Amends TCA Title 71, Chapter 5.

This bill requires the bureau of TennCare ("bureau"), on or before January 1, 2025, to establish a buy-in program ("program") for working individuals with disabilities that enables such individuals to access health insurance coverage through the TennCare program, including as a supplement to employer-sponsored coverage. <br /> <br /> PROGRAM ESTABLISHMENT<br /> <br /> This bill provides that, in establishing the buy-in program, the bureau:<br /> <br /> (1) Must establish cost-sharing requirements for the buy-in program in accordance with federal law and this bill;<br /> <br /> (2) Must establish and modify eligibility and cost-sharing requirements in order to administer the program within available funds;<br /> <br /> (3) Is prohibited from establishing eligibility restrictions for the buy-in program based upon a person's income, resources, or maximum age;<br /> <br /> (4) May consider, when applicable, a person's income, excluding spousal income or assets, when establishing cost-sharing requirements;<br /> <br /> (5) Must include a grace period that provides continuous coverage for an individual who experiences a temporary interruption of employment; and<br /> <br /> (6) Must make every effort to coordinate benefits with employer-sponsored coverage available to the working individuals with disabilities receiving benefits under applicable law.<br /> <br /> This bill requires the bureau to seek federal approval to exclude resources accumulated in a separate account that result from earnings during an individual's enrollment in the buy-in program, including IRS-approved retirement accounts, when determining the individual's subsequent eligibility for another medical assistance program. The director of TennCare ("director") is authorized to seek any federal waiver the director deems necessary to effectuate this bill.<br /> <br /> PROGRAM DESCRIPTION<br /> <br /> This bill requires the director to ensure that the buy-in program:<br /> <br /> (1) Provides categorically needy scope of care;<br /> <br /> (2) Provides home- and community-based long-term services and supports for an enrollee who meets the functional requirements for those programs, is approved for those services, and chooses to enroll in the buy-in program;<br /> <br /> (3) Approves coverage for six months effective the first of the month in which a person applies and meets program requirements;<br /> <br /> (4) Allows a person who is eligible for another TennCare program to choose not to participate in the buy-in program; and<br /> <br /> (5) Deems a person ineligible for buy-in program coverage for a month in which the person received TennCare benefits under the medically needy program.<br /> <br /> INDIVIDUAL ELIGIBILITY REQUIREMENTS<br /> <br /> This bill requires the director to ensure that the buy-in program requires that, for a person to qualify for the program, the person must meet the following general requirements as established for the medical assistance program: residence in this state, citizenship or immigration status in the United States, possession of a valid social security account number, and assignment of medical support rights to this state.<br /> <br /> Additionally, in order to qualify for the buy-in program, a person must be at least 18, meet federal disability requirements, and be employed full- or part-time, including self-employment. A resource test is not required in order to qualify; however, an enrollee must comply with cost-sharing provisions. If a person who is approved for the program experiences a job loss, then they may continue program coverage through the original six months if the job loss results from an involuntary dismissal or health crisis and they continue to pay the monthly premium based on their income.<br /> <br /> EMPLOYMENT REQUIREMENTS<br /> <br /> This bill requires the director to ensure that, for the purpose of the buy-in program, a person is considered to be employed if the person gets paid for working; has earnings that are subject to federal income tax; and unless the person is self-employed, has payroll taxes deducted from earnings received.<br /> <br /> DETERMINING PREMIUMS<br /> <br /> This bill requires the director to ensure, when determining the premium amount a person must pay for participation in the buy-in program, that the bureau counts only the income of the person approved for the program, and does not count the income of another household member. The director must also ensure, for purposes of determining countable income to be used in the premium calculation, that the bureau applies the following rules:<br /> <br /> (1) Income is considered available and owned when it is: received; and can be used to meet the person's needs for food, clothing, and shelter; and<br /> <br /> (2) Certain receipts are not income as described in federal regulations.<br /> <br /> This bill requires the director to ensure the buy-in program premium amount equals, rounded down to the nearest whole dollar, 5 percent of countable income described in (1) above, including both earned and unearned income. Additionally, the director must ensure that, when determining the premium amount, the bureau uses the verified income amount until a change in income is reported and processed, unless good cause for delay in verifying changes exists. Finally, the director must ensure that a change in the premium amount is effective the month after the change in income is reported to and processed by the bureau.<br /> <br /> BILLING AND PROCESSING PREMIUM PAYMENTS<br /> <br /> This bill requires the director to ensure, when billing for and processing payments of buy-in program premiums, that:<br /> <br /> (1) For current and ongoing coverage, the bureau bills for program premiums during the month following the benefit month;<br /> <br /> (2) The first monthly premium begins the first full month of coverage;<br /> <br /> (3) The bureau may terminate program coverage if premiums are not paid in full for four consecutive months;<br /> <br /> (4) The person must pay the monthly premium in full to avoid losing program coverage and, if a person makes a partial payment, the payment does not count as a full payment toward the premium;<br /> <br /> (5) Payments received are applied to premiums owed in the following order: past due months, beginning with the most delinquent month; followed by the current coverage month that has been invoiced; and<br /> <br /> (6) A person must pay a premium for any month that program coverage is provided, including months when a redetermination of coverage is made, months when continued coverage is requested, and during the period of an aid-pending eligibility appeal.<br />