EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*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 Ziegler, Bhandari, Guzzone, Hill, S. Johnson, Kaiser, Martinez,
and Rosenberg
Introduced and read first time: February 3, 2023
Assigned to: Health and Government Operations
Committee Report: Favorable with amendments
House action: Adopted
Read second time: March 5, 2023
CHAPTER ______
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; authorizing the use of federal pass–through 6
funds for certain programs as approved under a certain waiver; requiring the 7
Maryland Health Benefit Exchange to make qualified plans available to qualified 8
residents; requiring the Maryland Health Benefit Exchange to establish and 9
implement the Qualified Resident Enrollment Program to allow qualified residents 10
to obtain coverage, facilitate the enrollment of qualified residents in qualified health 11
plans, and, based on the availability of funds, provide premium assistance and 12
cost–sharing reductions to qualified residents; providing that the implementation of 13
subsidies under the Program is contingent on approval of a certain waiver 14
application amendment; requiring the Exchange to submit a certain report to the 15
General Assembly within a certain period of time before implementing certain 16
subsidies; and generally relating to the Qualified Resident Enrollment Program. 17
BY repealing and reenacting, without amendments, 18
Article – Insurance 19 2 HOUSE BILL 588
Section 31–101(a) and 31–108(a) 1
Annotated Code of Maryland 2
(2017 Replacement Volume and 2022 Supplement) 3
BY adding to 4
Article – Insurance 5
Section 31–101(u–1), 31–123, and 31–124 6
Annotated Code of Maryland 7
(2017 Replacement Volume and 2022 Supplement) 8
BY repealing and reenacting, with amendments, 9
Article – Insurance 10
Section 31–107, 31–108(b)(1), and 31–115(b)(7) 11
Annotated Code of Maryland 12
(2017 Replacement Volume and 2022 Supplement) 13
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 14
That the Laws of Maryland read as follows: 15
Article – Insurance 16
31–101. 17
(a) In this subtitle the following words have the meanings indicated. 18
(U–1) “QUALIFIED RESIDENT ” MEANS AN INDIVIDUAL , INCLUDING A MINOR , 19
REGARDLESS OF IMMIGR ATION STATUS, WHO AT THE TIME OF E NROLLMENT : 20
(1) IS SEEKING TO ENROLL IN A QUALIFIED HEALTH PLAN OFFERED 21
TO INDIVIDUALS THROU GH THE EXCHANGE; 22
(2) RESIDES IN THE STATE; 23
(3) IS NOT INCARCERATED , OTHER THAN INCARCERA TION PENDING 24
DISPOSITION OF CHARG ES; AND 25
(4) IS NOT ELIGIBLE FOR THE FEDERAL PREMIUM TAX CREDIT, THE 26
MARYLAND MEDICAL ASSISTANCE PROGRAM, MEDICARE, THE MARYLAND 27
CHILDREN’S HEALTH PLAN, OR EMPLOYER –SPONSORED MINIMUM ES SENTIAL 28
COVERAGE. 29
31–107. 30
(a) There is a Maryland Health Benefit Exchange Fund. 31
(b) (1) The purpose of the Fund is to: 32 HOUSE BILL 588 3
(i) provide funding for the operation and administration of the 1
Exchange in carrying out the purposes of the Exchange under this subtitle; 2
(ii) provide funding for the establishment and operation of the State 3
Reinsurance Program authorized under this subtitle; 4
(iii) provide funding for the Medical Assistance Program and the 5
Senior Prescription Drug Assistance Program; 6
(iv) provide funding for the establishment and operation of Health 7
Equity Resource Communities under Title 20, Subtitle 14 of the Health – General Article; 8
[and] 9
(v) provide funding for the establishment and operation of the 10
State–Based Young Adult Health Insurance Subsidies Pilot Program authorized under this 11
subtitle; AND 12
(VI) PROVIDE FUNDING FOR TH E ESTABLISHMENT AND 13
OPERATION OF THE QUALIFIED RESIDENT ENROLLMENT PROGRAM. 14
(2) The operation and administration of the Exchange, the State 15
Reinsurance Program, [and] the State–Based Young Adult Health Insurance Subsidies 16
Pilot Program, AND THE QUALIFIED RESIDENT ENROLLMENT PROGRAM may include 17
functions delegated by the Exchange to a third party under law or by contract. 18
(c) The Exchange shall administer the Fund. 19
(d) (1) The Fund is a special, nonlapsing fund that is not subject to § 7–302 of 20
the State Finance and Procurement Article. 21
(2) The State Treasurer shall hold the Fund separately, and the 22
Comptroller shall account for the Fund. 23
(e) The Fund consists of: 24
(1) any user fees or other assessments collected by the Exchange; 25
(2) all revenue deposited into the Fund that is received from the 26
distribution of the premium tax under § 6–103.2 of this article; 27
(3) income from investments made on behalf of the Fund; 28
(4) interest on deposits or investments of money in the Fund; 29
4 HOUSE BILL 588
(5) money collected by the Board as a result of legal or other actions taken 1
by the Board on behalf of the Exchange or the Fund; 2
(6) money donated to the Fund; 3
(7) money awarded to the Fund through grants; 4
(8) any pass–through funds received from the federal government under a 5
waiver approved under § 1332 of the Affordable Care Act; 6
(9) any funds designated by the federal government to provide reinsurance 7
to carriers that offer individual health benefit plans in the State; 8
(10) any funds designated by the State to provide reinsurance to carriers 9
that offer individual health benefit plans in the State; 10
(11) any funds designated by the State to provide State–based health 11
insurance subsidies to young adults in the State; 12
(12) any federal funds received in accordance with § 31–121 of this subtitle 13
for the administration of small business tax credits; [and] 14
(13) ANY FUNDS DESIGNATED BY THE STATE TO PROVIDE 15
STATE–BASED HEALTH INSURAN CE SUBSIDIES TO QUAL IFIED RESIDENTS IN T HE 16
STATE; AND 17
(14) any other money from any other source accepted for the benefit of the 18
Fund. 19
(f) (1) The Fund may be used only: 20
(i) 1. for the operation and administration of the Exchange in 21
carrying out the purposes authorized under this subtitle; 22
2. for the establishment and operation of the State 23
Reinsurance Program; and 24
3. for appropriations to the Health Equity Resource 25
Community Reserve Fund under § 20–1407 of the Health – General Article; 26
(ii) in fiscal years 2021 and 2022, for the Medical Assistance 27
Program within the Medical Care Programs Administration of the Maryland Department 28
of Health; 29
(iii) in fiscal year 2022, for the Senior Prescription Drug Assistance 30
Program established under Title 15, Subtitle 10 of the Health – General Article; [and] 31 HOUSE BILL 588 5
(iv) for the establishment and operation of the State–Based Young 1
Adult Health Insurance Subsidies Pilot Program; AND 2
(V) FOR THE ESTABLISHMEN T AND OPERATION OF T HE 3
QUALIFIED RESIDENT ENROLLMENT PROGRAM. 4
(2) In each of fiscal years 2023 through 2025, the Governor shall: 5
(i) transfer $15,000,000 to the Health Equity Resource Community 6
Reserve Fund; and 7
(ii) include the funds transferred in accordance with item (i) of this 8
paragraph in the annual budget bill as an appropriation to the Health Equity Resource 9
Community Reserve Fund under § 20–1407 of the Health – General Article. 10
(g) (1) The Board shall maintain separate accounts within the Fund for 11
Exchange operations, for the State Reinsurance Program, [and] for the State–Based Young 12
Adult Health Insurance Subsidies Pilot Program, AND FOR THE ESTABLIS HMENT AND 13
OPERATION OF THE QUALIFIED RESIDENT ENROLLMENT PROGRAM. 14
(2) Accounts within the Fund shall contain the money that is intended to 15
support the purpose for which each account is designated. 16
(3) Funds received from the distribution of the premium tax under § 17
6–103.2 of this article shall be placed in the account for Exchange operations and may be 18
used only for the purpose of funding the operation and administration of the Exchange. 19
(4) The following funds may be used only for the purposes of funding the 20
State Reinsurance Program: 21
(i) EXCEPT AS PROVIDED I N PARAGRAPH (5) OF THIS 22
SUBSECTION, any pass–through funds received from the federal government under a 23
waiver approved under § 1332 of the Affordable Care Act to provide reinsurance to carriers 24
that offer individual health benefit plans in the State; 25
(ii) any funds designated by the federal government to provide 26
reinsurance to carriers that offer individual health benefit plans in the State; 27
(iii) any funds designated by the State to provide reinsurance to 28
carriers that offer individual health benefit plans in the State; and 29
(iv) except as provided in subsection (f) of this section, funds received 30
from the distribution of the assessment under § 6–102.1 of this article. 31
6 HOUSE BILL 588
(5) IF THE FEDERAL GOVERN MENT APPROVES AN AME NDMENT TO 1
THE STATE’S § 1332 WAIVER OF THE AFFORDABLE CARE ACT TO INCLUDE ANY 2
PROGRAM IN ADDITION TO THE STATE REINSURANCE PROGRAM, ANY FEDERAL 3
PASS–THROUGH FUNDS MAY BE USED FOR THE ADDITIO NAL PROGRAM AS 4
APPROVED UNDER THE A MENDED § 1332 WAIVER. 5
(h) (1) Expenditures from the Fund for the purposes authorized by this 6
subtitle may be made only: 7
(i) with an appropriation from the Fund approved by the General 8
Assembly in the State budget; or 9
(ii) by the budget amendment procedure provided for in Title 7, 10
Subtitle 2 of the State Finance and Procurement Article. 11
(2) Notwithstanding § 7–304 of the State Finance and Procurement Article, 12
if the amount of the distribution from the premium tax under § 6–103.2 of this article 13
exceeds in any State fiscal year the actual expenditures incurred for the operation and 14
administration of the Exchange, funds in the Exchange operations account from the 15
premium tax that remain unspent at the end of the State fiscal year shall revert to the 16
General Fund of the State. 17
(3) If operating expenses of the Exchange may be charged to either State 18
or non–State fund sources, the non–State funds shall be charged before State funds are 19
charged. 20
(i) (1) The State Treasurer shall invest the money of the Fund in the same 21
manner as other State money may be invested. 22
(2) Any investment earnings of the Fund shall be credited to the Fund. 23
(3) Except as provided in subsection (h)(2) of this section, no part of the 24
Fund may revert or be credited to the General Fund or any special fund of the State. 25
(j) A debt or an obligation of the Fund is not a debt of the State or a pledge of 26
credit of the State. 27
31–108. 28
(a) On or before January 1, 2014, the functions and operations of the Exchange 29
shall include at a minimum all functions required by § 1311(d)(4) of the Affordable Care 30
Act. 31
(b) In compliance with § 1311(d)(4) of the Affordable Care Act, the Exchange 32
shall: 33
HOUSE BILL 588 7
(1) make qualified plans available to qualified individuals, QUALIFIED 1
RESIDENTS, and qualified employers; 2
31–115. 3
(b) To be certified as a qualified health plan, a health benefit plan shall: 4
(7) be in the interest of qualified individuals, QUALIFIED RESIDENTS , and 5
qualified employers, as determined by the Exchange; 6
31–123. 7
(A) ON OR BEFORE JULY 1, 2024, THE EXCHANGE, IN CONSULTATION WITH 8
THE COMMISSIONER AND AS APPROVED BY THE BOARD, SHALL SUBMIT A STATE 9
INNOVATION WAIVER APPLICATION AM ENDMENT UNDER § 1332 OF THE 10
AFFORDABLE CARE ACT TO ESTABLISH A QUALIFIED RESIDENT ENROLLMENT 11
PROGRAM AND SEEK FEDE RAL PASS–THROUGH FUNDING TO A LLOW QUALIFIED 12
RESIDENTS TO OBTAIN COVERAGE THROUGH THE EXCHANGE. 13
(B) ON OR BEFORE DECEMBER 31, 2024, THE COMMISSIONER MAY WAIV E 14
ANY NOTIFICATION OR OTHER REQUIREMENTS T HAT APPLY TO A CARRI ER UNDER 15
THIS ARTICLE IN CALE NDAR YEAR 2024 DUE TO THE IMPLEMENT ATION OF A WAIVER 16
APPROVED UNDER § 1332 OF THE AFFORDABLE CARE ACT. 17
31–124. 18
(A) THE EXCHANGE, IN CONSULTATION WITH THE COMMISSIONER AND AS 19
APPROVED BY THE BOARD, SHALL ESTABLISH AND IMPLEMENT A QUALIFIED 20
RESIDENT ENROLLMENT PROGRAM: 21
(1) TO FACILITATE THE EN ROLLMENT OF QUALIFIE D RESIDENTS IN 22
QUALIFIED HEALTH PLANS; 23
(2) BASED ON THE AVAILAB ILITY OF FUNDS , TO PROVIDE STATE 24
PREMIUM ASSISTANCE A ND COST–SHARING REDUCTIONS T O QUALIFIED RESIDENT S 25
ENROLLED IN QUALIFIE D HEALTH PLANS ; 26
(3) THAT, AS NECESSARY , MEETS THE REQUIREMEN TS OF A WAIVER 27
APPROVED UNDER § 1332 OF THE AFFORDABLE CARE ACT; AND 28
(4) THAT IS CONSISTENT W ITH FEDERAL AND STATE LAW. 29
(B) THE QUALIFIED RESIDENT ENROLLMENT PROGRAM SHALL BE 30
DESIGNED TO MAKE IND IVIDUAL MARKET HEALTH INSURANCE COVERAGE O FFERED 31
THROUGH THE EXCHANGE AVAILABLE TO QUALIFIED RESIDENTS . 32 8 HOUSE BILL 588
(C) BASED ON THE AVAILABI LITY OF FUNDS, AND SUBJECT TO SUBSE CTION 1
(E) OF THIS SECTION, THE EXCHANGE, IN CONSULTATION WITH THE COMMISSIONER 2
AND AS APPROVED BY T HE BOARD, SHALL ESTABLISH SUBS IDY ELIGIBILITY AND 3
PAYMENT PARAMETERS F OR CALENDAR YEAR 2025 AND EACH SUBSEQUENT 4
CALENDAR YEAR . 5
(D) BEGINNING JANUARY 1, 2025, FUNDING FOR THE QUALIFIED 6
RESIDENT ENROLLMENT PROGRAM MAY BE MADE U SING: 7
(1) ANY PASS–THROUGH FUNDS RECEIVED FROM THE FE DERAL 8
GOVERNMENT UNDER A W AIVER APPROVED UNDER § 1332 OF THE AFFORDABLE 9
CARE ACT; 10
(2) ANY FUNDS DESIGNATED BY THE FEDERAL GOVER NMENT TO 11
PROVIDE HEALTH COVER AGE FOR QUALIFIED RE SIDENTS; AND 12
(3) ANY FUNDS DESIGNATED BY THE STATE TO PROVIDE HEALTH 13
COVERAGE FOR QUALIFI ED RESIDENTS. 14
(E) (1) THE IMPLEMENTATION OF SUBSIDIES UNDER THE QUALIFIED 15
RESIDENT ENROLLMENT PROGRAM SHALL BE CONT INGENT ON APPROVAL F ROM 16
THE U.S. SECRETARY OF HEALTH AND HUMAN SERVICES AND THE U.S. 17
SECRETARY OF THE TREASURY OF A STATE INNOVATION WAIVER APPLICATION 18
AMENDMENT UNDER § 1332 OF THE AFFORDABLE CARE ACT. 19
(2) WITHIN 6 MONTHS BEFORE A FISC AL YEAR IN WHICH THE 20
EXCHANGE IMPLEMENTS S UBSIDIES UNDER THE QUALIFIED RESIDENT 21
ENROLLMENT PROGRAM, THE EXCHANGE SHALL SUBMIT A REPORT TO T HE 22
GENERAL ASSEMBLY, IN ACCORDANCE WITH § 2–1257 OF THE STATE GOVERNMENT 23
ARTICLE, ON ITS PLAN TO IMPLE MENT THE SUBSIDIES , INCLUDING: 24
(I) THE AMOUNT AND SOURC E OF THE FUNDING ; 25
(II) THE PARAMETERS OF TH E SUBSIDIES; AND 26
(III) THE NUMBER OF INDIVID UALS ANTICIPATED TO BE 27
ELIGIBLE FOR THE SUB SIDIES. 28
(F) ON OR BEFORE JANUARY 1, 2025, THE EXCHANGE SHALL ADOPT 29
REGULATIONS TO CARRY OUT THIS SECTION . 30
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 31
October 1, 2023. 32 HOUSE BILL 588 9
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.