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General Assembly Substitute Bill No. 7339
January Session, 2019
AN ACT CONCERNING A PUBLIC INSURANCE OPT ION.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (Effective from passage) (a) Within available appropriations, 1
the executive director of the Office of Health Strategy shall convene a 2
working group to make recommendations concerning the 3
establishment of a public health insurance coverage option not later 4
than January 1, 2022, that would be (1) funded by enrollee premiums, 5
and (2) open to individuals ineligible for Medicaid who earn less than 6
four hundred per cent of the federal poverty level. The working group 7
shall study how best to expand consumer choice and improve the 8
viability and affordability of the private insurance marketplace. 9
(b) In addition to the executive director of the Office of Health 10
Strategy, the working group shall include, but need not be limited to: 11
(1) Three consumer advocates, one each appointed by the speaker, 12
the majority leader and the minority leader of the House of 13
Representatives; 14
(2) Three providers, including at least one private insurance 15
provider and one Medicaid-enrolled health care provider, one each 16
appointed by the president pro tempore, the majority leader and the 17
minority leader of the Senate; 18 Substitute Bill No. 7339
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(3) The Commissioner of Social Services, or the commissioner's 19
designee; 20
(4) The State Comptroller, or the State Comptroller's designee; 21
(5) The Healthcare Advocate appointed pursuant to section 38a-1042 22
of the general statutes, or the Healthcare Advocate's designee; and 23
(6) Other stakeholders as deemed appropriate and appointed by the 24
executive director of the Office of Health Strategy, including, but not 25
limited to, (A) representatives of small businesses and employee 26
groups, (B) behavioral health providers, (C) representatives of groups 27
who have faced historical barriers to accessing healthcare, and (D) 28
representatives of state agencies. 29
(c) The executive director of the Office of Health Strategy shall serve 30
as chairperson of the working group, which shall provide 31
opportunities for stakeholder input prior to submitting its 32
recommendations. The working group shall: 33
(1) Evaluate how best to establish a public coverage option for 34
persons not otherwise eligible for Medicaid pursuant to the HUSKY 35
Health program, as defined in section 17b-290 of the general statutes; 36
(2) (A) Evaluate whether the coverage option should be jointly 37
administered with the Medicaid program or another existing program, 38
and (B) if the coverage option is jointly administered with the 39
Medicaid program, recommend how to ensure that the existing 40
Medicaid program will not move to a managed care model and that 41
existing enrollees will not experience reduction to their eligibility and 42
benefits as a result of the new program's implementation; 43
(3) Identify (A) the appropriate state agency or other public or 44
private entity to administer such program, and (B) consumer 45
protections that should be included in any applicable contract; 46
(4) Formulate a plan design that includes the ten essential benefits 47 Substitute Bill No. 7339
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required pursuant to 42 USC 18022 and that is funded by premiums 48
assessed on enrollees, and, if approved by the federal government, 49
federal premium tax credits and cost-sharing subsidies; 50
(5) Consider how to attract and maintain provider participation and 51
set adequate provider payment rates; 52
(6) Consider how to mitigate potential adverse selection or risk 53
segmentation; 54
(7) Evaluate whether and how to include components of the person-55
centered medical home, value-based insurance design or similar 56
models; 57
(8) Evaluate whether the state should apply for a state innovation 58
waiver under 42 USC 18052 to allow eligible persons who enroll in the 59
plan to use tax credits and cost-sharing subsidies toward their 60
premiums; and 61
(9) Advise on how to leverage, preserve or maximize federal dollars 62
available to Connecticut consumers, companies or other entities. 63
(d) The Office of Health Strategy shall provide administrative 64
support to the working group and may seek grants to support the 65
study. 66
(e) The executive director of the Office of Health Strategy may issue 67
interim reports and findings relating to the study as the executive 68
director deems appropriate to the Health Care Cabinet established 69
pursuant to section 19a-725 of the general statutes and legislative 70
committees of cognizance. 71
(f) Not later than February 15, 2021, the executive director of the 72
Office of Health Strategy shall submit a report, in accordance with the 73
provisions of section 11-4a of the general statutes, on the results of the 74
study required pursuant to this section to the joint standing 75
committees of the General Assembly having cognizance of matters 76 Substitute Bill No. 7339
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relating to appropriations and the budgets of state agencies, human 77
services and insurance. The report shall include an actuarial and 78
economic analysis of the public health insurance coverage option. 79
This act shall take effect as follows and shall amend the following
sections:
Section 1 from passage New section
Statement of Legislative Commissioners:
In section 1(b), the phrase "In addition to the executive director of the
Office of Health Strategy, the" was added for clarity.
HS Joint Favorable Subst.