MISSISSIPPI LEGISLATURE

1997 Regular Session

To: Public Health and Welfare; Appropriations

By: Representative Reeves

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. (1) (a) If an institutionalized or noninstitutionalized individual, or the spouse of such an individual, disposes of assets for less than fair market value on or after the look-back date specified in paragraph (b) of this subsection, the individual shall be ineligible for medical assistance under this article and for any services authorized under this article during the period beginning on the first day of the month during or after which the assets were transferred for less than fair market value and equal to the number of months specified in paragraph (c) of this subsection.

(b) (i) The look-back date for an institutionalized individual is a date that is thirty-six (36) months before the first date as of which the individual both is an institutionalized individual and has applied for medical assistance under this article.

(ii) The look-back date for a noninstitutionalized individual is a date that is thirty-six (36) months before the later of the date on which the individual applies for medical assistance under this article or the date on which the individual disposes of assets for less than fair market value.

(c) The number of months of ineligibility for an institutionalized or noninstitutionalized individual shall be equal to the total, cumulative uncompensated value of all assets transferred by the individual or the individual's spouse on or after the look-back date specified in paragraph (b) of this subsection, divided by the average monthly cost to a private patient of nursing facility services in the state at the time of application.

(2) An individual shall not be ineligible for medical assistance under this article under the provisions of subsection (1) of this section to the extent that:

(a) The assets transferred were a home and title to the home was transferred to:

(i) The spouse of such individual;

(ii) A child of such individual who is under age twenty-one (21) years, or is blind or disabled;

(iii) A sibling of such individual who has an equity interest in such home and who was residing in such individual's home for a period of at least one (1) year immediately before the date the individual becomes an institutionalized individual; or

(iv) A son or daughter of such individual who was residing in such individual's home for a period of at least two (2) years immediately before the date the individual becomes an institutionalized individual, and who provided care to such individual that permitted such individual to reside at home rather than in such an institution or facility;

(b) The assets:

(i) Were transferred to the individual's spouse or to another for the sole benefit of the individual's spouse;

(ii) Were transferred from the individual's spouse to another for the sole benefit of the individual's spouse;

(iii) Were transferred to, or to a trust established solely for the benefit of, the individual's child who is blind or disabled; or

(iv) Were transferred to a trust established solely for the benefit of an individual under sixty-five (65) years of age who is disabled;

(c) A satisfactory showing is made to the Division of Medicaid that:

(i) The individual intended to dispose of the assets either at fair market value or for other valuable consideration;

(ii) The assets were transferred exclusively for a purpose other than to qualify for medical assistance under this article; or

(iii) All assets transferred for less than fair market value have been returned to the individual; or

(d) The Division of Medicaid determines that the denial of eligibility for medical assistance would work an undue hardship.

(3) As used in this section, the term:

(a) "Assets" includes all income and resources of an individual and of the individual's spouse.

(b) "Institutionalized individual" means an individual who is an inpatient in a nursing facility, or who is an inpatient in a medical institution and with respect to whom payment is made based on a level of care provided in a nursing facility.

(c) "Noninstitutionalized individual" means an individual who is not an institutionalized individual.

SECTION 2. Any woman who applies for medical assistance under this article for herself and for one or more children shall be ineligible for medical assistance for herself and for any such child for whom paternity has not been acknowledged by the father or determined by a court. If paternity of the child or children has been acknowledged or judicially determined, the Division of Medicaid first must determine, before the woman and the child or children may be eligible for medical assistance, whether the father of the child or children has access to reasonably-priced health insurance that covers or could cover his children. If the division determines that the father has access to such insurance and that the woman and the child or children would otherwise be eligible for medical assistance under this article, the division shall establish for the woman and the child or children, as a condition of remaining eligible for medical assistance and the services authorized under this article, that the health insurance of the father shall be primarily responsible for payment of the costs of medical care for any child who is covered or could be covered under the health insurance and that the division shall be responsible only for the costs of medical care covered under this article that are not or could not be paid for by the health insurance of the father.

SECTION 3. (1) Each recipient of medical assistance under this article shall have his or her eligibility evaluated each month by the Division of Medicaid to determine if the recipient has access to reasonably-priced health insurance that covers or could cover him or her, and to determine if the recipient is employed.

(2) If the division determines that the recipient has access to such insurance, the division shall establish for the recipient, as a condition of his or her remaining eligible for medical assistance and the services authorized under this article, that the health insurance under which the recipient is covered or could be covered shall be primarily responsible for payment of the costs of medical care for the recipient and that the division shall be responsible only for the costs of medical care covered under this article that are not or could not be paid for by the health insurance.

(3) If the division determines that the recipient is not employed, the recipient must provide a valid, verifiable reason for not being employed in order to remain eligible for medical assistance. Valid reasons for unemployment shall be specified in regulations adopted by the division. If the recipient is employed and has income sufficient to pay a portion of the costs of his or her medical care, the division shall require the recipient to utilize a percentage of his or her income for payment of the costs of his or her medical care in order to remain eligible for medical assistance. The amount of a recipient's income that is deemed to be sufficient to pay a portion of the costs of his or her medical care and the percentage of income that must be utilized by each recipient for payment of medical care costs shall be specified in regulations adopted by the division and shall take into consideration the necessary expenses of individual recipients.

SECTION 4. Section 43-13-115, Mississippi Code of 1972, is amended as follows:

43-13-115. A. Recipients of medical assistance shall be the following persons only:

(1) Who are qualified for public assistance grants under provisions of Title IV-A and E of the Federal Social Security Act, as amended, including those statutorily deemed to be IV-A as determined by the State Department of Human Services and certified to the Division of Medicaid, but not optional groups unless otherwise specifically covered in this section.

(2) Those qualified for Supplemental Security Income (SSI) benefits under Title XVI of the Federal Social Security Act, as amended. The eligibility of individuals covered in this paragraph shall be determined by the Social Security Administration and certified to the Division of Medicaid.

(3) Qualified pregnant women as defined in Section 1905(n) of the Federal Social Security Act, as amended, and as determined to be eligible by the State Department of Human Services and certified to the Division of Medicaid, who:

(a) Would be eligible for aid to families with dependent children under Part A of Title IV (or would be eligible for such aid if coverage under the state plan under Part A of Title IV included aid to families with dependent children of unemployed parents pursuant to Section 407 of Title IV-A of the Federal Social Security Act, as amended) if her child had been born and was living with her in the month such aid would be paid, and such pregnancy has been medically verified; or

(b) Is a member of a family which would be eligible for aid under the state plan under Part A of Title IV of the Federal Social Security Act, as amended, pursuant to Section 407 if the plan required the payment of aid pursuant to such section.

(4) Qualified children who are under five (5) years of age, who were born after September 30, 1983, and who meet the income and resource requirements of the state plan under Part A of Title IV of the Federal Social Security Act, as amended. The eligibility of individuals covered in this paragraph shall be determined by the State Department of Human Services and certified to the Division of Medicaid.

(5) A child born on or after October 1, 1984, to a woman eligible for and receiving medical assistance under the state plan on the date of the child's birth shall be deemed to have applied for medical assistance and to have been found eligible for such assistance under such plan on the date of such birth and will remain eligible for such assistance for a period of one (1) year so long as the child is a member of the woman's household and the woman remains eligible for such assistance or would be eligible for assistance if pregnant. The eligibility of individuals covered in this paragraph shall be determined by the State Department of Human Services and certified to the Division of Medicaid.

(6) Children certified by the State Department of Human Services to the Division of Medicaid of whom the state and county human services agency has custody and financial responsibility, and children who are in adoptions subsidized in full or part by the Department of Human Services, who are approvable under Title XIX of the Medicaid program.

(7) (a) Persons certified by the Division of Medicaid who are patients in a medical facility (nursing home, hospital, tuberculosis sanatorium or institution for treatment of mental diseases), and who, except for the fact that they are patients in such medical facility, would qualify for grants under Title IV, supplementary security income benefits under Title XVI or state supplements, and those aged, blind and disabled persons who would not be eligible for supplemental security income benefits under Title XVI or state supplements if they were not institutionalized in a medical facility but whose income is below the maximum standard set by the Division of Medicaid, which standard shall not exceed that prescribed by federal regulation;

(b) Individuals who have elected to receive hospice care benefits and who are eligible using the same criteria and special income limits as those in institutions as described in subparagraph (a) of this paragraph (7).

(8) Children under eighteen (18) years of age and pregnant women (including those in intact families) who meet the AFDC financial standards of the state plan approved under Title IV-A of the Federal Social Security Act, as amended. The eligibility of children covered under this paragraph shall be determined by the State Department of Human Services and certified to the Division of Medicaid.

(9) Individuals who are:

(a) Children born after September 30, 1983, who have not attained the age of nineteen (19), with family income that does not exceed one hundred percent (100%) of the nonfarm official poverty line;

(b) Pregnant women, infants and children who have not attained the age of six (6), with family income that does not exceed one hundred thirty-three percent (133%) of the federal poverty level; and

(c) Pregnant women and infants who have not attained the age of one (1), with family income that does not exceed one hundred eighty-five percent (185%) of the federal poverty level.

The eligibility of individuals covered in (a), (b) and (c) of this paragraph shall be determined by the Department of Human Services.

(10) Certain disabled children age eighteen (18) or under who are living at home, who would be eligible, if in a medical institution, for SSI or a state supplemental payment under Title XVI of the Federal Social Security Act, as amended, and therefore for Medicaid under the plan, and for whom the state has made a determination as required under Section 1902(e)(3)(b) of the Federal Social Security Act, as amended. The eligibility of individuals under this paragraph shall be determined by the Division of Medicaid.

(11) Individuals who are sixty-five (65) years of age or older or are disabled as determined under Section 1614(a)(3) of the Federal Social Security Act, as amended, and who meet the following criteria:

(a) Whose income does not exceed one hundred percent (100%) of the nonfarm official poverty line as defined by the Office of Management and Budget and revised annually.

(b) Whose resources do not exceed those allowed under the Supplemental Security Income (SSI) Program.

The eligibility of individuals covered under this paragraph shall be determined by the Division of Medicaid, and such individuals determined eligible shall receive the same Medicaid services as other categorical eligible individuals.

(12) Individuals who are qualified Medicare beneficiaries (QMB) entitled to Part A Medicare as defined under Section 301, Public Law 100-360, known as the Medicare Catastrophic Coverage Act of 1988, and who meet the following criteria:

(a) Whose income does not exceed one hundred percent (100%) of the nonfarm official poverty line as defined by the Office of Management and Budget and revised annually.

(b) Whose resources do not exceed two hundred percent (200%) of the amount allowed under the Supplemental Security Income (SSI) Program as more fully prescribed under Section 301, Public Law 100-360.

The eligibility of individuals covered under this paragraph shall be determined by the Division of Medicaid, and such individuals determined eligible shall receive Medicare cost-sharing expenses only as more fully defined by the Medicare Catastrophic Coverage Act of 1988.

(13) Individuals who are entitled to Medicare Part B as defined in Section 4501 of the Omnibus Budget Reconciliation Act of 1990, and who meet the following criteria:

(a) Whose income does not exceed the percentage of the nonfarm official poverty line as defined by the Office of Management and Budget and revised annually which, on or after:

(i) January 1, 1993, is one hundred ten percent (110%); and

(ii) January 1, 1995, is one hundred twenty percent (120%).

(b) Whose resources do not exceed two hundred percent (200%) of the amount allowed under the Supplemental Security Income (SSI) Program as described in Section 301 of the Medicare Catastrophic Coverage Act of 1988.

The eligibility of individuals covered under this paragraph shall be determined by the Division of Medicaid, and such individuals determined eligible shall receive Medicare cost sharing.

(14) Effective from and after October 1, 1990, individuals in families who would be eligible for the AFDC unemployed parent program but do not receive AFDC payments. The eligibility of individuals covered in this paragraph shall be determined by the Department of Human Services.

(15) Disabled workers who are eligible to enroll in Part A Medicare as required by Public Law 101-239, known as the Omnibus Budget Reconciliation Act of 1989, and whose income does not exceed two hundred percent (200%) of the federal poverty level as determined in accordance with the Supplemental Security Income (SSI) Program. The eligibility of individuals covered under this paragraph shall be determined by the Division of Medicaid and such individuals shall be entitled to buy-in coverage of Medicare Part A premiums only under the provisions of this paragraph (15).

(16) In accordance with the terms and conditions of approved Title XIX waiver from the U.S. Department of Health and Human Services, persons provided home- and community-based services who are physically disabled and certified by the Division of Medicaid as eligible due to applying the income and deeming requirements as if they were institutionalized.

(17) In accordance with the terms of the federal Family Support Act of 1988 (P.L. 100-485), persons that become ineligible for AFDC because of increased earnings or hours of employment of the caretaker relative shall be eligible for Medicaid benefits for up to twelve (12) months.

(18) From and after July 1, 1995, individuals who are eligible to the extent of any federal waiver received by the state that waives any or all of the provisions of Title XIX or pursuant to any other federal law as adopted by amendment to the required Title XIX state plan. This paragraph (18) shall stand repealed from and after June 30, 1995.

B. Eligibility for medical assistance under this article shall be subject to the provisions of Sections 1, 2 and 3 of this act.

SECTION 5. The provisions of this act shall be implemented after the date that the Division of Medicaid has received all federal waivers that are necessary to implement the provisions of this act from the United States Department of Health and Human Services.

SECTION 6. Sections 1, 2 and 3 of this act shall be codified in Article 3, Chapter 13, Title 43 of the Mississippi Code of 1972.

SECTION 7. This act shall take effect and be in force from and after July 1, 1997.