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PRINTER'S NO. 4349
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2857
Session of
2020
INTRODUCED BY KEEFER, RYAN, BARRAR, SAYLOR, GROVE, GAYDOS,
KLUNK, BROOKS, RADER, SCHEMEL, SCHLEGEL CULVER, KNOWLES AND
MOUL, SEPTEMBER 9, 2020
REFERRED TO COMMITTEE ON HEALTH, SEPTEMBER 9, 2020
AN ACT
Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
act to consolidate, editorially revise, and codify the public
welfare laws of the Commonwealth," in public assistance,
further providing for persons eligible for medical
assistance.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 441.1 of the act of June 13, 1967
(P.L.31, No.21), known as the Human Services Code, is amended by
adding a subsection to read:
Section 441.1. Persons Eligible for Medical Assistance.--* *
*
(e) The department shall establish an enrollment process for
individuals eligible for medical assistance under this section
to enroll in an individual plan approved by the department and
offered as part of the Commonwealth's approved Title XIX State
Plan as follows:
(1) The enrollment process shall include information for the
individual that, except as otherwise provided for under
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paragraph (4), the individual shall remain enrolled with the
same plan for one year.
(2) After an individual eligible for medical assistance
under this section enrolls in a plan approved by the department
under the Commonwealth's approved Title XIX State Plan, the
individual shall remain enrolled in the individual plan until
the individual's redetermination period, but for at least 12
months unless the individual qualifies for an exemption under
paragraph (4), or until such time as the individual is no longer
eligible for medical assistance.
(3) The department shall notify the individual eligible for
medical assistance under this section about the ability at the
time of redetermination to change the plan in which the
individual is enrolled for services offered under the
Commonwealth's approved Title XIX State Plan.
(4) The department may grant an exemption to the limitation
on changing plans under this section only if the exemption
matches standard practices for health insurance plans approved
by the Insurance Department under the insurance laws of this
Commonwealth, including, but not limited to:
(i) a qualifying life event;
(ii) a relocation of the individual to a region which is not
served by the selected Medicaid managed care organization; or
(iii) a verified health condition which requires treatment
by a provider not currently participating in the Medicaid
managed care organization.
(5) The department shall approve the exemption for an
individual based on applicable Federal regulations regarding
enrollment or on the approved State plan.
(6) Nothing in this section shall be construed to remove an
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individual's eligibility for medical assistance for missing the
enrollment period provided in this subsection.
Section 2. This act shall take effect immediately.
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