HF 4745

1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 03/18/2024 04:22pm

A bill for an act
relating to health; establishing the MinnesotaCare public option; expanding
eligibility for MinnesotaCare; establishing a premium scale for public option
enrollees; requiring the commissioner of commerce to seek a section 1332 waiver;
appropriating money; amending Minnesota Statutes 2022, sections 62V.02, by
adding subdivisions; 62V.03, subdivisions 1, 3; 62V.05, subdivisions 3, 6, 11, by
adding a subdivision; 62V.051; 62V.06, subdivision 4; 256L.01, by adding
subdivisions; 256L.04, subdivisions 1c, 7a, by adding a subdivision; 256L.07,
subdivision 1; 256L.12, subdivision 7; Minnesota Statutes 2023 Supplement,
sections 62V.13, subdivision 3; 256L.03, subdivision 5; proposing coding for new
law in Minnesota Statutes, chapters 62V; 256L.

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

Section 1.

Minnesota Statutes 2022, section 62V.02, is amended by adding a subdivision
to read:

new text begin Subd. 7a. new text end

new text begin MinnesotaCare public option. new text end

new text begin "MinnesotaCare public option" or "public
option" 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, 2027, 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 2022, section 62V.02, is amended by adding a subdivision to
read:

new text begin Subd. 7b. new text end

new text begin MinnesotaCare public option enrollee. new text end

new text begin "MinnesotaCare public option
enrollee" or "public option enrollee" has the meaning provided in section 256L.01,
subdivision 5b.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, 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. 3.

Minnesota Statutes 2022, section 62V.03, subdivision 1, is amended to read:

Subdivision 1.

Creation.

MNsure is created as a board under section 15.012, paragraph
(a), to:

(1) promote informed consumer choice, innovation, competition, quality, value, market
participation, affordability, suitable and meaningful choices, health improvement, care
management, reduction of health disparities, and portability of health plans new text begin and the public
option new text end ;

(2) facilitate and simplify the comparison, choice, enrollment, and purchase of health
plans for individuals purchasing in the individual market through MNsure deleted text begin and deleted text end new text begin , new text end for employees
and employers purchasing in the small group market through MNsure new text begin , and for individuals
purchasing the public option new text end ;

(3) assist small employers with access to small business health insurance tax credits and
to assist individuals with access to public health care programs, premium assistance tax
credits and cost-sharing reductions, and certificates of exemption from individual
responsibility requirements;

(4) facilitate the integration and transition of individuals between public health care
programs new text begin , including the public option, new text end and health plans in the individual or group market
and develop processes that, to the maximum extent possible, provide for continuous coverage;
deleted text begin and
deleted text end

(5) establish and modify as necessary a name and brand for MNsure based on market
studies that show maximum effectiveness in attracting the uninsured and motivating them
to take action deleted text begin . deleted text end new text begin ; and
new text end

new text begin (6) ensure simple, convenient, and understandable access to enrollment in the public
option through the MNsure website.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, 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 2022, section 62V.03, subdivision 3, is amended to read:

Subd. 3.

Continued operation of a private marketplace.

(a) Nothing in this chapter
shall be construed to prohibit: (1) a health carrier from offering outside of MNsure a health
plan to a qualified individual or qualified employer; and (2) a qualified individual from
enrolling in, or a qualified employer from selecting for its employees, a health plan offered
outside of MNsure.

(b) Nothing in this chapter shall be construed to restrict the choice of a qualified individual
to enroll or not enroll in a qualified health plan new text begin , the public option, new text end or to participate in MNsure.
Nothing in this chapter shall be construed to compel an individual to enroll in a qualified
health plan new text begin , the public option, new text end or to participate in MNsure.

(c) For purposes of this subdivision, "qualified individual" and "qualified employer"
have the meanings given in section 1312 of the Affordable Care Act, Public Law 111-148,
and further defined through amendments to the act and regulations issued under the act.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, 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 2022, section 62V.05, subdivision 3, is amended to read:

Subd. 3.

Insurance producers.

(a) By April 30, 2013, the board, in consultation with
the commissioner of commerce, shall establish certification requirements that must be met
by insurance producers in order to assist individuals and small employers with purchasing
coverage through MNsure. deleted text begin Prior to January 1, 2015, the board may amend the requirements,
only if necessary, due to a change in federal rules.
deleted text end

(b) Certification requirements new text begin under paragraph (a) new text end shall not exceed the requirements
established under Code of Federal Regulations, title 45, deleted text begin part deleted text end new text begin section new text end 155.220. Certification
shall include training on health plans available through MNsure, available tax credits and
cost-sharing arrangements, compliance with privacy and security standards, eligibility
verification processes, online enrollment tools, and basic information on available public
health care programs. Training required for certification under this subdivision shall qualify
for continuing education requirements for insurance producers required under chapter 60K,
and must comply with course approval requirements under chapter 45.

(c) new text begin For enrollment in qualified health plans, new text end producer compensation shall be established
by health carriers that provide health plans through MNsure. The structure of compensation
to insurance producers must be similar for health plans sold through MNsure and outside
MNsure.

(d) Any insurance producer compensation structure established by a health carrier for
the small group market must include compensation for defined contribution plans that
involve multiple health carriers. The compensation offered must be commensurate with
other small group market defined health plans.

(e) Any insurance producer assisting an individual or small employer with purchasing
coverage through MNsure must disclose, orally and in writing, to the individual or small
employer at the time of the first solicitation with the prospective purchaser the following:

(1) the health carriers and qualified health plans offered through MNsure that the producer
is authorized to sell, and that the producer may not be authorized to sell all the qualified
health plans offered through MNsure;

(2) that the producer may be receiving compensation from a health carrier for enrolling
the individual or small employer into a particular health plan; deleted text begin and
deleted text end

(3) that information on all qualified health plans offered through MNsure new text begin and the public
option new text end is available through the MNsure website deleted text begin . deleted text end new text begin ; and
new text end

new text begin (4) that the producer may receive compensation from the state for enrolling an individual
in the public option.
new text end

For purposes of this paragraph, "solicitation" means any contact by a producer, or any person
acting on behalf of a producer made for the purpose of selling or attempting to sell coverage
through MNsure. If the first solicitation is made by telephone, the disclosures required under
this paragraph need not be made in writing, but the fact that disclosure has been made must
be acknowledged on the application.

(f) Beginning January 15, 2015, each health carrier that offers or sells qualified health
plans through MNsure shall report in writing to the board and the commissioner of commerce
the compensation and other incentives it offers or provides to insurance producers with
regard to each type of health plan the health carrier offers or sells both inside and outside
of MNsure. Each health carrier shall submit a report annually and upon any change to the
compensation or other incentives offered or provided to insurance producers.

(g) Nothing in this chapter shall prohibit an insurance producer from offering professional
advice and recommendations to a small group purchaser based upon information provided
to the producer.

(h) An insurance producer that offers health plans in the small group market shall notify
each small group purchaser of which group health plans qualify for Internal Revenue Service
approved section 125 tax benefits. The insurance producer shall also notify small group
purchasers of state law provisions that benefit small group plans when the employer agrees
to pay 50 percent or more of its employees' premium. Individuals who are eligible for
cost-effective medical assistance will count toward the 75 percent participation requirement
in section 62L.03, subdivision 3.

(i) Nothing in this subdivision shall be construed to limit the licensure requirements or
regulatory functions of the commissioner of commerce under chapter 60K.

new text begin (j) The board may establish certification requirements that must be met by insurance
producers in order to assist individuals with enrolling in the public option.
new text end

new text begin (k) Health carriers must pay an insurance producer a $....... application assistance bonus
for each applicant the insurance producer successfully enrolls in the public option.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval of the state's
section 1332 waiver request to establish a public option. The commissioner of commerce
shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 6.

Minnesota Statutes 2022, 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, new text begin the MinnesotaCare public option, new text end 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 EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 7.

Minnesota Statutes 2022, section 62V.05, subdivision 11, is amended to read:

Subd. 11.

Prohibition on other product lines.

MNsure is prohibited from certifying,
selecting, or offering products and policies of coverage that do not meet the definition of
health plan or dental plan as provided in section 62V.02. new text begin Nothing in this subdivision prevents
the commissioner of human services from offering the public option on the MNsure website.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, 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. 8.

Minnesota Statutes 2022, section 62V.05, is amended by adding a subdivision to
read:

new text begin Subd. 13. new text end

new text begin MinnesotaCare public option. new text end

new text begin The board has the powers and duties provided
in section 62V.15, with respect to the MinnesotaCare public option.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, 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. 9.

Minnesota Statutes 2022, section 62V.051, is amended to read:

62V.051 MNSURE; CONSUMER RETROACTIVE APPOINTMENT OF A
NAVIGATOR OR PRODUCER PERMITTED.

Notwithstanding any other law or rule to the contrary, for up to six months after the
effective date of the qualified health plan new text begin or coverage under the public option new text end , MNsure must
permit a qualified health plan policyholder new text begin or public option enrollee new text end , who has not designated
a navigator or an insurance producer, to retroactively appoint a navigator or insurance
producer. new text begin In the case of a qualified health plan, new text end MNsure must provide notice of the retroactive
appointment to the health carrier. The health carrier must retroactively pay commissions to
the insurance producer if the producer can demonstrate that they were certified by MNsure
at the time of the original enrollment, were appointed by the selected health carrier at the
time of the enrollment, and that an agent of record agreement was executed prior to or at
the time of the effective date of the policy. MNsure must adopt a standard form of agent of
record agreement for purposes of this section. new text begin In the case of the public option, MNsure must
provide notice of the retroactive appointment to the managed care or county-based purchasing
plan, and the plan must retroactively pay commissions to the insurance producer if the
producer can demonstrate they were certified by MNsure at the time of the original
enrollment.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, 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. 10.

Minnesota Statutes 2022, section 62V.06, subdivision 4, is amended to read:

Subd. 4.

Application and certification data.

(a) Data submitted by an insurance producer
in an application for certification to sell a health plan new text begin or the public option new text end through MNsure,
or submitted by an applicant seeking permission or a commission to act as a navigator or
in-person assister, are classified as follows:

(1) at the time the application is submitted, all data contained in the application are
private data, as defined in section 13.02, subdivision 12, or nonpublic data as defined in
section 13.02, subdivision 9, except that the name of the applicant is public; and

(2) upon a final determination related to the application for certification by MNsure, all
data contained in the application are public, with the exception of trade secret data as defined
in section 13.37.

(b) Data created or maintained by a government entity as part of the evaluation of an
application are protected nonpublic data, as defined in section 13.02, subdivision 13, until
a final determination as to certification is made and all rights of appeal have been exhausted.
Upon a final determination and exhaustion of all rights of appeal, these data are public, with
the exception of trade secret data as defined in section 13.37 and data subject to
attorney-client privilege or other protection as provided in section 13.393.

(c) If an application is denied, the public data must include the criteria used by the board
to evaluate the application and the specific reasons for the denial, and these data must be
published on the MNsure website.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, 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. 11.

Minnesota Statutes 2023 Supplement, section 62V.13, subdivision 3, is amended
to read:

Subd. 3.

Outreach letter and special enrollment period.

(a) MNsure must provide a
written letter of the projected assessment under subdivision 2 to a taxpayer who indicates
to the commissioner of revenue that the taxpayer is interested in obtaining information on
access to health insurance.

(b) MNsure must allow a special enrollment period for taxpayers who receive the outreach
letter in paragraph (a) and are determined eligible to enroll in a qualified health plan through
MNsure new text begin or in the public option new text end . The triggering event for the special enrollment period is
the day the outreach letter under this subdivision is mailed to the taxpayer. An eligible
individual, and their dependents, have 65 days from the triggering event to select a qualifying
health plan new text begin or the public option new text end and coverage for the qualifying health plan new text begin or the public
option new text end is effective the first day of the month after plan selection.

(c) Taxpayers who have a member of the taxpayer's household currently enrolled in a
qualified health plan through MNsure new text begin or in the public option new text end are not eligible for the special
enrollment under paragraph (b).

(d) MNsure must provide information to the general public about the easy enrollment
health insurance outreach program and the special enrollment period described in this
subdivision.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, 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. 12.

new text begin [62V.15] PUBLIC OPTION; APPLICATION AND ENROLLMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Public option application. new text end

new text begin (a) An individual eligible for the public option
must be able to enroll in the public option on the MNsure website.
new text end

new text begin (b) An individual must be able to apply for and, if eligible, enroll in the public option
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 they
are not eligible for medical assistance under chapter 256B or MinnesotaCare under chapter
256L through an eligibility pathway other than the public option.
new text end

new text begin (c) MNsure must ensure that individuals interested in applying for a qualified health
plan or the public option are able to compare coverage options in a simple, convenient, and
understandable manner on the MNsure website. The website must present the coverage
options in a comparable and standardized manner to the extent practicable.
new text end

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

new text begin Subd. 2. new text end

new text begin Eligibility determinations. new text end

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

new text begin (b) Eligibility for the public option is appealable to the MNsure board under this chapter
and Minnesota Rules, chapter 7700.
new text end

new text begin Subd. 3. new text end

new text begin Administrative functions. new text end

new text begin MNsure shall provide administrative functions to
facilitate the offering of the public option by the commissioner of human services. 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. 4. 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. 5. new text end

new text begin No limitation. new text end

new text begin Nothing in this section limits the rights of MinnesotaCare public
option enrollees or the commissioner of human services under chapter 256L.
new text end

new text begin Subd. 6. 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 board to develop and implement the technological requirements of
this section.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval of the state's
section 1332 waiver application to establish a public option. The commissioner of commerce
shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 13.

Minnesota Statutes 2022, section 256L.01, is amended by adding a subdivision
to read:

new text begin Subd. 5a. new text end

new text begin MinnesotaCare public option. new text end

new text begin "MinnesotaCare public option" or "public
option" 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, 2027, 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. 14.

Minnesota Statutes 2022, section 256L.01, is amended by adding a subdivision
to read:

new text begin Subd. 5b. new text end

new text begin MinnesotaCare public option enrollee. new text end

new text begin "MinnesotaCare public option
enrollee" or "public option 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, 2027, 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. 15.

Minnesota Statutes 2023 Supplement, 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 deleted text begin . deleted text end new text begin , but do apply to public option enrollees as provided in
section 256L.29.
new text end

(b) 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 new text begin ,
except as provided for public option enrollees under section 256L.29 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 begin The cost-sharing changes described in this paragraph
deleted text end deleted text begin shall not be implemented prior to January 1, 2016.
deleted text end

(c) The cost-sharing changes authorized under paragraph (b) 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.

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

(e) 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.

(f) 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.

(g) 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).

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, 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. 16.

Minnesota Statutes 2022, 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 MinnesotaCare deleted text begin shall deleted text end new text begin with
an income less than or equal to 200 percent of the federal poverty guidelines must new text end 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, 2027, 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. 17.

Minnesota Statutes 2022, 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 program new text begin , except as public option enrollees
under subdivision 15 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, 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. 18.

Minnesota Statutes 2022, 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 public option. new text end

new text begin (a) 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 the MinnesotaCare
public option, subject to the enrollment cap and additional requirements established under
section 256L.29. Families and individuals enrolled in the public option under this subdivision
are MinnesotaCare enrollees, and all provisions of this chapter applying generally to
MinnesotaCare enrollees apply to public option enrollees unless otherwise specified.
new text end

new text begin (b) Families and individuals may enroll in MinnesotaCare under this subdivision only
during an annual open enrollment period or special enrollment period, as designated by
MNsure in compliance with Code of Federal Regulations, title 45, sections 155.410 and
155.420.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, 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. 19.

Minnesota Statutes 2022, 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 deleted text begin , deleted text end are no longer eligible for the program and deleted text begin shall deleted text end new text begin must new text end be disenrolled by the
commissioner new text begin , unless the individuals continue MinnesotaCare enrollment through the public
option new 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, 2027, 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. 20.

Minnesota Statutes 2022, section 256L.12, subdivision 7, is amended to read:

Subd. 7.

Managed care plan vendor requirements.

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) shall reimburse health care providers for services provided to MinnesotaCare public
option 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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, 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. 21.

new text begin [256L.29] MINNESOTACARE PUBLIC OPTION.
new text end

new text begin Subdivision 1. new text end

new text begin MinnesotaCare requirements. new text end

new text begin The public option is part of the
MinnesotaCare program and all provisions of this chapter apply to the public option, 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 shall apply
for coverage under the public option as provided in section 62V.15. Enrollment in the public
option is limited to individuals eligible under section 256L.04, subdivision 15. The Board
of Directors of MNsure shall process public option applications and determine eligibility
for the public option as provided in section 62V.15.
new text end

new text begin Subd. 3. new text end

new text begin Premium scale. new text end

new text begin Public option enrollees shall 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 250% new text end	new text begin 4.88% new text end
new text begin 251% new text end	new text begin 300% new text end	new text begin 6.38% new text end
new text begin 301% new text end	new text begin 400% new text end	new text begin 7.88% new text end
new text begin 401% new text end	new text begin 500% new text end	new text begin 8.5% new text end
new text begin 501% new text end	new text begin 550% new text end	new text begin 9.01% new text end
new text begin 551% and over new text end	new text begin No maximum new text end	new text begin 10% new text end

new text begin Subd. 4. new text end

new text begin Cost-sharing. new text end

new text begin (a) Public option enrollees are subject to the MinnesotaCare
cost-sharing requirements established under section 256L.03, subdivision 5, except that:
new text end

new text begin (1) cost-sharing applies to all public option enrollees and there are no exemptions from
cost-sharing for specific groups of individuals, including but not limited to: (i) children
under age 21; (ii) pregnant women; and (iii) American Indians as defined in Code of Federal
Regulations, title 42, section 600.5, who have incomes greater than or equal to 300 percent
of the federal poverty guidelines;
new text end

new text begin (2) the commissioner shall set cost-sharing for public option enrollees at an actuarial
value of 94 percent, except that the actuarial value for public option enrollees with household
incomes above 400 percent of the federal poverty guidelines may be lower than 94 percent;
new text end

new text begin (3) the deductibles specified in paragraph (b) apply; and
new text end

new text begin (4) out-of-pocket maximums for public option enrollees must not exceed those outlined
in Code of Federal Regulations, title 45, section 156.130.
new text end

new text begin (b) Public option enrollees are subject to the following annual deductibles:
new text end

new text begin (1) for household incomes 401 percent to 500 percent of federal poverty guidelines,
$500;
new text end

new text begin (2) for household incomes 501 percent to 600 percent of federal poverty guidelines,
$1,000; and
new text end

new text begin (3) for household incomes 601 percent of federal poverty guidelines or above, $1,500.
new text end

new text begin (c) No annual deductible applies to public option enrollees with household incomes not
exceeding 400 percent of the federal poverty guidelines.
new text end

new text begin Subd. 5. new text end

new text begin Enrollment limits. new text end

new text begin Enrollment in the public option is subject to the following
limits:
new text end

new text begin (1) for the 2027 plan year, no enrollment limit for individuals with household incomes
not exceeding 400 percent of the federal poverty guidelines, and a limit of 10,000 enrollments
for individuals with household incomes exceeding 400 percent of the federal poverty
guidelines;
new text end

new text begin (2) for the 2028 plan year, no enrollment limit for individuals with household incomes
not exceeding 550 percent of the federal poverty guidelines, and a limit of 15,000 enrollments
for individuals with household incomes exceeding 550 percent of the federal poverty
guidelines; and
new text end

new text begin (3) for the 2029 plan year and subsequent plan years, no enrollment limit.
new text end

new text begin Subd. 6. 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 public
option 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 public option
enrollees.
new text end

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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, 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. 22. 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 Secretary of Health and Human Services,
to obtain federal approval to implement this act. The commissioner of commerce shall also
seek through the waiver federal approval for the state to:
new text end

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

new text begin (2) receive federal pass-through funding equal to the value of premium tax credits and
cost-sharing reductions that MinnesotaCare public option 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 to be necessary
and advisable for waiver approval to the Secretary of Health and Human Services and the
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

Sec. 23. new text begin APPROPRIATIONS.
new text end

new text begin Subdivision 1. new text end

new text begin MNsure board. new text end

new text begin (a) $....... in fiscal year 2025 is appropriated from the
general fund to the Board of Directors of MNsure for technology costs related to the
development and implementation of the public option application and enrollment process.
This is a onetime appropriation and is available through June 30, 2028.
new text end

new text begin (b) The general fund base in fiscal year 2027 for the Board of Directors of MNsure for
public awareness and marketing initiatives related to the public option is $1,000,000.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner of human services. new text end

new text begin $....... in fiscal year 2025 is appropriated
from the general fund to the commissioner of human services to develop and implement
the public option.
new text end

new text begin Subd. 3. new text end

new text begin Commissioner of commerce. new text end

new text begin $....... in fiscal year 2025 is appropriated from
the general fund to the commissioner of commerce to develop and submit a waiver application
to the federal government to implement the public option. This is a onetime appropriation
and is available until January 1, 2027.
new text end