HF 1635

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; allowing individuals and
small employers to elect to purchase state health
coverage at their own expense; allowing individuals
and small employers to purchase MinnesotaCare coverage
at full cost; amending Minnesota Statutes 2004,
sections 43A.27, subdivision 2, by adding a
subdivision; 256L.02, by adding a subdivision;
256L.04, subdivisions 1, 7a, by adding subdivisions;
256L.05, subdivisions 1, 3a; 256L.07; 256L.09, by
adding a subdivision; 256L.15, subdivision 3, by
adding a subdivision; 256L.17, subdivision 5;
proposing coding for new law in Minnesota Statutes,
chapter 43A.

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

Section 1.

Minnesota Statutes 2004, section 43A.27,
subdivision 2, is amended to read:

Subd. 2.

Elective eligibility.

The following persons, if
not otherwise covered by section 43A.24, may elect coverage for
themselves or their dependents at their own expense:

(a) a state employee, including persons on layoff from a
civil service position as provided in collective bargaining
agreements or a plan established pursuant to section 43A.18;

(b) an employee of the Board of Regents of the University
of Minnesota, including persons on layoff, as provided in
collective bargaining agreements or by the Board of Regents;

(c) an officer or employee of the State Agricultural
Society, State Horticultural Society, Sibley House Association,
Minnesota Humanities Commission, Minnesota Area Industry Labor
Management Councils, Minnesota International Center, Minnesota
Academy of Science, Science Museum of Minnesota, Minnesota
Safety Council, state Office of Disabled American Veterans,
state Office of the American Legion and its auxiliary, state
Office of Veterans of Foreign Wars and its auxiliary, or state
Office of the Military Order of the Purple Heart;

(d) a civilian employee of the adjutant general who is paid
from federal funds and who is not eligible for benefits from any
federal civilian employee group life insurance or health
benefits program; deleted text begin and
deleted text end

(e) an officer or employee of the State Capitol Credit
Union or the Highway Credit Union new text begin ; and
new text end

new text begin (f) a resident of the state of Minnesota who meets the
residency requirements provided by Code of Federal Regulations,
title 42, section 435.403, and who has not been medically
treated within three years of application for one or more of the
presumptive conditions sufficient for enrollment in the
Minnesota Comprehensive Health Association, as listed in the
operating rule adopted by the association under the authority of
Minnesota Rules, parts 2740.2700, subpart 4, and 2740.3600,
subpart 2, item B, except that persons electing coverage under
this clause are eligible only for hospital, medical, and dental
benefits new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 2.

Minnesota Statutes 2004, section 43A.27, is
amended by adding a subdivision to read:

new text begin Subd. 7. new text end

new text begin Small employer. new text end

new text begin (a) A small employer may elect
to purchase hospital, medical, and dental coverage for its
employees and dependents if:
new text end

new text begin (1) the employer and employee elect to enroll at their own
expense, in the manner and under the conditions of eligibility
the commissioner prescribes and otherwise approves;
new text end

new text begin (2) the small employer has at least 75 percent of its
eligible employees who have not waived coverage participating
and contributes at least 50 percent towards the cost of coverage
of each eligible employee; and
new text end

new text begin (3) the small employer is located in Minnesota.
new text end

new text begin (b) For purposes of this subdivision, "small employer" has
the meaning given in section 62L.02, subdivision 26.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 3.

new text begin [43A.275] COORDINATION WITH PRIVATE INSURANCE
POLICIES.
new text end

new text begin Subdivision 1. new text end

new text begin State administered coverage
secondary. new text end

new text begin Plans of hospital, medical, and dental coverage
provided to persons eligible under section 43A.27, subdivision
2, clause (f); or 7, are secondary to any available private
sector health coverage.
new text end

new text begin Subd. 2. new text end

new text begin Subrogation. new text end

new text begin (a) Upon providing hospital,
medical, or dental benefits to any person eligible under section
43A.27, subdivision 2, clause (f); or 7, who has private
hospital, medical, or dental coverage, or receives or has a
right to receive hospital, medical, or dental care from any type
of organization or entity, or has a cause of action arising out
of an occurrence that necessitated the provision of hospital,
medical, or dental benefits, the state agency or the state
agency's agent shall be subrogated, to the extent of the cost of
hospital, medical, or dental care provided, to any rights the
person may have under the terms of the coverage, or against the
organization or entity providing or liable to provide hospital,
medical, or dental care, or under the cause of action.
new text end

new text begin (b) The right of subrogation created in this subdivision
includes all portions of the cause of action, notwithstanding
any settlement allocation or apportionment that purports to
dispose of portions of the cause of action not subject to
subrogation.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 4.

Minnesota Statutes 2004, section 256L.02, is
amended by adding a subdivision to read:

new text begin Subd. 5. new text end

new text begin Minnesotacare coverage as secondary.
new text end

new text begin MinnesotaCare coverage for persons eligible under section
256L.04, subdivisions 14, 15, and 16, is secondary to any
available private sector health coverage.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 5.

Minnesota Statutes 2004, section 256L.04,
subdivision 1, is amended to read:

Subdivision 1.

Families with children.

(a) Families with
children with family income equal to or less than 275 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, including
the insurance-related barriers to enrollment under section
256L.07, shall apply unless otherwise specified.

(b) Parents who enroll in the MinnesotaCare program must
also enroll their children, if the children are eligible.
Children may be enrolled separately without enrollment by
parents. However, if one parent in the household enrolls, both
parents must enroll, unless other insurance is available. If
one child from a family is enrolled, all children must be
enrolled, unless other insurance is available. If one spouse in
a household enrolls, the other spouse in the household must also
enroll, unless other insurance is available. Families cannot
choose to enroll only certain uninsured members.

(c) Beginning October 1, 2003, the dependent sibling
definition no longer applies to the MinnesotaCare program.
These persons are no longer counted in the parental household
and may apply as a separate household.

(d) Beginning July 1, 2003, or upon federal approval,
whichever is later, parents are not eligible for MinnesotaCare
if their gross income exceeds $50,000. new text begin Parents eligible under
subdivision 14 are not subject to this paragraph.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 6.

Minnesota Statutes 2004, section 256L.04,
subdivision 7a, is amended to read:

Subd. 7a.

Ineligibility.

Applicants whose income is
greater than the limits established under this section may not
enroll in the MinnesotaCare program new text begin , except as provided in
subdivisions 14, 15, and 16 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 7.

Minnesota Statutes 2004, section 256L.04, is
amended by adding a subdivision to read:

new text begin Subd. 14. new text end

new text begin Other families with children. new text end

new text begin Families with
children with family incomes greater than 275 percent of the
federal poverty guidelines for the applicable family size, or
who are not otherwise eligible under subdivision 1, are eligible
for MinnesotaCare coverage under, and subject to all other
requirements of, section 256L.03 as if they were eligible under
subdivision 1, if they pay the full-cost premium. A family
member who has been medically treated within three years of
application for one or more of the presumptive conditions
sufficient for enrollment in the Minnesota Comprehensive Health
Association, as listed in the operating rule adopted by the
association under the authority of Minnesota Rules, parts
2740.2700, subpart 4, and 2740.3600, subpart 2, item B, is not
eligible under this subdivision.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 8.

Minnesota Statutes 2004, section 256L.04, is
amended by adding a subdivision to read:

new text begin Subd. 15. new text end

new text begin Other single adults and households with no
children. new text end

new text begin (a) Single adults and households with no children
with household incomes greater than 175 percent of the federal
poverty guidelines for the applicable household size, or who are
not otherwise eligible under subdivision 7, are eligible for
MinnesotaCare coverage under, and subject to all other
requirements of, section 256L.03 as if they were eligible under
subdivision 7, if they pay the full-cost premium.
new text end

new text begin (b) Single adults and households with no children with
household incomes greater than 75 percent of the federal poverty
guidelines for the applicable household size who are eligible
for limited benefit coverage under section 256L.035 may elect
coverage under paragraph (a), but must pay the full-cost premium.
new text end

new text begin (c) An individual who has been medically treated within
three years of application for one or more of the presumptive
conditions sufficient for enrollment in the Minnesota
Comprehensive Health Association, as listed in the operating
rule adopted by the association under the authority of Minnesota
Rules, parts 2740.2700, subpart 4, and 2740.3600, subpart 2,
item B, is not eligible under this subdivision.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 9.

Minnesota Statutes 2004, section 256L.04, is
amended by adding a subdivision to read:

new text begin Subd. 16. new text end

new text begin Employees and dependents of small
employers. new text end

new text begin (a) Employees and dependents of small employers are
eligible for MinnesotaCare coverage under, and subject to all
other requirements of, section 256L.03 as if they were eligible
under subdivisions 1 or 7, whichever is applicable, if:
new text end

new text begin (1) the small employer and employee pay the full-cost
premium;
new text end

new text begin (2) the small employer has at least 75 percent of its
eligible employees who have not waived coverage participating
and contributes at least 50 percent towards the cost of coverage
of each eligible employee; and
new text end

new text begin (3) the small employer is located in Minnesota.
new text end

new text begin (b) For purposes of this subdivision, "small employer" has
the meaning given in section 62L.02, subdivision 26.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 10.

Minnesota Statutes 2004, section 256L.05,
subdivision 1, is amended to read:

Subdivision 1.

Application and information
availability.

new text begin (a) new text end Applications and other information must be
made available to provider offices, local human services
agencies, school districts, public and private elementary
schools in which 25 percent or more of the students receive free
or reduced price lunches, community health offices, and Women,
Infants and Children (WIC) program sites. These sites may
accept applications and forward the forms to the commissioner.
Otherwise, applicants may apply directly to the commissioner.
Beginning January 1, 2000, MinnesotaCare enrollment sites will
be expanded to include local county human services agencies
which choose to participate.

new text begin (b) The commissioner shall make applications and other
information available to small employers and organizations
representing small employers, and shall work with these entities
to publicize the availability of small employer coverage under
section 256L.04, subdivision 16.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 11.

Minnesota Statutes 2004, section 256L.05,
subdivision 3a, is amended to read:

Subd. 3a.

Renewal of eligibility.

(a) Beginning January
1, 1999, an enrollee's eligibility must be renewed every 12
months. The 12-month period begins in the month after the month
the application is approved.

(b) Beginning October 1, 2004, an enrollee's eligibility
must be renewed every six months new text begin , except that enrollees eligible
under section 256L.04, subdivisions 14, 15, and 16, must renew
eligibility every 12 months new text end . The first six-month period of
eligibility begins in the month after the month the application
is approved. Each new period of eligibility must take into
account any changes in circumstances that impact eligibility and
premium amount. An enrollee must provide all the information
needed to redetermine eligibility by the first day of the month
that ends the eligibility period. The premium for the new
period of eligibility must be received as provided in section
256L.06 in order for eligibility to continue.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 12.

Minnesota Statutes 2004, section 256L.07, is
amended to read:

256L.07 ELIGIBILITY FOR MINNESOTACARE.

Subdivision 1.

General requirements.

(a) Children
enrolled in the original children's health plan as of September
30, 1992, children who enrolled in the MinnesotaCare program
after September 30, 1992, pursuant to Laws 1992, chapter 549,
article 4, section 17, and children who have family gross
incomes that are equal to or less than 150 percent of the
federal poverty guidelines are eligible without meeting the
requirements of subdivision 2 and the four-month requirement in
subdivision 3, as long as they maintain continuous coverage in
the MinnesotaCare program or medical assistance. Children who
apply for MinnesotaCare on or after the implementation date of
the employer-subsidized health coverage program as described in
Laws 1998, chapter 407, article 5, section 45, who have family
gross incomes that are equal to or less than 150 percent of the
federal poverty guidelines, must meet the requirements of
subdivision 2 to be eligible for MinnesotaCare.

(b) Families enrolled in MinnesotaCare under section
256L.04, subdivision 1, whose income increases above 275 percent
of the federal poverty guidelines, are no longer eligible for
the program and shall be disenrolled by the commissioner.
Individuals enrolled in MinnesotaCare under section 256L.04,
subdivision 7, whose income increases above 175 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 following
the month in which the commissioner determines that the income
of a family or individual exceeds program income limits.

(c)(1) Notwithstanding paragraph (b), families enrolled in
MinnesotaCare under section 256L.04, subdivision 1, may remain
enrolled in MinnesotaCare if ten percent of their annual income
is less than the annual premium for a policy with a $500
deductible available through the Minnesota Comprehensive Health
Association. Families who are no longer eligible for
MinnesotaCare under this subdivision shall be given an 18-month
notice period from the date that ineligibility is determined
before disenrollment. This clause expires February 1, 2004.

(2) Effective February 1, 2004, notwithstanding paragraph
(b), children may remain enrolled in MinnesotaCare if ten
percent of their annual family income is less than the annual
premium for a policy with a $500 deductible available through
the Minnesota Comprehensive Health Association. Children who
are no longer eligible for MinnesotaCare under this clause shall
be given a 12-month notice period from the date that
ineligibility is determined before disenrollment. The premium
for children remaining eligible under this clause shall be the
maximum premium determined under section 256L.15, subdivision 2,
paragraph (b).

(d) Effective July 1, 2003, notwithstanding paragraphs (b)
and (c), parents new text begin eligible under section 256L.04, subdivision 1,
new text end are no longer eligible for MinnesotaCare if gross household
income exceeds $50,000.

Subd. 2.

Must not have access to employer-subsidized
coverage.

(a) To be eligible, a family or individual must not
have access to subsidized health coverage through an employer
and must not have had access to employer-subsidized coverage
through a current employer for 18 months prior to application or
reapplication. A family or individual whose employer-subsidized
coverage is lost due to an employer terminating health care
coverage as an employee benefit during the previous 18 months is
not eligible.

(b) This subdivision does not apply to a family or
individual who was enrolled in MinnesotaCare within six months
or less of reapplication and who no longer has
employer-subsidized coverage due to the employer terminating
health care coverage as an employee benefit. new text begin This subdivision
does not apply to persons eligible under section 256L.04,
subdivisions 14, 15, and 16.
new text end

(c) For purposes of this requirement, subsidized health
coverage means health coverage for which the employer pays at
least 50 percent of the cost of coverage for the employee or
dependent, or a higher percentage as specified by the
commissioner. Children are eligible for employer-subsidized
coverage through either parent, including the noncustodial
parent. The commissioner must treat employer contributions to
Internal Revenue Code Section 125 plans and any other employer
benefits intended to pay health care costs as qualified employer
subsidies toward the cost of health coverage for employees for
purposes of this subdivision.

Subd. 3.

Other health coverage.

(a) Families and
individuals enrolled in the MinnesotaCare program must have no
health coverage while enrolled or for at least four months prior
to application and renewal. Children enrolled in the original
children's health plan and children in families with income
equal to or less than 150 percent of the federal poverty
guidelines, who have other health insurance, are eligible if the
coverage:

(1) lacks two or more of the following:

(i) basic hospital insurance;

(ii) medical-surgical insurance;

(iii) prescription drug coverage;

(iv) dental coverage; or

(v) vision coverage;

(2) requires a deductible of $100 or more per person per
year; or

(3) lacks coverage because the child has exceeded the
maximum coverage for a particular diagnosis or the policy
excludes a particular diagnosis.

The commissioner may change this eligibility criterion for
sliding scale premiums in order to remain within the limits of
available appropriations. The requirement of no health coverage
does not apply to newborns.

(b) Medical assistance, general assistance medical care,
and the Civilian Health and Medical Program of the Uniformed
Service, CHAMPUS, or other coverage provided under United States
Code, title 10, subtitle A, part II, chapter 55, are not
considered insurance or health coverage for purposes of the
four-month requirement described in this subdivision.

(c) For purposes of this subdivision, Medicare Part A or B
coverage under title XVIII of the Social Security Act, United
States Code, title 42, sections 1395c to 1395w-4, is considered
health coverage. An applicant or enrollee may not refuse
Medicare coverage to establish eligibility for MinnesotaCare.

(d) Applicants who were recipients of medical assistance or
general assistance medical care within one month of application
must meet the provisions of this subdivision and subdivision 2.

(e) Effective October 1, 2003, applicants who were
recipients of medical assistance and had cost-effective health
insurance which was paid for by medical assistance are exempt
from the four-month requirement under this section.

new text begin (f) This subdivision does not apply to persons eligible
under section 256L.04, subdivisions 14, 15, and 16.
new text end

Subd. 4.

Families with children in need of chemical
dependency treatment.

Premiums for families with children when
a parent has been determined to be in need of chemical
dependency treatment pursuant to an assessment conducted by the
county under section 626.556, subdivision 10, or a case plan
under section 260C.201, subdivision 6, or 260C.212, who are
eligible for MinnesotaCare under section 256L.04, subdivision 1,
may be paid by the county of residence of the person in need of
treatment for one year from the date the family is determined to
be eligible or if the family is currently enrolled in
MinnesotaCare from the date the person is determined to be in
need of chemical dependency treatment. Upon renewal, the family
is responsible for any premiums owed under section 256L.15. If
the family is not currently enrolled in MinnesotaCare, the local
county human services agency shall determine whether the family
appears to meet the eligibility requirements and shall assist
the family in applying for the MinnesotaCare program.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 13.

Minnesota Statutes 2004, section 256L.09, is
amended by adding a subdivision to read:

new text begin Subd. 8. new text end

new text begin Exemption from residency requirement for
employees of small employers. new text end

new text begin Persons eligible under section
256L.04, subdivision 16, are exempt from this section.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 14.

Minnesota Statutes 2004, section 256L.15,
subdivision 3, is amended to read:

Subd. 3.

Exceptions to sliding scale.

An annual premium
of $48 is required for all children in families new text begin eligible under
section 256L.04, subdivision 1, new text end with income at or less than 150
percent of federal poverty guidelines.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 15.

Minnesota Statutes 2004, section 256L.15, is
amended by adding a subdivision to read:

new text begin Subd. 4. new text end

new text begin Payment of full-cost premium; administrative
costs. new text end

new text begin (a) Enrollees eligible under section 256L.04,
subdivisions 14, 15, and 16, shall pay the full-cost premium.
The full-cost premium for families and children is defined as
the projected medical payments for all enrollees eligible under
section 256L.04, subdivisions 1 and 14, and all enrollees who
are families and children eligible under section 256L.04,
subdivision 16, divided by the projected monthly average
households enrolled for these groups. The full-cost premium for
single adults and households without children is defined as the
projected medical payments for all enrollees eligible under
section 256L.04, subdivision 7, receiving covered services under
section 256L.03; all enrollees eligible under section 256L.04,
subdivision 15; and all enrollees who are single adults or
households without children eligible under section 256L.04,
subdivision 16, divided by the projected monthly average
households enrolled for these groups.
new text end

new text begin (b) The commissioner may increase the full-cost premium
calculated under paragraph (a) to cover any administrative costs
incurred by the Department of Human Services in expanding
MinnesotaCare eligibility to include persons eligible under
section 256L.04, subdivisions 14, 15, and 16.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 16.

Minnesota Statutes 2004, section 256L.17,
subdivision 5, is amended to read:

Subd. 5.

Exemption.

This section does not apply to
pregnant women. For purposes of this subdivision, a woman is
considered pregnant for 60 days postpartum. new text begin This section does
not apply to persons eligible under section 256L.04,
subdivisions 14, 15, and 16.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end