EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*hb0588*
HOUSE BILL 588
J5 3lr1153
HB 1035/22 – HGO CF SB 365
By: Delegates Cullison, Taveras, Acevero, Alston, Bagnall, Boafo, Charkoudian,
Charles, Embry, Fair, Foley, Fraser–Hidalgo, Harris, Ivey, Kelly, Kerr,
R. Lewis, Lopez, Mireku–North, Palakovich Carr, Pena–Melnyk, Phillips,
Qi, Queen, Ruth, Simpson, Stewart, Terrasa, Turner, Vogel, White, Woods,
and Ziegler
Introduced and read first time: February 3, 2023
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Health Insurance – Qualified Resident Enrollment Program 2
(Access to Care Act) 3
FOR the purpose of altering the purpose for the Maryland Health Benefit Exchange Fund 4
to include the provision of funding for the establishment and operation of the 5
Qualified Resident Enrollment Program; requiring the Maryland Health Benefit 6
Exchange to make qualified plans available to qualified residents; requiring the 7
Maryland Health Benefit Exchange to establish and implement the Qualified 8
Resident Enrollment Program to allow qualified residents to obtain coverage, 9
facilitate the enrollment of qualified residents in qualified health plans, and, based 10
on the availability of funds, provide premium assistance and cost–sharing reductions 11
to qualified residents; providing that the implementation of the Program is 12
contingent on approval of a certain waiver application amendment; and generally 13
relating to the Qualified Resident Enrollment Program. 14
BY repealing and reenacting, without amendments, 15
Article – Insurance 16
Section 31–101(a) and 31–108(a) 17
Annotated Code of Maryland 18
(2017 Replacement Volume and 2022 Supplement) 19
BY adding to 20
Article – Insurance 21
Section 31–101(u–1), 31–123, and 31–124 22
Annotated Code of Maryland 23
(2017 Replacement Volume and 2022 Supplement) 24
2 HOUSE BILL 588
BY repealing and reenacting, with amendments, 1
Article – Insurance 2
Section 31–107, 31–108(b)(1), and 31–115(b)(7) 3
Annotated Code of Maryland 4
(2017 Replacement Volume and 2022 Supplement) 5
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 6
That the Laws of Maryland read as follows: 7
Article – Insurance 8
31–101. 9
(a) In this subtitle the following words have the meanings indicated. 10
(U–1) “QUALIFIED RESIDENT ” MEANS AN INDIVIDUAL , INCLUDING A MINOR , 11
REGARDLESS OF IMMIGR ATION STATUS, WHO AT THE TIME OF E NROLLMENT : 12
(1) IS SEEKING TO ENROLL IN A QUALIFIED HEALT H PLAN OFFERED 13
TO INDIVIDUALS THROU GH THE EXCHANGE; 14
(2) RESIDES IN THE STATE; 15
(3) IS NOT INCARCERATED , OTHER THAN INCARCERA TION PENDING 16
DISPOSITION OF CHARG ES; AND 17
(4) IS NOT ELIGIBLE FOR THE FEDERAL PREMIUM TAX CREDIT, THE 18
MARYLAND MEDICAL ASSISTANCE PROGRAM, MEDICARE, THE MARYLAND 19
CHILDREN’S HEALTH PLAN, OR EMPLOYER –SPONSORED MINIMUM ESSENTI AL 20
COVERAGE. 21
31–107. 22
(a) There is a Maryland Health Benefit Exchange Fund. 23
(b) (1) The purpose of the Fund is to: 24
(i) provide funding for the operation and administration of the 25
Exchange in carrying out the purposes of the Exchange under this subtitle; 26
(ii) provide funding for the establishment and operation of the State 27
Reinsurance Program authorized under this subtitle; 28
(iii) provide funding for the Medical Assistance Program and the 29
Senior Prescription Drug Assistance Program; 30
HOUSE BILL 588 3
(iv) provide funding for the establishment and operation of Health 1
Equity Resource Communities under Title 20, Subtitle 14 of the Health – General Article; 2
[and] 3
(v) provide funding for the establishment and operation of the 4
State–Based Young Adult Health Insurance Subsidies Pilot Program authorized under this 5
subtitle; AND 6
(VI) PROVIDE FUNDING FOR THE ESTABLISHMENT AN D 7
OPERATION OF THE QUALIFIED RESIDENT ENROLLMENT PROGRAM. 8
(2) The operation and administration of the Exchange, the State 9
Reinsurance Program, [and] the State–Based Young Adult Health Insurance Subsidies 10
Pilot Program, AND THE QUALIFIED RESIDENT ENROLLMENT PROGRAM may include 11
functions delegated by the Exchange to a third party under law or by contract. 12
(c) The Exchange shall administer the Fund. 13
(d) (1) The Fund is a special, nonlapsing fund that is not subject to § 7–302 of 14
the State Finance and Procurement Article. 15
(2) The State Treasurer shall hold the Fund separately, and the 16
Comptroller shall account for the Fund. 17
(e) The Fund consists of: 18
(1) any user fees or other assessments collected by the Exchange; 19
(2) all revenue deposited into the Fund that is received from the 20
distribution of the premium tax under § 6–103.2 of this article; 21
(3) income from investments made on behalf of the Fund; 22
(4) interest on deposits or investments of money in the Fund; 23
(5) money collected by the Board as a result of legal or other actions taken 24
by the Board on behalf of the Exchange or the Fund; 25
(6) money donated to the Fund; 26
(7) money awarded to the Fund through grants; 27
(8) any pass–through funds received from the federal government under a 28
waiver approved under § 1332 of the Affordable Care Act; 29
(9) any funds designated by the federal government to provide reinsurance 30 4 HOUSE BILL 588
to carriers that offer individual health benefit plans in the State; 1
(10) any funds designated by the State to provide reinsurance to carriers 2
that offer individual health benefit plans in the State; 3
(11) any funds designated by the State to provide State–based health 4
insurance subsidies to young adults in the State; 5
(12) any federal funds received in accordance with § 31–121 of this subtitle 6
for the administration of small business tax credits; [and] 7
(13) ANY FUNDS DESIGNATED BY THE STATE TO PROVIDE 8
STATE–BASED HEALTH INSURAN CE SUBSIDIES TO QUAL IFIED RESIDENTS IN T HE 9
STATE; AND 10
(14) any other money from any other source accepted for the benefit of the 11
Fund. 12
(f) (1) The Fund may be used only: 13
(i) 1. for the operation and administration of the Exchange in 14
carrying out the purposes authorized under this subtitle; 15
2. for the establishment and operation of the State 16
Reinsurance Program; and 17
3. for appropriations to the Health Equity Resource 18
Community Reserve Fund under § 20–1407 of the Health – General Article; 19
(ii) in fiscal years 2021 and 2022, for the Medical Assistance 20
Program within the Medical Care Programs Administration of the Maryland Department 21
of Health; 22
(iii) in fiscal year 2022, for the Senior Prescription Drug Assistance 23
Program established under Title 15, Subtitle 10 of the Health – General Article; [and] 24
(iv) for the establishment and operation of the State–Based Young 25
Adult Health Insurance Subsidies Pilot Program; AND 26
(V) FOR THE ESTABLISHMEN T AND OPERATION OF T HE 27
QUALIFIED RESIDENT ENROLLMENT PROGRAM. 28
(2) In each of fiscal years 2023 through 2025, the Governor shall: 29
(i) transfer $15,000,000 to the Health Equity Resource Community 30
Reserve Fund; and 31 HOUSE BILL 588 5
(ii) include the funds transferred in accordance with item (i) of this 1
paragraph in the annual budget bill as an appropriation to the Health Equity Resource 2
Community Reserve Fund under § 20–1407 of the Health – General Article. 3
(g) (1) The Board shall maintain separate accounts within the Fund for 4
Exchange operations, for the State Reinsurance Program, [and] for the State–Based Young 5
Adult Health Insurance Subsidies Pilot Program, AND FOR THE ESTABLIS HMENT AND 6
OPERATION OF THE QUALIFIED RESIDENT ENROLLMENT PROGRAM. 7
(2) Accounts within the Fund shall contain the money that is intended to 8
support the purpose for which each account is designated. 9
(3) Funds received from the distribution of the premium tax under § 10
6–103.2 of this article shall be placed in the account for Exchange operations and may be 11
used only for the purpose of funding the operation and administration of the Exchange. 12
(4) The following funds may be used only for the purposes of funding the 13
State Reinsurance Program: 14
(i) any pass–through funds received from the federal government 15
under a waiver approved under § 1332 of the Affordable Care Act to provide reinsurance to 16
carriers that offer individual health benefit plans in the State; 17
(ii) any funds designated by the federal government to provide 18
reinsurance to carriers that offer individual health benefit plans in the State; 19
(iii) any funds designated by the State to provide reinsurance to 20
carriers that offer individual health benefit plans in the State; and 21
(iv) except as provided in subsection (f) of this section, funds received 22
from the distribution of the assessment under § 6–102.1 of this article. 23
(h) (1) Expenditures from the Fund for the purposes authorized by this 24
subtitle may be made only: 25
(i) with an appropriation from the Fund approved by the General 26
Assembly in the State budget; or 27
(ii) by the budget amendment procedure provided for in Title 7, 28
Subtitle 2 of the State Finance and Procurement Article. 29
(2) Notwithstanding § 7–304 of the State Finance and Procurement Article, 30
if the amount of the distribution from the premium tax under § 6–103.2 of this article 31
exceeds in any State fiscal year the actual expenditures incurred for the operation and 32
administration of the Exchange, funds in the Exchange operations account from the 33
premium tax that remain unspent at the end of the State fiscal year shall revert to the 34 6 HOUSE BILL 588
General Fund of the State. 1
(3) If operating expenses of the Exchange may be charged to either State 2
or non–State fund sources, the non–State funds shall be charged before State funds are 3
charged. 4
(i) (1) The State Treasurer shall invest the money of the Fund in the same 5
manner as other State money may be invested. 6
(2) Any investment earnings of the Fund shall be credited to the Fund. 7
(3) Except as provided in subsection (h)(2) of this section, no part of the 8
Fund may revert or be credited to the General Fund or any special fund of the State. 9
(j) A debt or an obligation of the Fund is not a debt of the State or a pledge of 10
credit of the State. 11
31–108. 12
(a) On or before January 1, 2014, the functions and operations of the Exchange 13
shall include at a minimum all functions required by § 1311(d)(4) of the Affordable Care 14
Act. 15
(b) In compliance with § 1311(d)(4) of the Affordable Care Act, the Exchange 16
shall: 17
(1) make qualified plans available to qualified individuals, QUALIFIED 18
RESIDENTS, and qualified employers; 19
31–115. 20
(b) To be certified as a qualified health plan, a health benefit plan shall: 21
(7) be in the interest of qualified individuals, QUALIFIED RESIDENTS , and 22
qualified employers, as determined by the Exchange; 23
31–123. 24
(A) ON OR BEFORE JULY 1, 2024, THE EXCHANGE, IN CONSULTATION WITH 25
THE COMMISSIONER AND AS A PPROVED BY THE BOARD, SHALL SUBMIT A STATE 26
INNOVATION WAIVER APPLICATION AM ENDMENT UNDER § 1332 OF THE 27
AFFORDABLE CARE ACT TO ESTABLISH A QUALIFIED RESIDENT ENROLLMENT 28
PROGRAM AND SEEK FEDE RAL PASS–THROUGH FUNDING TO A LLOW QUALIFIED 29
RESIDENTS TO OBTAIN COVERAGE THROUGH THE EXCHANGE. 30
(B) ON OR BEFORE DECEMBER 31, 2024, THE COMMISSIONER MAY WAIV E 31 HOUSE BILL 588 7
ANY NOTIFICATION OR OTHER REQUIREMENTS T HAT APPLY TO A CARRI ER UNDER 1
THIS ARTICLE IN CALENDAR YE AR 2024 DUE TO THE IMPLEMENT ATION OF A WAIVER 2
APPROVED UNDER § 1332 OF THE AFFORDABLE CARE ACT. 3
31–124. 4
(A) THE EXCHANGE, IN CONSULTATION WITH THE COMMISSIONER AND AS 5
APPROVED BY THE BOARD, SHALL ESTABLISH AND IMPLEMENT A QUALIFIED 6
RESIDENT ENROLLMENT PROGRAM: 7
(1) TO FACILITATE THE EN ROLLMENT OF QUALIFIE D RESIDENTS IN 8
QUALIFIED HEALTH PLA NS; 9
(2) BASED ON THE AVAILAB ILITY OF FUNDS , TO PROVIDE STATE 10
PREMIUM ASSISTANCE A ND COST–SHARING REDUCTIONS T O QUALIFIED RESIDENT S 11
ENROLLED IN QUALIFIED HEALTH P LANS; 12
(3) THAT MEETS THE REQUI REMENTS OF A WAIVER APPROVED 13
UNDER § 1332 OF THE AFFORDABLE CARE ACT; AND 14
(4) THAT IS CONSISTENT W ITH FEDERAL AND STATE LAW. 15
(B) THE QUALIFIED RESIDENT ENROLLMENT PROGRAM SHALL BE 16
DESIGNED TO MAKE INDIVIDUAL MARKET HE ALTH INSURANCE COVER AGE OFFERED 17
THROUGH THE EXCHANGE AVAILABLE TO QUALIFIED RESIDENTS . 18
(C) BASED ON THE AVAILABI LITY OF FUNDS , THE EXCHANGE, IN 19
CONSULTATION WITH TH E COMMISSIONER AND AS A PPROVED BY THE BOARD, 20
SHALL ESTABLISH SUBS IDY ELIGIBILITY AND PAYM ENT PARAMETERS FOR 21
CALENDAR YEAR 2025 AND EACH SUBSEQUENT CALENDAR YEAR . 22
(D) BEGINNING JANUARY 1, 2025, FUNDING FOR THE QUALIFIED 23
RESIDENT ENROLLMENT PROGRAM MAY BE MADE U SING: 24
(1) ANY PASS–THROUGH FUNDS RECEIV ED FROM THE FEDERAL 25
GOVERNMENT UNDER A W AIVER APPROVED UNDER § 1332 OF THE AFFORDABLE 26
CARE ACT; 27
(2) ANY FUNDS DESIGNATED BY THE FEDERAL GOVER NMENT TO 28
PROVIDE HEALTH COVER AGE FOR QUALIFIED RE SIDENTS; AND 29
(3) ANY FUNDS DESIGNATED BY THE STATE TO PROVIDE HEAL TH 30
COVERAGE FO R QUALIFIED RESIDENT S. 31 8 HOUSE BILL 588
(E) THE IMPLEMENTATION OF THE QUALIFIED RESIDENT ENROLLMENT 1
PROGRAM SHALL BE CONT INGENT ON APPROVAL F ROM THE U.S. SECRETARY OF 2
HEALTH AND HUMAN SERVICES AND THE U.S. SECRETARY OF THE TREASURY OF A 3
STATE INNOVATION WAIVER APPLICATI ON AMENDMENT UNDER § 1332 OF THE 4
AFFORDABLE CARE ACT. 5
(F) ON OR BEFORE JANUARY 1, 2025, THE EXCHANGE SHALL ADOPT 6
REGULATIONS TO CARRY OUT THIS SECTION . 7
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 8
October 1, 2023. 9