made | 112 |
| for the FY 2014-FY 2015 biennium. | 113 |
| Appropriations |
| 114 | |
| General Revenue Fund | 115 |
| GRF | 651525 | Medicaid/Health Care Services | 116 | ||||||||
| State | $ | 0 | $ | 0 | 117 | ||||||
| Federal | $ | 499,665,563 | $ | 1,815,000,192 | 118 | ||||||
| Medicaid/Health Care Services Total | $ | 499,665,563 | $ | 1,815,000,192 | 119 | ||||||
| TOTAL GRF General Revenue Fund | 120 | ||||||||||
| State | $ | 0 | $ | 0 | 121 | ||||||
| Federal | $ | 499,665,563 | $ | 1,815,000,192 | 122 | ||||||
| GRF Total | $ | 499,665,563 | $ | 1,815,000,192 | 123 | ||||||
| TOTAL ALL BUDGET FUND GROUPS | $ | 499,665,563 | $ | 1,815,000,192 | 124 | ||||||
| Section 3. Within the limits set forth in this act, the | 126 |
| Director of Budget and Management shall establish accounts | 127 |
| indicating the source and amount of funds for each appropriation | 128 |
| made in this act, and shall determine the form and manner in which | 129 |
| appropriation accounts shall be maintained. Expenditures from | 130 |
| appropriations contained in this act shall be accounted for as | 131 |
| though made in the main operating appropriations act of the 130th | 132 |
| General Assembly. | 133 |
| The appropriations made in this act are subject to all | 134 |
| provisions of the main operating appropriations act of the 130th | 135 |
| General Assembly that are generally applicable to such | 136 |
| appropriations. | 137 |