1.1 	A bill for an act
1.2 	relating to human services; establishing transitional cost-sharing reduction, premium 
1.3 	subsidy, small employer public option, and transitional health care credit; expanding 
1.4 	eligibility for MinnesotaCare; modifying premium scale; requiring 
1.5 	recommendations for alternative delivery and payment system;amending Minnesota 
1.6 	Statutes 2020, sections 62V.05, by adding a subdivision; 256L.04, subdivisions 
1.7 	1c, 7a, 10, by adding a subdivision; 290.06, by adding a subdivision; Minnesota 
1.8 	Statutes 2021 Supplement, sections 256L.07, subdivision 1; 256L.15, subdivision 
1.9 	2; proposing coding for new law in Minnesota Statutes, chapter 62V.
1.10 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.11 	Section 1. Minnesota Statutes 2020, section 62V.05, is amended by adding a subdivision 
1.12 	to read:
1.13 		Subd. 13.Transitional cost-sharing reductions. (a) The board shall develop and 
1.14 	implement, for the 2023 and 2024 plan years only, a system to support eligible individuals 
1.15 	who choose to enroll in gold level health plans through MNsure.
1.16 	(b) For purposes of this section, an "eligible individual" is an individual who:
1.17 	(1) is a resident of Minnesota;
1.18 	(2) is enrolled in a gold level health plan offered in the enrollee's county of residence;
1.19 	(3) is ineligible for minimum essential coverage, as defined under United States Code, 
1.20 	title 26, section 5000A(f), through Medicare, medical assistance, or MinnesotaCare; and
1.21 	(4) applies for and accepts all federal advance premium tax credits for which the 
1.22 	individual may be eligible before receiving any state premium assistance.
1.23 	(c) Under the system established in this subdivision, the monthly subsidy for an eligible 
1.24 	individual is $75.
2.1 	(d) The board shall establish procedures for determining an individual's eligibility for 
2.2 	the subsidy and providing payments to a health carrier for any eligible individuals enrolled 
2.3 	in the carrier's health plans.

2.4 	Sec. 2. [62V.12] TRANSITIONAL PREMIUM SUBSIDY.
2.5 		Subdivision 1.Provision of subsidy. (a) A qualified individual is eligible to receive 
2.6 	from MNsure a transitional premium subsidy of $125 per month for the period of January 
2.7 	1, 2023, through December 31, 2024. MNsure must pay this premium subsidy directly to 
2.8 	health carriers. A health carrier that receives a premium subsidy from MNsure under this 
2.9 	section for an individual must reduce the monthly premium charged to the individual by 
2.10 	the amount of the premium subsidy.
2.11 	(b) MNsure shall establish and administer procedures to:
2.12 	(1) determine whether a person is eligible as a qualified individual; and
2.13 	(2) pay premium subsidies directly to health carriers.
2.14 	(c) MNsure may only implement this section if the provisions of the American Rescue 
2.15 	Plan Act of 2021 related to the calculation of and eligibility for premium tax credits, as 
2.16 	specified in section 36B(b)(3)(A)(iii) of the Internal Revenue Code, are not extended beyond 
2.17 	December 31, 2022.
2.18 		Subd. 2.Qualified individual. For the purposes of this section, "qualified individual" 
2.19 	means a person who:
2.20 	(1) is a resident of Minnesota;
2.21 	(2) is enrolled in a bronze, silver, gold, or platinum level health plan offered in the 
2.22 	person's county of residence;
2.23 	(3) applies for and accepts all federal advance premium tax credits for which the person 
2.24 	may be eligible before receiving any subsidy under this section; and
2.25 	(4) is ineligible for minimum essential coverage, as defined under United States Code, 
2.26 	title 26, section 5000A(f), through Medicare, medical assistance, or MinnesotaCare.

2.27 	EFFECTIVE DATE. This section is effective for the period of January 1, 2023, through 
2.28 	December 31, 2024, subject to the contingency requirement of subdivision 1, paragraph 
2.29 	(c).

3.1 	Sec. 3. Minnesota Statutes 2020, section 256L.04, subdivision 1c, is amended to read:
3.2 		Subd. 1c.General requirements. To be eligible for MinnesotaCare, a person must meet 
3.3 	the eligibility requirements of this section. A person eligible for MinnesotaCare shall with 
3.4 	an income less than or equal to 200 percent of the federal poverty guidelines must not be 
3.5 	considered a qualified individual under section 1312 of the Affordable Care Act, and is not 
3.6 	eligible for enrollment in a qualified health plan offered through MNsure under chapter 
3.7 	62V.

3.8 	EFFECTIVE DATE. This section is effective January 1, 2025, or upon federal approval, 
3.9 	whichever is later, subject to certification under section 13. The commissioner of human 
3.10 	services shall notify the revisor of statutes when federal approval is obtained.

3.11 	Sec. 4. Minnesota Statutes 2020, section 256L.04, subdivision 7a, is amended to read:
3.12 		Subd. 7a.Ineligibility. Adults whose income is greater than the limits established under 
3.13 	this section may not enroll in the MinnesotaCare program, except as provided in subdivision 
3.14 	15.

3.15 	EFFECTIVE DATE. This section is effective January 1, 2025, or upon federal approval, 
3.16 	whichever is later, subject to certification under section 13. The commissioner of human 
3.17 	services shall notify the revisor of statutes when federal approval is obtained.

3.18 	Sec. 5. Minnesota Statutes 2020, section 256L.04, subdivision 10, is amended to read:
3.19 		Subd. 10.Citizenship requirements. (a) Eligibility for MinnesotaCare is limited
3.20 	available to citizens or nationals of the United States and, lawfully present noncitizens as 
3.21 	defined in Code of Federal Regulations, title 8, section 103.12., and undocumented 
3.22 	noncitizens are ineligible for MinnesotaCare. For purposes of this subdivision, an 
3.23 	undocumented noncitizen is an individual who resides in the United States without the 
3.24 	approval or acquiescence of the United States Citizenship and Immigration Services. Families 
3.25 	with children who are citizens or nationals of the United States must cooperate in obtaining 
3.26 	satisfactory documentary evidence of citizenship or nationality according to the requirements 
3.27 	of the federal Deficit Reduction Act of 2005, Public Law 109-171.
3.28 	(b) Notwithstanding subdivisions 1 and 7, eligible persons include families and 
3.29 	individuals who are lawfully present and ineligible for medical assistance by reason of 
3.30 	immigration status and who have incomes equal to or less than 200 percent of federal poverty 
3.31 	guidelines.

3.32 	EFFECTIVE DATE. This section is effective January 1, 2024.

4.1 	Sec. 6. Minnesota Statutes 2020, section 256L.04, is amended by adding a subdivision to 
4.2 	read:
4.3 		Subd. 15.Persons eligible for public option. (a) Families and individuals with income 
4.4 	above the maximum income eligibility limit specified in subdivision 1 or 7, who meet all 
4.5 	other MinnesotaCare eligibility requirements, are eligible for MinnesotaCare. All other 
4.6 	provisions of this chapter apply unless otherwise specified.
4.7 	(b) Families and individuals may enroll in MinnesotaCare under this subdivision only 
4.8 	during an annual open enrollment period or special enrollment period, as designated by 
4.9 	MNsure in compliance with Code of Federal Regulations, title 45, parts 155.410 and 155.420.

4.10 	EFFECTIVE DATE. This section is effective January 1, 2025, or upon federal approval, 
4.11 	whichever is later, subject to certification under section 13. The commissioner of human 
4.12 	services shall notify the revisor of statutes when federal approval is obtained.

4.13 	Sec. 7. Minnesota Statutes 2020, section 256L.07, subdivision 1, is amended to read:
4.14 		Subdivision 1.General requirements. Individuals enrolled in MinnesotaCare under 
4.15 	section 256L.04, subdivision 1, and individuals enrolled in MinnesotaCare under section 
4.16 	256L.04, subdivision 7, whose income increases above 200 percent of the federal poverty 
4.17 	guidelines, are no longer eligible for the program and shall must be disenrolled by the 
4.18 	commissioner, unless the individuals continue MinnesotaCare enrollment through the public 
4.19 	option under section 256L.04, subdivision 15. For persons disenrolled under this subdivision, 
4.20 	MinnesotaCare coverage terminates the last day of the calendar month in which the 
4.21 	commissioner sends advance notice according to Code of Federal Regulations, title 42, 
4.22 	section 431.211, that indicates the income of a family or individual exceeds program income 
4.23 	limits.

4.24 	EFFECTIVE DATE. This section is effective January 1, 2025, or upon federal approval, 
4.25 	whichever is later, subject to certification under section 13. The commissioner of human 
4.26 	services shall notify the revisor of statutes when federal approval is obtained.

4.27 	Sec. 8. Minnesota Statutes 2021 Supplement, section 256L.15, subdivision 2, is amended 
4.28 	to read:
4.29 		Subd. 2.Sliding fee scale; monthly individual or family income. (a) The commissioner 
4.30 	shall establish a sliding fee scale to determine the percentage of monthly individual or family 
4.31 	income that households at different income levels must pay to obtain coverage through the 
5.1 	MinnesotaCare program. The sliding fee scale must be based on the enrollee's monthly 
5.2 	individual or family income.
5.3 	(b) Beginning January 1, 2014, MinnesotaCare enrollees shall pay premiums according 
5.4 	to the premium scale specified in paragraph (d).
5.5 	(c) (b) Paragraph (b) (a) does not apply to:
5.6 	(1) children 20 years of age or younger; and
5.7 	(2) individuals with household incomes below 35 percent of the federal poverty
5.8 	guidelines.
5.9 	(d) The following premium scale is established for each individual in the household who 
5.10 	is 21 years of age or older and enrolled in MinnesotaCare:

5.11
5.12	Federal Poverty Guideline 
Greater than or Equal to
	Less than
	Individual Premium 
Amount
	
5.13	35%
	55%
	$4
	
5.14	55%
	80%
	$6
	
5.15	80%
	90%
	$8
	
5.16	90%
	100%
	$10
	
5.17	100%
	110%
	$12
	
5.18	110%
	120%
	$14
	
5.19	120%
	130%
	$15
	
5.20	130%
	140%
	$16
	
5.21	140%
	150%
	$25
	
5.22	150%
	160%
	$37
	
5.23	160%
	170%
	$44
	
5.24	170%
	180%
	$52
	
5.25	180%
	190%
	$61
	
5.26	190%
	200%
	$71
	
5.27	200%
		$80
	
5.28 	(e) (c) Beginning January 1, 2021 2023, the commissioner shall continue to charge 
5.29 	premiums in accordance with the simplified premium scale established to comply with the 
5.30 	American Rescue Plan Act of 2021, in effect from January 1, 2021, through December 31, 
5.31 	2022, for families and individuals eligible under section 256L.04, subdivisions 1 and 7. The 
5.32 	commissioner shall adjust the premium scale established under paragraph (d) as needed to 
5.33 	ensure that premiums do not exceed the amount that an individual would have been required 
5.34 	to pay if the individual was enrolled in an applicable benchmark plan in accordance with 
5.35 	the Code of Federal Regulations, title 42, section 600.505 (a)(1).
6.1 	(d) The commissioner shall establish a sliding premium scale for persons eligible through 
6.2 	the public option under section 256L.04, subdivision 15. Beginning January 1, 2025, persons 
6.3 	eligible through the public option shall pay premiums according to this premium scale. 
6.4 	Persons eligible through the public option who are 20 years of age or younger are exempt 
6.5 	from paying premiums.

6.6 	EFFECTIVE DATE. This section is effective January 1, 2023, and certification under 
6.7 	section 13 is not required, except that paragraph (d) is effective January 1, 2025, or upon 
6.8 	federal approval, whichever is later, subject to certification under section 13. The 
6.9 	commissioner of human services shall notify the revisor of statutes when federal approval 
6.10 	is obtained.

6.11 	Sec. 9. Minnesota Statutes 2020, section 290.06, is amended by adding a subdivision to 
6.12 	read:
6.13 		Subd. 41.Small employer transitional health care credit. (a) For purposes of this 
6.14 	subdivision, the following terms have the meanings given:
6.15 	(1) "employee" has the meaning given in section 290.92, subdivision 1, clause (3);
6.16 	(2) "employer" has the meaning given in section 290.92, subdivision 1, clause (4);
6.17 	(3) "individual coverage HRA" means a health reimbursement arrangement considered 
6.18 	to be integrated with individual health insurance coverage under Code of Federal Regulations, 
6.19 	title 26, section 54.9802-4;
6.20 	(4) "qualified employee health care expenses" means, for calendar year 2023 and 2024 
6.21 	only, the aggregate amount paid by the employer in a calendar year for each employee with 
6.22 	respect to:
6.23 	(i) a group health plan as defined in section 5000(b)(1) of the Internal Revenue Code of 
6.24 	1986, as amended through December 31, 2021;
6.25 	(ii) a qualified small employer health reimbursement arrangement as defined in section 
6.26 	9831(d)(2)(A) of the Internal Revenue Code of 1986, as amended through December 31, 
6.27 	2021; and
6.28 	(iii) an individual coverage HRA; and
6.29 	(5) "qualified employer" means an employer that is not an applicable large employer as 
6.30 	defined in section 4980H(c)(2) of the Internal Revenue Code of 1986, as amended through 
6.31 	December 31, 2021.
7.1 	(b) A qualified employer subject to tax under section 290.02 or 290.03 may claim a 
7.2 	credit against the tax due under this chapter equal to 50 percent of the employer's qualified 
7.3 	employee health care expenses.
7.4 	(c) The credit is limited to the liability for tax, as computed under this chapter, for the 
7.5 	taxable year. If the amount of the credit determined under this subdivision for any taxable 
7.6 	year exceeds the liability for tax, the excess is a small employer health care credit carryover 
7.7 	to each of the five succeeding taxable years. The entire amount of the excess unused credit 
7.8 	for the taxable year is carried first to the earliest of the taxable years to which the credit 
7.9 	may be carried and then to each successive year to which the credit may be carried. The 
7.10 	amount of the unused credit that may be added under this paragraph must not exceed the 
7.11 	taxpayer's liability for tax, less any small employer health care credit for the taxable year.
7.12 	(d) For a nonresident or part-year resident, the credit under this section must be allocated 
7.13 	using the percentage calculated in section 290.06, subdivision 2c, paragraph (e).
7.14 	(e) Credits allowed to a partnership, a limited liability company taxed as a partnership, 
7.15 	or an S corporation pass through to the partners, members, shareholders, or owners, 
7.16 	respectively, pro rata to each based on the partner's, member's, shareholder's, or owner's 
7.17 	share of the entity's assets, or as specially allocated in the organizational documents or any 
7.18 	other executed agreement, as of the last day of the taxable year.
7.19 	(f) This subdivision expires January 1, 2025, for taxable years beginning after December 
7.20 	31, 2024, except that the expiration of this section does not affect the commissioner of 
7.21 	revenue's authority to audit or power of examination and assessment for credits claimed 
7.22 	under this subdivision.

7.23 	EFFECTIVE DATE. This section is effective for taxable years beginning after December 
7.24 	31, 2021, and before January 1, 2025.

7.25 	Sec. 10. SMALL EMPLOYER PUBLIC OPTION.
 7.26 	The commissioner of human services, in consultation with representatives of small 
7.27 	employers, shall develop a small employer public option that allows employees of businesses 
7.28 	with fewer than 50 employees to receive employer contributions toward MinnesotaCare. 
7.29 	The commissioner shall determine whether the employer makes contributions to the 
7.30 	commissioner directly or the employee makes contributions through a qualified small 
7.31 	employer health reimbursement arrangement account or other arrangement. In determining 
7.32 	the structure of the small employer public option, the commissioner shall consult with 
7.33 	federal officials to determine which arrangement will result in the employer contributions 
8.1 	being tax deductible to the employer and not being considered taxable income to the 
8.2 	employee. The commissioner shall present recommendations for a small employer public 
8.3 	option to the chairs and ranking minority members of the legislative committees with 
8.4 	jurisdiction over health and human services policy and finance by December 15, 2023.

8.5 	EFFECTIVE DATE. This section is effective the day following final enactment.

8.6 	Sec. 11. TRANSITION TO MINNESOTACARE PUBLIC OPTION.
 8.7 	(a) The commissioner of human services shall continue to administer MinnesotaCare 
8.8 	as a basic health program in accordance with Minnesota Statutes, section 256L.02, 
8.9 	subdivision 5, and shall seek federal waivers, approvals, and law changes as required under 
8.10 	section 12.
8.11 	(b) The commissioner shall present an implementation plan for the MinnesotaCare public 
8.12 	option under Minnesota Statutes, section 256L.04, subdivision 15, to the chairs and ranking 
8.13 	minority members of the legislative committees with jurisdiction over health care policy 
8.14 	and finance by December 15, 2023. The plan must include:
8.15 	(1) recommendations for any changes to the MinnesotaCare public option necessary to 
8.16 	continue federal basic health program funding or to receive other federal funding;
8.17 	(2) recommendations for implementing any small employer option developed under 
8.18 	section 10 in a manner that would allow any employee payments toward premiums to be 
8.19 	pretax;
8.20 	(3) recommendations for ensuring sufficient provider participation in MinnesotaCare;
8.21 	(4) estimates of state costs related to the MinnesotaCare public option;
8.22 	(5) a description of the proposed premium scale for persons eligible through the public 
8.23 	option, including an analysis of the extent to which the proposed premium scale:
8.24 	(i) ensures affordable premiums for persons across the income spectrum enrolled under 
8.25 	the public option; and
8.26 	(ii) avoids premium cliffs for persons transitioning to and enrolled under the public 
8.27 	option; and
8.28 	(6) draft legislation that includes any additional policy and conforming changes necessary 
8.29 	to implement the MinnesotaCare public option and the implementation plan 
8.30 	recommendations.
9.1 	(c) The commissioner shall present to the chairs and ranking minority members of the 
9.2 	legislative committees with jurisdiction over health care policy and finance, by January 15, 
9.3 	2024, a report comparing service delivery and payment system models for delivering services 
9.4 	to MinnesotaCare enrollees eligible under Minnesota Statutes, section 256L.04, subdivisions 
9.5 	1, 7, and 15. The report must compare the current delivery model with at least two alternative 
9.6 	models. The alternative models must include a state-based model in which the state holds 
9.7 	the plan risk as the insurer and may contract with a third-party administrator for claims 
9.8 	processing and plan administration. The alternative models may include but are not limited 
9.9 	to:
9.10 	(1) expanding the use of integrated health partnerships under Minnesota Statutes, section 
9.11 	256B.0755;
9.12 	(2) delivering care under fee-for-service through a primary care case management system; 
9.13 	and
9.14 	(3) continuing to contract with managed care and county-based purchasing plans for 
9.15 	some or all enrollees under modified contracts.
9.16 	(d) The report must also include:
9.17 	(1) a description of how each model would address:
9.18 	(i) racial inequities in the delivery of health care and health care outcomes;
9.19 	(ii) geographic inequities in the delivery of health care;
9.20 	(iii) incentives for preventive care and other best practices; and
9.21 	(iv) reimbursement of providers for high-quality, value-based care at levels sufficient 
9.22 	to sustain or increase enrollee access to care;
9.23 	(2) a comparison of the projected cost of each model; and
9.24 	(3) an implementation timeline for each model that includes the earliest date by which 
9.25 	each model could be implemented if authorized during the 2024 legislative session.

9.26 	EFFECTIVE DATE. This section is effective the day following final enactment.

9.27 	Sec. 12. REQUEST FOR FEDERAL APPROVAL.
 9.28 	(a) The commissioner of human services shall seek any federal waivers, approvals, and 
9.29 	law changes necessary to implement this act, including but not limited to those waivers, 
9.30 	approvals, and law changes necessary to allow the state to:
10.1 	(1) continue receiving federal basic health program payments for basic health 
10.2 	program-eligible MinnesotaCare enrollees and to receive other federal funding for the 
10.3 	MinnesotaCare public option;
10.4 	(2) receive federal payments equal to the value of premium tax credits and cost-sharing 
10.5 	reductions that MinnesotaCare enrollees with household incomes greater than 200 percent 
10.6 	of the federal poverty guidelines would otherwise have received; and
10.7 	(3) receive federal payments equal to the value of emergency medical assistance that 
10.8 	would otherwise have been paid to the state for covered services provided to eligible 
10.9 	enrollees.
10.10 	(b) In implementing this section, the commissioner of human services shall consult with 
10.11 	the commissioner of commerce and the Board of Directors of MNsure and may contract 
10.12 	for technical and actuarial assistance.

10.13 	EFFECTIVE DATE. This section is effective the day following final enactment.

10.14 	Sec. 13. CONTINGENT EFFECTIVE DATE.
 10.15 	Sections 3, 4, 6, and 7 and the specified portion of section 8 are effective January 1, 
10.16 	2025, or upon federal approval, whichever is later, but only if the commissioner of human 
10.17 	services certifies to the legislature that implementation of those sections will not result in 
10.18 	federal penalties to federal basic health program funding for MinnesotaCare enrollees with 
10.19 	incomes not exceeding 200 percent of the federal poverty guidelines. The commissioner of 
10.20 	human services shall notify the revisor of statutes when federal approval is obtained.