HOUSE BILL No. 4242

 

February 18, 2003, Introduced by Reps. Hunter, McConico, Hopgood, Lipsey, Cheeks, Vagnozzi, Smith, Clack, Condino, Murphy, Minore, Gleason, Stallworth and Phillips and referred to the Committee on Family and Children Services.

        

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                 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  according to title XIX.                             

                                                                                

9       (b)  An  Except as provided in section 106a, an individual                  

                                                                                

10  meeting  who meets all of the following conditions:                        

                                                                                


                                                                                

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 assistance                

                                                                                

5   available under this act for which  application has been made               

                                                                                

6   the individual applied has been professionally established and              

                                                                                

7   payment for it is not available through the legal obligation of a           

                                                                                

8   public or private contractor  , public or private,  to pay or               

                                                                                

9   provide for the care without regard to the income or resources of           

                                                                                

10  the patient.   The state department shall be subrogated to any              

                                                                                

11  right of recovery which a patient may have for the cost of                  

                                                                                

12  hospitalization, pharmaceutical services, physician services,               

                                                                                

13  nursing services, and other medical services not to exceed the              

                                                                                

14  amount of funds expended by the department for the care and                 

                                                                                

15  treatment of the patient.  The patient or other person acting in            

                                                                                

16  the patient's behalf shall execute and deliver an assignment of             

                                                                                

17  claim or other authorizations as necessary to secure the right of           

                                                                                

18  recovery to the department.  A payment may be withheld under this           

                                                                                

19  act for medical assistance for an injury or disability for which            

                                                                                

20  the patient is entitled to medical care or reimbursement for the            

                                                                                

21  cost of medical care under sections 3101 to 3179 of the insurance           

                                                                                

22  code 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                  


                                                                                

1   subrogation right, may do either of the following:  (a) intervene           

                                                                                

2   or join in an action or proceeding brought by the injured,                  

                                                                                

3   diseased, or disabled person, the person's guardian, personal               

                                                                                

4   representative, estate, dependents, or survivors, against the               

                                                                                

5   third person who may be liable for the injury, disease, or                  

                                                                                

6   disability, or against contractors, public or private, who may be           

                                                                                

7   liable to pay or provide medical care and services rendered to an           

                                                                                

8   injured, diseased, or disabled patient; (b) institute and                   

                                                                                

9   prosecute a legal proceeding against a third person who may be              

                                                                                

10  liable for the injury, disease, or disability, or against                   

                                                                                

11  contractors, public or private, who may be liable to pay or                 

                                                                                

12  provide medical care and services rendered to an injured,                   

                                                                                

13  diseased, or disabled patient, in state or federal court, either            

                                                                                

14  alone or in conjunction with the injured, diseased, or disabled             

                                                                                

15  person, the person's guardian, personal representative, estate,             

                                                                                

16  dependents, or survivors.  The state department may institute the           

                                                                                

17  proceedings in its own name or in the name of the injured,                  

                                                                                

18  diseased, or disabled person, the person's guardian, personal               

                                                                                

19  representative, estate, dependents, or survivors.  As provided in           

                                                                                

20  section 6023 of the revised judicature act of 1961, Act No. 236             

                                                                                

21  of the Public Acts of 1961, as amended, being section 600.6023 of           

                                                                                

22  the Michigan Compiled Laws, the state department, in enforcing              

                                                                                

23  its subrogation right, shall not satisfy a judgment against the             

                                                                                

24  third person's property which is exempt from levy and sale.  The            

                                                                                

25  injured, diseased, or disabled person may proceed in his or her             

                                                                                

26  own name, collecting the costs without the necessity of joining             

                                                                                

27  the state department or the state as a named party.  The injured,           


                                                                                

1   diseased, or disabled person shall notify the state department of           

                                                                                

2   the action or proceeding entered into upon commencement of the              

                                                                                

3   action or proceeding.  An action taken by the state or the state            

                                                                                

4   department in connection with the right of recovery afforded by             

                                                                                

5   this section does not operate to deny the injured, diseased, or             

                                                                                

6   disabled person any part of the recovery beyond the costs                   

                                                                                

7   expended on the person's behalf by the state department.  The               

                                                                                

8   costs of legal action initiated by the state shall be paid by the           

                                                                                

9   state.  A payment shall not be made under this act for medical              

                                                                                

10  assistance for an injury, disease, or disability for which the              

                                                                                

11  patient is entitled to medical care or the cost of medical care             

                                                                                

12  under the worker's disability compensation act of 1969, Act                 

                                                                                

13  No. 317 of the Public Acts of 1969, as amended, being sections              

                                                                                

14  418.101 to 418.941 of the Michigan Compiled Laws; except that               

                                                                                

15  payment may be made if an appropriate application for medical               

                                                                                

16  care or the cost of the medical care has been made under Act                

                                                                                

17  No. 317 of the Public Acts of 1969, as amended, entitlement has             

                                                                                

18  not been finally determined, and an arrangement satisfactory to             

                                                                                

19  the state department has been made for reimbursement if the claim           

                                                                                

20  under Act No. 317 of the Public Acts of 1969, as amended, is                

                                                                                

21  finally sustained.                                                          

                                                                                

22      (iii)  The  Except as provided in section 106a, the                          

                                                                                

23  individual has an annual income  which  that is below, or because           

                                                                                

24  of medical expenses falls below, the protected basic maintenance            

                                                                                

25  level.  The protected basic maintenance level for 1-person and              

                                                                                

26  2-person families shall be at least 100% of the higher of the               

                                                                                

27  payment standards generally used to determine eligibility in the            


                                                                                

1   aid to dependent children  family independence program and the             

                                                                                

2   supplemental security income program under title XVI,  of the               

                                                                                

3   social security act, 42 U.S.C. 1381 to 1385,  including state               

                                                                                

4   supplementation.  For families of 3 or more persons, the                    

                                                                                

5   protected basic maintenance level shall be at least 100% of the             

                                                                                

6   payment standard generally used to determine eligibility in the             

                                                                                

7   aid to dependent children  family independence program.  These             

                                                                                

8   levels shall recognize regional variations and shall not exceed             

                                                                                

9   133-1/3% of the payment standard generally used to determine                

                                                                                

10  eligibility in the  aid to dependent children  family                       

                                                                                

11  independence program.                                                       

                                                                                

12      (iv) The individual, if  an aid to dependent children  a                     

                                                                                

13  family independence program related individual and living alone,            

                                                                                

14  has liquid or marketable assets of not more than $1,500.00 in               

                                                                                

15  value, or, if a 2-person family, the family has liquid or                   

                                                                                

16  marketable assets of not more than $2,000.00 in value.  The                 

                                                                                

17  state department  family independence agency shall establish               

                                                                                

18  comparable liquid or marketable asset amounts for larger family             

                                                                                

19  groups.  Excluded in making the determination of the value of               

                                                                                

20  liquid or marketable assets are the values of:  the homestead;              

                                                                                

21  clothing; household effects; $1,000.00 of cash surrender value of           

                                                                                

22  life insurance, except that if the health of the insured  is such           

                                                                                

23  as to make  makes continuance of the insurance desirable, the               

                                                                                

24  entire cash surrender value of life insurance is  to be  excluded           

                                                                                

25  from consideration, up to the  maximums  maximum provided or                

                                                                                

26  allowed by federal regulations and in accordance with the rules             

                                                                                

27  of the  state department  family independence agency; the fair              


                                                                                

1   market value of tangible personal property used in earning                  

                                                                                

2   income; an amount paid as judgment or settlement for damages                

                                                                                

3   suffered as a result of exposure to agent orange, as defined in             

                                                                                

4   section 5701 of the public health code,  Act No. 368 of the                 

                                                                                

5   Public Acts of 1978, being section 333.5701 of the Michigan                 

                                                                                

6   Compiled Laws  1978 PA 368, MCL 333.5701; and a space or plot               

                                                                                

7   purchased for the purposes of burial for the person.  For                   

                                                                                

8   individuals related to the title XVI program,  of the social                

                                                                                

9   security act, 42 U.S.C. 1381 to 1385,  the appropriate resource             

                                                                                

10  levels and property exemptions specified in title XVI shall be              

                                                                                

11  used.                                                                       

                                                                                

12      (v) The individual is not an inmate of a public institution                 

                                                                                

13  except as a patient in a medical institution.                               

                                                                                

14      (vi) The individual meets the eligibility standards for                      

                                                                                

15  supplemental security income under title XVI  of the social                 

                                                                                

16  security act, 42 U.S.C. 1381 to 1385,  or for state                         

                                                                                

17  supplementation under the act, subject to limitations imposed by            

                                                                                

18  the director  pursuant  according to title XIX; or meets the                

                                                                                

19  eligibility standards for  aid to dependent children  family                

                                                                                

20  independence program benefits, except for income or income and              

                                                                                

21  resources; or is a child from 18 to 21 years of age and his or              

                                                                                

22  her adult caretaker would be eligible for  aid to dependent                 

                                                                                

23  children  family independence program benefits except for age,              

                                                                                

24  income, or income and resources; or is a child under 21 years of            

                                                                                

25  age and is from a family whose income is below the basic                    

                                                                                

26  maintenance level.                                                          

                                                                                

27      (2) As used in this act:  , "medical"                                       


                                                                                

1       (a) "Medical institution" means a state licensed or approved                

                                                                                

2   hospital, nursing home, medical care facility, psychiatric                  

                                                                                

3   hospital, or other facility or identifiable unit  thereof  of a             

                                                                                

4   listed institution certified as meeting established standards for           

                                                                                

5   a nursing home or hospital in accordance with the laws of this              

                                                                                

6   state.                                                                      

                                                                                

7       (b) "Title II" means title II of the social security act,                   

                                                                                

8   chapter 531, 49 Stat. 620, 42 U.S.C. 401 to 405, 406 to 418, 420            

                                                                                

9   to 423, 424a to 426-1, and 427 to 433.                                      

                                                                                

10      (c) "Title XVI" means title XVI of the social security act,                 

                                                                                

11  chapter 531, 49 Stat. 620, 42 U.S.C. 1381 to 1382j and 1383 to              

                                                                                

12  1383f.                                                                      

                                                                                

13      (3) The family independence agency is subrogated to a right                 

                                                                                

14  of recovery that a patient has for the cost of hospitalization,             

                                                                                

15  pharmaceutical services, physician services, nursing services,              

                                                                                

16  and other medical services not to exceed the amount of money                

                                                                                

17  expended by the department for the care and treatment of the                

                                                                                

18  patient.  The patient or other person acting in the patient's               

                                                                                

19  behalf shall execute and deliver an assignment of claim or other            

                                                                                

20  authorization as necessary to secure the right of recovery to the           

                                                                                

21  department.  A payment may be withheld under this act for medical           

                                                                                

22  assistance for an injury or disability for which the patient is             

                                                                                

23  entitled to medical care or reimbursement for the cost of medical           

                                                                                

24  care under sections 3101 to 3179 of the insurance code of 1956,             

                                                                                

25  1956 PA 218, MCL 500.3101 to 500.3179, or under another policy of           

                                                                                

26  insurance providing medical or hospital benefits, or both, for              

                                                                                

27  the patient unless the patient's entitlement to that medical care           


                                                                                

1   or reimbursement is at issue.  If a payment is made, the                    

                                                                                

2   department, to enforce its subrogation right, may do either of              

                                                                                

3   the following:                                                              

                                                                                

4       (a) Intervene or join in an action or proceeding brought by                 

                                                                                

5   the injured, diseased, or disabled person, or the person's                  

                                                                                

6   guardian, personal representative, estate, dependents, or                   

                                                                                

7   survivors, against the third person who may be liable for the               

                                                                                

8   injury, disease, or disability or against public or private                 

                                                                                

9   contractors who may be liable to pay or provide medical care and            

                                                                                

10  services rendered to an injured, diseased, or disabled patient.             

                                                                                

11      (b) Institute and prosecute a legal proceeding against a                    

                                                                                

12  third person who may be liable for the injury, disease, or                  

                                                                                

13  disability or against a public or private contractor who may be             

                                                                                

14  liable to pay or provide medical care and services rendered to an           

                                                                                

15  injured, diseased, or disabled patient, in state or federal                 

                                                                                

16  court, either alone or in conjunction with the injured, diseased,           

                                                                                

17  or disabled person or the person's guardian, personal                       

                                                                                

18  representative, estate, dependent, or survivor.                             

                                                                                

19      (4) In enforcing its subrogation right under subsection (3),                

                                                                                

20  the department may institute the proceedings in its own name or             

                                                                                

21  in the name of the injured, diseased, or disabled person or the             

                                                                                

22  person's guardian, personal representative, estate, dependent, or           

                                                                                

23  survivor.  As provided in section 6023 of the revised judicature            

                                                                                

24  act of 1961, 1961 PA 236, MCL 600.6023, the department, in                  

                                                                                

25  enforcing its subrogation right, shall not satisfy a judgment               

                                                                                

26  against the third person's property that is exempt from levy and            

                                                                                

27  sale.                                                                       


                                                                                

1       (5) The injured, diseased, or disabled person may proceed in                

                                                                                

2   his or her own name, collecting the costs without the necessity             

                                                                                

3   of joining the department or the state as a named party.  The               

                                                                                

4   injured, diseased, or disabled person shall notify the department           

                                                                                

5   of the action or proceeding entered into upon commencement of the           

                                                                                

6   action or proceeding.                                                       

                                                                                

7       (6) An action taken by the state or the department in                       

                                                                                

8   connection with the right of recovery afforded by this section              

                                                                                

9   does not deny the injured, diseased, or disabled person a part of           

                                                                                

10  the recovery beyond the costs expended on the person's behalf by            

                                                                                

11  the department.  The costs of legal action initiated by the state           

                                                                                

12  shall be paid by the state.  A payment shall not be made under              

                                                                                

13  this act for medical assistance for an injury, disease, or                  

                                                                                

14  disability for which the patient is entitled to medical care or             

                                                                                

15  the cost of medical care under the worker's disability                      

                                                                                

16  compensation act of 1969, 1969 PA 317, MCL 418.101 to 418.941;              

                                                                                

17  except that payment may be made if an appropriate application for           

                                                                                

18  medical care or the cost of the medical care has been made under            

                                                                                

19  the worker's disability compensation act of 1969, 1969 PA 317,              

                                                                                

20  MCL 418.101 to 418.941, entitlement has not been finally                    

                                                                                

21  determined, and an arrangement satisfactory to the department has           

                                                                                

22  been made for reimbursement if the claim is finally sustained.              

                                                                                

23      Sec. 106a.  (1) The department of community health shall                    

                                                                                

24  implement a program with provisions as prescribed by this                   

                                                                                

25  section.  The program shall offer medical assistance and                    

                                                                                

26  supplementary benefits to a person who meets either of the                  

                                                                                

27  following requirements:                                                     


                                                                                

1       (a) A person at least 16 years of age and younger than 65                   

                                                                                

2   years of age who would otherwise be eligible except that the                

                                                                                

3   person has earnings that exceed the limit established by the                

                                                                                

4   department of community health.                                             

                                                                                

5       (b) A person employed with a medically improved disability                  

                                                                                

6   whose assets, resources, and earned and unearned income do not              

                                                                                

7   exceed the limit established by the department of community                 

                                                                                

8   health.                                                                     

                                                                                

9       (2) The department of community health may require a person                 

                                                                                

10  eligible for benefits under subsection (1) to pay a premium or              

                                                                                

11  other cost-sharing charge that the department of community health           

                                                                                

12  determines set on a sliding scale based on income.                          

                                                                                

13      (3) The department of community health may require a person                 

                                                                                

14  eligible for benefits under subsection (1) to pay 100% of a                 

                                                                                

15  premium in a year that the person has income for a year that                

                                                                                

16  exceeds 250% of the federal poverty level applicable to a family            

                                                                                

17  of the size involved.  If the person has income for a year that             

                                                                                

18  does not exceed 450% of the federal poverty level, the                      

                                                                                

19  requirement to pay the premium only applies to the extent that              

                                                                                

20  the premium does not exceed 7.5% of the income.                             

                                                                                

21      (4) The department of community health shall require a person               

                                                                                

22  to pay 100% of the premium for a year when the person's adjusted            

                                                                                

23  gross income as defined in section 62 of the internal revenue               

                                                                                

24  code of 1986, 26 U.S.C. 62, exceeds $75,000.00.  The department             

                                                                                

25  of community health may elect to subsidize the premium by using             

                                                                                

26  state funds only that are not matched by federal funds under                

                                                                                

27  title XIX.                                                                  


                                                                                

1       (5) The department of community health shall make personal                  

                                                                                

2   assistance services available to a person eligible for medical              

                                                                                

3   assistance and supplementary benefits under subsection (1) to the           

                                                                                

4   extent necessary to enable the person to remain employed.                   

                                                                                

5       (6) The department of community health shall submit an annual               

                                                                                

6   report on the use of federal funds for the program established in           

                                                                                

7   this section to the secretary.  The report shall include the                

                                                                                

8   percentage increase in the number of title II and title XVI                 

                                                                                

9   disability beneficiaries in the state who return to work.                   

                                                                                

10      (7) The department of community health shall apply to the                   

                                                                                

11  secretary for approval of a pilot project under which up to a               

                                                                                

12  specified maximum number of individuals who are workers with a              

                                                                                

13  potentially severe disability are provided medical assistance               

                                                                                

14  equal to that provided under section 1905(a) of title XIX, 42               

                                                                                

15  U.S.C. 1396d, to a person described in section                              

                                                                                

16  1902(a)(10)(A)(ii)(XV) of title XIX, 42 U.S.C. 1396a.                        

                                                                                

17      (8) As used in this section:                                                

                                                                                

18      (a) "Employed" means a person who is either of the                          

                                                                                

19  following:                                                                  

                                                                                

20                                                                               (i) Earning at least the applicable minimum wage requirement                        

                                                                                

21  under section 6 of the fair labor standards act of 1938,                    

                                                                                

22  chapter 676, 52 Stat. 1062, 29 U.S.C. 206, and working 40 hours             

                                                                                

23  per month or more.                                                          

                                                                                

24      (ii) Engaged in a work effort that meets substantial and                     

                                                                                

25  reasonable criteria for hours of work, wages, or other measures,            

                                                                                

26  as defined by the department of community health.                           

                                                                                

27      (b) "Employed person with a medically improved disability"                  


                                                                                

1   means a person to whom all of the following apply:                          

                                                                                

2                                                                                (i) The person is at least 16 years of age and less than 65                         

                                                                                

3   years of age.                                                               

                                                                                

4       (ii) The person is employed.                                                 

                                                                                

5       (iii) The person is no longer eligible for medical assistance                

                                                                                

6   under section 106 because the person, due to medical improvement,           

                                                                                

7   is determined at the time of a regularly scheduled continuing               

                                                                                

8   disability review to no longer be eligible for benefits under               

                                                                                

9   sections 106 and 107.                                                       

                                                                                

10      (iv) The person continues to have a severe medically                         

                                                                                

11  determinable impairment as determined under regulations of the              

                                                                                

12  secretary.                                                                  

                                                                                

13      (c) "Personal assistance services" means a range of services,               

                                                                                

14  provided by 1 or more persons, designed to assist a person with a           

                                                                                

15  disability in performing daily activities on or off the job that            

                                                                                

16  the person would typically perform if he or she did not have a              

                                                                                

17  disability.  Personal assistance services shall be designed to              

                                                                                

18  increase the person's control in life and ability to perform                

                                                                                

19  everyday activities on or off the job.                                      

                                                                                

20      (d) "Secretary" means the secretary of the United States                    

                                                                                

21  department of health and human services.                                    

                                                                                

22      (e) "Worker with a potentially severe disability" means a                   

                                                                                

23  person who meets all of the following criteria:                             

                                                                                

24                                                                               (i) The person is at least 16 years of age and less than 65                         

                                                                                

25  years of age.                                                               

                                                                                

26      (ii) The person has a specific physical or mental impairment                 

                                                                                

27  that, as defined by the department of community health, is                  


                                                                                

1   reasonably expected, but for the receipt of items and services              

                                                                                

2   described in section 1905(a) of title XIX, 42 U.S.C. 1396d, to              

                                                                                

3   become blind or disabled as defined under section 1614(a) of                

                                                                                

4   title XVI, 42 U.S.C. 1382c.                                                 

                                                                                

5       (iii) The person is employed.