April 30, 2003, Introduced by Rep. Spade and referred to the Committee on Family and Children Services.
A bill to amend 1939 PA 280, entitled
"The social welfare act,"
by amending section 106 (MCL 400.106), as amended by 1990
PA 145.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
1 Sec. 106. (1) A medically indigent individual is defined
2 as:
3 (a) An individual
receiving aid to dependent children
4 family independence program benefits or an individual receiving
5 supplemental security
income under title XVI of the social
6 security act, 42
U.S.C. 1381 to 1385, or state
supplementation
7 thereunder under title XVI subject to limitations imposed
by
8 the director pursuant
according to title XIX.
9 (b) An individual meeting
who meets all of the following
10 conditions:
1 (i) The individual has made application applied
in the
2 manner prescribed by the
state department family independence
3 agency prescribes.
4 (ii) The individual's need for the type of medical assistance
5 available under this act
for which application has been made
6 the individual applied has been professionally established and
7 payment for it is not available through the legal obligation of a
8 public or private contractor
, public or private, to pay or
9 provide for the care without regard to the income or resources of
10 the patient. The
state department shall be subrogated to any
11 right of recovery
which a patient may have for the cost of
12 hospitalization,
pharmaceutical services, physician services,
13 nursing services, and
other medical services not to exceed the
14 amount of funds
expended by the department for the care and
15 treatment of the
patient. The patient or other person acting in
16 the patient's behalf
shall execute and deliver an assignment of
17 claim or other
authorizations as necessary to secure the right of
18 recovery to the
department. A payment may be withheld under this
19 act for medical
assistance for an injury or disability for which
20 the patient is
entitled to medical care or reimbursement for the
21 cost of medical care
under sections 3101 to 3179 of the insurance
22 code of 1956, Act No.
218 of the Public Acts of 1956, as amended,
23 being sections
500.3101 to 500.3179 of the Michigan Compiled
24 Laws, or under any
other policy of insurance providing medical or
25 hospital benefits, or
both, for the patient unless the patient's
26 entitlement to that
medical care or reimbursement is at issue.
27 If a payment is made,
the state department, to enforce its
1 subrogation right, may
do either of the following: (a) intervene
2 or join in an action
or proceeding brought by the injured,
3 diseased, or disabled
person, the person's guardian, personal
4 representative,
estate, dependents, or survivors, against the
5 third person who may
be liable for the injury, disease, or
6 disability, or against
contractors, public or private, who may be
7 liable to pay or
provide medical care and services rendered to an
8 injured, diseased, or
disabled patient; (b) institute and
9 prosecute a legal
proceeding against a third person who may be
10 liable for the injury,
disease, or disability, or against
11 contractors, public or
private, who may be liable to pay or
12 provide medical care
and services rendered to an injured,
13 diseased, or disabled
patient, in state or federal court, either
14 alone or in
conjunction with the injured, diseased, or disabled
15 person, the person's
guardian, personal representative, estate,
16 dependents, or
survivors. The state department may institute the
17 proceedings in its own
name or in the name of the injured,
18 diseased, or disabled
person, the person's guardian, personal
19 representative,
estate, dependents, or survivors. As provided in
20 section 6023 of the
revised judicature act of 1961, Act No. 236
21 of the Public Acts of
1961, as amended, being section 600.6023 of
22 the Michigan Compiled
Laws, the state department, in enforcing
23 its subrogation right,
shall not satisfy a judgment against the
24 third person's
property which is exempt from levy and sale. The
25 injured, diseased, or
disabled person may proceed in his or her
26 own name, collecting
the costs without the necessity of joining
27 the state department
or the state as a named party. The injured,
1 diseased, or disabled
person shall notify the state department of
2 the action or
proceeding entered into upon commencement of the
3 action or proceeding.
An action taken by the state or the state
4 department in
connection with the right of recovery afforded by
5 this section does not
operate to deny the injured, diseased, or
6 disabled person any
part of the recovery beyond the costs
7 expended on the
person's behalf by the state department. The
8 costs of legal action
initiated by the state shall be paid by the
9 state. A payment
shall not be made under this act for medical
10 assistance for an
injury, disease, or disability for which the
11 patient is entitled to
medical care or the cost of medical care
12 under the worker's
disability compensation act of 1969, Act
13 No. 317 of the Public
Acts of 1969, as amended, being sections
14 418.101 to 418.941 of
the Michigan Compiled Laws; except that
15 payment may be made if
an appropriate application for medical
16 care or the cost of
the medical care has been made under Act
17 No. 317 of the Public
Acts of 1969, as amended, entitlement has
18 not been finally
determined, and an arrangement satisfactory to
19 the state department
has been made for reimbursement if the claim
20 under Act No. 317 of
the Public Acts of 1969, as amended, is
21 finally sustained.
22 (iii) The individual has an annual income which that
is
23 below, or because of medical expenses falls below, the protected
24 basic maintenance level. The protected basic maintenance level
25 for 1-person and 2-person families shall be at least 100% of the
26 higher of the payment standards generally used to determine
27 eligibility in the aid
to dependent children family
1 independence program and the supplemental security income program
2 under title XVI, of
the social security act, 42 U.S.C. 1381 to
3 1385, including state supplementation. For families of 3
or
4 more persons, the protected basic maintenance level shall be at
5 least 100% of the payment standard generally used to determine
6 eligibility in the aid
to dependent children family
7 independence program. These levels shall recognize regional
8 variations and shall not exceed 133-1/3% of the payment standard
9 generally used to
determine eligibility in the aid to dependent
10 children family independence program.
11 (iv) The individual, if an aid to dependent children a
12 family independence program related individual and living alone,
13 has liquid or marketable assets of not more than $1,500.00 in
14 value, or, if a 2-person family, the family has liquid or
15 marketable assets of not more than $2,000.00 in value. The
16 state department family independence agency shall establish
17 comparable liquid or marketable asset amounts for larger family
18 groups. Excluded in making the determination of the value of
19 liquid or marketable assets are the values of: the homestead;
20 clothing; household effects; $1,000.00 of cash surrender value of
21 life insurance, except
that if the health of the insured is such
22 as to make makes continuance of the insurance desirable,
the
23 entire cash surrender
value of life insurance is to be excluded
24 from consideration, up to
the maximums maximum provided or
25 allowed by federal regulations and in accordance with the rules
26 of the state
department family independence agency; the fair
27 market value of tangible personal property used in earning
1 income; an amount paid as judgment or settlement for damages
2 suffered as a result of exposure to agent orange, as defined in
3 section 5701 of the
public health code, Act No. 368 of the
4 Public Acts of 1978,
being section 333.5701 of the Michigan
5 Compiled Laws 1978 PA 368, MCL 333.5701; the amount a nursing
6 home is required to pay an individual under section 21799c(4) of
7 the public health code, 1978 PA 368, MCL 333.21799c; and a space
8 or plot purchased for the purposes of burial for the person. For
9 individuals related to
the title XVI program, of the social
10 security act, 42
U.S.C. 1381 to 1385, the
appropriate resource
11 levels and property exemptions specified in title XVI shall be
12 used.
13 (v) The individual is not an inmate of a public institution
14 except as a patient in a medical institution.
15 (vi) The individual meets the eligibility standards for
16 supplemental security
income under title XVI of the social
17 security act, 42
U.S.C. 1381 to 1385, or for state
18 supplementation under the act, subject to limitations imposed by
19 the director pursuant
according to title XIX; or meets the
20 eligibility standards for
aid to dependent children family
21 independence program benefits, except for income or income and
22 resources; or is a child from 18 to 21 years of age and his or
23 her adult caretaker would
be eligible for aid to dependent
24 children family independence program benefits except
for age,
25 income, or income and resources; or is a child under 21 years of
26 age and is from a family whose income is below the basic
27 maintenance level.
1 (2) As used in this
act: , "medical"
2 (a) "Medical institution" means a state licensed or approved
3 hospital, nursing home, medical care facility, psychiatric
4 hospital, or other
facility or identifiable unit thereof of a
5 listed institution certified as meeting established standards for
6 a nursing home or hospital in accordance with the laws of this
7 state.
8 (b) "Title II" means title II of the social security act,
9 chapter 531, 49 Stat. 620, 42 U.S.C. 401 to 405, 406 to 418, 420
10 to 423, 424a to 426-1, and 427 to 434.
11 (c) "Title XVI" means title XVI of the social security act,
12 chapter 531, 49 Stat. 620, 42 U.S.C. 1381 to 1382j and 1383 to
13 1383f.
14 (3) The department of community health is subrogated to a
15 right of recovery that a patient has for the cost of
16 hospitalization, pharmaceutical services, physician services,
17 nursing services, and other medical services not to exceed the
18 amount of money expended by the department of community health
19 for the care and treatment of the patient. The patient or other
20 person acting in the patient's behalf shall execute and deliver
21 an assignment of claim or other authorization necessary to secure
22 the right of recovery to the department of community health. A
23 payment may be withheld under this act for medical assistance for
24 an injury or disability for which the patient is entitled to
25 medical care or reimbursement for the cost of medical care under
26 sections 3101 to 3179 of the insurance code of 1956, 1956 PA 218,
27 MCL 500.3101 to 500.3179, or under another policy of insurance
1 providing medical or hospital benefits, or both, for the patient
2 unless the patient's entitlement to that medical care or
3 reimbursement is at issue. If a payment is made, the department
4 of community health, to enforce its subrogation right, may do
5 either of the following:
6 (a) Intervene or join in an action or proceeding brought by
7 the injured, diseased, or disabled person, or the person's
8 guardian, personal representative, estate, dependents, or
9 survivors, against the third person who may be liable for the
10 injury, disease, or disability or against public or private
11 contractors who may be liable to pay or provide medical care and
12 services rendered to an injured, diseased, or disabled patient.
13 (b) Institute and prosecute a legal proceeding against a
14 third person who may be liable for the injury, disease, or
15 disability or against a public or private contractor who may be
16 liable to pay or provide medical care and services rendered to an
17 injured, diseased, or disabled patient, in state or federal
18 court, either alone or in conjunction with the injured, diseased,
19 or disabled person or the person's guardian, personal
20 representative, estate, dependent, or survivor.
21 (4) In enforcing its subrogation right under subsection (3),
22 the department of community health may institute the proceedings
23 in its own name or in the name of the injured, diseased, or
24 disabled person or the person's guardian, personal
25 representative, estate, dependent, or survivor. As provided in
26 section 6023 of the revised judicature act of 1961, 1961 PA 236,
27 MCL 600.6023, the department of community health, in enforcing
1 its subrogation right, shall not satisfy a judgment against the
2 third person's property that is exempt from levy and sale.
3 (5) The injured, diseased, or disabled person may proceed in
4 his or her own name, collecting the costs without the necessity
5 of joining the department of community health or the state as a
6 named party. The injured, diseased, or disabled person shall
7 notify the department of community health of the action or
8 proceeding entered into upon commencement of the action or
9 proceeding.
10 (6) An action taken by the state or the department of
11 community health in connection with the right of recovery
12 afforded by this section does not deny the injured, diseased, or
13 disabled person a part of the recovery beyond the costs expended
14 on the person's behalf by the department of community health.
15 The costs of legal action initiated by the state shall be paid by
16 the state. A payment shall not be made under this act for
17 medical assistance for an injury, disease, or disability for
18 which the patient is entitled to medical care or the cost of
19 medical care under the worker's disability compensation act of
20 1969, 1969 PA 317, MCL 418.101 to 418.941; except that payment
21 may be made if an appropriate application for medical care or the
22 cost of the medical care has been made under the worker's
23 disability compensation act of 1969, 1969 PA 317, MCL 418.101 to
24 418.941, entitlement has not been finally determined, and an
25 arrangement satisfactory to the department of community health
26 has been made for reimbursement if the claim is finally
27 sustained.
1 Enacting section 1. This amendatory act does not take
2 effect unless Senate Bill No. ______ or House Bill No. 4331
3 (request no. 02832'03) of the 92nd Legislature is enacted into
4 law.