EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb0365*
SENATE BILL 365
J5 3lr0531
SB 728/22 – FIN CF 3lr1153
By: Senator Lam
Introduced and read first time: January 31, 2023
Assigned to: Finance
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
BY repealing and reenacting, with amendments, 25
Article – Insurance 26
Section 31–107, 31–108(b)(1), and 31–115(b)(7) 27
Annotated Code of Maryland 28 2 SENATE BILL 365
(2017 Replacement Volume and 2022 Supplement) 1
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 2
That the Laws of Maryland read as follows: 3
Article – Insurance 4
31–101. 5
(a) In this subtitle the following words have the meanings indicated. 6
(U–1) “QUALIFIED RESIDENT ” MEANS AN INDIVIDUAL , INCLUDING A MINOR , 7
REGARDLESS OF IMMIGR ATION STATUS, WHO AT THE TIME OF E NROLLMENT : 8
(1) IS SEEKING TO ENROLL IN A QUALIFIED HEALT H PLAN OFFERED 9
TO INDIVIDUALS THROU GH THE EXCHANGE; 10
(2) RESIDES IN THE STATE; 11
(3) IS NOT INCARCERATED , OTHER THAN INCARCERA TION PENDING 12
DISPOSITION OF CHARG ES; AND 13
(4) IS NOT ELIGIBLE FOR THE FEDERAL PREMIUM TAX CREDIT, THE 14
MARYLAND MEDICAL ASSISTANCE PROGRAM, MEDICARE, THE MARYLAND 15
CHILDREN’S HEALTH PLAN, OR EMPLOYER –SPONSORED MINIMUM ESSENTI AL 16
COVERAGE. 17
31–107. 18
(a) There is a Maryland Health Benefit Exchange Fund. 19
(b) (1) The purpose of the Fund is to: 20
(i) provide funding for the operation and administration of the 21
Exchange in carrying out the purposes of the Exchange under this subtitle; 22
(ii) provide funding for the establishment and operation of the State 23
Reinsurance Program authorized under this subtitle; 24
(iii) provide funding for the Medical Assistance Program and the 25
Senior Prescription Drug Assistance Program; 26
(iv) provide funding for the establishment and operation of Health 27
Equity Resource Communities under Title 20, Subtitle 14 of the Health – General Article; 28
[and] 29
SENATE BILL 365 3
(v) provide funding for the establishment and operation of the 1
State–Based Young Adult Health Insurance Subsidies Pilot Program authorized under this 2
subtitle; AND 3
(VI) PROVIDE FUNDING FOR THE ESTABLISHMENT AN D 4
OPERATION OF THE QUALIFIED RESIDENT ENROLLMENT PROGRAM. 5
(2) The operation and administration of the Exchange, the State 6
Reinsurance Program, [and] the State–Based Young Adult Health Insurance Subsidies 7
Pilot Program, AND THE QUALIFIED RESIDENT ENROLLMENT PROGRAM may include 8
functions delegated by the Exchange to a third party under law or by contract. 9
(c) The Exchange shall administer the Fund. 10
(d) (1) The Fund is a special, nonlapsing fund that is not subject to § 7–302 of 11
the State Finance and Procurement Article. 12
(2) The State Treasurer shall hold the Fund separately, and the 13
Comptroller shall account for the Fund. 14
(e) The Fund consists of: 15
(1) any user fees or other assessments collected by the Exchange; 16
(2) all revenue deposited into the Fund that is received from the 17
distribution of the premium tax under § 6–103.2 of this article; 18
(3) income from investments made on behalf of the Fund; 19
(4) interest on deposits or investments of money in the Fund; 20
(5) money collected by the Board as a result of legal or other actions taken 21
by the Board on behalf of the Exchange or the Fund; 22
(6) money donated to the Fund; 23
(7) money awarded to the Fund through grants; 24
(8) any pass–through funds received from the federal government under a 25
waiver approved under § 1332 of the Affordable Care Act; 26
(9) any funds designated by the federal government to provide reinsurance 27
to carriers that offer individual health benefit plans in the State; 28
(10) any funds designated by the State to provide reinsurance to carriers 29
that offer individual health benefit plans in the State; 30 4 SENATE BILL 365
(11) any funds designated by the State to provide State–based health 1
insurance subsidies to young adults in the State; 2
(12) any federal funds received in accordance with § 31–121 of this subtitle 3
for the administration of small business tax credits; [and] 4
(13) ANY FUNDS DESIGNATED BY THE STATE TO PROVIDE 5
STATE–BASED HEALTH INSURANCE SUBSIDIES TO QUALIFI ED RESIDENTS IN THE 6
STATE; AND 7
(14) any other money from any other source accepted for the benefit of the 8
Fund. 9
(f) (1) The Fund may be used only: 10
(i) 1. for the operation and administration of the Exchange in 11
carrying out the purposes authorized under this subtitle; 12
2. for the establishment and operation of the State 13
Reinsurance Program; and 14
3. for appropriations to the Health Equity Resource 15
Community Reserve Fund under § 20–1407 of the Health – General Article; 16
(ii) in fiscal years 2021 and 2022, for the Medical Assistance 17
Program within the Medical Care Programs Administration of the Maryland Department 18
of Health; 19
(iii) in fiscal year 2022, for the Senior Prescription Drug Assistance 20
Program established under Title 15, Subtitle 10 of the Health – General Article; [and] 21
(iv) for the establishment and operation of the State–Based Young 22
Adult Health Insurance Subsidies Pilot Program; AND 23
(V) FOR THE ESTABLISHMEN T AND OPERATION OF T HE 24
QUALIFIED RESIDENT ENROLLMENT PROGRAM. 25
(2) In each of fiscal years 2023 through 2025, the Governor shall: 26
(i) transfer $15,000,000 to the Health Equity Resource Community 27
Reserve Fund; and 28
(ii) include the funds transferred in accordance with item (i) of this 29
paragraph in the annual budget bill as an appropriation to the Health Equity Resource 30
Community Reserve Fund under § 20–1407 of the Health – General Article. 31 SENATE BILL 365 5
(g) (1) The Board shall maintain separate accounts within the Fund for 1
Exchange operations, for the State Reinsurance Program, [and] for the State–Based Young 2
Adult Health Insurance Subsidies Pilot Program, AND FOR THE ESTABLIS HMENT AND 3
OPERATION OF THE QUALIFIED RESIDENT ENROLLMENT PROGRAM. 4
(2) Accounts within the Fund shall contain the money that is intended to 5
support the purpose for which each account is designated. 6
(3) Funds received from the distribution of the premium tax under § 7
6–103.2 of this article shall be placed in the account for Exchange operations and may be 8
used only for the purpose of funding the operation and administration of the Exchange. 9
(4) The following funds may be used only for the purposes of funding the 10
State Reinsurance Program: 11
(i) any pass–through funds received from the federal government 12
under a waiver approved under § 1332 of the Affordable Care Act to provide reinsurance to 13
carriers that offer individual health benefit plans in the State; 14
(ii) any funds designated by the federal government to provide 15
reinsurance to carriers that offer individual health benefit plans in the State; 16
(iii) any funds designated by the State to provide reinsurance to 17
carriers that offer individual health benefit plans in the State; and 18
(iv) except as provided in subsection (f) of this section, funds received 19
from the distribution of the assessment under § 6–102.1 of this article. 20
(h) (1) Expenditures from the Fund for the purposes authorized by this 21
subtitle may be made only: 22
(i) with an appropriation from the Fund approved by the General 23
Assembly in the State budget; or 24
(ii) by the budget amendment procedure provided for in Title 7, 25
Subtitle 2 of the State Finance and Procurement Article. 26
(2) Notwithstanding § 7–304 of the State Finance and Procurement Article, 27
if the amount of the distribution from the premium tax under § 6–103.2 of this article 28
exceeds in any State fiscal year the actual expenditures incurred for the operation and 29
administration of the Exchange, funds in the Exchange operations account from the 30
premium tax that remain unspent at the end of the State fiscal year shall revert to the 31
General Fund of the State. 32
(3) If operating expenses of the Exchange may be charged to either State 33
or non–State fund sources, the non–State funds shall be charged before State funds are 34 6 SENATE BILL 365
charged. 1
(i) (1) The State Treasurer shall invest the money of the Fund in the same 2
manner as other State money may be invested. 3
(2) Any investment earnings of the Fund shall be credited to the Fund. 4
(3) Except as provided in subsection (h)(2) of this section, no part of the 5
Fund may revert or be credited to the General Fund or any special fund of the State. 6
(j) A debt or an obligation of the Fund is not a debt of the State or a pledge of 7
credit of the State. 8
31–108. 9
(a) On or before January 1, 2014, the functions and operations of the Exchange 10
shall include at a minimum all functions required by § 1311(d)(4) of the Affordable Care 11
Act. 12
(b) In compliance with § 1311(d)(4) of the Affordable Care Act, the Exchange 13
shall: 14
(1) make qualified plans available to qualified individuals, QUALIFIED 15
RESIDENTS, and qualified employers; 16
31–115. 17
(b) To be certified as a qualified health plan, a health benefit plan shall: 18
(7) be in the interest of qualified individuals, QUALIFIED RESIDENTS , and 19
qualified employers, as determined by the Exchange; 20
31–123. 21
(A) ON OR BEFORE JULY 1, 2024, THE EXCHANGE, IN CONSULTATION WITH 22
THE COMMISSIONER AND AS A PPROVED BY THE BOARD, SHALL SUBMIT A STATE 23
INNOVATION WAIVER APPLICATION AMENDMENT UNDER § 1332 OF THE 24
AFFORDABLE CARE ACT TO ESTABLISH A QUALIFIED RESIDENT ENROLLMENT 25
PROGRAM AND SEEK FEDERAL PAS S–THROUGH FUNDING TO ALLOW QUALIFIED 26
RESIDENTS TO OBTAIN COVERAGE THROU GH THE EXCHANGE. 27
(B) ON OR BEFORE DECEMBER 31, 2024, THE COMMISSIONER MAY WAIV E 28
ANY NOTIFICATION OR OTHER REQUIREMENTS T HAT APPLY TO A CARRI ER UNDER 29
THIS ARTICLE IN CALE NDAR YEAR 2024 DUE TO THE IMPLEMENT ATION OF A WAIVER 30
APPROVED UNDER § 1332 OF THE AFFORDABLE CARE ACT. 31
SENATE BILL 365 7
31–124. 1
(A) THE EXCHANGE, IN CONSULTATION WITH THE COMMISSIONER AND AS 2
APPROVED BY THE BOARD, SHALL ESTABLISH AND IMPLEMENT A QUALIFIED 3
RESIDENT ENROLLMENT PROGRAM: 4
(1) TO FACILITATE THE ENROL LMENT OF QUALIFIED RESIDENTS IN 5
QUALIFIED HEALTH PLANS ; 6
(2) BASED ON THE AVAILAB ILITY OF FUNDS , TO PROVIDE STATE 7
PREMIUM ASSISTANCE A ND COST–SHARING REDUCTIONS T O QUALIFIED RESIDENT S 8
ENROLLED IN QUALIFIE D HEALTH PLANS ; 9
(3) THAT MEETS THE REQUI REMENTS OF A WAIVER APPROVED 10
UNDER § 1332 OF THE AFFORDABLE CARE ACT; AND 11
(4) THAT IS CONSISTENT W ITH FEDERAL AND STATE LAW. 12
(B) THE QUALIFIED RESIDENT ENROLLMENT PROGRAM SHALL BE 13
DESIGNED TO MAKE IND IVIDUAL MARKET HEALT H INSURANCE COVERAGE OFFERED 14
THROUGH THE EXCHANGE AVAILABLE TO QUALIFIED RESIDEN TS. 15
(C) BASED ON THE AVAILABI LITY OF FUNDS , THE EXCHANGE, IN 16
CONSULTATION WITH TH E COMMISSIONER AND AS A PPROVED BY THE BOARD, 17
SHALL ESTABLISH SUBS IDY ELIGIBILITY AND PAYMENT PARAMETE RS FOR 18
CALENDAR YEAR 2025 AND EACH SUBSEQUENT CALENDAR YEAR. 19
(D) BEGINNING JANUARY 1, 2025, FUNDING FOR THE QUALIFIED 20
RESIDENT ENROLLMENT PROGRAM MAY BE MADE U SING: 21
(1) ANY PASS–THROUGH FUNDS RECEIV ED FROM THE FEDERAL 22
GOVERNMENT UNDER A W AIVER APPROVE D UNDER § 1332 OF THE AFFORDABLE 23
CARE ACT; 24
(2) ANY FUNDS DESIGNATED BY THE FEDERAL GOVER NMENT TO 25
PROVIDE HEALTH COVER AGE FOR QUALIFIED RE SIDENTS; AND 26
(3) ANY FUNDS DESIGNATED BY THE STATE TO PROVIDE HEAL TH 27
COVERAGE FOR QUALIFI ED RESIDENTS. 28
(E) THE IMPLEMENTATION OF THE QUALIFIED RESIDENT ENROLLMENT 29
PROGRAM SHALL BE CONT INGENT ON APPROVAL F ROM THE U.S. SECRETARY OF 30
HEALTH AND HUMAN SERVICES AND THE U.S. SECRETARY OF THE TREASURY OF A 31 8 SENATE BILL 365
STATE INNOVATION WAIVER APPLICATION AMENDMENT UNDER § 1332 OF THE 1
AFFORDABLE CARE ACT. 2
(F) ON OR BEFORE JANUARY 1, 2025, THE EXCHANGE SHALL ADOPT 3
REGULATIONS TO CARRY OUT THIS SECTION . 4
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 5
October 1, 2023. 6