North Carolina § 108A-66 - 1. Medicaid buy-in for workers with disabilities.

§ 108A-66. 1. Medicaid buy-in for workers with disabilities.

Title. - This section may be cited as the Health Coverage for Workers With Disabilities Act. The Department shall implement a Medicaid buy-in eligibility category as permitted under P.L. 106-170, Ticket to Work and Work Incentives Improvement Act of 1999. The Department shall establish rules, policies, and procedures to implement this act in accordance with this section. Definitions. - As used in this section, unless the context clearly requires otherwise: "FPG" means the federal poverty guidelines. "HCWD" means Health Coverage for Workers With Disabilities. "SSI" means Supplemental Security Income. "Ticket to Work" means the Ticket to Work and Work Incentives Improvement Act of 1999. Eligibility. - An individual is eligible for HCWD if: The individual is at least 16 years of age and is less than 65 years of age; The individual meets Social Security Disability criteria, or the individual has been enrolled in HCWD and then becomes medically improved as defined in Ticket to Work and as further specified by the Department. An individual shall be determined to be eligible under this section without regard to the individual's ability to engage in, or actual engagement in, substantial gainful activity as defined in section 223 of the Social Security Act (42 U.S.C. § 423(d)(4)). In conducting annual redetermination of eligibility, the Department may not determine that an individual participating in HCWD is no longer disabled based solely on the individual's participation in employment or earned income; The individual's unearned income does not exceed one hundred fifty percent (150%) of FPG, and countable resources for the individual do not exceed the resource limit for the minimum community spouse resource standard under 42 U.S.C. § 1396r, and as further determined by the Department. In determining an individual's countable income and resources, the Department may not consider income or resources that are disregarded under the State Medical Assistance Plan's financial methodology, including the sixty-five-dollar ($65.00) disregard, impairment-related work expenses, student earned-income exclusions, and other SSI program work incentive income disregards; and The individual is engaged in a substantial and reasonable work effort (employed) as provided in this subdivision and as further defined by the Department and allowable under federal law. For purposes of this subsection, "engaged in substantial and reasonable work effort" means all of the following: Working in a competitive, inclusive work setting, or self-employed. Earning at least the applicable minimum wage. Having monthly earnings above the SSI basic sixty-five-dollar ($65.00) earned-income disregard. Being able to provide evidence of paying applicable Medicare, Social Security, and State and federal income taxes. Fees, Premiums, and Co-Payments. - Individuals who participate in HCWD and have countable income greater than one hundred fifty percent (150%) of FPG shall pay an annual enrollment fee of fifty dollars ($50.00) to their county department of social services. Individuals who participate in HCWD and have countable income greater than or equal to two hundred percent (200%) of FPG shall pay a monthly premium in addition to the annual fee. The Department shall set a sliding scale for premiums, which is consistent with applicable federal law. An individual with countable income equal to or greater than four hundred fifty percent (450%) of FPG shall pay not less than one hundred percent (100%) of the cost of the premium, as determined by the Department. The premium shall be based on the experience of all individuals participating in the Medical Assistance Program. Individuals who participate in HCWD are subject to co-payments equal to those required under the Medical Assistance Program. The Department may impose additional earnings requirements in defining "engaged in substantial and reasonable work effort" for individuals who are eligible for HCWD based on medical improvement. Individuals who participate in HCWD but thereafter become unemployed for involuntary reasons, including health reasons, shall have continued eligibility in HCWD for up to 12 months from the time of involuntary unemployment, so long as the individual (i) maintains a connection with the workforce, as determined by the Department, (ii) meets all other eligibility criteria for HCWD during the period, and (iii) pays applicable fees, premiums, and co-payments. History (2005-276, s. 10.18(a); 2006-66, s. 10.9(a); 2007-144, s. 2; 2009-451, s. 10.69; 2013-360, s. 12H.10(f).) Editor's Note. - Session Laws 2013-360, s. 38.6, recodified G.S. 108A-54.1 as G.S. 108A-66.1 by Session Laws 2013-360, s. 12H.10(f), effective July 1, 2013. Session Laws 2013-360, s. 12H.10(a)-(e), provides: "(a) Families and children who are categorically and medically needy are eligible for Medicaid, subject to the following annual income levels: Categorical ly Medically Family Needy Needy Size Income Level Income Level 1 $4,344 $2,900 2 5,664 3,800 3 6,528 4,400 4 7,128 4,800 5 7,776 5,200 6 8,376 5,600 7 8,952 6,000 8 9,256 6,300 "The Department of Health and Human Services shall provide Medicaid coverage to 19- and 20-year-olds under this subsection in accordance with federal rules and regulations. Medicaid enrollment of categorically needy families with children shall be continuous for one year without regard to changes in income or assets. "(b) For the following Medicaid eligibility classifications for which the federal poverty guidelines are used as income limits for eligibility determinations, the income limits will be updated each April 1 immediately following publication of federal poverty guidelines. The Department of Health and Human Services, Division of Medical Assistance, shall provide Medicaid coverage to the following: "(1) All elderly, blind, and disabled people who have incomes equal to or less than one hundred percent (100%) of the federal poverty guidelines. "(2) Pregnant women with incomes equal to or less than one hundred eighty-five percent (185%) of the federal poverty guidelines and without regard to resources. Services to pregnant women eligible under this subsection continue throughout the pregnancy but include only those related to pregnancy and to those other conditions determined by the Department as conditions that may complicate pregnancy. "(3) Infants under the age of one with family incomes equal to or less than two hundred percent (200%) of the federal poverty guidelines and without regard to resources. "(4) Children aged one through five with family incomes equal to or less than two hundred percent (200%) of the federal poverty guidelines and without regard to resources. "(5) Effective until January 1, 2014, children aged six through 18 with family incomes equal to or less than one hundred percent (100%) of the federal poverty guidelines and without regard to resources. "(6) Effective January 1, 2014, children aged six through 18 with family incomes equal to or less than one hundred thirty-three percent (133%) of the federal poverty guidelines and without regard to resources. "(7) Workers with disabilities described in G.S. 108A-66 A with unearned income equal to or less than one hundred fifty percent (150%) of the federal poverty guidelines. "The Department of Health and Human Services, Division of Medical Assistance, shall also provide family planning services to men and women of childbearing age with family incomes equal to or less than one hundred eighty-five percent (185%) of the federal poverty guidelines and without regard to resources. "(c) The Department of Health and Human Services, Division of Medical Assistance, shall provide Medicaid coverage to adoptive children with special or rehabilitative needs, regardless of the adoptive family's income. "(d) The Department of Health and Human Services, Division of Medical Assistance, shall provide Medicaid coverage to 'independent foster care adolescents,' ages 18, 19, and 20, as defined in section 1905(w)(1) of the Social Security Act (42 U.S.C. § 1396d(w)(1)), without regard to the adolescent's assets, resources, or income levels. "(e) The Department of Health and Human Services, Division of Medical Assistance, shall provide Medicaid coverage to women who need treatment for breast or cervical cancer and who are defined in 42 U.S.C. § 1396a(a)(10)(A)(ii)(XVIII)." This section is former G.S. 108A-54.1 , as recodified by Session Laws 2013-360, s. 12H.10(f), effective July 1, 2013. The historical citation from the former section has been retained in this section as recodified. Session Laws 2013-360, s. 1.1, provides: "This act shall be known as the 'Current Operations and Capital Improvements Appropriations Act of 2013.'" Session Laws 2013-360, s. 38.5 is a severability clause. Effect of Amendments. - Session Laws 2009-451, s. 10.69, effective July 1, 2009, substituted "Medical Assistance Program" for "North Carolina Health Choice Program" in the last sentence of subsection (d). Session Laws 2013-360, s. 12H.10(f), effective July 1, 2013, substituted "section" for "act" in subsection (a).