Senate Bill 2814

AN ACT TO CREATE NEW SECTION 43-13-122.1, MISSISSIPPI CODE OF 1972, TO DIRECT THE DIVISION OF MEDICAID TO APPLY FOR A WAIVER TO THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) FOR THE PROVISION OF SERVICE TO CERTAIN DISABLED CHILDREN WHO ARE LIVING AT HOME; TO SET FORTH THE ELIGIBILITY CRITERIA FOR THE WAIVER; TO AUTHORIZE THE DIVISION TO DETERMINE MEDICAL NECESSITY FOR THE PURPOSES OF THE PROGRAM; TO AUTHORIZE THE DIVISION TO IMPLEMENT COST-SHARING REQUIREMENTS FOR INDIVIDUALS ENROLLED IN THE PROGRAM WHOSE HOUSEHOLD INCOME EXCEEDS 300% OF THE FEDERAL POVERTY LEVEL; TO AUTHORIZE THE DIVISION TO REQUIRE INDIVIDUALS WITH HOUSEHOLD INCOME ABOVE 300% OF THE FEDERAL POVERTY LEVEL TO MAINTAIN OTHER CREDITABLE HEALTH INSURANCE; TO EXEMPT ANY EXISTING CONTRACTS NECESSARY TO CARRY OUT THE PROVISIONS OF THIS SECTION FROM STATE PROCUREMENT LAWS OR REGULATIONS FOR A PERIOD NOT TO EXCEED THREE YEARS; AND FOR RELATED PURPOSES.

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

SECTION 1. The following shall be codified as Section 43-13-122.1, Mississippi Code of 1972:

43-13-122.1. (1) (a) The division is directed to apply for a waiver to the Centers for Medicare and Medicaid Services (CMS) for the provision of services to 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. Notwithstanding any other provision of law, eligibility for this program shall include all of the following criteria:

(i) The child must be age eighteen (18) or younger;

(ii) The child must meet the Social Security Administration's definition of disability;

(iii) The child must be a United States citizen or qualified alien;

(iv) The child must have established residency in the State of Mississippi;

(v) The child must have a social security number or have applied for one;

(vi) The child's annual gross countable income must be less than the current Medicaid State Plan income limit established for long-term care services;

(vii) The child's countable assets do not exceed Two Thousand Dollars ($2,000.00) (parent(s) assets are not considered);

(viii) The child meets the medical necessity requirement for institutional placement, or level of care, or be at risk, in the future, for institutional placement, as determined by the division; and

(b) If the eligibility criteria described in paragraph (a) of this subsection are met, the child must also have access to medical care in the home, it must be deemed appropriate to provide such care outside an institution, and the estimated cost of care in the home must not exceed the estimated cost of care if the child were in an institution.

(2) For the purposes of this section, medical necessity for the program shall be determined by the division and may include, but not be limited to, the following criteria:

(a) The child must have a medical condition that would require institutional placement in a hospital, a skilled nursing facility, an intermediate care facility for individuals with intellectual disabilities, an alternative home placement, or be at risk for future institutional placement.

(b) Medical necessity may also be based on services that improve or maintain a child's health or prevent a child's health from getting worse, as determined by the division.

(3) The division is authorized to implement cost-sharing requirements, as determined by the division, for individuals enrolled in the program whose household income exceeds three hundred percent (300%) of the Federal Poverty Level. Nothing in this section shall authorize the division to implement a cost-sharing requirement that exceeds the maximum amount allowable under federal law.

(4) The division may require individuals with household income above three hundred percent (300%) of the Federal Poverty Level, or any minimum threshold higher than three hundred percent (300%) of the Federal Poverty Level as determined appropriate by the division, to maintain as a condition of participation other creditable health insurance coverage. Further, the division may determine any family who is determined by the division to have dropped other creditable health insurance coverage for the coverage provided under this program to be ineligible for benefits under this program for a period not to exceed six (6) months.

(5) Notwithstanding any provision of law, any contracts necessary to carry out the provisions of this section shall not be subject to state procurement laws or regulations for a period not to exceed three (3) years. The division, however, shall not enter into any new contracts to carry out the provisions of this section.

SECTION 2. This act shall take effect and be in force from and after its passage.