,i #aaeth ,,congress #b;d ,session ,h4 ,r4 #dica ,,in ,,the ,,house ,,of ,,representatives ,february #e1 #bjah,mr4 ,langevin 7for himself1 ,mr4 ,harper1 ,mr4 ,beyer1 ,mr4 ,sessions1 and ,mr4 ,foster7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to establish the ,transition to ,independence demonstration program4 #a4 ,short title ,this ,act may be cited as the ,transition to ,independence ,act of #bjah4 #b4 ,transition to ,independence ,demonstration ,program 7a7 ,establishment ,the ,secretary shall establish a demonstration program under which a ,state that is a ,medicaid ,buy-,in ,state and meets certain criteria may receive bonus payments for meeting specific measurable benchmarks in expanding individual integrated employment and reducing subminimum wage work1 congregate setting work1 or facility-based day habilitation placements for working-age individuals with a disability receiving ,medicaid-funded home or community-based services and for taking other actions conducive to expanding employment opportunities for individuals with disabilities within the ,state4 7b7 ,requirements for the ,transition to ,independence demonstration program 7#a7 ,minimum standards ,the ,secretary shall establish minimum standards for ,medicaid ,buy-,in ,states participating in the demonstration program to comply with in establishing eligibility requirements for individual participants1 benefits1 and administrative requirements for the ,transition to ,independence ,medicaid ,buy-,in ,option offered under the demonstration program4 7#b7 ,preference given to certain ,states for demonstration participation ,the ,secretary shall give preference in selecting ,states to participate in the demonstration program to ,states that have ,medicaid ,buy-,in programs that-- 7,a7 establish an assets or resources test for participation by an individual in the ,medicaid ,buy-,in ,option that is not less than #bj1jjj2 7,b7 establish an income requirement for participation by an individual in the ,medicaid ,buy-,in ,option that is at least up to #djj percent of the poverty line2 7,c7 offer home and community-based services1 including employment-based services and supports1 in the ,medicaid ,buy-,in ,option2 and 7,d7 establish such other requirements for an individual's participation in the ,medicaid ,buy-,in ,option as the ,secretary shall specify4 7#c7 ,work incentives coordinator ,the minimum standards shall require a ,medicaid ,buy-,in ,state participating in the demonstration program to provide work incentives coordinators who have been trained as work incentive specialists under a community-based work incentives planning and assistance program established under section #aadi of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#bj7 to assist the individuals who elect to participate in the ,medicaid ,buy-,in ,option in order to ensure the individuals are provided with appropriate items and services4 7c7 ,application and selection requirements 7#a7 ,in general ,not later than ,june #cj1 #bjai1 the ,secretary shall solicit applications from ,medicaid ,buy-,in ,states and select #ae ,medicaid ,buy-,in ,states to participate in the demonstration program4 7#b7 ,application requirements ,an application to participate in the demonstration program shall include the following3 7,a7 ,data and information regarding the numbers of working-age individuals with disabilities who are receiving ,medicaid-funded home or community-based services in the ,medicaid ,buy-,in ,state who are in individual integrated employment1 subminimum wage work1 congregate setting work1 or facility-based day habilitation or day treatment1 respectively4 7,b7 ,data and information verifying that the ,medicaid ,buy-,in ,state is prepared to meet the minimum standards established by the ,secretary for the ,medicaid ,buy-,in ,option4 7,c7 ,a plan for promoting the ,medicaid ,buy-,in ,option to potentially eligible individuals that includes-- 7i7 clear and easy-to-understand1 multi-media information on how to enroll in the ,medicaid ,buy-,in ,option on the ,web sites for the ,medicaid ,buy-,in ,state's ,medicaid and ,disability ,determination ,services ,agencies2 and 7ii7 a no-wrong door policy under which individuals who apply for a determination of eligibility for the ,medicaid ,buy-,in ,option are also determined if they are eligible for an applicable ,state health subsidy program in accordance with section #adac of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjhc7 7including the ,state ,medicaid program under another eligibility pathway71 informed of the results of such determinations and1 depending on their eligibility1 provided with the option to voluntarily elect to participate in the ,medicaid ,buy-,in ,option or an applicable ,state health subsidy program4 7,d7 7i7 ,an assurance that the ,state will establish and build capacity for an eligibility process to make eligibility determinations for the ,medicaid ,buy-,in program4 ,such process shall provide for a determination of eligibility not later than #ij days after the date that an application to participate in the program is filed1 including for individuals who are not receiving disability insurance benefits under title ,,ii of the ,social ,security ,act 7#db ,u4,s4,c4 #dja et seq47 or supplemental security income benefits under title ,,xvi of such ,act 7#db ,u4,s4,c4 #acha et seq474 7ii7 ,a description of the eligibility criteria the ,state will use1 the process it will use to determine eligibility1 for individuals who do not qualify for such title ,,ii or ,,ssi benefits and the staff who will be responsible for making those determinations4 ,this eligibility process shall not use the disability determination process used by the ,social ,security ,administration for such title ,,ii and ,,ssi benefits4 7,e7 ,verification that the ,medicaid ,buy-,in ,state shall establish a ,stakeholder ,advisory ,committee that meets the requirements of paragraph 7#c7 and shall consult with and consider recommendations of the ,committee while conducting the demonstration program4 7,f7 ,a description of the person-centered planning process that the ,state intends to use for participants in the demonstration program4 7,g7 ,such other information as the ,secretary may require relating to the demonstration program4 7#c7 ,stakeholder ,advisory ,committee requirements 7,a7 ,membership ,in establishing the ,stakeholder ,advisory ,committee required for the demonstration program1 the ,medicaid ,buy-,in ,state shall ensure that-- 7i7 at least #ej percent of the members of the ,stakeholder ,advisory ,committee are individuals with disabilities2 and 7ii7 at least #a member of the ,committee is a provider of services to individuals with disabilities4 7,b7 ,duties ,the ,stakeholder ,advisory ,committee shall-- 7i7 analyze outcomes data and other information related to the conduct of the demonstration program2 and 7ii7 regularly submit recommendations1 including for specific actions by the ,medicaid ,buy-,in ,state participating in the demonstration program1 that the ,committee determines appropriate with respect to the conduct of the demonstration program by the ,state4 7d7 ,requirement for selecting ,states ,in selecting ,medicaid ,buy-,in ,states to participate in the demonstration program1 the ,secretary shall ensure that the ,medicaid ,buy-,in ,states selected include ,medicaid ,buy-,in ,states with low1 medium1 and high numbers of working-age individuals with disabilities who are receiving ,medicaid-funded home or community-based services and are in individual integrated employment1 subminimum wage work1 congregate setting work1 or facility-based day habilitation or day treatment1 respectively4 7e7 ,length of demonstration program ,the demonstration program shall be conducted for a period of #e fiscal years1 beginning with fiscal year #bjbj4 7f7 ,performance bonus payments 7#a7 ,in general ,for each fiscal year in which the demonstration program is conducted1 a ,medicaid ,buy-,in ,state participating in the demonstration program during that fiscal year may qualify for a performance bonus payment4 7#b7 ,state-specified criteria and performance plans ,in order to participate in the demonstration program1 a ,medicaid ,buy-,in ,state shall submit criteria and a plan for achieving each of the mandatory benchmarks described in paragraph 7#c7 and a selection of the additional benchmarks described in paragraph 7#d7 as determined by the ,secretary4 ,the ,secretary shall establish a methodology for assessing ,state performance with respect to the ,state-specified criteria for the mandatory and additional benchmarks4 7#c7 ,mandatory benchmarks ,the mandatory benchmarks described in this paragraph are the following3 7,a7 ,reduced participation in segregated programs and increased participation in individual integrated employment 7i7 ,reduced population census of segregated programs 7,i7 ,in general ,achieving a reduction in the population in the ,state of working-age individuals with disabilities who are receiving ,medicaid-funded home or community-based services or who are receiving services through an ,intermediate ,care ,facility for ,persons with ,developmental ,disabilities 7,,icf-,,dd71 a nursing facility1 an institution for individuals with mental illness1 or other congregate facilities and are in subminimum wage work1 congregate setting work1 or facility-based day habilitation or day treatment4 7,,ii7 ,minimum percent reductions2 bonus based on achievement of differing tiers ,in order to receive a bonus payment for a fiscal year under this clause1 a ,medicaid ,buy-,in ,state shall achieve a reduction of the population described in subclause 7,i7 of at least #aj percent below the ,state's most recent prior fiscal year's census of the eligible population in subminimum wage work1 congregate setting work1 or facility-based day habilitation or day treatment4 ,subject to paragraph 7#e77;,b71 the ,secretary shall award an increased bonus payment for a fiscal year to a ,medicaid ,buy-,in ,state that achieves a percentage reduction of #bj1 #cj1 #dj or more with respect to the prior fiscal year's census of such population4 7,,iii7 ,requirements for meeting benchmark ,a working-age individual with a disability shall be deemed as counting towards a percentage reduction for purposes of this clause if the individual is-- 7aa7 employed in a competitive1 integrated employment setting for at least #aj hours a week on average over a #abj-;day period during the year involved2 7bb7 receiving integrated day services that reach the level of care required in the individual's person-centered plan2 or 7cc7 a combination of items 7aa7 and 7bb71 enabling the individual to achieve1 if desired1 a comparable level of benefit as before the change in placement4 ,the ,state must report aggregate data to the ,secretary on the outcome of all individuals transitioning out of congregate settings being counted towards fulfillment of this benchmark4 7ii7 ,increased population census of individual integrated employment 7,i7 ,in general ,achieving an increase in the population in the ,state of working-age individuals with disabilities who are receiving ,medicaid-funded home or community-based services and are in individual integrated employment4 7,,ii7 ,minimum percent increases2 bonus based on achievement of certain tiers ,in order to receive a bonus payment for a fiscal year under this clause1 a ,medicaid ,buy-,in ,state shall achieve an increase in the population described in subclause 7,i7 of at least #aj percent above the ,state's most recent prior fiscal year's census of the eligible population in individual integrated employment4 ,subject to paragraph 7#e77;,b71 the ,secretary shall award an increased bonus payment for a fiscal year to a ,medicaid ,buy-,in ,state that achieves a percentage increase of #bj1 #cj1 #dj or more with respect to the prior fiscal year's census of such population4 7,,iii7 ,requirements for meeting benchmark ,a working-age individual with a disability shall be deemed as counting towards a percentage increase for purposes of this clause if the individual is employed in an integrated individual employment setting for at least #aj hours a week on average over a #abj-;day period during the fiscal year involved4 7,b7 ,meeting the ,medicaid buy-in standards ,meeting the minimum standards established by the ,secretary for the ,medicaid ,buy-,in ,option4 7#d7 ,additional benchmarks ,the additional benchmarks described in this paragraph are the following3 7,a7 ,elimination of new placement approvals ,eliminating new approvals for placement in the ,state of working-age individuals with disabilities who are receiving ,medicaid-funded home or community-based services in subminimum wage work1 congregate setting work1 or facility-based day habilitation or day treatment1 in accordance with criteria established by the ,secretary4 7,b7 ,demonstration of inter-agency collaboration ,demonstrating inter-agency collaboration between the ,state agencies responsible for administering ,medicaid1 vocational rehabilitation1 and education 7and1 if the ,state is participating the ,promoting ,readiness of ,minors in ,supplemental ,security ,income initiative 7,,promise71 including coordination with that initiative71 in determining payer of last resort rules and rules for providing individuals with a seamless transition of services provided under such agencies1 in accordance with criteria established by the ,secretary4 7,c7 ,termination of vocational rehabilitation funding ,ending the use of vocational rehabilitation funding for subminimum wage work1 congregate setting work1 or facility-based day habilitation or day treatment1 in accordance with criteria established by the ,secretary4 7,d7 ,workforce development ,demonstrating in accordance with criteria established by the ,secretary satisfaction of at least two of the following strategies to promote workforce development3 7i7 ,increasing ,medicaid payments for supported employment providers for individuals with disabilities by an amount necessary to ensure an adequately supported employment network1 as determined by the ,secretary4 7ii7 ,adopting employment strategies that result in working-age individuals with disabilities who are receiving ,medicaid-funded home or community-based services being recruited1 hired1 and retained as full-time employees of ,state government or by contractors of ,state government4 7iii7 ,developing a ,state equivalent of section #ejc of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gic7 to recruit1 hire1 promote1 and retain working-age individuals with disabilities who are receiving ,medicaid-funded home or community-based services with a utilization goal of at least #g percent of the ,state government workforce4 7iv7 ,developing a special hiring authority mechanism akin to the ,schedule ,a appointing authority under section #bac4cajb7u7 of title #e of the ,code of ,federal ,regulations 7commonly referred to as the ,schedule ,a ,hiring ,authority7 to assist in easing the hiring of working-age individuals with disabilities who are receiving ,medicaid-funded home or community-based services within the ,state government with an accompanying plan submitted to the ,secretary outlining targeted implementation goals for the amount of individuals with disabilities within ,state government4 7v7 ,increasing the hiring of working-age individuals with disabilities who are receiving ,medicaid-funded home or community-based services in employment for which the individual is compensated at or above the minimum wage1 through collaboration with the ,state vocational rehabilitation and workforce development programs and ,federal contractors4 7vi7 ,providing ,state tax credits to employers for hiring new workers who are working-age individuals with disabilities who are receiving ,medicaid-funded home or community-based services4 7#e7 ,payment to states 7,a7 ,in general ,subject to the succeeding provisions of this paragraph1 the ,secretary shall make a performance bonus payment to each ,medicaid ,buy-,in ,state participating in the demonstration program that qualifies for such a payment with respect to a fiscal year as a single payment not later than the last day of the first calendar quarter of the fiscal year following the fiscal year to which the performance bonus payments applies4 ,payments to ,states made under this paragraph shall be considered to have been made under1 and are subject to the requirements of1 section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b74 7,b7 ,determination of payment ,the performance bonus payment for a ,medicaid ,buy-,in ,state shall consist of the additional amount that the ,state would have been paid for providing medical assistance to individuals enrolled in the ,state's ,medicaid ,buy-,in ,option during the preceding fiscal year if the regular ,,fmap applicable to such assistance were increased 7subject to subparagraph 7,c77 as follows3 7i7 ,two percentage points for achieving the minimum #aj percent reduction in the mandatory benchmark described in paragraph 7#c77;,a7 during the preceding fiscal year 7or #b4d percentage points for achieving a reduction of at least #bj percent 7but not more than #cj percent71 #b4f percentage points for achieving a reduction of at least #cj percent 7but not more than #dj percent71 and #b4h percentage points for achieving a reduction of at least #dj percent74 7ii7 ,two percentage points for achieving the minimum #aj percent increase in the mandatory benchmark described in paragraph 7#c77;,b7 during the preceding fiscal year 7or #b4d percentage points for achieving an increase of at least #bj percent 7but not more than #cj percent71 #b4f percentage points for achieving an increase of at least #cj percent 7but not more than #dj percent71 and #b4h percentage points for achieving an increase of at least #dj percent74 7iii7 ,one-half percentage points for each additional benchmark described in paragraph 7#d7 that the ,state achieves during the preceding fiscal year4 7,c7 ,limitations ,in no case may-- 7i7 the increase in the regular ,,fmap resulting from the application of subparagraph 7,b7 for any ,medicaid ,buy-,in ,state exceed #ajj percent of the costs for providing medical assistance to individuals enrolled in the ,medicaid ,buy-,in ,option with respect to each fiscal year of the #e-;fiscal-year period in which the demonstration project is conducted2 or 7ii7 payments be made to a ,medicaid ,buy-,in ,state under this paragraph after ,december #ca1 #bjbc4 7,d7 ,use of payments ,a ,medicaid ,buy-,in ,state receiving a performance bonus payment under this paragraph shall use the payment only to expand individual integrated employment and community integration for working-age individuals with disabilities who are receiving ,medicaid-funded home or community-based services4 7g7 ,reports2 recommendations 7#a7 ,annual ,state reports 7,a7 ,in general ,each ,medicaid ,buy-,in ,state participating in the demonstration program annually shall submit a detailed report to the ,secretary regarding the ,state's conduct of the demonstration program4 7,b7 ,information to be included ,such annual reports shall include1 in addition to data and information regarding ,state performance with respect the mandatory and additional benchmarks described in paragraphs 7#c7 and 7#d7 of subsection 7f7 and such other information as the ,secretary may require1 data and information regarding the extent to which1 since the start of the demonstration program-- 7i7 the ,state has reduced the ,state population of individuals with disabilities who have attained age #ah but have not attained age #ca1 are receiving ,medicaid-funded home or community-based services or services through an ,intermediate ,care ,facility for ,persons with ,developmental ,disabilities 7,,icf-,,dd71 a nursing facility1 an institution for individuals with mental illness1 or other congregate facilities1 and were in subminimum wage work1 congregate setting work1 or facility-based day habilitation or day treatment2 and 7ii7 the ,state has increased the ,state population of individuals with disabilities who have attained age #ah but have not attained age #ca1 are receiving ,medicaid-funded home or community-based services1 and are engaged in individual integrated employment4 7,c7 ,additional information on transitioning individuals to integrated employment ,each such annual report shall include information regarding-- 7i7 the ,state's efforts to transition individuals with disabilities who are participating in the demonstration program to individual integrated employment during the preceding fiscal year2 7ii7 the full spectrum of employment outcomes for such individuals2 7iii7 best practices for successfully achieving such transitions2 and 7iv7 lessons learned4 7,d7 ,promoting public participation ,to promote transparency with respect to such annual reports1 each ,medicaid ,buy-,in ,state shall-- 7i7 provide1 before submission of each such report-- 7,i7 for posting of a draft of the report for review by the public on a publicly accessible ,web site of the ,state2 7,,ii7 for providing a period of not less than #cj days for the receipt of public comments on the draft report2 and 7,,iii7 for at least two public hearings regarding the draft report2 and 7ii7 include in the report so submitted a response to public comments received during such period 7along with a description of whether changes have been made in the report in response to such comments74 ,with respect to each such ,state report submitted1 the ,secretary1 at the ,federal level1 shall provide for another #cj-;day public comment period to receive comments on such report4 7,e7 ,posting of reports on publicly accessible ,web site ,the ,secretary shall post each of the annual reports submitted under this paragraph1 with a summary of the comments received under subparagraph 7,d71 on a publicly accessible ,web site4 7#b7 ,reports and recommendations to ,congress 7,a7 ,in general ,not later than ,january #a1 #bjbj1 and ,january #a of each of the #f years thereafter1 the ,secretary shall submit to ,congress a report on the demonstration program4 ,each such report shall include data and information regarding ,state performance with respect to each of the mandatory and additional benchmarks described in paragraphs 7#c7 and 7#d7 of subsection 7f7 and other data and information reported by ,states under paragraph 7#a7 and an assessment of the extent to which the demonstration program is successful in transitioning working-age individuals with disabilities to independent living and work in their communities4 7,b7 ,recommendations ,not later than ,december #ca1 #bjba1 the ,secretary shall submit to ,congress recommendations regarding whether the demonstration program should be continued1 expanded1 modified1 or terminated4 7#c7 ,research and evaluation 7,a7 ,in general ,the ,secretary1 acting through the ,administration on ,community ,living1 directly or through grant or contract1 shall provide for research on1 and a national evaluation of1 the demonstration program1 including assistance to the ,secretary in preparing the final report required under subparagraph 7,c74 7,b7 ,contents of evaluation ,such national evaluation shall include an analysis of the characteristics and outcomes of the individuals participating in the demonstration program and the best practices developed to achieve the goals of the demonstration program4 7,c7 ,final report ,not later than ,june #cj1 #bjbb1 the ,secretary shall submit to the ,president and ,congress a final report that reflects the evaluation under subparagraph 7,a71 that provides findings and conclusions on the conduct and effectiveness of demonstration program1 and that includes a summary of the public comments received under paragraph 7#a77;,d74 7h7 ,definitions ,in this section3 7#a7 ,congregate setting work ,the term congregate setting work means a nonprofit1 for-profit1 or ,state agency entity that employs a majority of individuals with disabilities and receives ,medicaid or other ,state funds for the purpose of providing employment services1 or a facility or sub-unit of any such agency that meets such criteria4 7#b7 ,demonstration program ,the term demonstration program means the ,transition to ,independence ,demonstration ,program established under this section4 7#c7 ,facility-based day habilitation or day treatment ,the term facility-based day habilitation or day treatment has the meaning established by the ,secretary for that term for purposes of the demonstration program and shall include non-residential day services which take place predominantly or in large part at a single site1 fixed site1 or center-based program for individuals with disabilities4 ,in establishing the meaning of such term1 the ,secretary shall provide clear instructions distinguishing facility-based day habilitation or day treatment from integrated day habilitation or day treatment programs taking place in settings within the broader community and which do not isolate individuals participating in such integrated day habilitation or day treatment programs from mainstream life4 7#d7 ,individual integrated employment 7,a7 ,in general ,the term individual integrated employment means the ongoing supports to an individual who1 because of the individual's disabilities1 needs intensive on-going supports to obtain and maintain an individual job in competitive or customized employment1 self-employment1 or in an integrated working setting in the general workforce for which the individual is compensated at or above the minimum wage1 but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by an individual without a disability4 7,b7 ,customized employment services included ,such term includes customized employment services in which an individual receives support to craft a job description around their strengths and challenges4 7,c7 ,exclusions ,such term does not include segregated enclaves1 segregated mobile work crews1 or other employment scenarios where an individual is placed solely based on the individual's disability4 ,in this subparagraph1 the term segregated means1 with respect to a setting or work crew1 a setting or work crew in which individuals with disabilities are separated 7in place or in rates of pay7 from individuals without disabilities4 7#e7 ,integrated day habilitation services ,the term integrated day habilitation services means services that are provided outside of disability specific programs or facilities1 in a setting that supports the full access of individuals with disabilities to the greater community to the same degree as individuals not receiving services1 and consistent with the following3 7,a7 ,each individual receiving such services has an individually tailored schedule that is directly related to and reflects the individual's specific interests and goals4 7,b7 ,activities take place on an individual basis or in small groups of individuals who choose to be served together4 7,c7 ,the majority of time spent receiving such services takes place within the broader community rather than within a single-site1 fixed site1 or center-based program for individuals with disabilities1 regardless of the program size4 7,d7 ,the services are provided consistent with the requirements of section #dda4gaj of title #db1 ,code of ,federal ,regulations4 7#f7 ,medicaid ,the term ,medicaid means the program for medical assistance established under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#g7 ,medicaid ,buy-,in ,state ,the term ,medicaid ,buy-,in ,state means a ,state that1 under subclause 7,,xiii71 7,,xv71 or 7,,xvi7 of section #aijb7;a77#aj77;,a77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77ii771 a waiver approved under section #aaae or #aiae of such ,act 7#db ,u4,s4,c4 #acae1 #acifn71 or other authority1 has a program under which individuals with disabilities with earnings and assets that would otherwise make them ineligible for medical assistance under the ,state's ,medicaid program are able to maintain their eligibility for such assistance4 7#h7 ,nursing facility ,the term nursing facility has the meaning given that term in section #aiai7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr7a774 7#i7 ,poverty line ,the term poverty line has the meaning given that term in section #baaj7;c77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;jj7c77#e774 7#aj7 ,regular ,,fmap ,the term regular ,,fmap means the ,federal medical assistance percentage applicable to the ,state 7as determined under section #aije7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b777 without regard to any increases in that percentage applicable under subsection 7y71 7z71 7aa71 or 7dd7 of section #aije of such ,act or under any other provision of law4 7#aa7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#ab7 ,subminimum wage work ,the term subminimum wage work means any setting in which individuals with disabilities are paid less than minimum wage under a certificate issued in accordance with section #ad7;c7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bad7;c774 7#ac7 ,supported employment ,the term supported employment has the meaning given that term in section #g of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gje74 7#ad7 ,state ,the term ,state has the meaning given such term for purposes of title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#ae7 ,title ii disability beneficiary ,the term title ,,ii disability beneficiary means an individual entitled to disability insurance benefits under section #bbc of the ,social ,security ,act 7#db ,u4,s4,c4 #dbc7 or to monthly insurance benefits under section #bjb of such ,act 7#db ,u4,s4,c4 #djb7 based on such individual's disability 7as defined in section #bbc7;d7 of such ,act 7#db ,u4,s4,c4 #dbc7;d7774 7#af7 ,title xvi disability beneficiary ,the term title ,,xvi disability beneficiary means an individual eligible for supplemental security income benefits under title ,,xvi of the ,social ,security ,act 7#db ,u4,s4,c4 #acha et seq47 on the basis of blindness 7within the meaning of section #afad7;a77#b7 of such ,act 7#db ,u4,s4,c4 #achb;c7a77#b777 or disability 7within the meaning of section #afad7;a77#c7 of such ,act 7#db ,u4,s4,c4 #achb;c7a77#c7774 7#ag7 ,working-age individual with a disability receiving ,medicaid-funded home or community-based services ,the term working-age individual with a disability receiving ,medicaid-funded home or community-based services means a title ,,ii disability beneficiary or a title ,,xvi disability beneficiary who has attained age #ah1 but has not attained age #fe1 and is receiving home or community-based services-- 7,a7 under a waiver approved under subsection 7c7 or 7d7 of section #aiae the ,social ,security ,act 7#db ,u4,s4,c4 #acifn72 7,b7 under the ,state ,medicaid plan in accordance with subsection 7i71 7j71 or 7k7 of such section2 or 7,c7 under a ,medicaid waiver approved under section #aaae of the ,social ,security ,act 7#db ,u4,s4,c4 #acae74