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HF 11

4th Engrossment - 92nd Legislature (2021 - 2022) Posted on 03/21/2022 03:38pm

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

Bill Text Versions

Engrossments
Introduction Posted on 01/07/2021
1st Engrossment Posted on 01/28/2021
2nd Engrossment Posted on 02/15/2021
3rd Engrossment Posted on 02/17/2022
4th Engrossment Posted on 03/03/2022

Current Version - 4th Engrossment

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A bill for an act
relating to human services; establishing transitional cost-sharing reduction, premium
subsidy, small employer public option, and transitional health care credit; expanding
eligibility for MinnesotaCare; modifying premium scale; requiring
recommendations for alternative delivery and payment system; amending Minnesota
Statutes 2020, sections 62V.05, by adding a subdivision; 256L.04, subdivisions
1c, 7a, 10, by adding a subdivision; 256L.07, subdivision 1; 256L.15, subdivision
2, as amended; 290.06, by adding a subdivision; proposing coding for new law in
Minnesota Statutes, chapter 62V.

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

Section 1.

Minnesota Statutes 2020, section 62V.05, is amended by adding a subdivision
to read:


new text begin Subd. 13. new text end

new text begin Transitional cost-sharing reductions. new text end

new text begin (a) The board shall develop and
implement, for the 2023 and 2024 plan years only, a system to support eligible individuals
who choose to enroll in gold level health plans through MNsure.
new text end

new text begin (b) For purposes of this section, an "eligible individual" is an individual who:
new text end

new text begin (1) is a resident of Minnesota; and
new text end

new text begin (2) is enrolled in a gold level health plan offered in the enrollee's county of residence.
new text end

new text begin (c) Under the system established in this subdivision, the monthly transitional cost-sharing
reduction subsidy for an eligible individual is $75.
new text end

new text begin (d) The board shall establish procedures for determining an individual's eligibility for
the subsidy and providing payments to a health carrier for any eligible individuals enrolled
in the carrier's gold level health plans.
new text end

Sec. 2.

new text begin [62V.12] TRANSITIONAL PREMIUM SUBSIDY.
new text end

new text begin Subdivision 1. new text end

new text begin Provision of subsidy. new text end

new text begin (a) A qualified individual is eligible to receive
from MNsure a transitional premium subsidy of $125 per month for the period of January
1, 2023, through December 31, 2024. MNsure must pay this premium subsidy directly to
health carriers. A health carrier must reduce the monthly premium charged to the individual
by the amount of the premium subsidy for an individual determined eligible under this
section.
new text end

new text begin (b) MNsure shall establish and administer procedures to:
new text end

new text begin (1) determine whether a person is eligible as a qualified individual; and
new text end

new text begin (2) pay premium subsidies directly to health carriers.
new text end

new text begin (c) MNsure may only implement this section if the provisions of the American Rescue
Plan Act of 2021 related to the calculation of and eligibility for premium tax credits, as
specified in section 36B(b)(3)(A)(iii) of the Internal Revenue Code, are not extended beyond
December 31, 2022.
new text end

new text begin Subd. 2. new text end

new text begin Qualified individual. new text end

new text begin For the purposes of this section, "qualified individual"
means a person who:
new text end

new text begin (1) is a resident of Minnesota; and
new text end

new text begin (2) is enrolled in a bronze, silver, gold, or platinum level health plan offered in the
person's county of residence.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for the period of January 1, 2023, through
December 31, 2024, subject to the contingency requirement of subdivision 1, paragraph
(c).
new text end

Sec. 3.

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 MinnesotaCare deleted text beginshalldeleted text endnew 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, 2025, or upon federal approval,
whichever is later, subject to certification under section 13. The commissioner of human
services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 4.

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
new text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025, or upon federal approval,
whichever is later, subject to certification under section 13. The commissioner of human
services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 5.

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 deleted text beginlawfully present anddeleted text end ineligible for medical assistance by reason of
immigration status and who have incomes equal to or less than 200 percent of federal poverty
guidelines.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
new text end

Sec. 6.

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 (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 MinnesotaCare. All other
provisions of this chapter apply 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, parts 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, 2025, or upon federal approval,
whichever is later, subject to certification under section 13. The commissioner of human
services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 7.

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
guidelinesdeleted text begin,deleted text end are no longer eligible for the program and deleted text beginshalldeleted text endnew text begin mustnew text end be disenrolled by the
commissionernew text begin, unless the individuals continue MinnesotaCare enrollment through the public
option under section 256L.04, subdivision 15
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, 2025, or upon federal approval,
whichever is later, subject to certification under section 13. The commissioner of human
services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 8.

Minnesota Statutes 2021 Supplement, section 256L.15, subdivision 2, is amended
to read:


Subd. 2.

Sliding fee scale; monthly individual or family income.

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

deleted text begin (b) Beginning January 1, 2014, MinnesotaCare enrollees shall pay premiums according
to the premium scale specified in paragraph (d).
deleted text end

deleted text begin (c)deleted text endnew text begin (b)new text end Paragraph deleted text begin(b)deleted text endnew text begin (a)new text end does not apply todeleted text begin:
deleted text end

deleted text begin (1)deleted text end children 20 years of age or youngerdeleted text begin; and
deleted text end

deleted text begin (2) individuals with household incomes below 35 percent of the federal povertydeleted text end
deleted text begin guidelinesdeleted text end.

deleted text begin (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:
deleted text end

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

deleted text begin (e)deleted text endnew text begin (c)new text end Beginning January 1, deleted text begin2021deleted text endnew text begin 2023new text end, new text beginthe commissioner shall continue to charge
premiums in accordance with the simplified premium scale established to comply with the
American Rescue Plan Act of 2021, in effect from January 1, 2021, through December 31,
2022, for families and individuals eligible under section 256L.04, subdivisions 1 and 7.
new text endThe
commissioner shall adjust the premium scale deleted text beginestablished under paragraph (d)deleted text endnew text begin as needednew text end to
ensure that premiums do not exceed the amount that an individual would have been required
to pay if the individual was enrolled in an applicable benchmark plan in accordance with
the Code of Federal Regulations, title 42, section 600.505 (a)(1).

new text begin (d) The commissioner shall establish a sliding premium scale for persons eligible through
the public option under section 256L.04, subdivision 15. Beginning January 1, 2025, persons
eligible through the public option shall pay premiums according to this premium scale.
Persons eligible through the public option who are 20 years of age or younger are exempt
from paying premiums.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2023, and certification under
section 13 is not required, except that paragraph (d) is effective January 1, 2025, or upon
federal approval, whichever is later, subject to certification under section 13. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end

Sec. 9.

Minnesota Statutes 2020, section 290.06, is amended by adding a subdivision to
read:


new text begin Subd. 41. new text end

new text begin Small employer transitional health care credit. new text end

new text begin (a) For purposes of this
subdivision, the following terms have the meanings given:
new text end

new text begin (1) "employee" has the meaning given in section 290.92, subdivision 1, clause (3);
new text end

new text begin (2) "employer" has the meaning given in section 290.92, subdivision 1, clause (4);
new text end

new text begin (3) "individual coverage HRA" means a health reimbursement arrangement considered
to be integrated with individual health insurance coverage under Code of Federal Regulations,
title 26, section 54.9802-4;
new text end

new text begin (4) "qualified employee health care expenses" means, for calendar years 2023 and 2024
only, the aggregate amount paid by the employer in a calendar year for each employee with
respect to:
new text end

new text begin (i) a group health plan as defined in section 5000(b)(1) of the Internal Revenue Code of
1986, as amended through December 31, 2021;
new text end

new text begin (ii) a qualified small employer health reimbursement arrangement as defined in section
9831(d)(2)(A) of the Internal Revenue Code of 1986, as amended through December 31,
2021; and
new text end

new text begin (iii) an individual coverage HRA; and
new text end

new text begin (5) "qualified employer" means an employer that is not an applicable large employer as
defined in section 4980H(c)(2) of the Internal Revenue Code of 1986, as amended through
December 31, 2021.
new text end

new text begin (b) A qualified employer subject to tax under section 290.02 or 290.03 may claim a
credit against the tax due under this chapter equal to 50 percent of the employer's qualified
employee health care expenses.
new text end

new text begin (c) The credit is limited to the liability for tax, as computed under this chapter, for the
taxable year. If the amount of the credit determined under this subdivision for any taxable
year exceeds the liability for tax, the excess is a small employer health care credit carryover
to each of the five succeeding taxable years. The entire amount of the excess unused credit
for the taxable year is carried first to the earliest of the taxable years to which the credit
may be carried and then to each successive year to which the credit may be carried. The
amount of the unused credit that may be added under this paragraph must not exceed the
taxpayer's liability for tax, less any small employer health care credit for the taxable year.
new text end

new text begin (d) For a nonresident or part-year resident, the credit under this section must be allocated
using the percentage calculated in section 290.06, subdivision 2c, paragraph (e).
new text end

new text begin (e) Credits allowed to a partnership, a limited liability company taxed as a partnership,
or an S corporation pass through to the partners, members, shareholders, or owners,
respectively, pro rata to each based on the partner's, member's, shareholder's, or owner's
share of the entity's assets, or as specially allocated in the organizational documents or any
other executed agreement, as of the last day of the taxable year.
new text end

new text begin (f) This subdivision expires January 1, 2025, for taxable years beginning after December
31, 2024, except that the expiration of this section does not affect the commissioner of
revenue's authority to audit or power of examination and assessment for credits claimed
under this subdivision.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for taxable years beginning after December
31, 2021, and before January 1, 2025.
new text end

Sec. 10. new text beginSMALL EMPLOYER PUBLIC OPTION.
new text end

new text begin The commissioner of human services, in consultation with representatives of small
employers, shall develop a small employer public option that allows employees of businesses
with fewer than 50 employees to receive employer contributions toward MinnesotaCare.
The commissioner shall determine whether the employer makes contributions to the
commissioner directly or the employee makes contributions through a qualified small
employer health reimbursement arrangement account or other arrangement. In determining
the structure of the small employer public option, the commissioner shall consult with
federal officials to determine which arrangement will result in the employer contributions
being tax deductible to the employer and not being considered taxable income to the
employee. The commissioner shall present recommendations for a small employer public
option to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services policy and finance by December 15, 2023.
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 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 12.
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, 2023. 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 any small employer option developed under
section 10 in a manner that would allow any employee payments toward premiums to be
pretax;
new text end

new text begin (3) recommendations for ensuring sufficient provider participation in MinnesotaCare;
new text end

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

new text begin (5) a description of the proposed premium scale for persons eligible through the public
option, including an analysis of the extent to which the proposed premium scale:
new text end

new text begin (i) ensures affordable premiums for persons across the income spectrum enrolled under
the public option; and
new text end

new text begin (ii) avoids premium cliffs for persons transitioning to and enrolled under the public
option; and
new text end

new text begin (6) 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,
2024, a report comparing service delivery and payment system models for delivering services
to MinnesotaCare enrollees eligible under Minnesota Statutes, section 256L.04, subdivisions
1, 7, and 15. The report must compare the current delivery model with at least two alternative
models. The alternative models must include a state-based model in which the state holds
the plan risk as the insurer and may contract with a third-party administrator for claims
processing and plan administration. The alternative models may include but are not limited
to:
new text end

new text begin (1) expanding the use of integrated health partnerships under Minnesota Statutes, section
256B.0755;
new text end

new text begin (2) delivering care under fee-for-service through a primary care case management system;
and
new text end

new text begin (3) continuing to contract with managed care and county-based purchasing plans for
some or all enrollees under modified contracts.
new text end

new text begin (d) The report must also include:
new text end

new text begin (1) a description of how each model would address:
new text end

new text begin (i) racial inequities in the delivery of health care and health care outcomes;
new text end

new text begin (ii) geographic inequities in the delivery of health care;
new text end

new text begin (iii) incentives for preventive care and other best practices; and
new text end

new text begin (iv) reimbursement of providers for high-quality, value-based care at levels sufficient
to sustain or increase enrollee access to care;
new text end

new text begin (2) a comparison of the projected cost of each model; and
new text end

new text begin (3) an implementation timeline for each model that includes the earliest date by which
each model could be implemented if authorized during the 2024 legislative session.
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. 12. new text beginREQUEST FOR FEDERAL APPROVAL.
new text end

new text begin (a) 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 the state to:
new text end

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

new text begin (2) receive federal payments equal to the value of premium tax credits and cost-sharing
reductions that MinnesotaCare enrollees with household incomes greater than 200 percent
of the federal poverty guidelines would otherwise have received; and
new text end

new text begin (3) receive federal payments equal to the value of emergency medical assistance that
would otherwise have been paid to the state for covered services provided to eligible
enrollees.
new text end

new text begin (b) In implementing this section, the commissioner of human services shall consult with
the commissioner of commerce and the Board of Directors of MNsure and may contract
for technical and actuarial assistance.
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. 13. new text beginCONTINGENT EFFECTIVE DATE.
new text end

new text begin Sections 3, 4, 6, and 7 and the specified portion of section 8 are effective January 1,
2025, 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
federal penalties to federal basic health program funding for MinnesotaCare enrollees with
incomes not exceeding 200 percent of the federal poverty guidelines. The commissioner of
human services shall notify the revisor of statutes when federal approval is obtained.
new text end