1st Engrossment - 89th Legislature (2015 - 2016) Posted on 03/18/2016 11:43am
A bill for an act
relating to human services; increasing the MinnesotaCare
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income limit;
modifying
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premiums and cost-sharing; requiring the
commissioner of human services to seek federal waivers; amending Minnesota
Statutes 2014, sections 256L.02, by adding a subdivision; 256L.04, subdivisions
1, 7; 256L.07, subdivision 1; Minnesota Statutes 2015 Supplement, sections
256L.03, subdivision 5; 256L.15, subdivision 2.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Minnesota Statutes 2014, section 256L.02, is amended by adding a
subdivision to read:
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(a) The commissioner shall apply for an innovation
waiver under section 1332 of the Affordable Care Act, or any applicable federal waiver, to
allow the state to:
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(1) expand the
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program as a basic health program to include persons
with incomes up to 275
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of the federal poverty guidelines;
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(2) modify
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premiums and cost-sharing; and
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(3) receive for all
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enrollees, including but not limited to those with
incomes greater than 133
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but not exceeding 275
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of the federal poverty
guidelines, the full amount of advanced premium tax credits and cost-sharing reductions
that these individuals would have otherwise received if they obtained qualified health
plan coverage through MNsure.
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(b) The commissioner shall apply for a federal waiver under section 1115 of the
Social Security Act to receive a federal match for services provided to all
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enrollees, including but not limited to those with incomes greater than 133
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but not
exceeding 275
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of the federal poverty guidelines.
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This section is effective the day following final enactment.
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Minnesota Statutes 2015 Supplement, section 256L.03, subdivision 5, is
amended to read:
(a) Except as otherwise provided in this subdivision, the
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benefit plan shall include the following cost-sharing requirements for all
enrollees:
(1) $3 per prescription for adult enrollees;
(2) $25 for eyeglasses for adult enrollees;
(3) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
episode of service which is required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory setting by a physician or
physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
audiologist, optician, or optometrist;
(4) $6 for nonemergency visits to a hospital-based emergency room for services
provided through December 31, 2010, and $3.50 effective January 1, 2011; and
(5) a family deductible equal to $2.75 per month per family and adjusted annually
by the percentage increase in the medical care component of the CPI-U for the period
of September to September of the preceding calendar year, rounded to the next-higher
five cent increment.
(b) Paragraph (a) does not apply to children under the age of 21 and to American
Indians as defined in Code of Federal Regulations, title 42, section 447.51.
(c) Paragraph (a), clause (3), does not apply to mental health services.
(d)
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reimbursements to fee-for-service providers and payments to
managed care plans or county-based purchasing plans shall not be increased as a result of
the reduction of the co-payments in paragraph (a), clause (4), effective January 1, 2011.
(e) The commissioner, through the contracting process under section 256L.12,
may allow managed care plans and county-based purchasing plans to waive the family
deductible under paragraph (a), clause (5). The value of the family deductible shall not be
included in the capitation payment to managed care plans and county-based purchasing
plans. Managed care plans and county-based purchasing plans shall certify annually to the
commissioner the dollar value of the family deductible.
(f) The commissioner shall increase co-payments for covered services in a manner
sufficient to reduce the actuarial value of the benefit to 94
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incomes not exceeding 200
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of the federal poverty guidelines. The commissioner
shall increase co-payments for covered services in a manner sufficient to reduce the
actuarial value of the benefit to 87
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for recipients with incomes greater than
200
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but not exceeding 250
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of the federal poverty guidelines. The
commissioner shall increase co-payments for covered services in a manner sufficient to
reduce the actuarial value of the benefit to 80
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for recipients with incomes greater
than 250
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but not exceeding 275
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of the federal poverty guidelinesnew text end . The
cost-sharing changes described in this paragraph do not apply to eligible recipients or
services exempt from cost-sharing under state law. deleted text begin The cost-sharing changes described in
this paragraph shall not be implemented prior to January 1, 2016.
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(g) The cost-sharing changes authorized under paragraph (f) must satisfy the
requirements for cost-sharing under the Basic Health Program as set forth in Code of
Federal Regulations, title 42, sections 600.510 and 600.520.
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This section is effective January 1, 2017, or upon the effective
date of federal approval of the waivers requested under Minnesota Statutes, section
256L.02, subdivision 7, whichever is later. The commissioner of human services shall
notify the revisor of statutes when federal approval is obtained.
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Minnesota Statutes 2014, section 256L.04, subdivision 1, is amended to read:
Families with children with family income
above 133
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of the federal poverty guidelines and equal to or less than deleted text begin 200deleted text end new text begin 275
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of the federal poverty guidelines for the applicable family size shall be eligible
for
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according to this section. All other provisions of sections 256L.01 to
256L.18 shall apply unless otherwise specified. Children under age 19 with family income
at or below deleted text begin 200deleted text end new text begin 275new text end
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of the federal poverty guidelines and who are ineligible for
medical assistance by sole reason of the application of federal household composition
rules for medical assistance are eligible for
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.
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This section is effective January 1, 2017, or upon the effective
date of federal approval of the waivers requested under Minnesota Statutes, section
256L.02, subdivision 7, whichever is later. The commissioner of human services shall
notify the revisor of statutes when federal approval is obtained.
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Minnesota Statutes 2014, section 256L.04, subdivision 7, is amended to read:
The definition of eligible
persons includes all individuals and families with no children who have incomes that
are above 133
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and equal to or less than deleted text begin 200deleted text end new text begin 275new text end
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of the federal poverty
guidelines for the applicable family size.
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This section is effective January 1, 2017, or upon the effective
date of federal approval of the waivers requested under Minnesota Statutes, section
256L.02, subdivision 7, whichever is later. The commissioner of human services shall
notify the revisor of statutes when federal approval is obtained.
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Minnesota Statutes 2014, section 256L.07, subdivision 1, is amended to read:
Individuals enrolled in
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under section 256L.04, subdivision 1, and individuals enrolled in
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under
section 256L.04, subdivision 7, whose income increases above deleted text begin 200deleted text end new text begin 275new text end
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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,
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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.
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This section is effective January 1, 2017, or upon the effective
date of federal approval of the waivers requested under Minnesota Statutes, section
256L.02, subdivision 7, whichever is later. The commissioner of human services shall
notify the revisor of statutes when federal approval is obtained.
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Minnesota Statutes 2015 Supplement, section 256L.15, subdivision 2, is
amended to read:
(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
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program. The sliding fee scale must be based on the
enrollee's monthly individual or family income.
(b) Beginning January 1, 2014,
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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
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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
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:
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% |
$29 |
160% |
170% |
$33 |
170% |
180% |
$38 |
180% |
190% |
$43 |
190% |
$50 |
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(e) The commissioner shall extend the premium scale specified in paragraph (d) to
include individuals with incomes greater than 200
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but not exceeding 275
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of the federal poverty guidelines, such that individuals with incomes at 201
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of
the federal poverty guidelines shall pay 4.40
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of income, individuals with incomes
at 250
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of the federal poverty guidelines shall pay 7.24
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of income, and
individuals with incomes at 275
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of the federal poverty guidelines shall pay 8.83
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percent of income. The commissioner shall set other premium amounts in a proportional
manner using evenly spaced income steps.
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This section is effective January 1, 2017, or upon the effective
date of federal approval of the waivers requested under Minnesota Statutes, section
256L.02, subdivision 7, whichever is later. The commissioner of human services shall
notify the revisor of statutes when federal approval is obtained.
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