Minnesota Legislature
HF 11
1st Engrossment - 92nd Legislature (2021 - 2022) Posted on 01/28/2021 05:00pm
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A bill for an act
relating to health; creating a public option; expanding eligibility for MinnesotaCare;
modifying enrollee premiums; requiring an implementation plan and
recommendations for an alternative delivery and payment system; amending
Minnesota Statutes 2020, sections 256L.01, by adding a subdivision; 256L.04,
subdivisions 1c, 7a, 10, by adding a subdivision; 256L.07, subdivisions 1, 2;
256L.15, subdivision 2, by adding a subdivision.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2020, section 256L.01, is amended by adding a subdivision
to read:
new text begin Subd. 3b. new text end
new text begin Full cost premium. new text end
new text begin
"Full cost premium" means a base charge for one, two,
or three or more enrollees so that if all MinnesotaCare cases paid the full cost premium, the
total revenue would equal the cost of MinnesotaCare medical coverage. The full cost premium
for two enrollees shall be twice the full cost premium for one, and the full cost premium
for three or more enrollees shall be three times the full cost premium for one.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later, subject to certification under section 12.
new text end
Sec. 2.
Minnesota Statutes 2020, section 256L.04, subdivision 1c, is amended to read:
Subd. 1c.
General requirements.
To be eligible for MinnesotaCare, a person must meet
the eligibility requirements of this section. A person eligible for MinnesotaCarenew text begin with an
income less than or equal to 200 percent of the federal poverty guidelinesnew text end 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 EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later, subject to certification under section 12.
new text end
Sec. 3.
Minnesota Statutes 2020, section 256L.04, subdivision 7a, is amended to read:
Subd. 7a.
Ineligibility.
Adults whose income is greater than the limits established under
this section may not enroll in the MinnesotaCare programnew text begin , except as provided in subdivision
15 and section 256L.15, subdivision 5new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later, subject to certification under section 12.
new text end
Sec. 4.
Minnesota Statutes 2020, section 256L.04, subdivision 10, is amended to read:
Subd. 10.
Citizenship requirements.
(a) Eligibility for MinnesotaCare is deleted text begin limiteddeleted text end new text begin
availablenew text end to citizens or nationals of the United States deleted text begin anddeleted text end new text begin ,new text end lawfully present noncitizens as
defined in Code of Federal Regulations, title 8, section 103.12deleted text begin .deleted text end new text begin , andnew text end undocumented
noncitizens deleted text begin are ineligible for MinnesotaCaredeleted text end . For purposes of this subdivision, an
undocumented noncitizen is an individual who resides in the United States without the
approval or acquiescence of the United States Citizenship and Immigration Services. Families
with children who are citizens or nationals of the United States must cooperate in obtaining
satisfactory documentary evidence of citizenship or nationality according to the requirements
of the federal Deficit Reduction Act of 2005, Public Law 109-171.
(b) Notwithstanding subdivisions 1 and 7, eligible persons include families and
individuals who are lawfully present and ineligible for medical assistance by reason of
immigration status and who have incomes equal to or less than 200 percent of federal poverty
guidelines.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 5.
Minnesota Statutes 2020, 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 public option. new text end
new text begin
Families and individuals with income
above the maximum income eligibility limit specified in subdivision 1 or 7, who meet all
other MinnesotaCare eligibility requirements, are eligible for MinnesotaCare. All other
provisions of this chapter apply unless otherwise specified.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later, subject to certification under section 12.
new text end
Sec. 6.
Minnesota Statutes 2020, 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 200 percent of the federal poverty
guidelines, are no longer eligible for the program and shall be disenrolled by the
commissionernew text begin , unless they continue MinnesotaCare enrollment through the public option
under section 256L.04, subdivision 15, or receive an employer contribution toward
MinnesotaCare premiums under section 256L.15, subdivision 5new text end . 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, 2023, or upon federal approval,
whichever is later, subject to certification under section 12.
new text end
Sec. 7.
Minnesota Statutes 2020, section 256L.07, subdivision 2, is amended to read:
Subd. 2.
Must not have access to employer-subsidized minimum essential
coverage.
(a) To be eligible, a family or individual must not have access to subsidized health
coverage that is affordable and provides minimum value as defined in Code of Federal
Regulations, title 26, section 1.36B-2.
(b) new text begin Notwithstanding paragraph (a), an individual who has access to subsidized health
coverage through a spouse's or parent's employer that is deemed minimum essential coverage
under Code of Federal Regulations, title 26, section 1.36B-2, is eligible for MinnesotaCare
if the portion of the annual premium the employee pays for employee and dependent coverage
exceeds the required contribution percentage as described in Code of Federal Regulations,
title 26, section 1.36B-2.
new text end
new text begin (c) new text end This subdivision does not apply to a family or individual whonew text begin : (1)new text end no longer has
employer-subsidized coverage due to the employer terminating health care coverage as an
employee benefitnew text begin ; or (2) receives an employer contribution toward MinnesotaCare premiums
under section 256L.15, subdivision 5new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 8.
Minnesota Statutes 2020, 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, new text begin through December 31, 2022, new text end 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% |
$37 |
| 160% |
170% |
$44 |
| 170% |
180% |
$52 |
| 180% |
190% |
$61 |
| 190% |
200% |
$71 |
| 200% |
$80 |
new text begin
(e) Effective January 1, 2023, MinnesotaCare enrollees enrolled under section 256L.04,
subdivision 1 or 7, shall pay premiums according to the premium scale specified in paragraph
(g). The following persons are exempt from paying premiums under paragraph (g):
new text end
new text begin
(1) persons 20 years of age or younger, with incomes not exceeding 200 percent of the
federal poverty guidelines; and
new text end
new text begin
(2) individuals with household incomes below 35 percent of the federal poverty
guidelines.
new text end
new text begin
(f) Beginning January 1, 2023, persons eligible through the public option under section
256L.04, subdivision 15, with household incomes not exceeding 400 percent of the federal
poverty guidelines, shall pay premiums according to the premium scale specified in paragraph
(g). Persons 20 years of age or younger, with incomes not exceeding 275 percent of the
federal poverty guidelines, are exempt from paying premiums under paragraph (g).
new text end
new text begin
(g) Per-person premium scale for households, effective January 1, 2023:
new text end
|
new text begin
Federal Poverty Guideline Percentage Greater than or Equal to new text end |
new text begin
Federal Poverty Guideline Percentage Less than or Equal to new text end |
new text begin
Per-Person Premium Amount new text end |
|
new text begin
0 new text end |
new text begin
34 new text end |
new text begin
$0 new text end |
|
new text begin
35 new text end |
new text begin
54 new text end |
new text begin
$4 new text end |
|
new text begin
55 new text end |
new text begin
79 new text end |
new text begin
$6 new text end |
|
new text begin
80 new text end |
new text begin
89 new text end |
new text begin
$8 new text end |
|
new text begin
90 new text end |
new text begin
99 new text end |
new text begin
$10 new text end |
|
new text begin
100 new text end |
new text begin
109 new text end |
new text begin
$12 new text end |
|
new text begin
110 new text end |
new text begin
119 new text end |
new text begin
$14 new text end |
|
new text begin
120 new text end |
new text begin
129 new text end |
new text begin
$15 new text end |
|
new text begin
130 new text end |
new text begin
139 new text end |
new text begin
$16 new text end |
|
new text begin
140 new text end |
new text begin
149 new text end |
new text begin
$25 new text end |
|
new text begin
150 new text end |
new text begin
159 new text end |
new text begin
$37 new text end |
|
new text begin
160 new text end |
new text begin
169 new text end |
new text begin
$44 new text end |
|
new text begin
170 new text end |
new text begin
179 new text end |
new text begin
$52 new text end |
|
new text begin
180 new text end |
new text begin
189 new text end |
new text begin
$61 new text end |
|
new text begin
190 new text end |
new text begin
199 new text end |
new text begin
$71 new text end |
|
new text begin
200 new text end |
new text begin
200 new text end |
new text begin
$80 new text end |
|
new text begin
201 new text end |
new text begin
209 new text end |
new text begin
$91 new text end |
|
new text begin
210 new text end |
new text begin
219 new text end |
new text begin
$101 new text end |
|
new text begin
220 new text end |
new text begin
229 new text end |
new text begin
$111 new text end |
|
new text begin
230 new text end |
new text begin
239 new text end |
new text begin
$122 new text end |
|
new text begin
240 new text end |
new text begin
249 new text end |
new text begin
$134 new text end |
|
new text begin
250 new text end |
new text begin
259 new text end |
new text begin
$146 new text end |
|
new text begin
260 new text end |
new text begin
269 new text end |
new text begin
$157 new text end |
|
new text begin
270 new text end |
new text begin
279 new text end |
new text begin
$169 new text end |
|
new text begin
280 new text end |
new text begin
289 new text end |
new text begin
$181 new text end |
|
new text begin
290 new text end |
new text begin
299 new text end |
new text begin
$193 new text end |
|
new text begin
300 new text end |
new text begin
309 new text end |
new text begin
$206 new text end |
|
new text begin
310 new text end |
new text begin
319 new text end |
new text begin
$213 new text end |
|
new text begin
320 new text end |
new text begin
329 new text end |
new text begin
$220 new text end |
|
new text begin
330 new text end |
new text begin
339 new text end |
new text begin
$227 new text end |
|
new text begin
340 new text end |
new text begin
349 new text end |
new text begin
$234 new text end |
|
new text begin
350 new text end |
new text begin
359 new text end |
new text begin
$241 new text end |
|
new text begin
360 new text end |
new text begin
369 new text end |
new text begin
$248 new text end |
|
new text begin
370 new text end |
new text begin
379 new text end |
new text begin
$254 new text end |
|
new text begin
380 new text end |
new text begin
389 new text end |
new text begin
$261 new text end |
|
new text begin
390 new text end |
new text begin
399 new text end |
new text begin
$268 new text end |
|
new text begin
400 new text end |
new text begin
$275 new text end |
new text begin
Premiums under this paragraph are charged on a per-person basis, except that the total
premium for households with two or more eligible persons shall not exceed the calendar
year's applicable percentage value specified for the household's income that does not exceed
400 percent of the federal poverty guidelines as used for advance premium tax credits under
United States Code, title 26, section 36B(b)(3)(A)(i), as indexed according to item (ii) of
that section.
new text end
new text begin
(h) Beginning January 1, 2023, for persons eligible through the public option under
section 256L.04, subdivision 15, with household incomes greater than 400 percent of the
federal poverty guidelines but not exceeding 500 percent of the federal poverty guidelines,
the per-person premium shall be the full cost premium.
new text end
new text begin
(i) Beginning January 1, 2023, for persons eligible through the public option under
section 256L.04, subdivision 15, with household incomes greater than 500 percent of the
federal poverty guidelines, the per-household premium shall be the highest of:
new text end
new text begin
(1) the required contribution percentage specified for the current calendar year used for
advance premium tax credits eligibility under United States Code, title 26, section
36B(c)(2)(C)(i)(II), as indexed according to item (iv) of that section; or
new text end
new text begin
(2) 125 percent of the average of gold-level plan premiums for qualified health plan
coverage through MNsure for covered household members.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later, subject to certification under section 12.
new text end
Sec. 9.
Minnesota Statutes 2020, section 256L.15, is amended by adding a subdivision to
read:
new text begin Subd. 5. new text end
new text begin Small employer public option. new text end
new text begin
(a) An employer with 50 or fewer employees
may pay to the commissioner, as an employer contribution to employee health care costs,
an amount up to the portion of an enrollee's MinnesotaCare premium for which the enrollee
is financially responsible. The commissioner shall set premiums for employees for whom
an employer makes a payment under this subdivision at the full cost premium. The
commissioner shall establish a minimum employer contribution under this subdivision
toward employee premiums.
new text end
new text begin
(b) An enrollee is eligible for MinnesotaCare under this subdivision without regard to
any program income limit.
new text end
new text begin
(c) The commissioner shall establish a procedure through which employers can pay
premium contributions for employees directly to the commissioner on an aggregate, monthly
basis.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later, subject to certification under section 12.
new text end
Sec. 10. new text begin TRANSITION TO MINNESOTACARE PUBLIC OPTION.
new text end
new text begin
(a) The commissioner of human services shall continue to administer MinnesotaCare
as a basic health program in accordance with Minnesota Statutes, section 256L.02,
subdivision 5, and shall seek federal waivers, approvals, and law changes as required under
section 11.
new text end
new text begin
(b) The commissioner shall present an implementation plan for the MinnesotaCare public
option under Minnesota Statutes, section 256L.04, subdivision 15, to the chairs and ranking
minority members of the legislative committees with jurisdiction over health care policy
and finance by December 15, 2021. The plan must include:
new text end
new text begin
(1) recommendations for any changes to the MinnesotaCare public option necessary to
continue federal basic health program funding or to receive other federal funding;
new text end
new text begin
(2) recommendations for implementing Minnesota Statutes, section 256L.15, subdivision
5, in a manner that would allow any employee premium contributions to be pretax and allow
any employer contribution toward employee premiums to not be considered taxable income
for the employee;
new text end
new text begin
(3) recommendations for increasing MinnesotaCare provider enrollment, including an
analysis of the feasibility of requiring participation in MinnesotaCare as a condition for
state licensure;
new text end
new text begin
(4) estimates of state costs related to the MinnesotaCare public option; and
new text end
new text begin
(5) draft legislation that includes any additional policy and conforming changes necessary
to implement the MinnesotaCare public option and the implementation plan
recommendations.
new text end
new text begin
(c) The commissioner shall present to the chairs and ranking minority members of the
legislative committees with jurisdiction over health care policy and finance by January 15,
2023, recommendations for an alternative service delivery and payment system for
MinnesotaCare. The recommendations must address:
new text end
new text begin
(1) terminating managed care and county-based purchasing plan contracts under
Minnesota Statutes, sections 256L.12 and 256L.121, effective January 1, 2025;
new text end
new text begin
(2) delivering services beginning January 1, 2025, to MinnesotaCare enrollees eligible
under Minnesota Statutes, section 256L.04, subdivisions 1, 7, and 15, through alternative
delivery methods that may include but are not limited to expanding the use of integrated
health partnerships under Minnesota Statutes, section 256B.0755, and delivering care under
fee-for-service through a primary care case management system; and
new text end
new text begin
(3) reimbursing providers for high-quality, value-based care at levels sufficient to increase
enrollee access to care, address racial and geographic inequities in the delivery of health
care, and incentivize preventive care and other best practices.
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. 11. new text begin REQUEST FOR FEDERAL APPROVAL.
new text end
new text begin
(a) The commissioner of human services shall seek any federal waivers, approvals, and
law changes necessary to implement this act, including but not limited to those waivers,
approvals, and law changes necessary to allow:
new text end
new text begin
(1) the state to continue to receive federal basic health program payments for basic health
program-eligible MinnesotaCare enrollees and to receive other federal funding for the
MinnesotaCare public option; and
new text end
new text begin
(2) the state to receive federal payments equal to the value of advance premium tax
credits and cost-sharing reductions that MinnesotaCare enrollees with household incomes
greater than 200 percent of the federal poverty guidelines would otherwise have received.
new text end
new text begin
(b) In implementing this section, the commissioner of human services shall consult with
the commissioner of commerce and the board of directors of MNsure, and may contract for
technical and actuarial assistance.
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. 12. new text begin CONTINGENT EFFECTIVE DATE.
new text end
new text begin
Sections 1, 2, 3, 5, 6, 8, and 9 are effective January 1, 2023, or upon federal approval,
whichever is later, but only if the commissioner of human services certifies to the legislature
that implementation of those sections will not result in the loss of federal basic health
program funding for MinnesotaCare enrollees with incomes not exceeding 200 percent of
the federal poverty guidelines.
new text end