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HF 2491

as introduced - 89th Legislature (2015 - 2016) Posted on 04/20/2016 12:36pm

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
relating to human services; increasing the MinnesotaCare income limit;
modifying MinnesotaCare premiums and cost-sharing; requiring the
commissioner of human services to seek federal waivers; amending Minnesota
Statutes 2014, sections 256L.02, by adding a subdivision; 256L.04, subdivisions
1, 7; 256L.07, subdivision 1; Minnesota Statutes 2015 Supplement, sections
256L.03, subdivision 5; 256L.15, subdivision 2.

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

Section 1.

Minnesota Statutes 2014, section 256L.02, is amended by adding a
subdivision to read:


new text begin Subd. 7. new text end

new text begin Federal waivers. new text end

new text begin (a) The commissioner shall apply for an innovation
waiver under section 1332 of the Affordable Care Act, or any applicable federal waiver, to
allow the state to:
new text end

new text begin (1) expand the MinnesotaCare program as a basic health program to include persons
with incomes up to 275 percent of the federal poverty guidelines;
new text end

new text begin (2) modify MinnesotaCare premiums and cost-sharing; and
new text end

new text begin (3) receive for all MinnesotaCare enrollees, including but not limited to those with
incomes greater than 133 percent but not exceeding 275 percent of the federal poverty
guidelines, the full amount of advanced premium tax credits and cost-sharing reductions
that these individuals would have otherwise received if they obtained qualified health
plan coverage through MNsure.
new text end

new text begin (b) The commissioner shall apply for a federal waiver under section 1115 of the
Social Security Act to receive a federal match for services provided to all MinnesotaCare
enrollees, including but not limited to those with incomes greater than 133 percent but not
exceeding 275 percent of the federal poverty guidelines.
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. 2.

Minnesota Statutes 2015 Supplement, section 256L.03, subdivision 5, is
amended to read:


Subd. 5.

Cost-sharing.

(a) Except as otherwise provided in this subdivision, the
MinnesotaCare benefit plan shall include the following cost-sharing requirements for all
enrollees:

(1) $3 per prescription for adult enrollees;

(2) $25 for eyeglasses for adult enrollees;

(3) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
episode of service which is required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory setting by a physician or
physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
audiologist, optician, or optometrist;

(4) $6 for nonemergency visits to a hospital-based emergency room for services
provided through December 31, 2010, and $3.50 effective January 1, 2011; and

(5) a family deductible equal to $2.75 per month per family and adjusted annually
by the percentage increase in the medical care component of the CPI-U for the period
of September to September of the preceding calendar year, rounded to the next-higher
five cent increment.

(b) Paragraph (a) does not apply to children under the age of 21 and to American
Indians as defined in Code of Federal Regulations, title 42, section 447.51.

(c) Paragraph (a), clause (3), does not apply to mental health services.

(d) MinnesotaCare reimbursements to fee-for-service providers and payments to
managed care plans or county-based purchasing plans shall not be increased as a result of
the reduction of the co-payments in paragraph (a), clause (4), effective January 1, 2011.

(e) The commissioner, through the contracting process under section 256L.12,
may allow managed care plans and county-based purchasing plans to waive the family
deductible under paragraph (a), clause (5). The value of the family deductible shall not be
included in the capitation payment to managed care plans and county-based purchasing
plans. Managed care plans and county-based purchasing plans shall certify annually to the
commissioner the dollar value of the family deductible.

(f) The commissioner shall increase co-payments for covered services in a manner
sufficient to reduce the actuarial value of the benefit to 94 percentnew text begin for recipients with
incomes not exceeding 200 percent of the federal poverty guidelines. The commissioner
shall increase co-payments for covered services in a manner sufficient to reduce the
actuarial value of the benefit to 87 percent for recipients with incomes greater than
200 percent but not exceeding 250 percent of the federal poverty guidelines. The
commissioner shall increase co-payments for covered services in a manner sufficient to
reduce the actuarial value of the benefit to 73 percent for recipients with incomes greater
than 250 percent but not exceeding 275 percent of the federal poverty guidelines
new text end. The
cost-sharing changes described in this paragraph do not apply to eligible recipients or
services exempt from cost-sharing under state law. deleted text beginThe cost-sharing changes described in
this paragraph shall not be implemented prior to January 1, 2016.
deleted text end

(g) The cost-sharing changes authorized under paragraph (f) 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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2017, or upon the effective
date of federal approval of the waivers requested under Minnesota Statutes, section
256L.02, subdivision 7, whichever is later. The commissioner of human services shall
notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 3.

Minnesota Statutes 2014, section 256L.04, subdivision 1, is amended to read:


Subdivision 1.

Families with children.

Families with children with family income
above 133 percent of the federal poverty guidelines and equal to or less than deleted text begin200deleted text end new text begin275
new text endpercent 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 shall apply unless otherwise specified. Children under age 19 with family income
at or below deleted text begin200deleted text endnew text begin 275new text end percent of the federal poverty guidelines and who are ineligible for
medical assistance by sole reason of the application of federal household composition
rules for medical assistance are eligible for MinnesotaCare.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2017, or upon the effective
date of federal approval of the waivers requested under Minnesota Statutes, section
256L.02, subdivision 7, whichever is later. The commissioner of human services shall
notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 4.

Minnesota Statutes 2014, section 256L.04, subdivision 7, is amended to read:


Subd. 7.

Single adults and households with no children.

The definition of eligible
persons includes all individuals and families with no children who have incomes that
are above 133 percent and equal to or less than deleted text begin200deleted text endnew text begin 275new text end percent of the federal poverty
guidelines for the applicable family size.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2017, or upon the effective
date of federal approval of the waivers requested under Minnesota Statutes, section
256L.02, subdivision 7, whichever is later. The commissioner of human services shall
notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 5.

Minnesota Statutes 2014, 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 deleted text begin200deleted text endnew text begin 275new text end 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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2017, or upon the effective
date of federal approval of the waivers requested under Minnesota Statutes, section
256L.02, subdivision 7, whichever is later. The commissioner of human services shall
notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 6.

Minnesota Statutes 2015 Supplement, 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, 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%
$29
160%
170%
$33
170%
180%
$38
180%
190%
$43
190%
$50

new text begin (e) The commissioner shall extend the premium scale specified in paragraph (d) to
include individuals with incomes greater than 200 percent but not exceeding 275 percent
of the federal poverty guidelines, such that individuals with incomes at 201 percent of
the federal poverty guidelines shall pay 4.40 percent of income, individuals with incomes
at 250 percent of the federal poverty guidelines shall pay 7.24 percent of income, and
individuals with incomes at 275 percent of the federal poverty guidelines shall pay 8.83
percent of income. The commissioner shall set other premium amounts in a proportional
manner using evenly spaced income steps.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2017, or upon the effective
date of federal approval of the waivers requested under Minnesota Statutes, section
256L.02, subdivision 7, whichever is later. The commissioner of human services shall
notify the revisor of statutes when federal approval is obtained.
new text end