S 448

GENERAL ASSEMBLY OF NORTH CAROLINA
  SESSION 2025
 S  1
  SENATE BILL 448
 Short Title:   Remove Employment Barriers/Ppl w Disabilities.  (Public)
 Sponsors:      Senators Lee and Grafstein (Primary Sponsors).
 Referred to:   Rules and Operations of the Senate
  March 25, 2025
1A BILL TO BE ENTITLED
2 AN ACT TO REMOVE BARRIERS TO EMPLOYMENT FOR PEOPLE WITH
3     DISABILITIES BY REMOVING THE UNEARNED INCOME LIMIT AND THE
4     RESOURCE LIMIT FROM THE HEALTH COVERAGE FOR WORKERS WITH
5     DISABILITIES ACT UNDER THE MEDICAID PROGRAM.
6 The General Assembly of North Carolina enacts:
7SECTION 1. No later than 90 days after this act becomes law, the Department of
8 Health and Human Services, Division of Health Benefits, shall submit the necessary
9 documentation to the Centers for Medicare and Medicaid Services (CMS) for approval to remove
10 the unearned income limit and the resource limit from the eligibility requirements for the Health
11 Coverage for Workers with Disabilities Medicaid eligibility category. Upon approval by CMS
12 of the removal of the unearned income and resource limits, the Secretary of the Department of
13 Health and Human Services shall notify the Revisor of Statutes of the effective date approved by
14 CMS for the removal.
15SECTION 2.(a) G.S. 108A-66.1 reads as rewritten:
16 "§ 108A-66.1. Medicaid buy-in for workers with disabilities.
17     (a)      Title. – This section may be cited as the Health Coverage for Workers With
18 Disabilities Act. The Department shall implement a Medicaid buy-in eligibility category as
19 permitted under P.L. 106-170, Ticket to Work and Work Incentives Improvement Act of 1999.
20 The Department shall establish rules, policies, and procedures to implement this act in
21 accordance with this section.
22     …
23     (c)      Eligibility. – An Except as provided in subsection (c1) of this section, an individual
24 is eligible for HCWD if:if all of the following apply:
25(1)     The individual is at least 16 years of age and is less than 65 years of age;age.
26(2)     The individual either meets Social Security Disability criteria, criteria or the
27individual has been enrolled in HCWD and then becomes medically improved
28improved, as defined in Ticket to Work and as further specified by the
29Department. An individual shall be determined to be eligible under this
30section without regard to the individual's ability to engage in, or actual
31engagement in, substantial gainful activity as defined in section 223 of the
32Social Security Act (42 U.S.C. § 423(d)(4)). In conducting annual
33redetermination of eligibility, the Department may not determine that an
34individual participating in HCWD is no longer disabled based solely on the
35individual's participation in employment or earned income;income.
  *S448-v-1*
 General Assembly Of North Carolina  Session 2025
1(3)       The individual's unearned income does not exceed one hundred fifty percent
2(150%) of FPG, and countable resources for the individual do not exceed the
3resource limit for the minimum community spouse resource standard under
442 U.S.C. § 1396r, and as further determined by the Department. In
5determining an individual's countable income and resources, the Department
6may not consider income or resources that are disregarded under the State
7Medical Assistance Plan's financial methodology, including the
8sixty-five-dollar ($65.00) disregard, impairment-related work expenses,
9student earned-income exclusions, and other SSI program work incentive
10income disregards; and
11(4)     The individual is engaged in a substantial and reasonable work effort
12(employed) effort, as provided in this subdivision and subdivision, as further
13defined by the Department Department, and as allowable under federal law.
14For purposes of this subsection, "engaged in substantial and reasonable work
15effort" means all of the following:
16a.      Working in a competitive, inclusive work setting, or self-employed.
17b.      Earning at least the applicable minimum wage.
18c.      Having monthly earnings above the SSI basic sixty-five-dollar
19($65.00) earned-income disregard.
20d.      Being able to provide evidence of paying applicable Medicare, Social
21Security, and State and federal income taxes.
22      (c1) Additional Earnings Requirements. – The Department may impose additional
23 earnings requirements in defining "engaged in substantial and reasonable work effort" for
24 individuals who are eligible for HCWD based on medical improvement.
25      (c2) Involuntary Unemployment. – Individuals who participate in HCWD but thereafter
26 become unemployed for involuntary reasons, including health reasons, shall have continued
27 eligibility in HCWD for up to 12 months from the time of involuntary unemployment, so long as
28 the individual (i) maintains a connection with the workforce, as determined by the Department,
29 (ii) meets all other eligibility criteria for HCWD during the period, and (iii) pays applicable fees,
30 premiums, and co-payments.
31      (d)     Fees, Premiums, and Co-Payments. – Individuals who participate in HCWD and have
32 countable income greater than one hundred fifty percent (150%) of FPG shall pay an annual
33 enrollment fee of fifty dollars ($50.00) to their county department of social services. Individuals
34 who participate in HCWD and have countable income greater than or equal to two hundred
35 percent (200%) of FPG shall pay a monthly premium in addition to the annual fee. The
36 Department shall set a sliding scale for premiums, which is consistent with applicable federal
37 law. An individual with countable income equal to or greater than four hundred fifty percent
38 (450%) of FPG shall pay not less than one hundred percent (100%) of the cost of the premium,
39 as determined by the Department. The premium shall be based on the experience of all
40 individuals participating in the Medical Assistance Program. Individuals who participate in
41 HCWD are subject to co-payments equal to those required under the Medical Assistance
42 Program.
43      (e)     Countable Income. – In determining an individual's countable income, the
44 Department may not consider income that is disregarded under the State Medical Assistance
45 Plan's financial methodology, including the sixty-five dollar ($65.00) disregard,
46 impairment-related work expenses, student earned-income exclusions, and other SSI program
47 work incentive income disregards."
48SECTION 2.(b) This section is effective on the date approved by the Centers for
49 Medicare and Medicaid Services for the removal of the unearned income and resource limits for
50 Health Coverage for Workers with Disabilities program eligibility, as required by Section 1 of
51 this act.
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General Assembly Of North Carolina  Session 2025
1SECTION 3. Effective July 1, 2025, there is appropriated from the General Fund to
2 the Department of Health and Human Services, Division of Health Benefits, the sum of one
3 hundred sixty-five thousand dollars ($165,000) in recurring funds for each year of the 2025-2027
4 fiscal biennium. These funds shall provide a State match for three hundred one thousand dollars
5 ($301,000) in recurring federal funds for each year of the 2025-2027 fiscal biennium, and those
6 federal funds are appropriated to the Division of Health Benefits.
7SECTION 4. Except as otherwise provided, this act is effective when it becomes
8 law.
Senate Bill 448-First Edition  Page 3