Self-Sufficiency in Medicaid Act

Self-Sufficiency in Medicaid Act

 

Summary
This Act provides that the state’s Medicaid Program will institute a work requirement for able-bodied adults receiving services and benefits from the Medicaid program in {insert state}.
Model Legislation
Section 1. Short Title. This Act shall be known as the “Self-Sufficiency for Medicaid Act”
Section 2. Purpose. The purpose of the Act is to institute a requirement for able-bodied individuals who qualify for Medicaid to become employed, actively seek employment, enter into a job training or vocational program or volunteer for an IRS-designated nonprofit organization for a minimum of twenty hours per week.
Section 3. Definitions. When used in this Act, the following definitions apply:
(A) “Able-bodied” means an individual who is physically and mentally capable of working.
(B) “Adult” means an individual who is at least eighteen years of age.

Section 4. Self-Sufficiency in Medicaid Act.
A. On or before March 30 of each year, the Medicaid Director shall apply to the Centers for Medicare and Medicaid Services for waivers or amendments to the state plan to allow the state to institute a work requirement for able-bodied adults receiving services pursuant to this article. The work requirement shall require an eligible person to either:
1. Become employed.
2. Actively seek employment which would be verified by the department.
3. Attend a job or vocational training program.
4. Require an able-bodied, Medicaid eligible person to verify on a monthly basis any change in family income.
5. Require the Administration to confirm an eligible individual’s change in family income as reported and re-determine the individual’s eligibility under this Article.
6. Allow the Administration to ban an eligible person from enrollment for one year if the eligible person failed to report a change in family income or made a false statement regarding compliance with the requirements of subdivision (A) of this paragraph.
B. Under this Act, an exemption is allowed if a person meets any of the following conditions:

1. The individual is at least eighteen years of age but is still attending high school as a full-time student.
2. Is the sole caregiver of a family member who is under five years of age.

3. Is currently receiving temporary or permanent long-term disability benefits from a private insurer or from the government.
C. Under this Act, able-bodied adults must adhere to a lifetime limit of five years of benefits, unless the person meets any of the following conditions:
1. Is pregnant.
2. Is the sole caregiver of a family member who is under five years of age.
3. Is currently receiving temporary or permanent long-term disability benefits from a private insurer or from the government.
4. Is at least eighteen years of age but still attending high school as a full-time student.
5. Is employed full-time but continues to meet income eligibility requirements under this Article.
D. Under this Act, {insert state} should develop and impose meaningful co-payments to deter both:
1. The nonemergency use of emergency departments.
2. The use of ambulance services for nonemergency transportation or when it is not medically necessary.
E. On or before April 1 of each year, the Medicaid Director shall submit a letter confirming the submission of the waiver requests required under subsection A of this section to the Governor, the President of the Senate and the Speaker of the House of Representatives.

Section 5. {Severability Clause}
Section 6. {Repealer Clause}
Section 7. {Effective Date}