Florida Senate - 2013                                     SB 794
       
       
       
       By Senator Brandes
       
       
       
       
       22-00908B-13                                           2013794__
    1                        A bill to be entitled                      
    2         An act relating to Medicaid eligibility; creating s.
    3         409.995, F.S.; providing conditions for the Department
    4         of Children and Families to evaluate an applicant’s
    5         life insurance policy when determining eligibility for
    6         Medicaid services; authorizing the Agency for Health
    7         Care Administration to use federal or state funds
    8         under the Medicaid program to pay life insurance
    9         premiums of an applicant or recipient under certain
   10         circumstances; providing restrictions on the sale,
   11         assignation, or transfer of ownership of a life
   12         insurance policy for which the state is named as a
   13         beneficiary or which is collaterally assigned to the
   14         state; providing for proceeds to be paid to a
   15         beneficiary under certain conditions; providing
   16         conditions for the owner of a life insurance policy to
   17         enter into a viatical settlement contract with a
   18         health care services provider for coverage of Medicaid
   19         long-term care services; specifying content of the
   20         contract; requiring that all marketing materials,
   21         actuarial memoranda, and pricing methodologies used by
   22         the viatical settlement provider be filed with and
   23         approved by the Office of Insurance Regulation;
   24         requiring the office to conduct market examinations
   25         and financial audits of certain viatical settlement
   26         providers; requiring the department to provide notice
   27         of life insurance policy options; authorizing the
   28         department, the agency, and the office to adopt rules;
   29         authorizing the agency to seek state plan amendments
   30         and federal waivers; defining the term “value”;
   31         providing an effective date.
   32  
   33  Be It Enacted by the Legislature of the State of Florida:
   34  
   35         Section 1. Section 409.995, Florida Statutes, is created to
   36  read:
   37         409.995 Life insurance assets.—
   38         (1) Notwithstanding any provision of law to the contrary,
   39  the department, in determining an applicant’s eligibility for
   40  Medicaid, is authorized to treat a life insurance policy owned
   41  by an applicant as follows:
   42         (a) The value of a life insurance policy that is in force
   43  and owned by an applicant or a recipient who meets the state’s
   44  nursing home level of care shall not be considered as a resource
   45  or asset in determining the applicant’s or recipient’s
   46  eligibility for Medicaid if the applicant or recipient:
   47         1. Makes an irrevocable election to name the state as a
   48  beneficiary of the life insurance policy for an amount that is
   49  not greater than the amount of Medicaid benefits provided to the
   50  recipient plus any premiums or other costs incurred by the
   51  agency to the insurer that issued the life insurance policy;
   52         2. Collaterally assigns the life insurance policy to the
   53  state under a written agreement submitted to and recorded by the
   54  issuing company of the life insurance policy; or
   55         3. Irrevocably assigns the ownership of the policy in favor
   56  of the state.
   57         (b) Medicaid benefits may not be authorized or provided
   58  until the designation of the state as an irrevocable beneficiary
   59  or the collateral assignment in favor of the state or written
   60  acknowledgement of irrevocable assignment by the insurer is
   61  completed and accepted by the department as part of the
   62  application process.
   63         (c) Any designation of the state as an irrevocable
   64  beneficiary, any collateral assignment, or an irrevocable
   65  assignment in favor of the state is void if the application for
   66  Medicaid benefits is not approved.
   67         (2) To the extent allowed by federal law, the agency may
   68  use federal or state funds under the Medicaid program to pay
   69  premiums plus any other costs related to a life insurance policy
   70  that is in force and owned by an applicant or a recipient who:
   71         (a) Meets the state’s nursing home level of care;
   72         (b) Has made an irrevocable election to name the state as a
   73  beneficiary of the life insurance policy for an amount that is
   74  not greater than the amount of Medicaid benefits provided to the
   75  recipient and the premiums or expenses paid by the agency to the
   76  insurer that issued the life insurance policy; or
   77         (c) Collaterally assigned the life insurance policy to the
   78  state under a written agreement submitted to and recorded by the
   79  issuing company of the life insurance policy.
   80         (3) Any life insurance policy that is in force and under
   81  which the state is named as an irrevocable beneficiary or that
   82  has been collaterally assigned to the state may not be sold,
   83  assigned, or have the ownership transferred to any person or
   84  entity. This restriction exists as long as the policy names the
   85  state as an irrevocable beneficiary or as long as the policy is
   86  collaterally assigned to the state.
   87         (4) Upon the death of the insured who is the subject of the
   88  policy, proceeds that exceed the amount of Medicaid benefits
   89  provided to a recipient plus premiums and other costs incurred
   90  by the agency shall be paid to a beneficiary named by the
   91  applicant or recipient.
   92         (5) The owner of a life insurance policy with a face value
   93  in excess of $10,000, may enter into a viatical settlement
   94  contract pursuant to part X of chapter 626 in exchange for
   95  payments to a health care provider chosen by the viator, which
   96  payments shall be used solely to provide Medicaid-covered long
   97  term care services as of the effective date of the contract for
   98  the viator, and only when the viatical settlement contract
   99  complies with the requirements of part X of chapter 626. The
  100  contract must contain the following:
  101         (a) The lesser of 5 percent of the face value of the life
  102  insurance policy or $5,000 is reserved as the death benefit
  103  payable to the viator’s estate or beneficiary.
  104         (b) The balance of payments required under the contract
  105  unpaid at the death of the viator must be paid to the viator’s
  106  estate or a named beneficiary.
  107         (c) A schedule evidencing the total amount payable to the
  108  viator under the contract.
  109         (d) All moneys must be held in an irrevocable state or
  110  federally insured account.
  111         (e) The contract must provide that the type of long-term
  112  care benefits payable under the settlement contract shall be
  113  chosen only by the viator or recipient of the benefits. An
  114  attempt by any person to require the use of a specific long-term
  115  care provider to obtain long-term benefits under a settlement
  116  contract is strictly prohibited and constitutes an unfair trade
  117  practice under s. 626.9927.
  118         (6) For purposes of this section, all marketing materials,
  119  including benefit projections, sales brochures, and contracts
  120  used by the viatical settlement provider or its brokers and
  121  agents, must be filed with and approved by the Office of
  122  Insurance Regulation. All pricing and valuation materials,
  123  including actuarial memoranda and pricing methodologies, must be
  124  filed with and approved by the Office of Insurance Regulation.
  125         (7) The Office of Insurance Regulation shall conduct
  126  periodic market examinations and financial audits of each
  127  viatical settlement provider issuing viatical settlement
  128  contracts to provide long-term care benefits to a viator.
  129         (8) The Department of Children and Families must provide,
  130  as part of the application for enrollment in the Medicaid
  131  program, written notice of the life insurance policy options
  132  provided in subsections (1) and (2).
  133         (9) The Office of Insurance Regulation, the Department of
  134  Children and Families, and the Agency for Health Care
  135  Administration are authorized to adopt rules to implement this
  136  section.
  137         (10) The agency is instructed to seek any state plan
  138  amendments or federal waivers that may be required to implement
  139  this section.
  140         (11) As used in this section, the term “value” includes the
  141  face value of a life insurance policy, the cash value of a life
  142  insurance policy, and the value received under subsection (5).
  143         Section 2. This act shall take effect July 1, 2013.