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 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


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 Fund115

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