Minnesota Legislature
HF 419
as introduced - 90th Legislature (2017 - 2018) Posted on 02/02/2017 03:59pm
Current Version - as introduced
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A bill for an act
relating to human services; increasing the MinnesotaCare income limit; modifying
MinnesotaCare premiums and cost-sharing; requiring the commissioner of human
services to seek federal waivers; amending Minnesota Statutes 2016, sections
256L.02, by adding a subdivision; 256L.03, subdivision 5; 256L.04, subdivisions
1, 7; 256L.07, subdivision 1; 256L.15, subdivision 2.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2016, section 256L.02, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Federal waivers. new text end
new text begin
(a) The commissioner shall apply for an innovation waiver
under section 1332 of the Affordable Care Act, or any applicable federal waiver, to allow
the state to:
new text end
new text begin
(1) expand the MinnesotaCare program as a basic health program to include persons
with incomes up to 275 percent of the federal poverty guidelines;
new text end
new text begin
(2) modify MinnesotaCare premiums and cost-sharing; and
new text end
new text begin
(3) receive for all MinnesotaCare enrollees, including but not limited to those with
incomes greater than 133 percent but not exceeding 275 percent of the federal poverty
guidelines, the full amount of advanced premium tax credits and cost-sharing reductions
that these persons would have otherwise received if the persons obtained qualified health
plan coverage through MNsure.
new text end
new text begin
(b) The commissioner shall apply for a federal waiver under section 1115 of the Social
Security Act to receive a federal match for services provided to all MinnesotaCare enrollees,
including but not limited to those with incomes greater than 133 percent but not exceeding
275 percent of the federal poverty guidelines.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 2.
Minnesota Statutes 2016, section 256L.03, subdivision 5, is amended to read:
Subd. 5.
Cost-sharing.
(a) Except as otherwise provided in this subdivision, the
MinnesotaCare benefit plan shall include the following cost-sharing requirements for all
enrollees:
(1) $3 per prescription for adult enrollees;
(2) $25 for eyeglasses for adult enrollees;
(3) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
episode of service which is required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory setting by a physician or
physician assistant, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
audiologist, optician, or optometrist;
(4) $6 for nonemergency visits to a hospital-based emergency room for services provided
through December 31, 2010, and $3.50 effective January 1, 2011; and
(5) a family deductible equal to $2.75 per month per family and adjusted annually by
the percentage increase in the medical care component of the CPI-U for the period of
September to September of the preceding calendar year, rounded to the next-higher five
cent increment.
(b) Paragraph (a) does not apply to children under the age of 21 and to American Indians
as defined in Code of Federal Regulations, title 42, section 447.51.
(c) Paragraph (a), clause (3), does not apply to mental health services.
(d) MinnesotaCare reimbursements to fee-for-service providers and payments to managed
care plans or county-based purchasing plans shall not be increased as a result of the reduction
of the co-payments in paragraph (a), clause (4), effective January 1, 2011.
(e) The commissioner, through the contracting process under section 256L.12, may
allow managed care plans and county-based purchasing plans to waive the family deductible
under paragraph (a), clause (5). The value of the family deductible shall not be included in
the capitation payment to managed care plans and county-based purchasing plans. Managed
care plans and county-based purchasing plans shall certify annually to the commissioner
the dollar value of the family deductible.
(f) The commissioner shall increase co-payments for covered services in a manner
sufficient to reduce the actuarial value of the benefit to 94 percentnew text begin for recipients with incomes
not exceeding 200 percent of the federal poverty guidelines. The commissioner shall increase
co-payments for covered services in a manner sufficient to reduce the actuarial value of the
benefit to 87 percent for recipients with incomes greater than 200 percent but not exceeding
250 percent of the federal poverty guidelines. The commissioner shall increase co-payments
for covered services in a manner sufficient to reduce the actuarial value of the benefit to 73
percent for recipients with incomes greater than 250 percent but not exceeding 275 percent
of the federal poverty guidelinesnew text end . The cost-sharing changes described in this paragraph do
not apply to eligible recipients or services exempt from cost-sharing under state law. deleted text begin The
cost-sharing changes described in this paragraph shall not be implemented prior to January
1, 2016.
deleted text end
(g) The cost-sharing changes authorized under paragraph (f) must satisfy the requirements
for cost-sharing under the Basic Health Program as set forth in Code of Federal Regulations,
title 42, sections 600.510 and 600.520.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2018, or upon the effective
date of federal approval of the waivers requested under Minnesota Statutes, section 256L.02,
subdivision 7, whichever is later. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained.
new text end
Sec. 3.
Minnesota Statutes 2016, section 256L.04, subdivision 1, is amended to read:
Subdivision 1.
Families with children.
Families with children with family income
above 133 percent of the federal poverty guidelines and equal to or less than deleted text begin 200deleted text end new text begin 275 new text end percent
of the federal poverty guidelines for the applicable family size shall be eligible for
MinnesotaCare according to this section. All other provisions of sections 256L.01 to 256L.18
shall apply unless otherwise specified. Children under age 19 with family income at or
below deleted text begin 200deleted text end new text begin 275new text end percent of the federal poverty guidelines and who are ineligible for medical
assistance by sole reason of the application of federal household composition rules for
medical assistance are eligible for MinnesotaCare.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2018, or upon the effective
date of federal approval of the waivers requested under Minnesota Statutes, section 256L.02,
subdivision 7, whichever is later. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained.
new text end
Sec. 4.
Minnesota Statutes 2016, section 256L.04, subdivision 7, is amended to read:
Subd. 7.
Single adults and households with no children.
The definition of eligible
persons includes all individuals and families with no children who have incomes that are
above 133 percent and equal to or less than deleted text begin 200deleted text end new text begin 275new text end percent of the federal poverty guidelines
for the applicable family size.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2018, or upon the effective
date of federal approval of the waivers requested under Minnesota Statutes, section 256L.02,
subdivision 7, whichever is later. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained.
new text end
Sec. 5.
Minnesota Statutes 2016, section 256L.07, subdivision 1, is amended to read:
Subdivision 1.
General requirements.
Individuals enrolled in MinnesotaCare under
section 256L.04, subdivision 1, and individuals enrolled in MinnesotaCare under section
256L.04, subdivision 7, whose income increases above deleted text begin 200deleted text end new text begin 275new text end percent of the federal
poverty guidelines, are no longer eligible for the program and shall be disenrolled by the
commissioner. For persons disenrolled under this subdivision, MinnesotaCare coverage
terminates the last day of the calendar month in which the commissioner sends advance
notice according to Code of Federal Regulations, title 42, section 431.211, that indicates
the income of a family or individual exceeds program income limits.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2018, or upon the effective
date of federal approval of the waivers requested under Minnesota Statutes, section 256L.02,
subdivision 7, whichever is later. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained.
new text end
Sec. 6.
Minnesota Statutes 2016, section 256L.15, subdivision 2, is amended to read:
Subd. 2.
Sliding fee scale; monthly individual or family income.
(a) The commissioner
shall establish a sliding fee scale to determine the percentage of monthly individual or family
income that households at different income levels must pay to obtain coverage through the
MinnesotaCare program. The sliding fee scale must be based on the enrollee's monthly
individual or family income.
(b) Beginning January 1, 2014, MinnesotaCare enrollees shall pay premiums according
to the premium scale specified in paragraph (d).
(c) Paragraph (b) does not apply to:
(1) children 20 years of age or younger; and
(2) individuals with household incomes below 35 percent of the federal poverty
guidelines.
(d) The following premium scale is established for each individual in the household who
is 21 years of age or older and enrolled in MinnesotaCare:
|
Federal Poverty Guideline Greater than or Equal to |
Less than |
Individual Premium Amount |
| 35% |
55% |
$4 |
| 55% |
80% |
$6 |
| 80% |
90% |
$8 |
| 90% |
100% |
$10 |
| 100% |
110% |
$12 |
| 110% |
120% |
$14 |
| 120% |
130% |
$15 |
| 130% |
140% |
$16 |
| 140% |
150% |
$25 |
| 150% |
160% |
$29 |
| 160% |
170% |
$33 |
| 170% |
180% |
$38 |
| 180% |
190% |
$43 |
| 190% |
$50 |
new text begin
(e) The commissioner shall extend the premium scale specified in paragraph (d) to
include individuals with incomes greater than 200 percent but not exceeding 275 percent
of the federal poverty guidelines, such that individuals with incomes at 201 percent of the
federal poverty guidelines shall pay 4.40 percent of income, individuals with incomes at
250 percent of the federal poverty guidelines shall pay 7.24 percent of income, and
individuals with incomes at 275 percent of the federal poverty guidelines shall pay 8.83
percent of income. The commissioner shall set other premium amounts in a proportional
manner using evenly spaced income steps.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2018, or upon the effective
date of federal approval of the waivers requested under Minnesota Statutes, section 256L.02,
subdivision 7, whichever is later. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained.
new text end