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Regular Session, 2014
HOUSE BILL NO. 261
BY REPRESENTATIVE DIXON
MEDICAID: Causes eligibility standards for the La. Medicaid Program to conform to those
established by the ACA and creates the La. Health Care Independence Program
AN ACT1
To enact Chapter 8-B of Title 46 of the Louisiana Revised Statutes of 1950, to be comprised2
of R.S. 46:979.11 through 979.15, relative to the medical assistance program; to3
provide for eligibility for benefits of the medical assistance program; to require state4
participation in the expansion of medical assistance program eligibility provided in5
federal law; to provide specifications for a program through which the state shall6
implement the expansion of medical assistance program eligibility; to provide for7
definitions; to provide for legislative findings and intent; to provide for termination;8
and to provide for related matters.9
Be it enacted by the Legislature of Louisiana:10
Section 1. Chapter 8-B of Title 46 of the Louisiana Revised Statutes of 1950,11
comprised of R.S. 46:979.11 through 979.15, is hereby enacted to read as follows: 12
CHAPTER 8-B. LOUISIANA HEALTH CARE INDEPENDENCE PROGRAM13
§979.11. Title14
This Chapter shall be known and may be cited as the "Louisiana Health Care15
Independence Act".16
§979.12. Definitions17
As used in this Chapter, the following terms have the meaning ascribed to18
them in this Section:19 HLS 14RS-327 ORIGINAL
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(1) "ACA" and "Affordable Care Act" mean the following acts of congress,1
collectively:2
(a) The Patient Protection and Affordable Care Act, which originated as H.R.3
3590 in the One Hundred Eleventh United States Congress and became Public Law4
111-148.5
(b) The Health Care and Education Reconciliation Act, which originated as6
H.R. 4872 in the One Hundred Eleventh United States Congress and became Public7
Law 111-152.8
(2) "Centers for Medicare and Medicaid Services" means the division of the9
United States Department of Health and Human Services which administers and10
regulates the Medicaid program.11
(3)(a) "Cost sharing" means a mechanism by which a portion of the cost of12
a covered medical service is paid by or on behalf of an eligible Medicaid enrollee,13
and may include copayments or coinsurance.14
(b) "Cost sharing" shall not include deductibles.15
(4) "Department" means the Department of Health and Hospitals.16
(5) "Health insurance marketplace" means the online service also known as17
the "health insurance exchange" which is administered by the United States18
Department of Health and Human Services for states that opted not to operate a state-19
based insurance exchange in accordance with the provisions of the ACA, and which20
assists individuals, families, and small businesses in shopping for and purchasing21
health insurance coverage in a way that permits comparison of available qualified22
health plans based upon price, benefits, services, and quality.23
(6) "Independence account" means a financial account for health care24
expenses of a person that can be utilized in a manner similar to a health savings25
account or a medical savings account.26
(7) "Medicaid" and "medical assistance program" mean the medical27
assistance program provided for in Title XIX of the Social Security Act.28 HLS 14RS-327 ORIGINAL
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(8) "Premium" means a charge that a person pays as a condition of enrolling1
in health care coverage.2
(9) "Program" means the Louisiana Health Care Independence Program3
established by this Chapter.4
(10) "Qualified health plan" means a federally certified individual health5
insurance plan offered by a carrier through the health insurance marketplace in6
Louisiana.7
(11) "Secretary" means the secretary of the Department of Health and8
Hospitals.9
§979.13. Legislative findings; purpose10
A. The Legislature of Louisiana hereby finds and declares the following:11
(1) The Affordable Care Act, referred to hereafter in this Chapter as the12
"ACA", sets forth health policy reforms which reshape the way virtually all13
Americans will receive and finance their health care.14
(2) In a decision announced on June 28, 2012, the Supreme Court of the15
United States in National Federation of Independent Business Et Al. v. Sebelius,16
Secretary of Health and Human Services, Et Al. upheld the overall constitutionality17
of the ACA; but in the same ruling, a majority of the court held that the mandatory18
expansion of Medicaid eligibility as provided in the ACA is unconstitutionally19
coercive of states, thereby making participation in the Medicaid expansion a20
voluntary proposition for each state.21
(3) The Centers for Medicare and Medicaid Services has demonstrated22
flexibility in administering the expansion of Medicaid eligibility by approving23
applications submitted by states to implement the expansion through programs that24
provide premium assistance to persons who purchase private insurance through25
health insurance exchanges, known commonly as the "private insurance option".26
(4) The legislature declares that due to compelling moral and economic27
reasons, participation in the expansion of Medicaid eligibility is in the best interest28
of this state.29 HLS 14RS-327 ORIGINAL
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B. The purposes of this state in expanding Medicaid eligibility to conform1
to the standards provided in the ACA, as required by this Chapter, are as follows:2
(1) To maximize the number of Louisianians who are covered by some form3
of health insurance.4
(2) To provide basic health coverage to the working poor of the state who5
are not offered insurance through their employer and do not earn enough money to6
meet basic family needs and pay for private health insurance.7
(3) To assure health care providers who serve low- to moderate-income8
persons of some amount of compensation for the care they provide, as the ACA9
provides for a dramatic reduction in funding to federal programs which currently10
finance care for the uninsured as a means of financing the Medicaid expansion.11
(4) To avert the economic and human costs of crises in both access to health12
care and health services financing which are likely to result from not participating13
in the expansion of Medicaid while other federal sources of financing for medical14
care for the uninsured and the indigent are being drastically reduced or eliminated.15
§979.14. Medicaid eligibility; administration of the Louisiana Health Care16
Independence Program17
A. The department shall create and administer the Louisiana Health Care18
Independence Program, referred to hereafter in this Chapter as the "program", in19
accordance with the provisions of this Section.20
B. On or before September 1, 2014, the department shall submit all of the21
following:22
(1) Applications for any federal waivers necessary to implement the program23
in a manner consistent with this Chapter, including without limitation approval for24
a comprehensive waiver under Section 1115 of the Social Security Act (42 U.S.C.25
1315).26
(2) Medicaid state plan amendments necessary to implement the program in27
a manner consistent with this Chapter.28 HLS 14RS-327 ORIGINAL
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(3) Any Medicaid state plan amendments that are optional and may be1
revoked by the state at its discretion.2
C.(1) Prior to implementing the program, the department shall confirm that3
employers will not be subject to any penalty, including without limitation an4
assessable payment, as provided in the ACA relative to shared responsibility for5
employees who would become eligible for Medicaid pursuant to this Chapter if the6
employees enroll in either the program or a qualified health plan through the health7
insurance marketplace.8
(2) The department shall not implement the program if it is unable to9
confirm that employer penalties are inapplicable in accordance with Paragraph (1)10
of this Subsection.11
D.(1) Implementation of the program shall be contingent upon the receipt of12
necessary federal approvals.13
(2) The department shall not implement the program if it does not receive14
all necessary federal approvals as provided in Paragraph (1) of this Subsection.15
E. The program shall provide premium assistance for eligible individuals for16
the purpose of facilitating their enrollment in a qualified health plan through the17
federal health insurance marketplace.18
F.(1) The department is hereby specifically authorized to pay premiums and19
supplemental cost-sharing subsidies directly to federally qualified health plans on20
behalf of enrolled eligible individuals.21
(2) The purposes of the authorization provided in this Subsection are to22
increase participation in the health insurance market, intensify price pressures, and23
reduce costs for both publicly and privately funded health care.24
G. In developing and implementing the program, the department shall25
accomplish all of the following to the extent allowable by law:26
(1) Pursue strategies that promote insurance coverage of children, including27
those eligible for the Louisiana Children's Health Insurance Program (LaCHIP), by28
the health insurance plans of their parents or caretakers.29 HLS 14RS-327 ORIGINAL
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(2) Conduct outreach and provide information on coverage options to1
Medicaid enrollees whose needs would be reduced or better served through2
participation in the federal health insurance marketplace.3
H.(1) For the purposes of this Subsection, "new eligibles" means the group4
of persons determined to be eligible for Medicaid benefits under the new adult group5
as provided in the ACA and who meet the definition of "newly eligible" in section6
1905(y)(2)(A) of the Patient Protection and Affordable Care Act.7
(2) The program shall terminate within one hundred twenty days after8
publication in the Federal Register of any reduction in one or more of the following9
federal medical assistance percentages for services to new eligibles:10
(a) One hundred percent for 2014, 2015, or 2016.11
(b) Ninety-five percent for 2017.12
(c) Ninety-four percent for 2018.13
(d) Ninety-three percent for 2019.14
(e) Ninety percent for 2020 or any year after 2020.15
I. The department shall require each adult who enrolls in the program to16
affirmatively acknowledge all of the following:17
(1) The program is neither a perpetual right provided by the federal or state18
government nor a guarantee of assistance.19
(2) The program is subject to cancellation upon appropriate notice.20
(3) The program is not an entitlement program.21
J.(1) The department shall develop the necessary program elements and seek22
from the Centers for Medicare and Medicaid Services all necessary waivers and23
approvals to allow non-aged, non-disabled persons who are eligible for the program24
to utilize independence accounts that operate in a manner similar to a health savings25
account or medical savings account during the calendar year 2016.26
(2) The independence accounts shall accomplish all of the following27
functions:28 HLS 14RS-327 ORIGINAL
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(a) Allow a participant to purchase cost-effective high-deductible health1
insurance.2
(b) Promote independence and self-sufficiency.3
(3) Subject to federal approval, the department shall implement cost sharing4
as a program requirement for any enrollee whose income exceeds fifty percent of the5
applicable federal poverty level.6
(4) The program may offer rewards to enrollees based on healthy living and7
self-sufficiency.8
(5)(a) At the end of each fiscal year, if there are funds remaining in an9
independence account, a majority of the contribution by the state shall remain in the10
control of the participant as a positive incentive for the responsible use of the health11
care system and personal responsibility for health maintenance.12
(b) Allowable uses of an independence account may include, without13
limitation, transferring of funds from the account into a private sector health savings14
account for the participant in accordance with program rules promulgated by the15
department.16
K. On a quarterly basis, the department shall report to the Joint Legislative17
Committee on the Budget, within two weeks of the end of each quarter, information18
regarding the following aspects of the program:19
(1) Program enrollment.20
(2) Patient experience.21
(3) Economic impact including enrollment distribution.22
(4) Carrier competition.23
(5) Success in avoiding uncompensated care.24
L. The department shall take the following actions to provide for25
implementation of the program and managing program operations:26
(1) Promulgate all rules necessary to implement the program in accordance27
with the Administrative Procedure Act.28 HLS 14RS-327 ORIGINAL
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(2) Project, track, and report state obligations for uncompensated care in1
order to identify potential incremental future decreases.2
(3) Recommend to the legislature adjustments in program funding as it3
deems appropriate.4
§979.15. Termination5
The provisions of this Chapter shall terminate and become null and void on6
and after July 1, 2018.7
Section 2. This Act shall become effective upon signature by the governor or, if not8
signed by the governor, upon expiration of the time for bills to become law without signature9
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If10
vetoed by the governor and subsequently approved by the legislature, this Act shall become11
effective on the day following such approval.12
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
Dixon HB No. 261
Abstract: Creates the La. Health Care Independence Program as a means by which to
implement the expansion of Medicaid eligibility as provided in federal law.
Proposed law creates the La. Health Care Independence Program, referred to hereafter as the
"program", as a means by which to implement the expansion of Medicaid eligibility
standards as provided in the Patient Protection and Affordable Care Act. Provides that the
program shall be comprised of all of the following components and functions and subject
to conditions as follows:
(1)On or before Sept. 1, 2014, DHH shall submit and apply for federal waivers and state
plan amendments as are necessary to implement the program in a manner consistent
with proposed law, including without limitation approval for a comprehensive
waiver under Section 1115 of the Social Security Act.
(2)As a condition for program implementation, DHH shall confirm that employers will
not be subject to any penalty provided in federal law concerning shared
responsibility for employees who are Medicaid-eligible if the employees are enrolled
in the program and enroll in a qualified health plan through the federal health
insurance marketplace.
(3)The program shall include premium assistance for eligible individuals to enable their
enrollment in a qualified health plan through the federal health insurance
marketplace. HLS 14RS-327 ORIGINAL
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(4)DHH is authorized to pay premiums and supplemental cost-sharing subsidies directly
to the federally qualified health plans for enrolled eligible individuals.
(5)DHH is required to pursue strategies that promote insurance coverage of children in
their parents' or caregivers' plan, including children eligible for the La. Children's
Health Insurance Program (LaCHIP), and to conduct outreach and provide
information on coverage options to Medicaid enrollees whose needs would be
reduced or better served through participation in the federal health insurance
marketplace.
(6)The program shall terminate within 120 days after a reduction in any enhanced
federal medical assistance percentages established pursuant to federal law for
services to newly eligible individuals.
(7)Program enrollees shall affirmatively acknowledge that the program is not a
perpetual federal or state right or a guarantee of assistance, is subject to cancellation
with notice, and is not an entitlement program.
(8)DHH shall seek from the Centers for Medicare and Medicaid Services all necessary
waivers and approvals in order to allow non-aged, non-disabled program-eligible
participants to utilize a system of accounts to be known as "independence accounts"
that operate in a manner similar to health savings accounts or medical savings
accounts commencing in calendar year 2016.
(9)DHH is required to report to the Joint Legislative Committee on the Budget on a
quarterly basis, and within two weeks of the end of each quarter, information
regarding program enrollment, patient experience, economic impact, carrier
competition, and success in avoiding uncompensated care.
Proposed law requires DHH to take the following actions to provide for implementation of
the program and managing program operations:
(1)Promulgate all rules necessary to implement the program in accordance with the
APA.
(2)Project, track, and report state obligations for uncompensated care in order to
identify potential incremental future decreases.
(3)Recommend to the legislature adjustments in program funding as it deems
appropriate.
Proposed law terminates and becomes null and void on and after July 1, 2018.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Adds R.S. 46:979.11-979.15)