S. B. No. 117 As Introduced

As Introduced

130th General Assembly

Regular Session

2013-2014

S. B. No. 117

Senator Smith

Cosponsors: Senators Brown, Cafaro, Gentile, Kearney, Sawyer, Schiavoni, Skindell, Tavares, Turner

A BILL

To enact sections 5111.0126, 5111.0127, and 5111.0128

of the Revised Code to permit the Medicaid program

to cover the eligibility expansion group

authorized by the Patient Protection and

Affordable Care Act and to make an appropriation.

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

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

MCD DEPARTMENT OF MEDICAID	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