HS HB 612 -- COMMUNITY FIRST ACT (Ladd Baker) This substitute affects programs for the needy and disabled. MEDICAL ASSISTANCE FOR EMPLOYED INDIVIDUALS The substitute establishes eligibility requirements for needy persons to receive medical assistance, as derived from the federal Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA). A person who is employed is eligible to receive medical assistance when he or she: (1) Meets the definition of the term "disabled" under the Supplemental Security Income Program or meets the definition of "employed individual with a medically improved disability" under TWWIIA; (2) Meets the asset limits specified in the substitute; and (3) Has an annual income of 250% or less of the federal poverty guidelines. Individuals with incomes greater than 150% of the federal poverty guidelines will pay a premium for participation. A person otherwise eligible for medical assistance under the substitute will not lose eligibility if he or she maintains an independent living development account. If an eligible individual's employer offers employer-sponsored health insurance and the Department of Social Services determines that it is more cost-effective than medical assistance, the individual will participate in the employer-sponsored insurance. The department will pay the individual's portion of the premiums, co-payments, and other associated costs. If the department elects to pay the employer-sponsored insurance, medical assistance will be provided to an eligible person as a secondary or supplemental policy. The department will submit appropriate documentation to the federal government for approval and will apply for all grants available to offset the costs associated with the substitute's provisions. ELIGIBILITY LIMITS FOR MEDICAL ASSISTANCE The substitute revises the eligibility requirements for medical assistance benefits. It allows the department to use less-restrictive income methodologies to raise the eligibility limit for certain individuals to 100% of the federal poverty level. COMMUNITY FIRST COMMISSION The substitute establishes the Community First Commission, whose duties include helping state agencies accomplish recommended objectives of the Temporary Home and Community-based Services and Consumer-directed Care Commission of 2000; assessing how institutionalized persons with disabilities move into community-based settings and evaluating the success of these settings in keeping persons with disabilities out of institutions; and developing recommendations for legislative and administrative action. The commission will have 24 members and will meet at least twice a year. The commission will report by January 31 of each year to the Governor and General Assembly on the state's compliance with a recent U. S. Supreme Court decision (Olmstead v. L.C.) that prohibits requiring a person to be institutionalized in order to receive services and will recommend statutory and regulatory changes. A one-time transition grant of up to $1,500 for institutionalized persons who want to move back into the community will be administered by the Division of Vocational Rehabilitation in consultation with the Department of Social Services. The division and the department will also cooperate to seek federal and private grant moneys for this purpose; the moneys will not limit the appropriation of state moneys for the grant. FISCAL NOTE: Estimated Net Cost to General Revenue Fund of $6,427,918 in FY 2002, $11,273,312 in FY 2003, and $12,772,981 in FY 2004.Copyright (c) Missouri House of Representatives