1.1                          A bill for an act 
  1.2             relating to health; establishing an 
  1.3             employer-subsidized health coverage program; requiring 
  1.4             federal approval of waiver requests prior to 
  1.5             implementation; adding a sunset provision; amending 
  1.6             Minnesota Statutes 1998, section 256L.07, subdivision 
  1.7             3; proposing coding for new law as Minnesota Statutes, 
  1.8             chapter 256M. 
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  Minnesota Statutes 1998, section 256L.07, 
  1.11  subdivision 3, is amended to read: 
  1.12     Subd. 3.  [OTHER HEALTH COVERAGE.] (a) Families and 
  1.13  individuals enrolled in the MinnesotaCare program must have no 
  1.14  health coverage while enrolled or for at least four months prior 
  1.15  to application and renewal.  Children enrolled in the original 
  1.16  children's health plan and children in families with income 
  1.17  equal to or less than 150 percent of the federal poverty 
  1.18  guidelines, who have other health insurance, are eligible if the 
  1.19  other health coverage meets the requirements of Minnesota Rules, 
  1.20  part 9506.0020, subpart 3, item B.  The commissioner may change 
  1.21  this eligibility criterion for sliding scale premiums in order 
  1.22  to remain within the limits of available appropriations.  The 
  1.23  requirement of no health coverage does not apply to newborns. 
  1.24     (b) For purposes of this section, medical assistance, 
  1.25  general assistance medical care, and civilian health and medical 
  1.26  program of the uniformed service, CHAMPUS, are not considered 
  1.27  insurance or health coverage. 
  2.1      (c) For purposes of this section, the requirement of no 
  2.2   health coverage does not apply to children who are no longer 
  2.3   eligible for the subsidized employer health coverage program 
  2.4   described in chapter 256M due to employment termination. 
  2.5      (d) For purposes of this section, Medicare Part A or B 
  2.6   coverage under title XVIII of the Social Security Act, United 
  2.7   States Code, title 42, sections 1395c to 1395w-4, is considered 
  2.8   health coverage.  An applicant or enrollee may not refuse 
  2.9   Medicare coverage to establish eligibility for MinnesotaCare. 
  2.10            SUBSIDIZED EMPLOYER HEALTH COVERAGE PROGRAM 
  2.11     Sec. 2.  [256M.01] [DEFINITIONS.] 
  2.12     Subdivision 1.  [APPLICABILITY.] For purposes of this 
  2.13  chapter, the terms defined in this section have the meanings 
  2.14  given them. 
  2.15     Subd. 2.  [COMMISSIONER.] "Commissioner" means the 
  2.16  commissioner of human services. 
  2.17     Subd. 3.  [EMPLOYER-SUBSIDIZED HEALTH 
  2.18  COVERAGE.] "Employer-subsidized health coverage" has the meaning 
  2.19  provided in section 256L.07, subdivision 2, paragraph (b). 
  2.20     Sec. 3.  [256M.03] [ELIGIBILITY FOR EMPLOYER-SUBSIDIZED 
  2.21  COVERAGE.] 
  2.22     Subdivision 1.  [GENERAL REQUIREMENTS.] (a) A child who is 
  2.23  under the age of 19 and whose family gross income is equal to or 
  2.24  less than 275 percent of the federal poverty guidelines for the 
  2.25  applicable family size and who would otherwise be eligible for 
  2.26  coverage under the MinnesotaCare program, except for the 
  2.27  availability of employer-subsidized dependent health coverage, 
  2.28  is eligible for subsidized payment of the employee share of the 
  2.29  employer-subsidized dependent health coverage available to the 
  2.30  child's family in accordance with section 256M.05.  
  2.31     (b) To be eligible under this section, a child must not be 
  2.32  covered under employer-subsidized dependent health coverage at 
  2.33  the time of application.  
  2.34     Subd. 2.  [EMPLOYER-SUBSIDIZED HEALTH COVERAGE.] To be 
  2.35  eligible for the premium payment under this chapter, the 
  2.36  employer-subsidized coverage offered to employees must meet the 
  3.1   requirements for a number two qualified plan described in 
  3.2   section 62E.06 or its actuarial equivalent. 
  3.3      Subd. 3.  [LOW-COST HEALTH PLAN OPTION.] If an employer 
  3.4   offers more than one health plan option to employees, 
  3.5   eligibility for subsidized premium payments shall be limited to 
  3.6   the lowest cost health plan option offered that serves the 
  3.7   geographic area in which the eligible child resides. 
  3.8      Subd. 4.  [PROBATIONARY PERIOD.] If an employer has a 
  3.9   probationary period during which an employee or an employee's 
  3.10  dependent is not eligible for employer-subsidized health 
  3.11  coverage, the employee's dependent shall not be considered 
  3.12  eligible under this section until the employer's probationary 
  3.13  period is over. 
  3.14     Sec. 4.  [256M.05] [PAYMENTS.] 
  3.15     Subdivision 1.  [PREMIUMS.] Children who are eligible under 
  3.16  section 256M.03 shall pay a premium in accordance with the 
  3.17  MinnesotaCare sliding premium scale as specified in section 
  3.18  256L.15, except that children in families with income at or 
  3.19  below 150 percent of the federal poverty guidelines for the 
  3.20  applicable family size, shall not be required to pay an amount 
  3.21  in excess of the maximum monthly charge allowable under title 
  3.22  XXI of the Social Security Act, section 2103(e)(3)(A).  The 
  3.23  commissioner shall inform the employer and the employee of the 
  3.24  premium owed by each eligible employee and the subsidy amount to 
  3.25  be paid by the department of human services.  The employee shall 
  3.26  pay the employer the premium owed.  The employer may deduct the 
  3.27  premium from the employee's paycheck. 
  3.28     Subd. 2.  [PAYMENT TO EMPLOYER.] The commissioner shall pay 
  3.29  the employer the difference between the premiums paid by the 
  3.30  employee as specified under subdivision 1 and the cost of the 
  3.31  employee share of the employer-subsidized health coverage.  
  3.32  Payment of the employee share is limited to the amount of the 
  3.33  premium attributable to the cost of dependent coverage for the 
  3.34  eligible children, unless the amount of the premium for 
  3.35  dependent coverage does not differentiate between adult and 
  3.36  child dependents.  
  4.1      Subd. 3.  [PAYMENTS TO HEALTH CARE PROVIDERS.] Any 
  4.2   copayments, deductibles, or coinsurance owed on behalf of an 
  4.3   eligible child under the employer's health plan shall be paid by 
  4.4   the commissioner to the health care provider.  Payment shall be 
  4.5   made according to the usual and customary charges established 
  4.6   under the employer's health plan.  The family is responsible for 
  4.7   notifying the health care provider that they are covered under 
  4.8   the subsidized employer health coverage program.  The provider 
  4.9   must bill the commissioner for any copayment, deductible, or 
  4.10  coinsurance owed by the family for covered services provided to 
  4.11  the eligible child by the health care provider.  Upon the 
  4.12  submission of a bill, the commissioner must promptly pay the 
  4.13  provider the amount of any copay, deductible, or coinsurance 
  4.14  owed on behalf of an eligible child plus an administrative fee 
  4.15  equal to one percent of the total amount paid by the 
  4.16  commissioner.  
  4.17     Sec. 5.  [256M.07] [APPLICATIONS.] 
  4.18     Subdivision 1.  [AVAILABILITY.] Applicants shall apply for 
  4.19  the program through the licensed insurance broker who provides 
  4.20  employee benefits to their employer, or through another 
  4.21  individual as designated by their employer.  The licensed 
  4.22  insurance broker or individual designated by the employer shall 
  4.23  accept applications and forward them to the commissioner for 
  4.24  processing.  The commissioner of human services shall make 
  4.25  information on the program available to employers, employees, 
  4.26  and other interested parties. 
  4.27     Subd. 2.  [PROCESSING.] The commissioner shall determine an 
  4.28  applicant's initial eligibility.  Applicants who from the 
  4.29  information provided on the application appear to meet the 
  4.30  eligibility requirements shall be enrolled without income 
  4.31  verification.  
  4.32     Subd. 3.  [RENEWAL OF ELIGIBILITY.] An enrollee's 
  4.33  eligibility must be renewed every 12 months.  Renewal of 
  4.34  eligibility may be completed by the licensed insurance broker or 
  4.35  individual designated by the employer.  Renewal applications 
  4.36  must include income verification information.  
  5.1      Sec. 6.  [WAIVER REQUESTS.] 
  5.2      (a) The commissioner shall seek federal approval for a 
  5.3   waiver under section 1115 of the Social Security Act to obtain 
  5.4   federal financial participation under title XIX for children in 
  5.5   the subsidized employer health coverage program whose premium 
  5.6   obligation under the MinnesotaCare sliding premium scale would 
  5.7   exceed five percent of gross family income. 
  5.8      (b) The commissioner shall seek federal approval for a 
  5.9   waiver under section 1115 of the Social Security Act to allow, 
  5.10  at the family's option, federal financial participation under 
  5.11  title XIX for subsidized employer health coverage for a 
  5.12  Medicaid-eligible child who has a sibling eligible for the 
  5.13  subsidized employer health coverage program. 
  5.14     (c) The commissioner shall seek federal approval for a 
  5.15  waiver under title XXI of the Social Security Act for authority 
  5.16  to obtain federal financial participation for health coverage 
  5.17  for the employee's spouse when an employer offers family 
  5.18  coverage. 
  5.19     (d) The commissioner shall seek federal approval for a 
  5.20  waiver under title XXI of the Social Security Act to use the 
  5.21  number two qualified plan or its actuarial equivalent as 
  5.22  benchmark coverage. 
  5.23     Sec. 7.  [EFFECTIVE DATE.] 
  5.24     (a) Sections 1 to 5 are effective 30 days following federal 
  5.25  approval of all waiver requests in section 6.  If the federal 
  5.26  government does not approve all waiver requests in section 6, 
  5.27  sections 1 to 5 shall not be implemented by the commissioner of 
  5.28  human services. 
  5.29     (b) Section 6 is effective the day following final 
  5.30  enactment. 
  5.31     Sec. 8.  [SUNSET; RECOMMENDATIONS.] 
  5.32     (a) Sections 1 to 5 sunset two years after their effective 
  5.33  date. 
  5.34     (b) If sections 1 to 5 are implemented, the commissioner of 
  5.35  human services shall present recommendations to the legislature 
  5.36  on whether the subsidized employer health coverage program 
  6.1   should continue beyond the sunset date.