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SF 1029

as introduced - 92nd Legislature (2021 - 2022) Posted on 03/26/2021 01:00pm

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - as introduced

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A bill for an act
relating to health; expanding eligibility for MinnesotaCare and establishing a public
option; modifying enrollee premiums; modifying the definition of affordability
for certain families; requiring an implementation plan and recommendations for
an alternative delivery and payment system; amending Minnesota Statutes 2020,
sections 256L.04, subdivisions 1c, 7a, 10, by adding a subdivision; 256L.07,
subdivisions 1, 2; 256L.15, subdivision 2, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2020, section 256L.04, subdivision 1c, is amended to read:


Subd. 1c.

General requirements.

To be eligible for MinnesotaCare, a person must meet
the eligibility requirements of this section. A person eligible for MinnesotaCarenew text begin with an
income less than or equal to 200 percent of the federal poverty guidelines
new text end shall not be
considered a qualified individual under section 1312 of the Affordable Care Act, and is not
eligible for enrollment in a qualified health plan offered through MNsure under chapter
62V.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or upon federal approval,
whichever is later, subject to certification under section 11.
new text end

Sec. 2.

Minnesota Statutes 2020, section 256L.04, subdivision 7a, is amended to read:


Subd. 7a.

Ineligibility.

Adults whose income is greater than the limits established under
this section may not enroll in the MinnesotaCare programnew text begin, except as provided in subdivision
15 and section 256L.15, subdivision 5
new text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or upon federal approval,
whichever is later, subject to certification under section 11.
new text end

Sec. 3.

Minnesota Statutes 2020, section 256L.04, subdivision 10, is amended to read:


Subd. 10.

Citizenship requirements.

(a) Eligibility for MinnesotaCare is deleted text beginlimiteddeleted text endnew text begin
available
new text end to citizens or nationals of the United States deleted text beginanddeleted text endnew text begin,new text end lawfully present noncitizens as
defined in Code of Federal Regulations, title 8, section 103.12deleted text begin.deleted text endnew text begin, andnew text end undocumented
noncitizens deleted text beginare ineligible for MinnesotaCaredeleted text end. For purposes of this subdivision, an
undocumented noncitizen is an individual who resides in the United States without the
approval or acquiescence of the United States Citizenship and Immigration Services. Families
with children who are citizens or nationals of the United States must cooperate in obtaining
satisfactory documentary evidence of citizenship or nationality according to the requirements
of the federal Deficit Reduction Act of 2005, Public Law 109-171.

(b) Notwithstanding subdivisions 1 and 7, eligible persons include families and
individuals who are lawfully present and ineligible for medical assistance by reason of
immigration status and who have incomes equal to or less than 200 percent of federal poverty
guidelines.

Sec. 4.

Minnesota Statutes 2020, section 256L.04, is amended by adding a subdivision to
read:


new text begin Subd. 15. new text end

new text begin Persons eligible for public option. new text end

new text begin Families and individuals with income
above the maximum income eligibility limit specified in subdivision 1 or 7, who meet all
other MinnesotaCare eligibility requirements, are eligible for MinnesotaCare. All other
provisions of this chapter apply unless otherwise specified.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or upon federal approval,
whichever is later, subject to certification under section 11.
new text end

Sec. 5.

Minnesota Statutes 2020, section 256L.07, subdivision 1, is amended to read:


Subdivision 1.

General requirements.

Individuals enrolled in MinnesotaCare under
section 256L.04, subdivision 1, and individuals enrolled in MinnesotaCare under section
256L.04, subdivision 7, whose income increases above 200 percent of the federal poverty
guidelines, are no longer eligible for the program and shall be disenrolled by the
commissionernew text begin, unless they continue MinnesotaCare enrollment through the public option
under section 256L.04, subdivision 15, or receive an employer contribution toward
MinnesotaCare premiums under section 256L.15, subdivision 5
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, 2022, or upon federal approval,
whichever is later, subject to certification under section 11.
new text end

Sec. 6.

Minnesota Statutes 2020, section 256L.07, subdivision 2, is amended to read:


Subd. 2.

Must not have access to employer-subsidized minimum essential
coverage.

(a) To be eligible, a family or individual must not have access to subsidized health
coverage that is affordable and provides minimum value as defined in Code of Federal
Regulations, title 26, section 1.36B-2.

(b) new text beginNotwithstanding paragraph (a), an individual who has access to subsidized health
coverage through a spouse's employer that is deemed minimum essential coverage under
Code of Federal Regulations, title 26, section 1.36B-2, is eligible for MinnesotaCare if the
portion of the annual premium the employee pays for employee and dependent coverage
exceeds the required contribution percentage as described in Code of Federal Regulations,
title 26, section 1.36B-2.
new text end

new text begin (c) new text endThis subdivision does not apply to a family or individual whonew text begin: (1)new text end no longer has
employer-subsidized coverage due to the employer terminating health care coverage as an
employee benefitnew text begin; or (2) receives an employer contribution toward MinnesotaCare premiums
under section 256L.15, subdivision 5
new text end.

Sec. 7.

Minnesota Statutes 2020, section 256L.15, subdivision 2, is amended to read:


Subd. 2.

Sliding fee scale; monthly individual or family income.

(a) The commissioner
shall establish a sliding fee scale to determine the percentage of monthly individual or family
income that households at different income levels must pay to obtain coverage through the
MinnesotaCare program. The sliding fee scale must be based on the enrollee's monthly
individual or family income.

(b) Beginning January 1, 2014, new text beginthrough December 31, 2021, new text endMinnesotaCare enrollees
shall pay premiums according to the premium scale specified in paragraph (d).

(c) Paragraph (b) does not apply to:

(1) children 20 years of age or younger; and

(2) individuals with household incomes below 35 percent of the federal poverty
guidelines.

(d) The following premium scale is established for each individual in the household who
is 21 years of age or older and enrolled in MinnesotaCare:

Federal Poverty Guideline
Greater than or Equal to
Less than
Individual Premium
Amount
35%
55%
$4
55%
80%
$6
80%
90%
$8
90%
100%
$10
100%
110%
$12
110%
120%
$14
120%
130%
$15
130%
140%
$16
140%
150%
$25
150%
160%
$37
160%
170%
$44
170%
180%
$52
180%
190%
$61
190%
200%
$71
200%
$80

new text begin (e) Effective January 1, 2022, MinnesotaCare enrollees enrolled under section 256L.04,
subdivision 1 or 7, shall pay premiums according to the premium scale specified in paragraph
(h). The following persons are exempt from paying premiums under paragraph (h):
new text end

new text begin (1) persons 20 years of age or younger, with incomes not exceeding 200 percent of the
federal poverty guidelines; and
new text end

new text begin (2) individuals with household incomes below 35 percent of the federal poverty
guidelines.
new text end

new text begin (f) Beginning January 1, 2022, through December 31, 2022, the commissioner shall set
per-person premiums for persons eligible through the public option under section 256L.04,
subdivision 15, at a level sufficient to cover the full cost of benefits and program
administration for that group. Persons 20 years of age or younger, with incomes not exceeding
275 percent of the federal poverty guidelines, are exempt from paying premiums under this
paragraph.
new text end

new text begin (g) Beginning January 1, 2023, persons eligible through the public option under section
256L.04, subdivision 15, with household incomes not exceeding 400 percent of the federal
poverty guidelines, shall pay premiums according to the premium scale specified in paragraph
(h). Persons 20 years of age or younger, with incomes not exceeding 275 percent of the
federal poverty guidelines, are exempt from paying premiums under paragraph (h).
new text end

new text begin (h) Per-person premium scale for households, effective January 1, 2022:
new text end

new text begin Federal Poverty Guideline
Percentage Greater than or
Equal to
new text end
new text begin Federal Poverty Guideline
Percentage Less than or Equal
to
new text end
new text begin Per-Person Premium Amount
new text end
new text begin 0
new text end
new text begin 34
new text end
new text begin $0
new text end
new text begin 35
new text end
new text begin 54
new text end
new text begin $4
new text end
new text begin 55
new text end
new text begin 79
new text end
new text begin $6
new text end
new text begin 80
new text end
new text begin 89
new text end
new text begin $8
new text end
new text begin 90
new text end
new text begin 99
new text end
new text begin $10
new text end
new text begin 100
new text end
new text begin 109
new text end
new text begin $12
new text end
new text begin 110
new text end
new text begin 119
new text end
new text begin $14
new text end
new text begin 120
new text end
new text begin 129
new text end
new text begin $15
new text end
new text begin 130
new text end
new text begin 139
new text end
new text begin $16
new text end
new text begin 140
new text end
new text begin 149
new text end
new text begin $25
new text end
new text begin 150
new text end
new text begin 159
new text end
new text begin $37
new text end
new text begin 160
new text end
new text begin 169
new text end
new text begin $44
new text end
new text begin 170
new text end
new text begin 179
new text end
new text begin $52
new text end
new text begin 180
new text end
new text begin 189
new text end
new text begin $61
new text end
new text begin 190
new text end
new text begin 199
new text end
new text begin $71
new text end
new text begin 200
new text end
new text begin 200
new text end
new text begin $80
new text end
new text begin 201
new text end
new text begin 209
new text end
new text begin $91
new text end
new text begin 210
new text end
new text begin 219
new text end
new text begin $101
new text end
new text begin 220
new text end
new text begin 229
new text end
new text begin $111
new text end
new text begin 230
new text end
new text begin 239
new text end
new text begin $122
new text end
new text begin 240
new text end
new text begin 249
new text end
new text begin $134
new text end
new text begin 250
new text end
new text begin 259
new text end
new text begin $146
new text end
new text begin 260
new text end
new text begin 269
new text end
new text begin $157
new text end
new text begin 270
new text end
new text begin 279
new text end
new text begin $169
new text end
new text begin 280
new text end
new text begin 289
new text end
new text begin $181
new text end
new text begin 290
new text end
new text begin 299
new text end
new text begin $193
new text end
new text begin 300
new text end
new text begin 309
new text end
new text begin $206
new text end
new text begin 310
new text end
new text begin 319
new text end
new text begin $213
new text end
new text begin 320
new text end
new text begin 329
new text end
new text begin $220
new text end
new text begin 330
new text end
new text begin 339
new text end
new text begin $227
new text end
new text begin 340
new text end
new text begin 349
new text end
new text begin $234
new text end
new text begin 350
new text end
new text begin 359
new text end
new text begin $241
new text end
new text begin 360
new text end
new text begin 369
new text end
new text begin $248
new text end
new text begin 370
new text end
new text begin 379
new text end
new text begin $254
new text end
new text begin 380
new text end
new text begin 389
new text end
new text begin $261
new text end
new text begin 390
new text end
new text begin 399
new text end
new text begin $268
new text end
new text begin 400
new text end
new text begin $275
new text end

new text begin Premiums under this paragraph are charged on a per-person basis, except that the total
premium for households with two or more persons shall not exceed the required contribution
percentage specified for their income level in the current required contribution table used
for advance premium tax credits under United States Code, title 26, section 36B(b)(3)(A)(i),
as indexed according to item (ii) of that section.
new text end

new text begin (i) Beginning January 1, 2023, for persons eligible through the public option under
section 256L.04, subdivision 15, with household incomes greater than 400 percent of the
federal poverty guidelines, the per-household premium shall be the highest of:
new text end

new text begin (1) the highest required contribution percentage specified in the current required
contribution table used for advance premium tax credits under United States Code, title 26,
section 36B(b)(3)(A)(i), as indexed according to item (ii) of that section; or
new text end

new text begin (2) 125 percent of the statewide gold premium for qualified health plan coverage through
MNsure for covered household members.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or upon federal approval,
whichever is later, subject to certification under section 11.
new text end

Sec. 8.

Minnesota Statutes 2020, section 256L.15, is amended by adding a subdivision to
read:


new text begin Subd. 5. new text end

new text begin Employer contribution. new text end

new text begin (a) An employer with 50 or fewer employees may
pay to the commissioner, as an employer contribution to employee health care costs, an
amount up to the portion of an enrollee's MinnesotaCare premium for which the enrollee
is financially responsible.
new text end

new text begin (b) An enrollee is eligible for MinnesotaCare under this subdivision without regard to
any program income limit, but shall be financially responsible for premiums as specified
in section 256L.15, subdivision 2, paragraphs (h) and (i).
new text end

new text begin (c) The commissioner shall establish a procedure through which employers can pay
premium contributions for employees directly to the commissioner on an aggregate, monthly
basis.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Paragraphs (a) and (c) are effective July 1, 2021. Paragraph (b)
is effective January 1, 2022, or upon federal approval, whichever is later, subject to
certification under section 11.
new text end

Sec. 9. new text beginTRANSITION TO MINNESOTACARE PUBLIC OPTION.
new text end

new text begin (a) The commissioner of human services shall continue to administer MinnesotaCare
as a basic health program in accordance with Minnesota Statutes, section 256L.02,
subdivision 5, and shall seek federal waivers, approvals, and law changes as required under
section 10.
new text end

new text begin (b) The commissioner shall present an implementation plan for the MinnesotaCare public
option under Minnesota Statutes, section 256L.04, subdivision 15, to the chairs and ranking
minority members of the legislative committees with jurisdiction over health care policy
and finance by December 15, 2021. The plan must include:
new text end

new text begin (1) recommendations for any changes to the MinnesotaCare public option necessary to
continue federal basic health program funding or to receive other federal funding;
new text end

new text begin (2) recommendations for implementing Minnesota Statutes, section 256L.15, subdivision
5, in a manner that would allow any employee premium contributions to be pretax;
new text end

new text begin (3) recommendations for increasing MinnesotaCare provider enrollment, including an
analysis of the feasibility of requiring participation in MinnesotaCare as a condition for
state licensure;
new text end

new text begin (4) estimates of state costs related to the MinnesotaCare public option; and
new text end

new text begin (5) draft legislation that includes any additional policy and conforming changes necessary
to implement the MinnesotaCare public option and the implementation plan
recommendations.
new text end

new text begin (c) The commissioner shall present to the chairs and ranking minority members of the
legislative committees with jurisdiction over health care policy and finance by January 15,
2022, recommendations for an alternative service delivery and payment system for
MinnesotaCare. The recommendations must address:
new text end

new text begin (1) terminating managed care and county-based purchasing plan contracts under
Minnesota Statutes, sections 256L.12 and 256L.121, effective January 1, 2024;
new text end

new text begin (2) delivering services beginning January 1, 2024, to MinnesotaCare enrollees eligible
under Minnesota Statutes, section 256L.04, subdivisions 1, 7, and 15, through alternative
delivery methods that may include but are not limited to expanding the use of integrated
health partnerships under Minnesota Statutes, section 256B.0755, and delivering care under
fee-for-service through a primary care case management system; and
new text end

new text begin (3) reimbursing providers for high-quality, value-based care at levels sufficient to increase
enrollee access to care, address racial and geographic inequities in the delivery of health
care, and incentivize preventive care and other best practices.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 10. new text beginREQUEST FOR FEDERAL APPROVAL.
new text end

new text begin The commissioner of human services shall seek any federal waivers, approvals, and law
changes necessary to implement this act, including but not limited to those waivers, approvals,
and law changes necessary to allow:
new text end

new text begin (1) the state to continue to receive federal basic health program payments for basic health
program eligible MinnesotaCare enrollees and to receive other federal funding for the
MinnesotaCare public option; and
new text end

new text begin (2) MinnesotaCare enrollees with household incomes greater than 200 percent of the
federal poverty guidelines to be eligible to receive advanced premium tax credits.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 11. new text beginCONTINGENT EFFECTIVE DATE.
new text end

new text begin Sections 1; 2; 4; 5; 7; and 8, paragraph (b); are effective January 1, 2022, or upon federal
approval, whichever is later, but only if the commissioner of human services certifies to the
legislature that implementation of those sections will not result in the loss of federal basic
health program funding for MinnesotaCare enrollees with incomes not exceeding 200 percent
of the federal poverty guidelines.
new text end