September 29, 2010, Introduced by Senator BRATER and referred to the Committee on Families and Human Services.
A bill to amend 1939 PA 280, entitled
"The social welfare act,"
by amending section 106 (MCL 400.106), as amended by 2006 PA 144,
and by adding section 105c.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 105c. (1) A recipient shall remain eligible and an
applicant may be determined eligible for medical assistance under
this act during a period of incarceration or detention. Medical
assistance coverage is limited to off-site inpatient
hospitalization only.
(2) If an individual who is eligible for medical assistance
remains incarcerated or detained for 1 year or more, the department
shall conduct a medical assistance eligibility redetermination 1
time each year the individual remains incarcerated.
(3) A recipient is considered incarcerated or detained until
released on bail, released as not guilty, released on parole,
released on pardon, released upon completing a sentence, or
released under home detention or tether.
Sec. 106. (1) A medically indigent individual is defined as:
(a) An individual receiving family independence program
benefits or an individual receiving supplemental security income
under title XVI or state supplementation under title XVI subject to
limitations imposed by the director according to title XIX.
(b) Except as provided in section 106a, an individual who
meets all of the following conditions:
(i) The individual has applied in the manner the family
independence
agency department prescribes.
(ii) The individual's need for the type of medical assistance
available under this act for which the individual applied has been
professionally established and payment for it is not available
through the legal obligation of a public or private contractor to
pay or provide for the care without regard to the income or
resources of the patient. The state department is subrogated to any
right of recovery that a patient may have for the cost of
hospitalization, pharmaceutical services, physician services,
nursing services, and other medical services not to exceed the
amount of funds expended by the state department for the care and
treatment of the patient. The patient or other person acting in the
patient's behalf shall execute and deliver an assignment of claim
or other authorizations as necessary to secure the right of
recovery to the department. A payment may be withheld under this
act for medical assistance for an injury or disability for which
the individual is entitled to medical care or reimbursement for the
cost of medical care under sections 3101 to 3179 of the insurance
code of 1956, 1956 PA 218, MCL 500.3101 to 500.3179, or under
another policy of insurance providing medical or hospital benefits,
or both, for the individual unless the individual's entitlement to
that medical care or reimbursement is at issue. If a payment is
made, the state department, to enforce its subrogation right, may
do either of the following: (a) intervene or join in an action or
proceeding brought by the injured, diseased, or disabled
individual, the individual's guardian, personal representative,
estate, dependents, or survivors, against the third person who may
be liable for the injury, disease, or disability, or against
contractors, public or private, who may be liable to pay or provide
medical care and services rendered to an injured, diseased, or
disabled individual; (b) institute and prosecute a legal proceeding
against a third person who may be liable for the injury, disease,
or disability, or against contractors, public or private, who may
be liable to pay or provide medical care and services rendered to
an injured, diseased, or disabled individual, in state or federal
court, either alone or in conjunction with the injured, diseased,
or disabled individual, the individual's guardian, personal
representative, estate, dependents, or survivors. The state
department may institute the proceedings in its own name or in the
name of the injured, diseased, or disabled individual, the
individual's guardian, personal representative, estate, dependents,
or survivors. As provided in section 6023 of the revised judicature
act of 1961, 1961 PA 236, MCL 600.6023, the state department, in
enforcing its subrogation right, shall not satisfy a judgment
against the third person's property that is exempt from levy and
sale. The injured, diseased, or disabled individual may proceed in
his or her own name, collecting the costs without the necessity of
joining the state department or the state as a named party. The
injured, diseased, or disabled individual shall notify the state
department of the action or proceeding entered into upon
commencement of the action or proceeding. An action taken by the
state or the state department in connection with the right of
recovery afforded by this section does not deny the injured,
diseased, or disabled individual any part of the recovery beyond
the costs expended on the individual's behalf by the state
department. The costs of legal action initiated by the state shall
be paid by the state. A payment shall not be made under this act
for medical assistance for an injury, disease, or disability for
which the individual is entitled to medical care or the cost of
medical care under the worker's disability compensation act of
1969, 1969 PA 317, MCL 418.101 to 418.941; except that payment may
be made if an appropriate application for medical care or the cost
of the medical care has been made under the worker's disability
compensation act of 1969, 1969 PA 317, MCL 418.101 to 418.941,
entitlement has not been finally determined, and an arrangement
satisfactory to the state department has been made for
reimbursement if the claim under the worker's disability
compensation act of 1969, 1969 PA 317, MCL 418.101 to 418.941, is
finally sustained.
(iii) The individual has an annual income that is below, or
subject to limitations imposed by the director and because of
medical expenses falls below, the protected basic maintenance
level. The protected basic maintenance level for 1-person and 2-
person families shall be at least 100% of the payment standards
generally used to determine eligibility in the family independence
program. For families of 3 or more persons, the protected basic
maintenance level shall be at least 100% of the payment standard
generally used to determine eligibility in the family independence
program. These levels shall recognize regional variations and shall
not exceed 133-1/3% of the payment standard generally used to
determine eligibility in the family independence program.
(iv) The individual, if a family independence program related
individual and living alone, has liquid or marketable assets of not
more than $2,000.00 in value, or, if a 2-person family, the family
has liquid or marketable assets of not more than $3,000.00 in
value. The state department shall establish comparable liquid or
marketable asset amounts for larger family groups. Excluded in
making the determination of the value of liquid or marketable
assets are the values of: the homestead; clothing; household
effects; $1,000.00 of cash surrender value of life insurance,
except
that if the insured's health of the insured makes
continuance
of continuing the insurance desirable, the entire cash
surrender value of life insurance is excluded from consideration,
up to the maximum provided or allowed by federal regulations and in
accordance with state department rules; the fair market value of
tangible personal property used in earning income; an amount paid
as judgment or settlement for damages suffered as a result of
exposure to agent orange, as defined in section 5701 of the public
health code, 1978 PA 368, MCL 333.5701; and a space or plot
purchased for the purposes of burial for the person. For
individuals related to the title XVI program, the appropriate
resource levels and property exemptions specified in title XVI
shall be used.
(v) The Except as provided in section 105c, the individual is
not an inmate of a public institution except as a patient in a
medical institution.
(vi) The individual meets the eligibility standards for
supplemental security income under title XVI or for state
supplementation under the act, subject to limitations imposed by
the director according to title XIX; or meets the eligibility
standards for family independence program benefits; or meets the
eligibility standards for optional eligibility groups under title
XIX, subject to limitations imposed by the director according to
title XIX.
(2) As used in this act:
(a) "Medicaid contracted health plan" means a managed care
organization with whom the state department contracts to provide or
arrange for the delivery of comprehensive health care services as
authorized under this act.
(b) "Medical institution" means a state licensed or approved
hospital, nursing home, medical care facility, psychiatric
hospital, or other facility or identifiable unit of a listed
institution certified as meeting established standards for a
nursing home or hospital in accordance with the laws of this state.
(c) "Title XVI" means title XVI of the social security act, 42
USC 1381 to 1382j and 1383 to 1383f.
(3) An individual receiving medical assistance under this act
or his or her legal counsel shall notify the state department when
filing an action in which the state department may have a right to
recover expenses paid under this act. If the individual is enrolled
in a medicaid contracted health plan, the individual or his or her
legal counsel shall provide notice to the medicaid contracted
health plan in addition to providing notice to the state
department.
(4) If a legal action in which the state department, a
medicaid contracted health plan, or both has a right to recover
expenses paid under this act is filed and settled after November
29, 2004 without notice to the state department or the medicaid
contracted health plan, the state department or the medicaid
contracted health plan may file a legal action against the
individual or his or her legal counsel, or both, to recover
expenses paid under this act. The attorney general shall recover
any cost or attorney fees associated with a recovery under this
subsection.
(5) The state department has first priority against the
proceeds of the net recovery from the settlement or judgment in an
action settled in which notice has been provided under subsection
(3). A medicaid contracted health plan has priority immediately
after the state department in an action settled in which notice has
been provided under subsection (3). The state department and a
medicaid contracted health plan shall recover the full cost of
expenses paid under this act unless the state department or the
medicaid contracted health plan agrees to accept an amount less
than the full amount. If the individual would recover less against
the proceeds of the net recovery than the expenses paid under this
act, the state department or medicaid contracted health plan, and
the individual shall share equally in the proceeds of the net
recovery. As used in this subsection, "net recovery" means the
total settlement or judgment less the costs and fees incurred by or
on behalf of the individual who obtains the settlement or judgment.