249J.8 - EXPANSION POPULATION MEMBERS -- FINANCIAL PARTICIPATION.
249J.8 EXPANSION POPULATION MEMBERS -- FINANCIAL
PARTICIPATION.
1. Each expansion population member whose family income exceeds
one hundred percent of the federal poverty level as defined by the
most recently revised poverty income guidelines published by the
United States department of health and human services shall pay a
monthly premium not to exceed one-twelfth of five percent of the
member's annual family income. Each expansion population member
whose family income is equal to or less than one hundred percent of
the federal poverty level as defined by the most recently revised
poverty income guidelines published by the United States department
of health and human services shall not be subject to payment of a
monthly premium. All premiums shall be paid on the last day of the
month of coverage. The department shall deduct the amount of any
monthly premiums paid by an expansion population member for benefits
under the healthy and well kids in Iowa program when computing the
amount of monthly premiums owed under this subsection. An expansion
population member shall pay the monthly premium during the entire
period of the member's enrollment. Regardless of the length of
enrollment, the member is subject to payment of the premium for a
minimum of four consecutive months. However, an expansion population
member who complies with the requirement of payment of the premium
for a minimum of four consecutive months during a consecutive
twelve-month period of enrollment shall be deemed to have complied
with this requirement for the subsequent consecutive twelve-month
period of enrollment and shall only be subject to payment of the
monthly premium on a month-by-month basis. Timely payment of
premiums, including any arrearages accrued from prior enrollment, is
a condition of receiving any expansion population services. The
payment to and acceptance by an automated case management system or
the department of the premium required under this subsection shall
not automatically confer initial or continuing program eligibility on
an individual. A premium paid to and accepted by the department's
premium payment process that is subsequently determined to be
untimely or to have been paid on behalf of an individual ineligible
for the program shall be refunded to the remitter in accordance with
rules adopted by the department. Premiums collected under this
subsection shall be deposited in the premiums subaccount of the
account for health care transformation created pursuant to section
249J.23. An expansion population member shall also pay the same
copayments required of other adult recipients of medical assistance.
2. The department may reduce the required out-of-pocket
expenditures for an individual expansion population member based upon
the member's increased wellness activities such as smoking cessation
or compliance with the personal health improvement plan completed by
the member. The department shall also waive the required
out-of-pocket expenditures for an individual expansion population
member based upon a hardship that would accrue from imposing such
required expenditures. Information regarding the premium payment
obligation and the hardship exemption, including the process by which
a prospective enrollee may apply for the hardship exemption, shall be
provided to a prospective enrollee at the time of application. The
prospective enrollee shall acknowledge, in writing, receipt and
understanding of the information provided.
3. The department shall submit to the governor and the general
assembly by March 15, 2006, a design for each of the following:
a. An insurance cost subsidy program for expansion population
members who have access to employer health insurance plans, provided
that the design shall require that no less than fifty percent of the
cost of such insurance shall be paid by the employer.
b. A health care account program option for individuals
eligible for enrollment in the expansion population. The health care
account program option shall be available only to adults who have
been enrolled in the expansion population for at least twelve
consecutive calendar months. Under the health care account program
option, the individual would agree to exchange one year's receipt of
benefits under the expansion population, to which the individual
would otherwise be entitled, for a credit to obtain any medical
assistance program covered service up to a specified amount. The
balance in the health care account at the end of the year, if any,
would be available for withdrawal by the individual.
4. The department shall track the impact of the out-of-pocket
expenditures on expansion population enrollment and shall report the
findings on at least a quarterly basis to the medical assistance
projections and assessment council established pursuant to section
249J.20. The findings shall include estimates of the number of
expansion population members complying with payment of required
out-of-pocket expenditures, the number of expansion population
members not complying with payment of required out-of-pocket
expenditures and the reasons for noncompliance, any impact as a
result of the out-of-pocket requirements on the provision of services
to the populations previously served, the administrative time and
cost associated with administering the out-of-pocket requirements,
and the benefit to the state resulting from the out-of-pocket
expenditures. To the extent possible, the department shall track the
income level of the member, the health condition of the member, and
the family status of the member relative to the out-of-pocket
information. Section History: Recent Form
2005 Acts, ch 167, §8, 66; 2005 Acts, ch 175, §117; 2006 Acts, ch
1184, §115, 127; 2007 Acts, ch 218, §104, 112; 2008 Acts, ch 1014, §3
Referred to in § 249J.23
Healthy and well kids in Iowa program, see chapter 514I