EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb0728*
SENATE BILL 728
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By: Senator Lam
Introduced and read first time: February 7, 2022
Assigned to: Finance
A BILL ENTITLED
AN ACT concerning 1
Health Insurance – Qualified Resident State Subsidy Program 2
(Access to Care Act) 3
FOR the purpose of altering the purpose of the Maryland Health Benefit Exchange Fund 4
to include the provision of funding for the establishment and operation of the 5
Qualified Resident State Subsidy Program; requiring the Maryland Health Benefit 6
Exchange to establish and implement the Program to provide State premium 7
assistance and cost–sharing reductions to qualified residents; providing that the 8
implementation of the Program is contingent on approval of a certain waiver 9
application; and generally relating to the Qualified Resident State Subsidy Program. 10
BY repealing and reenacting, without amendments, 11
Article – Insurance 12
Section 31–101(a) and 31–108(a) 13
Annotated Code of Maryland 14
(2017 Replacement Volume and 2021 Supplement) 15
BY adding to 16
Article – Insurance 17
Section 31–101(u–1), 31–123, and 31–124 18
Annotated Code of Maryland 19
(2017 Replacement Volume and 2021 Supplement) 20
BY repealing and reenacting, with amendments, 21
Article – Insurance 22
Section 31–107, 31–108(b)(1), and 31–115(b)(7) 23
Annotated Code of Maryland 24
(2017 Replacement Volume and 2021 Supplement) 25
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 26
That the Laws of Maryland read as follows: 27 2 SENATE BILL 728
Article – Insurance 1
31–101. 2
(a) In this subtitle the following words have the meanings indicated. 3
(U–1) “QUALIFIED RESIDENT ” MEANS AN INDIVIDUAL , INCLUDING A MINOR , 4
REGARDLESS OF IMMIGR ATION STATUS, WHO AT THE TIME OF E NROLLMENT : 5
(1) IS SEEKING TO ENROLL IN A QUALIFIED HEALT H PLAN OFFERED 6
TO INDIVIDUALS THROU GH THE EXCHANGE; 7
(2) RESIDES IN THE STATE; 8
(3) IS NOT INCARCERATED , OTHER THAN INCARCERA TION PENDING 9
DISPOSITION OF CHARG ES; AND 10
(4) IS NOT ELIGIBLE FOR THE FEDERAL PRE MIUM TAX CREDIT , THE 11
MARYLAND MEDICAL ASSISTANCE PROGRAM, MEDICARE, THE MARYLAND 12
CHILDREN’S HEALTH PLAN, OR EMPLOYER –SPONSORED MINIMUM ES SENTIAL 13
COVERAGE. 14
31–107. 15
(a) There is a Maryland Health Benefit Exchange Fund. 16
(b) (1) The purpose of the Fund is to: 17
(i) provide funding for the operation and administration of the 18
Exchange in carrying out the purposes of the Exchange under this subtitle; 19
(ii) provide funding for the establishment and operation of the State 20
Reinsurance Program authorized under this subtitle; 21
(iii) provide funding for the Medical Assistance Program and the 22
Senior Prescription Drug Assistance Program; 23
(iv) provide funding for the establishment and operation of Health 24
Equity Resource Communities under Title 20, Subtitle 14 of the Health – General Article; 25
[and] 26
(v) provide funding for the establishment and operation of the 27
State–Based Young Adult Health Insurance Subsidies Pilot Program authorized under this 28
subtitle; AND 29 SENATE BILL 728 3
(VI) PROVIDE FUNDING FOR THE ESTABLISHMENT AND 1
OPERATION OF THE QUALIFIED RESIDENT STATE SUBSIDY PROGRAM. 2
(2) The operation and administration of the Exchange, the State 3
Reinsurance Program, [and] the State–Based Young Adult Health Insurance Subsidies 4
Pilot Program, AND THE QUALIFIED RESIDENT STATE SUBSIDY PROGRAM may 5
include functions delegated by the Exchange to a third party under law or by contract. 6
(c) The Exchange shall administer the Fund. 7
(d) (1) The Fund is a special, nonlapsing fund that is not subject to § 7–302 of 8
the State Finance and Procurement Article. 9
(2) The State Treasurer shall hold the Fund separately, and the 10
Comptroller shall account for the Fund. 11
(e) The Fund consists of: 12
(1) any user fees or other assessments collected by the Exchange; 13
(2) all revenue deposited into the Fund that is received from the 14
distribution of the premium tax under § 6–103.2 of this article; 15
(3) income from investments made on behalf of the Fund; 16
(4) interest on deposits or investments of money in the Fund; 17
(5) money collected by the Board as a result of legal or other actions taken 18
by the Board on behalf of the Exchange or the Fund; 19
(6) money donated to the Fund; 20
(7) money awarded to the Fund through grants; 21
(8) any pass–through funds received from the federal government under a 22
waiver approved under § 1332 of the Affordable Care Act; 23
(9) any funds designated by the federal government to provide reinsurance 24
to carriers that offer individual health benefit plans in the State; 25
(10) any funds designated by the State to provide reinsurance to carriers 26
that offer individual health benefit plans in the State; 27
(11) any funds designated by the State to provide State–based health 28
insurance subsidies to young adults in the State; 29
4 SENATE BILL 728
(12) any federal funds received in accordance with § 31–121 of this subtitle 1
for the administration of small business tax credits; [and] 2
(13) ANY FUNDS DESIGNATED BY THE STATE TO PROVIDE 3
STATE–BASED HEALTH INSURAN CE SUBSIDIES TO QUAL IFIED RESIDENTS IN T HE 4
STATE; AND 5
(14) any other money from any other source accepted for the benefit of the 6
Fund. 7
(f) (1) The Fund may be used only: 8
(i) 1. for the operation and administration of the Exchange in 9
carrying out the purposes authorized under this subtitle; 10
2. for the establishment and operation of the State 11
Reinsurance Program; and 12
3. for appropriations to the Health Equity Resource 13
Community Reserve Fund under § 20–1407 of the Health – General Article; 14
(ii) in fiscal years 2021 and 2022, for the Medical Assistance 15
Program within the Medical Care Programs Administration of the Maryland Department 16
of Health; 17
(iii) in fiscal year 2022, for the Senior Prescription Drug Assistance 18
Program established under Title 15, Subtitle 10 of the Health – General Article; [and] 19
(iv) for the establishment and operation of the State–Based Young 20
Adult Health Insurance Subsidies Pilot Program; AND 21
(V) FOR THE ESTABLISHMEN T AND OPERATION OF T HE 22
QUALIFIED RESIDENT STATE SUBSIDY PROGRAM. 23
(2) In each of fiscal years 2023 through 2025, the Governor shall: 24
(i) transfer $15,000,000 to the Health Equity Resource Community 25
Reserve Fund; and 26
(ii) include the funds transferred in accordance with item (i) of this 27
paragraph in the annual budget bill as an appropriation to the Health Equity Resource 28
Community Reserve Fund under § 20–1407 of the Health – General Article. 29
(g) (1) The Board shall maintain separate accounts within the Fund for 30
Exchange operations, for the State Reinsurance Program, [and] for the State–Based Young 31
Adult Health Insurance Subsidies Pilot Program, AND FOR THE ESTABLIS HMENT AND 32 SENATE BILL 728 5
OPERATION OF THE QUALIFIED RESIDENT STATE SUBSIDY PROGRAM. 1
(2) Accounts within the Fund shall contain the money that is intended to 2
support the purpose for which each account is designated. 3
(3) Funds received from the distribution of the premium tax under § 4
6–103.2 of this article shall be placed in the account for Exchange operations and may be 5
used only for the purpose of funding the operation and administration of the Exchange. 6
(4) The following funds may be used only for the purposes of funding the 7
State Reinsurance Program: 8
(i) any pass–through funds received from the federal government 9
under a waiver approved under § 1332 of the Affordable Care Act to provide reinsurance to 10
carriers that offer individual health benefit plans in the State; 11
(ii) any funds designated by the federal government to provide 12
reinsurance to carriers that offer individual health benefit plans in the State; and 13
(iii) any funds designated by the State to provide reinsurance to 14
carriers that offer individual health benefit plans in the State. 15
(h) (1) Expenditures from the Fund for the purposes authorized by this 16
subtitle may be made only: 17
(i) with an appropriation from the Fund approved by the General 18
Assembly in the State budget; or 19
(ii) by the budget amendment procedure provided for in Title 7, 20
Subtitle 2 of the State Finance and Procurement Article. 21
(2) Notwithstanding § 7–304 of the State Finance and Procurement Article, 22
if the amount of the distribution from the premium tax under § 6–103.2 of this article 23
exceeds in any State fiscal year the actual expenditures incurred for the operation and 24
administration of the Exchange, funds in the Exchange operations account from the 25
premium tax that remain unspent at the end of the State fiscal year shall revert to the 26
General Fund of the State. 27
(3) If operating expenses of the Exchange may be charged to either State 28
or non–State fund sources, the non–State funds shall be charged before State funds are 29
charged. 30
(i) (1) The State Treasurer shall invest the money of the Fund in the same 31
manner as other State money may be invested. 32
(2) Any investment earnings of the Fund shall be credited to the Fund. 33
6 SENATE BILL 728
(3) Except as provided in subsection (h)(2) of this section, no part of the 1
Fund may revert or be credited to the General Fund or any special fund of the State. 2
(j) A debt or an obligation of the Fund is not a debt of the State or a pledge of 3
credit of the State. 4
31–108. 5
(a) On or before January 1, 2014, the functions and operations of the Exchange 6
shall include at a minimum all functions required by § 1311(d)(4) of the Affordable Care 7
Act. 8
(b) In compliance with § 1311(d)(4) of the Affordable Care Act, the Exchange 9
shall: 10
(1) make qualified plans available to qualified individuals, QUALIFIED 11
RESIDENTS, and qualified employers; 12
31–115. 13
(b) To be certified as a qualified health plan, a health benefit plan shall: 14
(7) be in the interest of qualified individuals, QUALIFIED RESIDENTS, and 15
qualified employers, as determined by the Exchange; 16
31–123. 17
(A) ON OR BEFORE JULY 1, 2023, THE EXCHANGE, IN CONSULTATION WITH 18
THE COMMISSIONER AND AS A PPROVED BY THE BOARD, SHALL SUBMIT A STATE 19
INNOVATION WAIVER APPLICATION UN DER § 1332 OF THE AFFORDABLE CARE ACT 20
TO ESTABLISH A QUALIFIED RESIDENT STATE SUBSIDY PROGRAM AND SEEK 21
FEDERAL PASS –THROUGH FUNDING TO A LLOW QUALIFIED RESID ENTS TO OBTAIN 22
COVERAGE THROUGH THE EXCHANGE. 23
(B) ON OR BEFORE DECEMBER 31, 2023, THE COMMISSIONER MAY WAIV E 24
ANY NOTIFICATION OR OTHER REQUIREMENTS T HAT APPLY TO A CARRI ER UNDER 25
THIS ARTICLE IN CALENDAR YEAR 2023 DUE TO THE IMPLEMENT ATION OF A WAIVER 26
APPROVED UNDER § 1332 OF THE AFFORDABLE CARE ACT. 27
31–124. 28
(A) THE EXCHANGE, IN CONSULTATION WITH THE COMMISSIONER AND AS 29
APPROVED BY THE BOARD, SHALL ESTABLISH AND IMPLEMENT A QUALIFIED 30
RESIDENT STATE SUBSIDY PROGRAM: 31
SENATE BILL 728 7
(1) TO PROVIDE STATE PREMIUM ASSISTA NCE AND COST –SHARING 1
REDUCTIONS TO QUALIF IED RESIDENTS; 2
(2) THAT MEETS THE REQUI REMENTS OF A WAIVER APPROVED 3
UNDER § 1332 OF THE AFFORDABLE CARE ACT; AND 4
(3) THAT IS CONSISTENT W ITH FEDERAL AND STATE LAW. 5
(B) THE QUALIFIED RESIDENT STATE SUBSIDY PROGRAM SHALL BE 6
DESIGNED TO MAKE IND IVIDUAL MARKET HEALT H INSURANCE COVERAGE OFFERED 7
THROUGH THE EXCHANGE AFFORDABLE T O QUALIFIED RESIDENT S. 8
(C) (1) BASED ON AVAILABLE FU NDS, THE EXCHANGE, IN CONSULTATION 9
WITH THE COMMISSIONER AND AS A PPROVED BY THE BOARD, SHALL ESTABLISH 10
SUBSIDY ELIGIBILITY AND PAYMENT PARAMETE RS FOR CALENDAR YEAR 2024 AND 11
EACH SUBSEQUENT CALE NDAR YEAR. 12
(2) THE SUBSIDY ELIGIBILITY AND PAYM ENT PARAMETERS 13
ESTABLISHED BY THE EXCHANGE SHALL, TO THE GREATEST EXTE NT POSSIBLE, 14
MIRROR THOSE APPLICA BLE TO QUALIFIED IND IVIDUALS. 15
(D) BEGINNING JANUARY 1, 2024, FUNDING FOR THE QUALIFIED 16
RESIDENT STATE SUBSIDY PROGRAM MAY BE MADE B Y USING: 17
(1) ANY PASS–THROUGH FUNDS RE CEIVED FROM THE FEDE RAL 18
GOVERNMENT UNDER A W AIVER APPROVED UNDER § 1332 OF THE AFFORDABLE 19
CARE ACT; 20
(2) ANY FUNDS DESIGNATED BY THE FEDERAL GOVER NMENT TO 21
PROVIDE HEALTH COVER AGE FOR QUALIFIED RE SIDENTS; AND 22
(3) ANY FUNDS DESIGNATED BY THE STATE TO PROVIDE HEAL TH 23
COVERAGE FOR QUALIFI ED RESIDENTS. 24
(E) THE IMPLEMENTATION OF THE QUALIFIED RESIDENT STATE SUBSIDY 25
PROGRAM SHALL BE CONT INGENT ON APPROVAL F ROM THE U.S. SECRETARY OF 26
HEALTH AND HUMAN SERVICES AND THE U.S. SECRETARY OF THE TREASURY OF A 27
STATE INNOVATION WAIVER APPLICATION UN DER § 1332 OF THE AFFORDABLE 28
CARE ACT. 29
(F) ON OR BEFORE JANUARY 1, 2024, THE EXCHANGE SHALL ADOPT 30
REGULATIONS TO CARRY OUT THIS SECTION . 31
8 SENATE BILL 728
SECTION 2. AND BE IT FURTHER ENACTED, Tha t this Act shall take effect 1
October 1, 2022. 2