SF 2323

Introduction - 94th Legislature (2025 - 2026)

Posted on 03/18/2025 09:26 a.m.

A bill for an act
relating to health; expanding eligibility for MinnesotaCare; establishing a premium
scale for MinnesotaCare expansion enrollees; requiring the commissioner of
commerce to seek a section 1332 waiver; appropriating money; amending
Minnesota Statutes 2024, sections 62V.02, by adding a subdivision; 62V.05,
subdivision 6, by adding a subdivision; 256L.01, by adding subdivisions; 256L.03,
subdivision 5; 256L.04, subdivisions 1c, 7a, by adding a subdivision; 256L.07,
subdivision 1; 256L.12, subdivision 7; proposing coding for new law in Minnesota
Statutes, chapter 256L.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2024, section 62V.02, is amended by adding a subdivision
to read:

new text begin Subd. 7a. new text end

new text begin MinnesotaCare expansion. new text end

new text begin "MinnesotaCare expansion" has the meaning
provided in section 256L.01, subdivision 5a.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2029, or upon federal approval,
whichever is later. The commissioner of commerce shall notify the revisor of statutes when
federal approval is obtained.
new text end

Sec. 2.

Minnesota Statutes 2024, section 62V.05, subdivision 6, is amended to read:

Subd. 6.

Appeals.

(a) The board may conduct hearings, appoint hearing officers, and
recommend final orders related to appeals of any MNsure determinations, except for those
determinations identified in paragraph (d). An appeal by a health carrier regarding a specific
certification or selection determination made by MNsure under subdivision 5 must be
conducted as a contested case proceeding under chapter 14, with the report or order of the
administrative law judge constituting the final decision in the case, subject to judicial review
under sections 14.63 to 14.69. For other appeals, the board shall establish hearing processes
which provide for a reasonable opportunity to be heard and timely resolution of the appeal
and which are consistent with the requirements of federal law and guidance. An appealing
party may be represented by legal counsel at these hearings, but this is not a requirement.

(b) MNsure may establish service-level agreements with state agencies to conduct
hearings for appeals. Notwithstanding section 471.59, subdivision 1, a state agency is
authorized to enter into service-level agreements for this purpose with MNsure.

(c) For proceedings under this subdivision, MNsure may be represented by an attorney
who is an employee of MNsure.

(d) This subdivision does not apply to appeals of determinations where a state agency
hearing is available under section 256.045.

(e) An appellant aggrieved by an order of MNsure issued in an eligibility appeal, as
defined in Minnesota Rules, part 7700.0101, may appeal the order to the district court of
the appellant's county of residence by serving a written copy of a notice of appeal upon
MNsure and any other adverse party of record within 30 days after the date MNsure issued
the order, the amended order, or order affirming the original order, and by filing the original
notice and proof of service with the court administrator of the district court. Service may
be made personally or by mail; service by mail is complete upon mailing; no filing fee shall
be required by the court administrator in appeals taken pursuant to this subdivision. MNsure
shall furnish all parties to the proceedings with a copy of the decision and a transcript of
any testimony, evidence, or other supporting papers from the hearing held before the appeals
examiner within 45 days after service of the notice of appeal.

(f) Any party aggrieved by the failure of an adverse party to obey an order issued by
MNsure may compel performance according to the order in the manner prescribed in sections
586.01 to 586.12.

(g) Any party may obtain a hearing at a special term of the district court by serving a
written notice of the time and place of the hearing at least ten days prior to the date of the
hearing. The court may consider the matter in or out of chambers, and shall take no new or
additional evidence unless it determines that such evidence is necessary for a more equitable
disposition of the appeal.

(h) Any party aggrieved by the order of the district court may appeal the order as in
other civil cases. No costs or disbursements shall be taxed against any party nor shall any
filing fee or bond be required of any party.

(i) If MNsure or district court orders eligibility for qualified health plan coverage through
MNsure, or eligibility for federal advance payment of premium tax credits or cost-sharing
reductions contingent upon full payment of respective premiums, the premiums must be
paid or provided pending appeal to the district court, court of appeals, or supreme court.
Provision of eligibility by MNsure pending appeal does not render moot MNsure's position
in a court of law. new text begin This paragraph expires upon the effective date of paragraph (j).
new text end

new text begin (j) Effective January 1, 2029, or upon federal approval, whichever is later, if MNsure
or the district court orders eligibility for qualified health plan coverage through MNsure or
the MinnesotaCare expansion, or eligibility for federal advance payment of premium tax
credits or cost-sharing reductions contingent upon full payment of respective premiums,
the premiums must be paid or provided pending appeal to the district court, court of appeals,
or supreme court. Provision of eligibility by MNsure pending appeal does not render moot
MNsure's position in a court of law.
new text end

Sec. 3.

Minnesota Statutes 2024, section 62V.05, is amended by adding a subdivision to
read:

new text begin Subd. 13. new text end

new text begin MinnesotaCare expansion. new text end

new text begin The board has the powers and duties provided
to the board in section 256L.29 with respect to the MinnesotaCare expansion.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2029, or upon federal approval,
whichever is later. The commissioner of commerce shall notify the revisor of statutes when
federal approval is obtained.
new text end

Sec. 4.

Minnesota Statutes 2024, section 256L.01, is amended by adding a subdivision to
read:

new text begin Subd. 5a. new text end

new text begin MinnesotaCare expansion. new text end

new text begin "MinnesotaCare expansion" means health coverage
provided under section 256L.29.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2029, or upon federal approval,
whichever is later. The commissioner of commerce shall notify the revisor of statutes when
federal approval is obtained.
new text end

Sec. 5.

Minnesota Statutes 2024, section 256L.01, is amended by adding a subdivision to
read:

new text begin Subd. 5b. new text end

new text begin MinnesotaCare expansion enrollee. new text end

new text begin "MinnesotaCare expansion enrollee"
or "expansion enrollee" means an individual enrolled in MinnesotaCare under section
256L.04, subdivision 15.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2029, or upon federal approval,
whichever is later. The commissioner of commerce shall notify the revisor of statutes when
federal approval is obtained.
new text end

Sec. 6.

Minnesota Statutes 2024, section 256L.03, subdivision 5, is amended to read:

Subd. 5.

Cost-sharing.

(a) Co-payments, coinsurance, and deductibles do not apply to
children under the age of 21 and to American Indians as defined in Code of Federal
Regulations, title 42, section 600.5. new text begin This paragraph expires upon the effective date of
paragraph (b).
new text end

new text begin (b) Effective January 1, 2029, or upon federal approval, whichever is later, co-payments,
coinsurance, and deductibles do not apply to children under the age of 21 and to American
Indians as defined in Code of Federal Regulations, title 42, section 600.5, but do apply to
expansion enrollees as provided in section 256L.29.
new text end

deleted text begin (b) deleted text end new text begin (c) new text end The commissioner must adjust co-payments, coinsurance, and deductibles for
covered services in a manner sufficient to maintain the actuarial value of the benefit to 94
percent. The cost-sharing changes described in this paragraph do not apply to eligible
recipients or services exempt from cost-sharing under state law. The cost-sharing changes
described in this paragraph shall not be implemented prior to January 1, 2016. new text begin This paragraph
expires upon the effective date of paragraph (d).
new text end

new text begin (d) Effective January 1, 2029, or upon federal approval, whichever is later, the
commissioner must adjust co-payments, coinsurance, and deductibles for covered services
in a manner sufficient to maintain the actuarial value of the benefit to 94 percent, except as
provided for expansion enrollees under section 256L.29. The cost-sharing changes described
in this paragraph do not apply to eligible recipients or services exempt from cost-sharing
under state law.
new text end

deleted text begin (c) deleted text end new text begin (e) new text end The cost-sharing changes authorized under deleted text begin paragraph (b) deleted text end new text begin paragraphs (c) and (d) new text end
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.

deleted text begin (d) deleted text end new text begin (f) new text end Cost-sharing for prescription drugs and related medical supplies to treat chronic
disease must comply with the requirements of section 62Q.481.

deleted text begin (e) deleted text end new text begin (g) new text end Co-payments, coinsurance, and deductibles do not apply to additional diagnostic
services or testing that a health care provider determines an enrollee requires after a
mammogram, as specified under section 62A.30, subdivision 5.

deleted text begin (f) deleted text end new text begin (h) new text end Cost-sharing must not apply to drugs used for tobacco and nicotine cessation or
to tobacco and nicotine cessation services covered under section 256B.0625, subdivision
68.

deleted text begin (g) deleted text end new text begin (i) new text end Co-payments, coinsurance, and deductibles do not apply to pre-exposure
prophylaxis (PrEP) and postexposure prophylaxis (PEP) medications when used for the
prevention or treatment of the human immunodeficiency virus (HIV).

Sec. 7.

Minnesota Statutes 2024, section 256L.04, subdivision 1c, is amended to read:

Subd. 1c.

General requirements.

new text begin (a) new text end To be eligible for MinnesotaCare, a person must
meet the eligibility requirements of this section. A person eligible for MinnesotaCare shall
not be considered a qualified individual under section 1312 of the Affordable Care Act, and
is not eligible for enrollment in a qualified health plan offered through MNsure under chapter
62V. new text begin This paragraph expires upon the effective date of paragraph (b).
new text end

new text begin (b) Effective January 1, 2029, or upon federal approval, whichever is later, to be eligible
for MinnesotaCare, a person must meet the eligibility requirements of this section. A person
eligible for MinnesotaCare, including but not limited to individuals eligible for the
MinnesotaCare expansion, must not be considered a qualified individual under section 1312
of the Affordable Care Act and is not eligible for enrollment in a qualified health plan
offered through MNsure under chapter 62V.
new text end

Sec. 8.

Minnesota Statutes 2024, section 256L.04, subdivision 7a, is amended to read:

Subd. 7a.

Ineligibility.

new text begin (a) new text end Adults whose income is greater than the limits established
under this section may not enroll in the MinnesotaCare program. new text begin This paragraph expires
upon the effective date of paragraph (b).
new text end

new text begin (b) Effective January 1, 2029, or upon federal approval, whichever is later, adults whose
income is greater than the limits established under this section may not enroll in the
MinnesotaCare program, except as expansion enrollees under subdivision 15.
new text end

Sec. 9.

Minnesota Statutes 2024, section 256L.04, is amended by adding a subdivision to
read:

new text begin Subd. 15. new text end

new text begin Persons eligible for the MinnesotaCare expansion. new text end

new text begin (a) Effective January
1, 2029, or upon federal approval, whichever is later, families and individuals with incomes
above the maximum income eligibility limit specified in subdivision 1 or 7, with incomes
equal to or below 275 percent of the federal poverty guidelines, and who meet all other
MinnesotaCare eligibility requirements, are eligible for the MinnesotaCare expansion,
subject to the additional requirements established under section 256L.29. Families and
individuals enrolled in the MinnesotaCare expansion under this subdivision are
MinnesotaCare enrollees, and all provisions of this chapter applying generally to
MinnesotaCare enrollees apply to expansion enrollees unless otherwise specified.
new text end

new text begin (b) Effective January 1, 2029, or upon federal approval, whichever is later, families and
individuals may enroll in MinnesotaCare at any time in which the family or individual meets
the eligibility criteria set forth in paragraph (a).
new text end

Sec. 10.

Minnesota Statutes 2024, section 256L.07, subdivision 1, is amended to read:

Subdivision 1.

General requirements.

new text begin (a) new text end 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 200 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 This paragraph expires
upon the effective date of paragraph (b).
new text end

new text begin (b) Effective January 1, 2029, or upon federal approval, whichever is later, 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 200
percent of the federal poverty guidelines are no longer eligible for the program and must
be disenrolled by the commissioner, unless the individuals continue MinnesotaCare
enrollment through the MinnesotaCare expansion. 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 end

Sec. 11.

Minnesota Statutes 2024, section 256L.12, subdivision 7, is amended to read:

Subd. 7.

Managed care plan vendor requirements.

(a) The following requirements
apply to all counties or vendors who contract with the Department of Human Services to
serve MinnesotaCare recipients. Managed care plan contractors:

(1) shall authorize and arrange for the provision of the full range of services listed in
section 256L.03 in order to ensure appropriate health care is delivered to enrollees;

(2) shall accept the prospective, per capita payment or other contractually defined payment
from the commissioner in return for the provision and coordination of covered health care
services for eligible individuals enrolled in the program;

(3) may contract with other health care and social service practitioners to provide services
to enrollees;

(4) shall provide for an enrollee grievance process as required by the commissioner and
set forth in the contract with the department;

(5) shall retain all revenue from enrollee co-payments;

(6) shall accept all eligible MinnesotaCare enrollees, without regard to health status or
previous utilization of health services;

(7) shall demonstrate capacity to accept financial risk according to requirements specified
in the contract with the department. A health maintenance organization licensed under
chapter 62D, or a nonprofit health plan licensed under chapter 62C, is not required to
demonstrate financial risk capacity, beyond that which is required to comply with chapters
62C and 62D; deleted text begin and
deleted text end

(8) shall submit information as required by the commissioner, including data required
for assessing enrollee satisfaction, quality of care, cost, and utilization of services deleted text begin . deleted text end new text begin ; and
new text end

new text begin (9) effective January 1, 2029, or upon federal approval, whichever is later, shall reimburse
health care providers for services provided to MinnesotaCare expansion enrollees at payment
rates equal to or greater than the fee-for-service Medicare payment rate for the same service
or for a similar service if the specific service is not reimbursed under Medicare.
new text end

(b) A health maintenance organization must be a nonprofit corporation organized under
chapter 317A to serve as a managed care contractor under this section and section 256L.121.

Sec. 12.

new text begin [256L.29] MINNESOTACARE EXPANSION.
new text end

new text begin Subdivision 1. new text end

new text begin MinnesotaCare requirements. new text end

new text begin Effective January 1, 2029, or upon federal
approval, whichever is later, the MinnesotaCare expansion is part of the MinnesotaCare
program and all provisions of this chapter apply to the MinnesotaCare expansion, unless
otherwise specified. These provisions include but are not limited to those related to covered
health services under section 256L.03; eligibility of undocumented noncitizens under section
256L.04, subdivision 10; eligibility requirements under section 256L.07; and premium
payment methods under section 256L.15.
new text end

new text begin Subd. 2. new text end

new text begin Application process and eligibility determination. new text end

new text begin Individuals must apply
for coverage under the MinnesotaCare expansion as provided in subdivision 6. Enrollment
in the MinnesotaCare expansion is limited to individuals eligible under section 256L.04,
subdivision 15. The Board of Directors of MNsure must process MinnesotaCare expansion
applications and determine eligibility for the MinnesotaCare expansion as provided in
subdivision 7.
new text end

new text begin Subd. 3. new text end

new text begin Premium scale. new text end

new text begin Expansion enrollees must pay premiums for individual or
family coverage, as applicable, according to the following premium scale:
new text end

new text begin Household Income as Percentage of Federal Poverty Guidelines new text end
new text begin Greater Than or Equal to new text end	new text begin Not Exceeding new text end	new text begin Required Premium Contribution as Percentage of Household Income new text end
new text begin 201% new text end	new text begin 225% new text end	new text begin ... new text end
new text begin 226% new text end	new text begin 250% new text end	new text begin ... new text end
new text begin 251% new text end	new text begin 275% new text end	new text begin ... new text end

new text begin Subd. 4. new text end

new text begin Cost-sharing. new text end

new text begin (a) Expansion enrollees are subject to the MinnesotaCare
cost-sharing requirements established under section 256L.03, subdivisions 1b and 5, except
that:
new text end

new text begin (1) cost-sharing applies to all expansion enrollees with no exemptions from cost-sharing
for specific groups of individuals, including but not limited to: (i) children under age 21;
and (ii) pregnant women;
new text end

new text begin (2) the commissioner shall set cost-sharing for expansion enrollees at an actuarial value
of 94 percent; and
new text end

new text begin (3) out-of-pocket maximums for expansion enrollees must not exceed those outlined in
Code of Federal Regulations, title 45, section 156.130.
new text end

new text begin (b) No annual deductible applies to expansion enrollees.
new text end

new text begin Subd. 5. new text end

new text begin Contracting and service delivery. new text end

new text begin (a) The commissioner may contract with
managed care and county-based purchasing plans for the delivery of services to expansion
enrollees using a procurement process that is separate and unique from that used to contract
for the delivery of services to MinnesotaCare enrollees who are not expansion enrollees.
new text end

new text begin (b) The commissioner shall establish MinnesotaCare expansion participation requirements
for managed care and county-based purchasing plans. Expansion enrollees are not considered
MinnesotaCare enrollees for the purpose of the participation requirement specified in section
256B.0644.
new text end

new text begin Subd. 6. new text end

new text begin MinnesotaCare expansion application. new text end

new text begin (a) MNsure must allow an individual
eligible for the MinnesotaCare expansion to apply for the MinnesotaCare expansion on the
MNsure website.
new text end

new text begin (b) MNsure must allow an individual to apply for and, if eligible, enroll in the
MinnesotaCare expansion by completing the application for a qualified health plan with
premium tax credits or cost-sharing reductions. An individual must provide information
needed to confirm the individual is not eligible for medical assistance under chapter 256B
or MinnesotaCare under chapter 256L through an eligibility pathway other than the
MinnesotaCare expansion.
new text end

new text begin (c) The MNsure website must include clear and conspicuous language stating that
individuals can apply for the MinnesotaCare expansion on the website.
new text end

new text begin Subd. 7. new text end

new text begin Eligibility determinations. new text end

new text begin (a) MNsure must process all MinnesotaCare
expansion applications and make all eligibility determinations for the MinnesotaCare
expansion. MNsure shall make all MinnesotaCare expansion eligibility determinations in
accordance with section 256L.04, subdivision 15.
new text end

new text begin (b) Eligibility for the MinnesotaCare expansion is appealable to the MNsure board under
chapter 62V and Minnesota Rules, chapter 7700.
new text end

new text begin Subd. 8. new text end

new text begin Administrative functions. new text end

new text begin MNsure shall provide administrative functions to
the commissioner of human services to facilitate offering the MinnesotaCare expansion.
These functions include but are not limited to marketing, call center operations, and
certification of insurance producers. MNsure may provide additional administrative functions
as requested by the commissioner of human services.
new text end

new text begin Subd. 9. new text end

new text begin Diversion of resources. new text end

new text begin MNsure may utilize existing resources, personnel, and
operations to carry out its duties under this section.
new text end

new text begin Subd. 10. new text end

new text begin Contracting authorization. new text end

new text begin The MNsure board may contract on a single-source
basis under section 16C.10, subdivision 1, with a third-party entity already providing
technical support to the MNsure board to develop and implement the technological
requirements of this section.
new text end

Sec. 13. new text begin REQUEST FOR FEDERAL WAIVER.
new text end

new text begin (a) The commissioner of commerce, in cooperation with the commissioner of human
services and the Board of Directors of MNsure, shall submit a section 1332 waiver pursuant
to United States Code, title 42, section 18052, to the United States Secretary of Health and
Human Services to obtain federal approval to implement this act. The commissioner of
commerce shall also seek through the waiver approval for the state to:
new text end

new text begin (1) continue receiving federal Medicaid payments for individuals eligible for Medicaid
and federal basic health program payments for MinnesotaCare individuals eligible for the
basic health program; and
new text end

new text begin (2) receive federal pass-through money equal to the value of premium tax credits and
cost-sharing reductions that MinnesotaCare expansion enrollees with household incomes
greater than 200 percent of the federal poverty guidelines would otherwise have received.
new text end

new text begin (b) The commissioner of commerce is authorized to contract for any analyses,
certification, data, or other information required to complete the section 1332 waiver
application in accordance with Code of Federal Regulations, title 33, part 108; Code of
Federal Regulations, title 155, part 1308; and any other applicable federal law. The
commissioner must cooperate with the federal government to obtain waiver approval under
this section and may provide any information the commissioner determines necessary and
advisable for waiver approval to the United States Secretary of Health and Human Services
and the United States Secretary of the Treasury.
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