hb4088 intr

H. B. 4088

(By Delegates Fleischauer, Leach, Perdue,

R. M. Thompson, Warner, Poling and Boggs)

[Introduced January 18, 2002; referred to the

Committee on Health and Human Resources then Finance.]

A BILL to amend chapter nine of the code of West Virginia, one thousand nine hundred thirty-one, as amended, by adding thereto two new articles, designated articles ten and eleven, all relating to increasing senior citizens' access to medicines; establishing medicaid outreach and enrollment program and expanding medicaid eligibility for prescription drug coverage.

Be it enacted by the Legislature of West Virginia:

That chapter nine of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be amended by adding thereto two new articles, designated articles ten and eleven, all to read as follows:
ARTICLE 10. MEDICAID OUTREACH AND ENROLLMENT FOR QUALIFYING MEDICARE BENEFICIARIES PROGRAM.

§9-10-1. Medicaid outreach and enrollment program.

This article shall be known and may be cited as the "Medicaid Outreach and Enrollment Program."
§9-10-2. Purpose and Intent.

(a) The Legislature recognizes that:

(1) About three out of every ten medicare enrollees, or more than two hundred seventy-four thousand medicare enrollees in West Virginia have no coverage for pharmaceuticals;

(2) Nearly a quarter of this group lives below the federal poverty level;

(3) Under the medicaid program, West Virginia provides pharmaceutical coverage for qualifying individuals; and

(4) There are thousands of medicare beneficiaries in the state who qualify for medicaid services, but are not enrolled and participating.

(b) The Legislature intends that the medicare enrollees who are eligible for medicaid services, but are not participating, be identified by outreach initiatives implemented under a medicaid outreach and enrollment program.

§9-10-3. Medicaid outreach and enrollment program created.

The West Virginia medicaid outreach and enrollment program is hereby created to be administered by the secretary of health and human resources. The secretary shall implement and administer the program through the development of outreach initiatives to identify medicaid-eligible medicare beneficiaries who are not participating in the medicaid program and to promote and encourage enrollment of these eligibles in the medicaid program. Initiatives may include, but are not limited to, mailings, advertisements, public service announcements, literature dissemination and community outreach.

§9-10-4. Annual report required.

The secretary shall report annually to the Legislature's joint committee on government and finance beginning one year from the implementation date of the medicaid outreach and enrollment program. The report shall include:

(1) The baseline number of medicare beneficiaries who were medicaid eligible at the beginning of the previous year;

(2) The number of medicaid-eligible medicare beneficiaries who were targeted via the medicaid outreach and enrollment program;

(3) The number of medicaid-eligible medicare beneficiaries who enrolled in medicaid in a given year and any information of enrollment via the medicaid outreach and enrollment program;

(4) A description of the outreach initiatives used by the medicaid outreach and enrollment program; and

(5) A detailed accounting of how funding was used.
ARTICLE 11. MEDICAID RX SENIOR ELIGIBILITY EXPANSION PROGRAM.

§9-11-1. Medicaid RX senior eligibility expansion program created; how administered; duties and authority.

(a) The medicaid RX senior eligibility expansion program is hereby created, to be administered by the secretary of health and human resources.

(b) The department of health and human resources shall apply for a federal medicare 1115 demonstration waiver from the secretary of the United States department of health and human services to expand medicaid eligibility for the purposes of prescription drug coverage to qualified medicare beneficiaries and specified low-income medicare beneficiaries under the medicaid RX senior eligibility expansion program.

(c) The department may propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code as are necessary to implement the provisions in this article.
§9-11-2. Purpose and benefits of the program.

The Legislature recognizes that:

(1) Solutions are needed to improve the access of needy seniors to prescription medicines;

(2) About three of ten medicare enrollees, or approximately two hundred seventy-four thousand people in the state, have no coverage for pharmaceuticals, and that a quarter of this group lives below the federal poverty level;

(3) Thousands more elderly and disabled medicare enrollees are under-insured for prescription drugs;

(4) A federal 1115 medicaid waiver to extend prescription drug coverage to qualified medicare beneficiaries and special low-income medicare beneficiaries would provide meaningful access to prescription drugs for the state's poor and near-poor senior population; and

(5) A federal 1115 medicaid waiver enables the state to benefit from the well-established state-federal partnership in medicaid through access to federal matching funds in addition to state funds.
§9-11-3. Definitions.

(a) For the purpose of this article:

(1) "Department" means the department of health and human resources;

(2) "Qualified medicare beneficiaries" means medicare beneficiaries with incomes equal to or below one hundred percent of the federal poverty level who are eligible for medicaid assistance for the part-a or part-b medicare premiums and for medicare deductibles and co-insurance requirements as set forth in section 1905(p)(1) of Title XIX of the Social Security Act, codified at 42 U.S.C. 1396 et seq..

(3) "Specified low-income medicare beneficiaries" means medicare beneficiaries who have incomes greater than one hundred percent of the federal poverty level and less than or equal to one hundred twenty percent of the federal poverty level and meet the requirements set forth in section 1902(a)(10)(E)(iii) of Title XIX of the Social Security Act.
§9-11-4. Eligibility.

(a) To be eligible for the program an individual must meet the following requirements:

(1) Be a United States citizen or a lawfully admitted alien;

(2) Be a state resident;

(3) Be at least sixty-five years of age or an individual between the ages of nineteen and sixty-four who is otherwise eligible for benefits under Title II of the Social Security Act, codified at 42 U.S.C. 401 et seq.;

(4) Meet the definition of a qualified medicare beneficiary or a specified low-income medicare beneficiary; and

(5) Be ineligible for and/or not receiving a prescription drug benefit through a medicare supplemental policy or any other third party payer prescription benefit.

(b) Individuals eligible for the medicaid RX senior eligibility expansion program shall be entitled to the medicaid prescription drug coverage as provided to medicaid recipients as set forth in Title XIX of the Social Security Act.

NOTE: The purpose of this bill is to increase access to medicines for needy seniors through programs to be administered by the secretary of health and human resources to identify medicaid-eligible medicare beneficiaries and to promote enrollment of these eligible individuals in the medicaid program, and to expand medicaid waiver benefits available to poor and near-poor senior citizens.

These articles are new; therefore, strike-throughs and underscoring have been omitted.