Minnesota Legislature
HF 2677
as introduced - 88th Legislature (2013 - 2014) Posted on 03/07/2014 11:31am
Bill Text Versions
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| Introduction | Posted on 03/03/2014 |
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A bill for an act
relating to health; establishing a state-only MinnesotaCare program to cover
uninsured Minnesotans who are ineligible for medical assistance, MinnesotaCare,
or the MNsure insurance marketplace; amending Minnesota Statutes 2012,
sections 256B.06, subdivision 5, by adding a subdivision; 256L.04, subdivision
10; proposing coding for new law in Minnesota Statutes, chapter 256L.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
STATE-ONLY MINNESOTACARE PROGRAM
Section 1.
Minnesota Statutes 2012, section 256L.04, subdivision 10, is amended to
read:
Subd. 10.
Citizenship requirements.
new text begin (a) new text end Eligibility for MinnesotaCare is limited
to citizens or nationals of the United States, qualified noncitizens, and other persons
residing lawfully in the United States as defined in Code of Federal Regulations, title
8, section 103.12. Undocumented noncitizens and nonimmigrants are ineligible for
MinnesotaCare. For purposes of this subdivision, a nonimmigrant is an individual in one
or more of the classes listed in United States Code, title 8, section 1101(a)(15), and 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.
new text begin
(b) Notwithstanding paragraph (a) and subdivisions 1 and 7, families and individuals
who are nonimmigrants as defined in section 256B.06, subdivision 4, paragraph (e), are
eligible for the state-only MinnesotaCare program under section 256L.30.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2014.
new text end
Sec. 2.
new text begin
[256L.30] STATE-ONLY MINNESOTACARE PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin State-only MinnesotaCare program. new text end
new text begin
(a) The commissioner shall
establish a state-only MinnesotaCare program.
new text end
new text begin
(b) The following individuals are eligible for the program if the individuals meet
all other MinnesotaCare eligibility requirements under this chapter, except as otherwise
specified in this section:
new text end
new text begin
(1) uninsured low-income nonimmigrants as defined in section 256B.06, subdivision
4, paragraph (e), who do not have access to coverage through MNsure or Minnesota
public health care programs; and
new text end
new text begin
(2) uninsured low-income immigrants who are lawfully present in the state but are
not eligible for medical assistance, MinnesotaCare, or coverage through MNsure due to
either the required five-year waiting period or the deeming of sponsor income when the
sponsor's income is not available to them for reasons beyond their control.
new text end
new text begin
(c) Individuals and families eligible for the state-only MinnesotaCare program under
this subdivision are exempt from the income eligibility limits in sections 256L.04 and
256L.07 and remain eligible for the program so long as their income is equal to or less
than 400 percent of the federal poverty guidelines.
new text end
new text begin
(d) Individuals or families that are eligible for medical assistance under chapter
256B, MinnesotaCare under this chapter, or coverage through MNsure under chapter 62V,
are not eligible for the state-only MinnesotaCare program under this section.
new text end
new text begin
(e) All application, navigation, eligibility determination and enrollment services,
requirements, and procedures of the MinnesotaCare program apply to the state-only
MinnesotaCare program.
new text end
new text begin Subd. 2. new text end
new text begin Covered services. new text end
new text begin
(a) The state-only MinnesotaCare program covers the
services described under section 256L.03, except as otherwise specified in this subdivision.
new text end
new text begin
(b) The state-only MinnesotaCare program does not cover services for emergency
medical conditions that are covered by the emergency medical assistance program under
section 256B.06, subdivision 4, paragraphs (e) to (h). The commissioner shall coordinate
the state-only MinnesotaCare program with the federally subsidized emergency medical
assistance program with the goal of making transitions between the programs seamless
and invisible to the enrollee to the extent possible.
new text end
new text begin
(c) For individuals who are eligible under subdivision 1, the state-only
MinnesotaCare program covers nursing facility services described under section 144.0724,
subdivision 11, and home and community-based services described in paragraph
(d), if the individual's income is equal to or less than the medical assistance income
eligibility requirements described in section 256B.056, subdivision 4, or meets the excess
requirements of section 256B.056, subdivisions 5 and 5c. All requirements of the medical
assistance program under chapter 256B relating to these services apply to the state-only
MinnesotaCare program under this section.
new text end
new text begin
(d) For purposes of this section, home and community-based services include:
new text end
new text begin
(1) home and community-based waivered services for persons with developmental
disabilities, including consumer-directed community supports under section 256B.092;
new text end
new text begin
(2) waivered services under community alternatives for persons with disabilities,
including consumer-directed community supports under section 256B.49;
new text end
new text begin
(3) community alternative care waivered services, including consumer-directed
community supports under section 256B.49;
new text end
new text begin
(4) brain injury waivered services, including consumer-directed community supports
under section 256B.49;
new text end
new text begin
(5) home and community-based waivered services for the elderly under section
256B.0915;
new text end
new text begin
(6) nursing services and home health services under section 256B.0625, subdivision
6a;
new text end
new text begin
(7) personal care services and qualified professional supervision of personal care
services under section 256B.0625, subdivisions 6a and 19a;
new text end
new text begin
(8) private duty nursing services under section 256B.0625, subdivision 7; and
new text end
new text begin
(9) community first services and supports under section 256B.85.
new text end
new text begin Subd. 3. new text end
new text begin Premiums and cost-sharing. new text end
new text begin
(a) For individuals and families who are
eligible under subdivision 1 and whose income is equal to or less than 200 percent of the
federal poverty guidelines, the premium and cost-sharing provisions of MinnesotaCare
apply.
new text end
new text begin
(b) For individuals and families who are eligible under subdivision 1 and whose
income is greater than 200 percent, but equal to or less than 400 percent of the federal
poverty guidelines, the cost-sharing requirements shall be the same as a silver level qualified
health plan offered through MNsure and the premium shall be the same as the premium
that would be paid by an individual or family of the same size, income, and geographic
area for the second lowest cost silver level qualified health plan offered through MNsure
after deducting the federal premium tax credits that would be available through MNsure.
new text end
new text begin Subd. 4. new text end
new text begin Service delivery. new text end
new text begin
(a) The commissioner may contract with managed care
organizations, provider networks, nonprofit coverage programs, counties, or health care
delivery systems established under section 256B.0755 or 256B.0756 to administer the
state-only MinnesotaCare program authorized under this section in order to control the
costs of the program through care coordination, limited provider networks, fee discounts,
and other methods. The commissioner may delegate to a contractor the responsibility
to perform case reviews and authorize payment. The commissioner may contract on a
capitated or fixed budget basis under which the contractor is responsible for providing the
covered services to eligible individuals and families within the limits of the capitation
or budgeted amount. The commissioner may also contract using gain-sharing and
risk-sharing methods authorized for demonstration projects established under sections
256B.0755 and 256B.0756. If the commissioner contracts with a contractor under
this subdivision, the commissioner may separate nursing facility services, home and
community-based services, and pharmacy services from other covered services and may
provide payment for these services under the commissioner's fee-for-service payment
system instead of payment to the contracted entity.
new text end
new text begin
(b) If no qualified contractors are available and willing to contract on alternative
payment terms in a geographic area of the state, the commissioner shall administer the
program as a fee-for-service program in that area, but may establish additional utilization
review and care management programs and requirements in order to control the costs
of the program.
new text end
new text begin
(c) The commissioner shall ensure that in every case an eligible individual or family
is able to choose to receive covered services from any essential community provider, as
defined in section 62Q.19, and that the terms of participation of the essential community
provider meet the requirements of section 62Q.19.
new text end
new text begin Subd. 5. new text end
new text begin
MNsure premium subsidy for dependents of an employee with group
coverage.
new text end
new text begin
The commissioner shall provide a subsidy on behalf of the dependents of
an employee who is eligible for subsidized employer coverage, but the employee's
dependents are not eligible for the federal premium tax credit due to an Internal Revenue
Service ruling that they are not eligible due to the availability of unsubsidized dependent
coverage through the employer that does not include an employer contribution for
dependent coverage. The amount of the state subsidy must be equal to the federal tax
premium credit that otherwise would be provided to eligible families enrolled in individual
health coverage through MNsure with the same family size, makeup, income, and
geographic area. The state subsidy may be used to subsidize the purchase of dependent
coverage through the employer.
new text end
new text begin Subd. 6. new text end
new text begin
MNsure premium for uninsured individuals and families who are
exempt from the federal individual mandate.
new text end
new text begin
The commissioner shall provide a
subsidy for uninsured individuals and families who are exempt from the federal individual
mandate to maintain health insurance coverage because the cost of available health
coverage is deemed unaffordable for them under federal requirements. The amount of the
state subsidy must be equal to an amount necessary to make the cost of the premium of the
second lowest silver level qualified health plan offered through MNsure for an individual
or family of the same size, income, and geographic area affordable after deducting any
federal premium credits and cost-sharing subsidies that may be available.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2014.
new text end
ARTICLE 2
MEDICAL ASSISTANCE
Section 1.
Minnesota Statutes 2012, section 256B.06, subdivision 5, is amended to read:
Subd. 5.
Deeming of sponsor income and resources.
new text begin (a) new text end When determining
eligibility for any federal or state funded medical assistance under this section, the income
and resources of all noncitizens shall be deemed to include their sponsors' income
and resources as required under the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and
subsequently set out in federal rules. This section is effective May 1, 1997. Beginning
July 1, 2010, sponsor deeming does not apply to pregnant women and children who are
qualified noncitizens, as described in section 256B.06, subdivision 4, paragraph (b).
new text begin
(b) If the commissioner determines that some or all deemed sponsor income and
resources are unavailable to a noncitizen for reasons outside the control of the noncitizen,
the commissioner may:
new text end
new text begin
(1) enroll the noncitizen in the state-only MinnesotaCare program under section
256L.30; or
new text end
new text begin
(2) pay a portion of the noncitizen's premium for health coverage in order for the
person to obtain coverage through medical assistance or a qualified health plan offered
through MNsure, if cost-effective.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2014.
new text end
Sec. 2.
Minnesota Statutes 2012, section 256B.06, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Federal authority. new text end
new text begin
The commissioner shall seek federal authority to make
changes to the emergency medical assistance program established under subdivision 4,
paragraphs (e) to (h), to allow coverage and payment for cost-effective community-based
and outpatient services as an alternative to hospital inpatient and emergency department
services in order to reduce the total cost of care.
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