Human services; medical services; federal work incentives
improvement act; enact conforming state provision to allow
continued insurance coverage for the working disabled.
HUMAN SERVICES: Medical services; LABOR: Employment incentives;
LABOR: Health and safety; DISABILITIES:
A bill to amend 1939 PA 280, entitled
"The social welfare act,"
by amending section 106 (MCL 400.106), as amended by 1990 PA 145,
and by adding section 106a.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
1 Sec. 106. (1) A medically indigent individual is defined
2 as:
3 (a) An individual receiving aid to dependent children
4 FAMILY INDEPENDENCE PROGRAM BENEFITS or an individual receiving
5 supplemental security income under title XVI of the social
6 security act, 42 U.S.C. 1381 to 1385, or state
supplementation
7 thereunder UNDER TITLE XVI subject to limitations
imposed by
8 the director pursuant to title XIX.
9 (b) An EXCEPT AS PROVIDED IN SECTION 106A,
AN individual
10 meeting WHO MEETS all of the following
conditions:
04119'99 LTB
2
1 (i) The individual has made application
APPLIED in the
2 manner prescribed by the state
department FAMILY INDEPENDENCE
3 AGENCY PRESCRIBES.
4 (ii) The individual's need for the type of medical
assist-
5 ance available under this act for which application has
been
6 made THE INDIVIDUAL APPLIED has been
professionally established
7 and payment for it is not available through the legal obligation
8 of a PUBLIC OR PRIVATE contractor , public or private,
to pay
9 or provide for the care without regard to the income or resources
10 of the patient. The state department shall be subrogated to
any
11 right of recovery which a patient may have for the cost of
hospi-
12 talization, pharmaceutical services, physician services,
nursing
13 services, and other medical services not to exceed the
amount of
14 funds expended by the department for the care and treatment
of
15 the patient. The patient or other person acting in the
patient's
16 behalf shall execute and deliver an assignment of claim or
other
17 authorizations as necessary to secure the right of recovery
to
18 the department. A payment may be withheld under this act
for
19 medical assistance for an injury or disability for which the
20 patient is entitled to medical care or reimbursement for the
cost
21 of medical care under sections 3101 to 3179 of the insurance
code
22 of 1956, Act No. 218 of the Public Acts of 1956, as amended,
23 being sections 500.3101 to 500.3179 of the Michigan Compiled
24 Laws, or under any other policy of insurance providing
medical or
25 hospital benefits, or both, for the patient unless the
patient's
26 entitlement to that medical care or reimbursement is at
issue.
27 If a payment is made, the state department, to enforce its
04119'99
3
1 subrogation right, may do either of the following: (a)
intervene
2 or join in an action or proceeding brought by the injured,
dis-
3 eased, or disabled person, the person's guardian, personal
repre-
4 sentative, estate, dependents, or survivors, against the
third
5 person who may be liable for the injury, disease, or
disability,
6 or against contractors, public or private, who may be liable
to
7 pay or provide medical care and services rendered to an
injured,
8 diseased, or disabled patient; (b) institute and prosecute a
9 legal proceeding against a third person who may be liable
for the
10 injury, disease, or disability, or against contractors,
public or
11 private, who may be liable to pay or provide medical care
and
12 services rendered to an injured, diseased, or disabled
patient,
13 in state or federal court, either alone or in conjunction
with
14 the injured, diseased, or disabled person, the person's
guardian,
15 personal representative, estate, dependents, or survivors.
The
16 state department may institute the proceedings in its own
name or
17 in the name of the injured, diseased, or disabled person,
the
18 person's guardian, personal representative, estate,
dependents,
19 or survivors. As provided in section 6023 of the revised
judica-
20 ture act of 1961, Act No. 236 of the Public Acts of 1961, as
21 amended, being section 600.6023 of the Michigan Compiled
Laws,
22 the state department, in enforcing its subrogation right,
shall
23 not satisfy a judgment against the third person's property
which
24 is exempt from levy and sale. The injured, diseased, or
disabled
25 person may proceed in his or her own name, collecting the
costs
26 without the necessity of joining the state department or the
27 state as a named party. The injured, diseased, or disabled
04119'99
4
1 person shall notify the state department of the action or
2 proceeding entered into upon commencement of the action or
3 proceeding. An action taken by the state or the state
department
4 in connection with the right of recovery afforded by this
section
5 does not operate to deny the injured, diseased, or disabled
6 person any part of the recovery beyond the costs expended on
the
7 person's behalf by the state department. The costs of legal
8 action initiated by the state shall be paid by the state. A
pay-
9 ment shall not be made under this act for medical assistance
for
10 an injury, disease, or disability for which the patient is
enti-
11 tled to medical care or the cost of medical care under the
12 worker's disability compensation act of 1969, Act No. 317 of
the
13 Public Acts of 1969, as amended, being sections 418.101 to
14 418.941 of the Michigan Compiled Laws; except that payment
may be
15 made if an appropriate application for medical care or the
cost
16 of the medical care has been made under Act No. 317 of the
Public
17 Acts of 1969, as amended, entitlement has not been finally
deter-
18 mined, and an arrangement satisfactory to the state
department
19 has been made for reimbursement if the claim under Act No.
317 of
20 the Public Acts of 1969, as amended, is finally sustained.
21 (iii) The EXCEPT AS PROVIDED IN
SECTION 106A, THE individ-
22 ual has an annual income which THAT is below, or
because of
23 medical expenses falls below, the protected basic maintenance
24 level. The protected basic maintenance level for 1-person and
25 2-person families shall be at least 100% of the higher of the
26 payment standards generally used to determine eligibility in the
27 aid to dependent children FAMILY INDEPENDENCE
program and the
04119'99
5
1 supplemental security income program under title XVI, of
the
2 social security act, 42 U.S.C. 1381 to 1385,
including state
3 supplementation. For families of 3 or more persons, the pro-
4 tected basic maintenance level shall be at least 100% of the pay-
5 ment standard generally used to determine eligibility in the
aid
6 to dependent children FAMILY INDEPENDENCE program.
These levels
7 shall recognize regional variations and shall not exceed 133-1/3%
8 of the payment standard generally used to determine eligibility
9 in the aid to dependent children FAMILY
INDEPENDENCE program.
10 (iv) The individual, if an aid to dependent
children A
11 FAMILY INDEPENDENCE PROGRAM related individual and living alone,
12 has liquid or marketable assets of not more than $1,500.00 in
13 value, or, if a 2-person family, the family has liquid or market-
14 able assets of not more than $2,000.00 in value. The state
15 department FAMILY INDEPENDENCE AGENCY shall
establish comparable
16 liquid or marketable asset amounts for larger family groups.
17 Excluded in making the determination of the value of liquid or
18 marketable assets are the values of: the homestead; clothing;
19 household effects; $1,000.00 of cash surrender value of life
20 insurance, except that if the health of the insured is such
as
21 to make MAKES continuance of the insurance
desirable, the entire
22 cash surrender value of life insurance is to be
excluded from
23 consideration, up to the maximums MAXIMUM
provided or allowed
24 by federal regulations and in accordance with the rules of the
25 state department FAMILY INDEPENDENCE AGENCY; the
fair market
26 value of tangible personal property used in earning income; an
27 amount paid as judgment or settlement for damages suffered as a
04119'99
6
1 result of exposure to agent orange, as defined in section 5701 of
2 the public health code, Act No. 368 of the Public Acts of
1978,
3 being section 333.5701 of the Michigan Compiled Laws
1978 PA
4 368, MCL 333.5701; and a space or plot purchased for the purposes
5 of burial for the person. For individuals related to the title
6 XVI program, of the social security act, 42 U.S.C. 1381 to
7 1385, the appropriate resource levels and property
exemptions
8 specified in title XVI shall be used.
9 (v) The individual is not an inmate of a public
institution
10 except as a patient in a medical institution.
11 (vi) The individual meets the eligibility standards for
sup-
12 plemental security income under title XVI of the social
security
13 act, 42 U.S.C. 1381 to 1385, or for state
supplementation under
14 the act, subject to limitations imposed by the director pursuant
15 to title XIX; or meets the eligibility standards for aid to
16 dependent children FAMILY INDEPENDENCE PROGRAM
BENEFITS, except
17 for income or income and resources; or is a child from 18 to 21
18 years of age and his or her adult caretaker would be eligible for
19 aid to dependent children FAMILY INDEPENDENCE
PROGRAM BENEFITS
20 except for age, income, or income and resources; or is a child
21 under 21 years of age and is from a family whose income is below
22 the basic maintenance level.
23 (2) As used in this act, "medical institution" means a state
24 licensed or approved hospital, nursing home, medical care facili-
25 ty, psychiatric hospital, or other facility or identifiable unit
26 thereof OF A LISTED INSTITUTION certified as
meeting
04119'99
7
1 established standards for a nursing home or hospital in
2 accordance with the laws of this state.
3 (3) THE FAMILY INDEPENDENCE AGENCY IS SUBROGATED TO A RIGHT
4 OF RECOVERY THAT A PATIENT HAS FOR THE COST OF HOSPITALIZATION,
5 PHARMACEUTICAL SERVICES, PHYSICIAN SERVICES, NURSING SERVICES,
6 AND OTHER MEDICAL SERVICES NOT TO EXCEED THE AMOUNT OF MONEY
7 EXPENDED BY THE DEPARTMENT FOR THE CARE AND TREATMENT OF THE
8 PATIENT. THE PATIENT OR OTHER PERSON ACTING IN THE PATIENT'S
9 BEHALF SHALL EXECUTE AND DELIVER AN ASSIGNMENT OF CLAIM OR OTHER
10 AUTHORIZATION AS NECESSARY TO SECURE THE RIGHT OF RECOVERY TO THE
11 DEPARTMENT. A PAYMENT MAY BE WITHHELD UNDER THIS ACT FOR MEDICAL
12 ASSISTANCE FOR AN INJURY OR DISABILITY FOR WHICH THE PATIENT IS
13 ENTITLED TO MEDICAL CARE OR REIMBURSEMENT FOR THE COST OF MEDICAL
14 CARE UNDER SECTIONS 3101 TO 3179 OF THE INSURANCE CODE OF 1956,
15 1956 PA 218, MCL 500.3101 TO 500.3179, OR UNDER ANOTHER POLICY OF
16 INSURANCE PROVIDING MEDICAL OR HOSPITAL BENEFITS, OR BOTH, FOR
17 ANOTHER THE PATIENT UNLESS THE PATIENT'S ENTITLEMENT TO THAT MED-
18 ICAL CARE OR REIMBURSEMENT IS AT ISSUE. IF A PAYMENT IS MADE,
19 THE FAMILY INDEPENDENCE AGENCY, TO ENFORCE ITS SUBROGATION RIGHT,
20 MAY DO EITHER OF THE FOLLOWING:
21 (A) INTERVENE OR JOIN IN AN ACTION OR PROCEEDING BROUGHT BY
22 THE INJURED, DISEASED, OR DISABLED PERSON, OR THE PERSON'S GUARD-
23 IAN, PERSONAL REPRESENTATIVE, ESTATE, DEPENDENTS, OR SURVIVORS,
24 AGAINST THE THIRD PERSON WHO MAY BE LIABLE FOR THE INJURY, DIS-
25 EASE, OR DISABILITY OR AGAINST PUBLIC OR PRIVATE CONTRACTORS WHO
26 MAY BE LIABLE TO PAY OR PROVIDE MEDICAL CARE AND SERVICES
27 RENDERED TO AN INJURED, DISEASED, OR DISABLED PATIENT.
04119'99
8
1 (B) INSTITUTE AND PROSECUTE A LEGAL PROCEEDING AGAINST A
2 THIRD PERSON WHO MAY BE LIABLE FOR THE INJURY, DISEASE, OR DIS-
3 ABILITY OR AGAINST A PUBLIC OR PRIVATE CONTRACTOR WHO MAY BE
4 LIABLE TO PAY OR PROVIDE MEDICAL CARE AND SERVICES RENDERED TO AN
5 INJURED, DISEASED, OR DISABLED PATIENT, IN STATE OR FEDERAL
6 COURT, EITHER ALONE OR IN CONJUNCTION WITH THE INJURED, DISEASED,
7 OR DISABLED PERSON OR THE PERSON'S GUARDIAN, PERSONAL REPRESENTA-
8 TIVE, ESTATE, DEPENDENT, OR SURVIVOR.
9 (4) IN ENFORCING ITS SUBROGATION RIGHT UNDER SUBSECTION (3),
10 THE FAMILY INDEPENDENCE AGENCY MAY INSTITUTE THE PROCEEDINGS IN
11 ITS OWN NAME OR IN THE NAME OF THE INJURED, DISEASED, OR DISABLED
12 PERSON OR THE PERSON'S GUARDIAN, PERSONAL REPRESENTATIVE, ESTATE,
13 DEPENDENT, OR SURVIVOR. AS PROVIDED IN SECTION 6023 OF THE
14 REVISED JUDICATURE ACT OF 1961, 1961 PA 236, MCL 600.6023, THE
15 FAMILY INDEPENDENCE AGENCY, IN ENFORCING ITS SUBROGATION RIGHT,
16 SHALL NOT SATISFY A JUDGMENT AGAINST THE THIRD PERSON'S PROPERTY
17 THAT IS EXEMPT FROM LEVY AND SALE.
18 (5) THE INJURED, DISEASED, OR DISABLED PERSON MAY PROCEED IN
19 HIS OR HER OWN NAME, COLLECTING THE COSTS WITHOUT THE NECESSITY
20 OF JOINING THE FAMILY INDEPENDENCE AGENCY OR THE STATE AS A NAMED
21 PARTY. THE INJURED, DISEASED, OR DISABLED PERSON SHALL NOTIFY
22 THE FAMILY INDEPENDENCE AGENCY OF THE ACTION OR PROCEEDING
23 ENTERED INTO UPON COMMENCEMENT OF THE ACTION OR PROCEEDING.
24 (6) AN ACTION TAKEN BY THE STATE OR THE FAMILY INDEPENDENCE
25 AGENCY IN CONNECTION WITH THE RIGHT OF RECOVERY AFFORDED BY THIS
26 SECTION DOES NOT DENY THE INJURED, DISEASED, OR DISABLED PERSON A
27 PART OF THE RECOVERY BEYOND THE COSTS EXPENDED ON THE PERSON'S
04119'99
9
1 BEHALF BY THE FAMILY INDEPENDENCE AGENCY. THE COSTS OF LEGAL
2 ACTION INITIATED BY THE STATE SHALL BE PAID BY THE STATE. A PAY-
3 MENT SHALL NOT BE MADE UNDER THIS ACT FOR MEDICAL ASSISTANCE FOR
4 AN INJURY, DISEASE, OR DISABILITY FOR WHICH THE PATIENT IS ENTI-
5 TLED TO MEDICAL CARE OR THE COST OF MEDICAL CARE UNDER THE
6 WORKER'S DISABILITY COMPENSATION ACT OF 1969, 1969 PA 317, MCL
7 418.101 TO 418.941; EXCEPT THAT PAYMENT MAY BE MADE IF AN APPRO-
8 PRIATE APPLICATION FOR MEDICAL CARE OR THE COST OF THE MEDICAL
9 CARE HAS BEEN MADE UNDER THE WORKER'S DISABILITY COMPENSATION ACT
10 OF 1969, 1969 PA 317, MCL 418.101 TO 418.941, ENTITLEMENT HAS NOT
11 BEEN FINALLY DETERMINED, AND AN ARRANGEMENT SATISFACTORY TO THE
12 FAMILY INDEPENDENCE AGENCY HAS BEEN MADE FOR REIMBURSEMENT IF THE
13 CLAIM IS FINALLY SUSTAINED.
14 SEC. 106A. (1) THE DEPARTMENT OF COMMUNITY HEALTH SHALL
15 IMPLEMENT A PROGRAM WITH PROVISIONS AS PRESCRIBED BY THIS SEC-
16 TION, WHICH PROGRAM OFFERS MEDICAL ASSISTANCE AND SUPPLEMENTARY
17 BENEFITS TO A PERSON WHO IS EITHER OF THE FOLLOWING:
18 (A) A PERSON WHO IS AT LEAST 16 YEARS OF AGE AND YOUNGER
19 THAN 65 YEARS OF AGE AND WHO WOULD OTHERWISE BE ELIGIBLE EXCEPT
20 THAT THE PERSON HAS EARNINGS IN EXCESS OF THE LIMIT ESTABLISHED
21 BY THE DEPARTMENT OF COMMUNITY HEALTH.
22 (B) A PERSON WHO IS EMPLOYED WITH A MEDICALLY IMPROVED DIS-
23 ABILITY AND WHOSE ASSETS, RESOURCES, AND EARNED AND UNEARNED
24 INCOME DO NOT EXCEED THE LIMIT ESTABLISHED BY THE DEPARTMENT OF
25 COMMUNITY HEALTH.
26 (2) THE DEPARTMENT OF COMMUNITY HEALTH MAY REQUIRE A PERSON
27 ELIGIBLE FOR BENEFITS UNDER SUBSECTION (1) TO PAY A PREMIUM OR
04119'99
10
1 OTHER COST-SHARING CHARGE SET ON A SLIDING SCALE BASED ON INCOME
2 THAT THE DEPARTMENT OF COMMUNITY HEALTH DETERMINES.
3 (3) THE DEPARTMENT OF COMMUNITY HEALTH MAY REQUIRE A PERSON
4 ELIGIBLE FOR BENEFITS UNDER SUBSECTION (1) TO PAY 100% OF A PRE-
5 MIUM IN A YEAR THAT THE PERSON WHO HAS INCOME THAT EXCEEDS 250%
6 OF THE INCOME OFFICIAL POVERTY LINE APPLICABLE TO A FAMILY OF THE
7 SIZE INVOLVED. IF THE PERSON WHO HAS INCOME FOR A YEAR THAT DOES
8 NOT EXCEED 450% OF THE INCOME OFFICIAL POVERTY LINE, THE REQUIRE-
9 MENT TO PAY THE PREMIUM ONLY APPLIES TO THE EXTENT THAT THE PRE-
10 MIUM DOES NOT EXCEED 7.5% OF THE INCOME.
11 (4) THE DEPARTMENT OF COMMUNITY HEALTH SHALL REQUIRE A
12 PERSON TO PAY 100% OF THE PREMIUM FOR A YEAR WHEN THE PERSON'S
13 ADJUSTED GROSS INCOME AS DEFINED IN SECTION 62 OF THE INTERNAL
14 REVENUE CODE OF 1986 EXCEEDS $75,000.00. THE DEPARTMENT OF COM-
15 MUNITY HEALTH MAY ELECT TO SUBSIDIZE THE PREMIUM BY USING STATE
16 FUNDS ONLY THAT ARE NOT MATCHED BY FEDERAL FUNDS UNDER TITLE
17 XIX.
18 (5) THE DEPARTMENT OF COMMUNITY HEALTH SHALL MAKE PERSONAL
19 ASSISTANCE SERVICES AVAILABLE TO A PERSON ELIGIBLE FOR MEDICAL
20 ASSISTANCE AND SUPPLEMENTARY BENEFITS UNDER SUBSECTION (1) TO THE
21 EXTENT NECESSARY TO ENABLE THE PERSON TO REMAIN EMPLOYED.
22 (6) THE DEPARTMENT OF COMMUNITY HEALTH SHALL SUBMIT AN
23 ANNUAL REPORT ON THE USE OF FEDERAL FUNDS TO THE SECRETARY. THE
24 REPORT SHALL INCLUDE THE PERCENTAGE INCREASE IN THE NUMBER OF
25 TITLE II AND TITLE XVI DISABILITY BENEFICIARIES IN THE STATE WHO
26 RETURN TO WORK.
04119'99
11
1 (7) THE DEPARTMENT OF COMMUNITY HEALTH SHALL APPLY TO THE
2 SECRETARY FOR APPROVAL OF A PILOT PROJECT UNDER WHICH UP TO A
3 SPECIFIED MAXIMUM NUMBER OF INDIVIDUALS WHO ARE WORKERS WITH A
4 POTENTIALLY SEVERE DISABILITY ARE PROVIDED MEDICAL ASSISTANCE
5 EQUAL TO THAT PROVIDED UNDER SECTION 1905(a) OF TITLE XIX OF THE
6 SOCIAL SECURITY ACT, 42 U.S.C. 1396d, TO A PERSON DESCRIBED IN
7 SECTION 1902(a)(10)(A)(ii)(XV) OF TITLE XIX OF THE SOCIAL
SECUR-
8 ITY ACT, 42. U.S.C. 1396a.
9 (8) AS USED IN THIS ACT:
10 (A) "EMPLOYED" MEANS A PERSON WHO IS DOING EITHER OF THE
11 FOLLOWING:
12 (i) EARNING AT LEAST THE APPLICABLE MINIMUM WAGE
REQUIREMENT
13 UNDER SECTION 6 OF THE FAIR LABOR STANDARDS ACT OF 1938,
14 CHAPTER 676, 52 STAT. 1062, 29 U.S.C. 206, AND WORKING 40 HOURS
15 PER MONTH OR MORE.
16 (ii) ENGAGED IN A WORK EFFORT THAT MEETS SUBSTANTIAL AND
17 REASONABLE CRITERIA FOR HOURS OF WORK, WAGES, OR OTHER MEASURES,
18 AS DEFINED BY THE FAMILY INDEPENDENCE AGENCY.
19 (B) "EMPLOYED PERSON WITH A MEDICALLY IMPROVED DISABILITY"
20 MEANS A PERSON TO WHOM ALL OF THE FOLLOWING APPLY:
21 (i) THE PERSON IS AT LEAST 16 YEARS OF AGE AND LESS THAN
65
22 YEARS OF AGE.
23 (ii) THE PERSON IS EMPLOYED.
24 (iii) THE PERSON IS NO LONGER ELIGIBLE FOR MEDICAL
ASSIST-
25 ANCE UNDER SECTION 106 BECAUSE THE PERSON, DUE TO MEDICAL
26 IMPROVEMENT, IS DETERMINED AT THE TIME OF A REGULARLY SCHEDULED
04119'99
12
1 CONTINUING DISABILITY REVIEW TO NO LONGER BE ELIGIBLE FOR
2 BENEFITS UNDER SECTIONS 106 AND 107.
3 (iv) THE PERSON CONTINUES TO HAVE A SEVERE MEDICALLY
DETER-
4 MINABLE IMPAIRMENT AS DETERMINED UNDER REGULATIONS OF THE
5 SECRETARY.
6 (C) "PERSONAL ASSISTANCE SERVICES" MEANS A RANGE OF SERV-
7 ICES, PROVIDED BY 1 OR MORE PERSONS, DESIGNED TO ASSIST A PERSON
8 WITH A DISABILITY IN PERFORMING DAILY ACTIVITIES ON OR OFF THE
9 JOB THAT THE PERSON WOULD TYPICALLY PERFORM IF HE OR SHE DID NOT
10 HAVE A DISABILITY. PERSONAL ASSISTANCE SERVICES SHALL BE
11 DESIGNED TO INCREASE THE PERSON'S CONTROL IN LIFE AND ABILITY TO
12 PERFORM EVERYDAY ACTIVITIES ON OR OFF THE JOB.
13 (D) "SECRETARY" MEANS THE SECRETARY OF THE DEPARTMENT OF
14 HEALTH AND HUMAN SERVICES.
15 (E) "TITLE II" MEANS TITLE II OF THE SOCIAL SECURITY ACT,
16 CHAPTER 531, 49 STAT. 620, 42 U.S.C. 401 TO 405, 406 TO 418, 420
17 TO 423, 424a TO 426-1, AND 427 TO 433.
18 (F) "TITLE XVI" MEANS TITLE XVI OF THE SOCIAL SECURITY ACT,
19 CHAPTER 531, 49 STAT. 620, 42 U.S.C. 1381 TO 1382j AND 1383 TO
20 1383f.
21 (G) "WORKER WITH A POTENTIALLY SEVERE DISABILITY" MEANS AN
22 INDIVIDUAL WHO MEETS ALL OF THE FOLLOWING CRITERIA:
23 (i) THE PERSON IS AT LEAST 16 YEARS OF AGE AND LESS THAN
65
24 YEARS OF AGE.
25 (ii) THE PERSON HAS A SPECIFIC PHYSICAL OR MENTAL
IMPAIRMENT
26 THAT, AS DEFINED BY THE DEPARTMENT OF COMMUNITY HEALTH, IS
27 REASONABLY EXPECTED, BUT FOR THE RECEIPT OF ITEMS AND SERVICES
04119'99
13
1 DESCRIBED IN SECTION 1905(a) OF TITLE XIX OF THE SOCIAL SECURITY
2 ACT TO BECOME BLIND OR DISABLED AS DEFINED UNDER SECTION 1614(a)
3 OF TITLE XVI.
4 (iii) THE PERSON IS EMPLOYED.
04119'99 Final page. LTB