1.1 	A bill for an act
1.2 	relating to health; expanding eligibility for MinnesotaCare; establishing a premium 
1.3 	scale for MinnesotaCare expansion enrollees; requiring the commissioner of 
1.4 	commerce to seek a section 1332 waiver; appropriating money;amending 
1.5 	Minnesota Statutes 2024, sections 62V.02, by adding a subdivision; 62V.05, 
1.6 	subdivision 6, by adding a subdivision; 256L.01, by adding subdivisions; 256L.03, 
1.7 	subdivision 5; 256L.04, subdivisions 1c, 7a, by adding a subdivision; 256L.07, 
1.8 	subdivision 1; 256L.12, subdivision 7; proposing coding for new law in Minnesota 
1.9 	Statutes, chapter 256L.
1.10 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.11 	Section 1. Minnesota Statutes 2024, section 62V.02, is amended by adding a subdivision 
1.12 	to read:
1.13 		Subd. 7a.MinnesotaCare expansion. "MinnesotaCare expansion" has the meaning 
1.14 	provided in section 256L.01, subdivision 5a.

1.15 	EFFECTIVE DATE. This section is effective January 1, 2029, or upon federal approval, 
1.16 	whichever is later. The commissioner of commerce shall notify the revisor of statutes when 
1.17 	federal approval is obtained.

1.18 	Sec. 2. Minnesota Statutes 2024, section 62V.05, subdivision 6, is amended to read:
1.19 		Subd. 6.Appeals. (a) The board may conduct hearings, appoint hearing officers, and 
1.20 	recommend final orders related to appeals of any MNsure determinations, except for those 
1.21 	determinations identified in paragraph (d). An appeal by a health carrier regarding a specific 
1.22 	certification or selection determination made by MNsure under subdivision 5 must be 
1.23 	conducted as a contested case proceeding under chapter 14, with the report or order of the 
1.24 	administrative law judge constituting the final decision in the case, subject to judicial review 
2.1 	under sections 14.63 to 14.69. For other appeals, the board shall establish hearing processes 
2.2 	which provide for a reasonable opportunity to be heard and timely resolution of the appeal 
2.3 	and which are consistent with the requirements of federal law and guidance. An appealing 
2.4 	party may be represented by legal counsel at these hearings, but this is not a requirement.
2.5 	(b) MNsure may establish service-level agreements with state agencies to conduct 
2.6 	hearings for appeals. Notwithstanding section 471.59, subdivision 1, a state agency is 
2.7 	authorized to enter into service-level agreements for this purpose with MNsure.
2.8 	(c) For proceedings under this subdivision, MNsure may be represented by an attorney 
2.9 	who is an employee of MNsure.
2.10 	(d) This subdivision does not apply to appeals of determinations where a state agency 
2.11 	hearing is available under section 256.045.
2.12 	(e) An appellant aggrieved by an order of MNsure issued in an eligibility appeal, as 
2.13 	defined in Minnesota Rules, part 7700.0101, may appeal the order to the district court of 
2.14 	the appellant's county of residence by serving a written copy of a notice of appeal upon 
2.15 	MNsure and any other adverse party of record within 30 days after the date MNsure issued 
2.16 	the order, the amended order, or order affirming the original order, and by filing the original 
2.17 	notice and proof of service with the court administrator of the district court. Service may 
2.18 	be made personally or by mail; service by mail is complete upon mailing; no filing fee shall 
2.19 	be required by the court administrator in appeals taken pursuant to this subdivision. MNsure 
2.20 	shall furnish all parties to the proceedings with a copy of the decision and a transcript of 
2.21 	any testimony, evidence, or other supporting papers from the hearing held before the appeals 
2.22 	examiner within 45 days after service of the notice of appeal.
2.23 	(f) Any party aggrieved by the failure of an adverse party to obey an order issued by 
2.24 	MNsure may compel performance according to the order in the manner prescribed in sections 
2.25 	586.01 to 586.12.
2.26 	(g) Any party may obtain a hearing at a special term of the district court by serving a 
2.27 	written notice of the time and place of the hearing at least ten days prior to the date of the 
2.28 	hearing. The court may consider the matter in or out of chambers, and shall take no new or 
2.29 	additional evidence unless it determines that such evidence is necessary for a more equitable 
2.30 	disposition of the appeal.
2.31 	(h) Any party aggrieved by the order of the district court may appeal the order as in 
2.32 	other civil cases. No costs or disbursements shall be taxed against any party nor shall any 
2.33 	filing fee or bond be required of any party.
3.1 	(i) If MNsure or district court orders eligibility for qualified health plan coverage through 
3.2 	MNsure, or eligibility for federal advance payment of premium tax credits or cost-sharing 
3.3 	reductions contingent upon full payment of respective premiums, the premiums must be 
3.4 	paid or provided pending appeal to the district court, court of appeals, or supreme court. 
3.5 	Provision of eligibility by MNsure pending appeal does not render moot MNsure's position 
3.6 	in a court of law. This paragraph expires upon the effective date of paragraph (j).
3.7 	(j) Effective January 1, 2029, or upon federal approval, whichever is later, if MNsure 
3.8 	or the district court orders eligibility for qualified health plan coverage through MNsure or 
3.9 	the MinnesotaCare expansion, or eligibility for federal advance payment of premium tax 
3.10 	credits or cost-sharing reductions contingent upon full payment of respective premiums, 
3.11 	the premiums must be paid or provided pending appeal to the district court, court of appeals, 
3.12 	or supreme court. Provision of eligibility by MNsure pending appeal does not render moot 
3.13 	MNsure's position in a court of law.

3.14 	Sec. 3. Minnesota Statutes 2024, section 62V.05, is amended by adding a subdivision to 
3.15 	read:
3.16 		Subd. 13.MinnesotaCare expansion. The board has the powers and duties provided 
3.17 	to the board in section 256L.29 with respect to the MinnesotaCare expansion.

3.18 	EFFECTIVE DATE. This section is effective January 1, 2029, or upon federal approval, 
3.19 	whichever is later. The commissioner of commerce shall notify the revisor of statutes when 
3.20 	federal approval is obtained.

3.21 	Sec. 4. Minnesota Statutes 2024, section 256L.01, is amended by adding a subdivision to 
3.22 	read:
3.23 		Subd. 5a.MinnesotaCare expansion. "MinnesotaCare expansion" means health coverage 
3.24 	provided under section 256L.29.

3.25 	EFFECTIVE DATE. This section is effective January 1, 2029, or upon federal approval, 
3.26 	whichever is later. The commissioner of commerce shall notify the revisor of statutes when 
3.27 	federal approval is obtained.

3.28 	Sec. 5. Minnesota Statutes 2024, section 256L.01, is amended by adding a subdivision to 
3.29 	read:
3.30 		Subd. 5b.MinnesotaCare expansion enrollee. "MinnesotaCare expansion enrollee" 
3.31 	or "expansion enrollee" means an individual enrolled in MinnesotaCare under section 
3.32 	256L.04, subdivision 15.

4.1 	EFFECTIVE DATE. This section is effective January 1, 2029, or upon federal approval, 
4.2 	whichever is later. The commissioner of commerce shall notify the revisor of statutes when 
4.3 	federal approval is obtained.

4.4 	Sec. 6. Minnesota Statutes 2024, section 256L.03, subdivision 5, is amended to read:
4.5 		Subd. 5.Cost-sharing. (a) Co-payments, coinsurance, and deductibles do not apply to 
4.6 	children under the age of 21 and to American Indians as defined in Code of Federal 
4.7 	Regulations, title 42, section 600.5. This paragraph expires upon the effective date of 
4.8 	paragraph (b).
4.9 	(b) Effective January 1, 2029, or upon federal approval, whichever is later, co-payments, 
4.10 	coinsurance, and deductibles do not apply to children under the age of 21 and to American 
4.11 	Indians as defined in Code of Federal Regulations, title 42, section 600.5, but do apply to 
4.12 	expansion enrollees as provided in section 256L.29.
4.13 	(b) (c) The commissioner must adjust co-payments, coinsurance, and deductibles for 
4.14 	covered services in a manner sufficient to maintain the actuarial value of the benefit to 94 
4.15 	percent. The cost-sharing changes described in this paragraph do not apply to eligible 
4.16 	recipients or services exempt from cost-sharing under state law. The cost-sharing changes 
4.17 	described in this paragraph shall not be implemented prior to January 1, 2016. This paragraph 
4.18 	expires upon the effective date of paragraph (d).
4.19 	(d) Effective January 1, 2029, or upon federal approval, whichever is later, the 
4.20 	commissioner must adjust co-payments, coinsurance, and deductibles for covered services 
4.21 	in a manner sufficient to maintain the actuarial value of the benefit to 94 percent, except as 
4.22 	provided for expansion enrollees under section 256L.29. The cost-sharing changes described 
4.23 	in this paragraph do not apply to eligible recipients or services exempt from cost-sharing 
4.24 	under state law.
4.25 	(c) (e) The cost-sharing changes authorized under paragraph (b) paragraphs (c) and (d)
4.26 	must satisfy the requirements for cost-sharing under the Basic Health Program as set forth 
4.27 	in Code of Federal Regulations, title 42, sections 600.510 and 600.520.
4.28 	(d) (f) Cost-sharing for prescription drugs and related medical supplies to treat chronic 
4.29 	disease must comply with the requirements of section 62Q.481.
4.30 	(e) (g) Co-payments, coinsurance, and deductibles do not apply to additional diagnostic 
4.31 	services or testing that a health care provider determines an enrollee requires after a 
4.32 	mammogram, as specified under section 62A.30, subdivision 5.
5.1 	(f) (h) Cost-sharing must not apply to drugs used for tobacco and nicotine cessation or 
5.2 	to tobacco and nicotine cessation services covered under section 256B.0625, subdivision 
5.3 	68.
5.4 	(g) (i) Co-payments, coinsurance, and deductibles do not apply to pre-exposure 
5.5 	prophylaxis (PrEP) and postexposure prophylaxis (PEP) medications when used for the 
5.6 	prevention or treatment of the human immunodeficiency virus (HIV).

5.7 	Sec. 7. Minnesota Statutes 2024, section 256L.04, subdivision 1c, is amended to read:
5.8 		Subd. 1c.General requirements. (a) To be eligible for MinnesotaCare, a person must 
5.9 	meet the eligibility requirements of this section. A person eligible for MinnesotaCare shall 
5.10 	not be considered a qualified individual under section 1312 of the Affordable Care Act, and 
5.11 	is not eligible for enrollment in a qualified health plan offered through MNsure under chapter 
5.12 	62V. This paragraph expires upon the effective date of paragraph (b).
5.13 	(b) Effective January 1, 2029, or upon federal approval, whichever is later, to be eligible 
5.14 	for MinnesotaCare, a person must meet the eligibility requirements of this section. A person 
5.15 	eligible for MinnesotaCare, including but not limited to individuals eligible for the 
5.16 	MinnesotaCare expansion, must not be considered a qualified individual under section 1312 
5.17 	of the Affordable Care Act and is not eligible for enrollment in a qualified health plan 
5.18 	offered through MNsure under chapter 62V.

5.19 	Sec. 8. Minnesota Statutes 2024, section 256L.04, subdivision 7a, is amended to read:
5.20 		Subd. 7a.Ineligibility. (a) Adults whose income is greater than the limits established 
5.21 	under this section may not enroll in the MinnesotaCare program. This paragraph expires 
5.22 	upon the effective date of paragraph (b).
5.23 	(b) Effective January 1, 2029, or upon federal approval, whichever is later, adults whose 
5.24 	income is greater than the limits established under this section may not enroll in the 
5.25 	MinnesotaCare program, except as expansion enrollees under subdivision 15.

5.26 	Sec. 9. Minnesota Statutes 2024, section 256L.04, is amended by adding a subdivision to 
5.27 	read:
5.28 		Subd. 15.Persons eligible for the MinnesotaCare expansion. (a) Effective January 
5.29 	1, 2029, or upon federal approval, whichever is later, families and individuals with incomes 
5.30 	above the maximum income eligibility limit specified in subdivision 1 or 7, with incomes 
5.31 	equal to or below 275 percent of the federal poverty guidelines, and who meet all other 
5.32 	MinnesotaCare eligibility requirements, are eligible for the MinnesotaCare expansion, 
6.1 	subject to the additional requirements established under section 256L.29. Families and 
6.2 	individuals enrolled in the MinnesotaCare expansion under this subdivision are 
6.3 	MinnesotaCare enrollees, and all provisions of this chapter applying generally to 
6.4 	MinnesotaCare enrollees apply to expansion enrollees unless otherwise specified.
6.5 	(b) Effective January 1, 2029, or upon federal approval, whichever is later, families and 
6.6 	individuals may enroll in MinnesotaCare at any time in which the family or individual meets 
6.7 	the eligibility criteria set forth in paragraph (a).

6.8 	Sec. 10. Minnesota Statutes 2024, section 256L.07, subdivision 1, is amended to read:
6.9 		Subdivision 1.General requirements. (a) Individuals enrolled in MinnesotaCare under 
6.10 	section 256L.04, subdivision 1, and individuals enrolled in MinnesotaCare under section 
6.11 	256L.04, subdivision 7, whose income increases above 200 percent of the federal poverty 
6.12 	guidelines, are no longer eligible for the program and shall be disenrolled by the 
6.13 	commissioner. For persons disenrolled under this subdivision, MinnesotaCare coverage 
6.14 	terminates the last day of the calendar month in which the commissioner sends advance 
6.15 	notice according to Code of Federal Regulations, title 42, section 431.211, that indicates 
6.16 	the income of a family or individual exceeds program income limits. This paragraph expires 
6.17 	upon the effective date of paragraph (b).
6.18 	(b) Effective January 1, 2029, or upon federal approval, whichever is later, individuals 
6.19 	enrolled in MinnesotaCare under section 256L.04, subdivision 1, and individuals enrolled 
6.20 	in MinnesotaCare under section 256L.04, subdivision 7, whose income increases above 200 
6.21 	percent of the federal poverty guidelines are no longer eligible for the program and must 
6.22 	be disenrolled by the commissioner, unless the individuals continue MinnesotaCare 
6.23 	enrollment through the MinnesotaCare expansion. For persons disenrolled under this 
6.24 	subdivision, MinnesotaCare coverage terminates the last day of the calendar month in which 
6.25 	the commissioner sends advance notice according to Code of Federal Regulations, title 42, 
6.26 	section 431.211, that indicates the income of a family or individual exceeds program income 
6.27 	limits.

6.28 	Sec. 11. Minnesota Statutes 2024, section 256L.12, subdivision 7, is amended to read:
6.29 		Subd. 7.Managed care plan vendor requirements. (a) The following requirements 
6.30 	apply to all counties or vendors who contract with the Department of Human Services to 
6.31 	serve MinnesotaCare recipients. Managed care plan contractors:
6.32 	(1) shall authorize and arrange for the provision of the full range of services listed in 
6.33 	section 256L.03 in order to ensure appropriate health care is delivered to enrollees;
7.1 	(2) shall accept the prospective, per capita payment or other contractually defined payment 
7.2 	from the commissioner in return for the provision and coordination of covered health care 
7.3 	services for eligible individuals enrolled in the program;
7.4 	(3) may contract with other health care and social service practitioners to provide services 
7.5 	to enrollees;
7.6 	(4) shall provide for an enrollee grievance process as required by the commissioner and 
7.7 	set forth in the contract with the department;
7.8 	(5) shall retain all revenue from enrollee co-payments;
7.9 	(6) shall accept all eligible MinnesotaCare enrollees, without regard to health status or 
7.10 	previous utilization of health services;
7.11 	(7) shall demonstrate capacity to accept financial risk according to requirements specified 
7.12 	in the contract with the department. A health maintenance organization licensed under 
7.13 	chapter 62D, or a nonprofit health plan licensed under chapter 62C, is not required to 
7.14 	demonstrate financial risk capacity, beyond that which is required to comply with chapters 
7.15 	62C and 62D; and
7.16 	(8) shall submit information as required by the commissioner, including data required 
7.17 	for assessing enrollee satisfaction, quality of care, cost, and utilization of services.; and
7.18 	(9) effective January 1, 2029, or upon federal approval, whichever is later, shall reimburse 
7.19 	health care providers for services provided to MinnesotaCare expansion enrollees at payment 
7.20 	rates equal to or greater than the fee-for-service Medicare payment rate for the same service 
7.21 	or for a similar service if the specific service is not reimbursed under Medicare.
7.22 	(b) A health maintenance organization must be a nonprofit corporation organized under 
7.23 	chapter 317A to serve as a managed care contractor under this section and section 256L.121.

7.24 	Sec. 12. [256L.29] MINNESOTACARE EXPANSION.
7.25 		Subdivision 1.MinnesotaCare requirements. Effective January 1, 2029, or upon federal 
7.26 	approval, whichever is later, the MinnesotaCare expansion is part of the MinnesotaCare 
7.27 	program and all provisions of this chapter apply to the MinnesotaCare expansion, unless 
7.28 	otherwise specified. These provisions include but are not limited to those related to covered 
7.29 	health services under section 256L.03; eligibility of undocumented noncitizens under section 
7.30 	256L.04, subdivision 10; eligibility requirements under section 256L.07; and premium 
7.31 	payment methods under section 256L.15.
8.1 		Subd. 2.Application process and eligibility determination. Individuals must apply 
8.2 	for coverage under the MinnesotaCare expansion as provided in subdivision 6. Enrollment 
8.3 	in the MinnesotaCare expansion is limited to individuals eligible under section 256L.04, 
8.4 	subdivision 15. The Board of Directors of MNsure must process MinnesotaCare expansion 
8.5 	applications and determine eligibility for the MinnesotaCare expansion as provided in 
8.6 	subdivision 7.
8.7 		Subd. 3.Premium scale. Expansion enrollees must pay premiums for individual or 
8.8 	family coverage, as applicable, according to the following premium scale:

8.9	Household Income as Percentage of Federal Poverty Guidelines
	
8.10
8.11	Greater Than or 
Equal to
	Not Exceeding
	Required Premium Contribution
as Percentage of Household Income
	
8.12	201%
	225%
	...
	
8.13	226%
	250%
	...
	
8.14	251%
	275%
	...
	
8.15 		Subd. 4.Cost-sharing. (a) Expansion enrollees are subject to the MinnesotaCare 
8.16 	cost-sharing requirements established under section 256L.03, subdivisions 1b and 5, except 
8.17 	that:
8.18 	(1) cost-sharing applies to all expansion enrollees with no exemptions from cost-sharing 
8.19 	for specific groups of individuals, including but not limited to: (i) children under age 21; 
8.20 	and (ii) pregnant women;
8.21 	(2) the commissioner shall set cost-sharing for expansion enrollees at an actuarial value 
8.22 	of 94 percent; and
8.23 	(3) out-of-pocket maximums for expansion enrollees must not exceed those outlined in 
8.24 	Code of Federal Regulations, title 45, section 156.130.
8.25 	(b) No annual deductible applies to expansion enrollees.
8.26 		Subd. 5.Contracting and service delivery. (a) The commissioner may contract with 
8.27 	managed care and county-based purchasing plans for the delivery of services to expansion 
8.28 	enrollees using a procurement process that is separate and unique from that used to contract 
8.29 	for the delivery of services to MinnesotaCare enrollees who are not expansion enrollees.
8.30 	(b) The commissioner shall establish MinnesotaCare expansion participation requirements 
8.31 	for managed care and county-based purchasing plans. Expansion enrollees are not considered 
8.32 	MinnesotaCare enrollees for the purpose of the participation requirement specified in section 
8.33 	256B.0644.
9.1 		Subd. 6.MinnesotaCare expansion application. (a) MNsure must allow an individual 
9.2 	eligible for the MinnesotaCare expansion to apply for the MinnesotaCare expansion on the 
9.3 	MNsure website.
9.4 	(b) MNsure must allow an individual to apply for and, if eligible, enroll in the 
9.5 	MinnesotaCare expansion by completing the application for a qualified health plan with 
9.6 	premium tax credits or cost-sharing reductions. An individual must provide information 
9.7 	needed to confirm the individual is not eligible for medical assistance under chapter 256B 
9.8 	or MinnesotaCare under chapter 256L through an eligibility pathway other than the 
9.9 	MinnesotaCare expansion.
9.10 	(c) The MNsure website must include clear and conspicuous language stating that 
9.11 	individuals can apply for the MinnesotaCare expansion on the website.
9.12 		Subd. 7.Eligibility determinations. (a) MNsure must process all MinnesotaCare 
9.13 	expansion applications and make all eligibility determinations for the MinnesotaCare 
9.14 	expansion. MNsure shall make all MinnesotaCare expansion eligibility determinations in 
9.15 	accordance with section 256L.04, subdivision 15.
9.16 	(b) Eligibility for the MinnesotaCare expansion is appealable to the MNsure board under 
9.17 	chapter 62V and Minnesota Rules, chapter 7700.
9.18 		Subd. 8.Administrative functions. MNsure shall provide administrative functions to 
9.19 	the commissioner of human services to facilitate offering the MinnesotaCare expansion. 
9.20 	These functions include but are not limited to marketing, call center operations, and 
9.21 	certification of insurance producers. MNsure may provide additional administrative functions 
9.22 	as requested by the commissioner of human services.
9.23 		Subd. 9.Diversion of resources. MNsure may utilize existing resources, personnel, and 
9.24 	operations to carry out its duties under this section.
9.25 		Subd. 10.Contracting authorization. The MNsure board may contract on a single-source 
9.26 	basis under section 16C.10, subdivision 1, with a third-party entity already providing 
9.27 	technical support to the MNsure board to develop and implement the technological 
9.28 	requirements of this section.

9.29 	Sec. 13. REQUEST FOR FEDERAL WAIVER.
 9.30 	(a) The commissioner of commerce, in cooperation with the commissioner of human 
9.31 	services and the Board of Directors of MNsure, shall submit a section 1332 waiver pursuant 
9.32 	to United States Code, title 42, section 18052, to the United States Secretary of Health and 
10.1 	Human Services to obtain federal approval to implement this act. The commissioner of 
10.2 	commerce shall also seek through the waiver approval for the state to:
10.3 	(1) continue receiving federal Medicaid payments for individuals eligible for Medicaid 
10.4 	and federal basic health program payments for MinnesotaCare individuals eligible for the 
10.5 	basic health program; and
10.6 	(2) receive federal pass-through money equal to the value of premium tax credits and 
10.7 	cost-sharing reductions that MinnesotaCare expansion enrollees with household incomes 
10.8 	greater than 200 percent of the federal poverty guidelines would otherwise have received.
10.9 	(b) The commissioner of commerce is authorized to contract for any analyses, 
10.10 	certification, data, or other information required to complete the section 1332 waiver 
10.11 	application in accordance with Code of Federal Regulations, title 33, part 108; Code of 
10.12 	Federal Regulations, title 155, part 1308; and any other applicable federal law. The 
10.13 	commissioner must cooperate with the federal government to obtain waiver approval under 
10.14 	this section and may provide any information the commissioner determines necessary and 
10.15 	advisable for waiver approval to the United States Secretary of Health and Human Services 
10.16 	and the United States Secretary of the Treasury.

10.17 	EFFECTIVE DATE. This section is effective the day following final enactment.