SF 3046

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, subdivision 1; 256L.07, subdivision 2; 256L.09,
by adding a subdivision; 256L.15, by adding a subdivision; 256L.17, subdivision
5; Minnesota Statutes 2005 Supplement, sections 256L.05, subdivision 3a;
256L.07, subdivisions 1, 3; 256L.15, subdivision 3; 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 deleted text begin . deleted text end 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, 2007.
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, 2007.
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, 2007.
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, 2007.
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, 2007.
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, 2007.
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 of the 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, 2007.
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 of the 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 of the 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, 2007.
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 of the full 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, 2007.
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, 2007.
new text end

Sec. 11.

Minnesota Statutes 2005 Supplement, 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 the
month the application is received by the commissioner. The effective date of coverage
within the first six-month period of eligibility is as provided in subdivision 3. 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.

(c) For single adults and households with no children formerly enrolled in general
assistance medical care and enrolled in MinnesotaCare according to section 256D.03,
subdivision 3, the first six-month period of eligibility begins the month the enrollee
submitted the application or renewal for general assistance medical care.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2007.
new text end

Sec. 12.

Minnesota Statutes 2005 Supplement, section 256L.07, subdivision 1, is
amended to read:

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) Notwithstanding paragraph (b), children may remain enrolled in MinnesotaCare
if ten percent of their gross individual or gross family income as defined in section
256L.01, subdivision 4, is less than the premium for a six-month 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) Notwithstanding paragraphs (b) and (c), parents new text begin eligible under section 256L.04,
subdivision 1, new text end are not eligible for MinnesotaCare if gross household income exceeds
$25,000 for the six-month period of eligibility.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2007.
new text end

Sec. 13.

Minnesota Statutes 2004, section 256L.07, subdivision 2, is amended to read:

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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2007.
new text end

Sec. 14.

Minnesota Statutes 2005 Supplement, section 256L.07, subdivision 3, is
amended to read:

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, an applicant or enrollee who is entitled to
Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social
Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to
have health coverage. An applicant or enrollee who is entitled to premium-free Medicare
Part A may not refuse to apply for or enroll in 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) Cost-effective health insurance that was paid for by medical assistance is not
considered health coverage for purposes of the four-month requirement under this
section, except if the insurance continued after medical assistance no longer considered it
cost-effective or after medical assistance closed.

new text begin (f) This subdivision 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, 2007.
new text end

Sec. 15.

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, 2007.
new text end

Sec. 16.

Minnesota Statutes 2005 Supplement, section 256L.15, subdivision 3, is
amended to read:

Subd. 3.

Exceptions to sliding scale.

Children in families new text begin eligible under section
256L.04, subdivision 1, new text end with income at or below 150 percent of the federal poverty
guidelines pay a monthly premium of $4.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2007.
new text end

Sec. 17.

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

new text begin Subd. 5. new text end

new text begin Payment of full cost of 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 of the
premium. The full 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 of the 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 household income enrolled for these groups.
new text end

new text begin (b) The commissioner may increase the full cost of the 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, 2007.
new text end

Sec. 18.

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, 2007.
new text end