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.
*hb0728*
HOUSE BILL 728
J5 4lr1922
CF SB 705
By: Delegates Cullison, Acevero, Boafo, Boyce, Charkoudian, Embry, Fair,
Fennell, Fraser–Hidalgo, Guzzone, Harris, Healey, Kaiser, Kerr, Lehman,
R. Lewis, J. Long, Lopez, Love, Martinez, McCaskill, Mireku –North,
Palakovich Carr, Patterson, Queen, Ruth, Simpson , Solomon, Spiegel,
Stein, Taveras, Terrasa, Turner, White Holland, Williams, and Ziegler
Ziegler, Alston, Bagnall, Bhandari, Hill, S. Johnson, Pena–Melnyk,
Rosenberg, and Woods
Introduced and read first time: January 29, 2024
Assigned to: Health and Government Operations
Committee Report: Favorable with amendments
House action: Adopted
Read second time: February 21, 2024
CHAPTER ______
AN ACT concerning 1
Health Insurance – Qualified Resident Enrollment Program 2
(Access to Care Act) 3
FOR the purpose of requiring the Maryland Health Benefit Exchange to establish and 4
implement the Qualified Resident Enrollment Program to facilitate the enrollment 5
of qualified residents in qualified plans; providing that the operation and 6
administration of the Program may include functions delegated by the Maryland 7
Exchange to a third party; providing that the implementation of the Program is 8
contingent on approval of a certain waiver application amendment; and generally 9
relating to the Qualified Resident Enrollment 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 2023 Supplement) 15
BY adding to 16
Article – Insurance 17 2 HOUSE BILL 728
Section 31–101(u–1), 31–123, and 31–124 1
Annotated Code of Maryland 2
(2017 Replacement Volume and 2023 Supplement) 3
BY repealing and reenacting, with amendments, 4
Article – Insurance 5
Section 31–107, 31–108(b)(1), and 31–115(b)(7) 6
Annotated Code of Maryland 7
(2017 Replacement Volume and 2023 Supplement) 8
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 9
That the Laws of Maryland read as follows: 10
Article – Insurance 11
31–101. 12
(a) In this subtitle the following words have the meanings indicated. 13
(U–1) “QUALIFIED RESIDENT ” MEANS AN INDIVIDUAL , INCLUDING A MINOR , 14
REGARDLESS OF IMMIGR ATION STATUS, WHO AT THE TIME OF E NROLLMENT : 15
(1) IS SEEKING TO ENROLL IN A QUALIFIED PLAN OFFERED TO 16
INDIVIDUALS THROUGH THE EXCHANGE; 17
(2) RESIDES IN THE STATE; 18
(3) IS NOT INCARCERATED , OTHER THAN INCARCERA TION PENDING 19
DISPOSITION OF CHARG ES; AND 20
(4) IS NOT ELIGIBLE FOR THE FEDERAL PREMIUM TAX CREDIT, THE 21
MARYLAND MEDICAL ASSISTANCE PROGRAM, MEDICARE, THE MARYLAND 22
CHILDREN’S HEALTH PLAN, OR EMPLOYER –SPONSORED MINI MUM ESSENTIAL 23
COVERAGE. 24
31–107. 25
(a) There is a Maryland Health Benefit Exchange Fund. 26
(b) (1) The purpose of the Fund is to: 27
(i) provide funding for the operation and administration of the 28
Exchange in carrying out the purposes of the Exchange under this subtitle; 29
(ii) provide funding for the establishment and operation of the State 30
Reinsurance Program authorized under this subtitle; 31 HOUSE BILL 728 3
(iii) provide funding for the Medical Assistance Program and the 1
Senior Prescription Drug Assistance Program; 2
(iv) provide funding for the establishment and operation of Health 3
Equity Resource Communities under Title 20, Subtitle 14 of the Health – General Article; 4
and 5
(v) provide funding for the establishment and operation of the 6
State–Based Young Adult Health Insurance Subsidies Pilot Program authorized under this 7
subtitle. 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
4 HOUSE BILL 728
(9) any funds designated by the federal government to provide reinsurance 1
to carriers that offer individual health benefit plans in the State; 2
(10) any funds designated by the State to provide reinsurance to carriers 3
that offer individual health benefit plans in the State; 4
(11) any funds designated by the State to provide State–based health 5
insurance subsidies to young adults in the State; 6
(12) any federal funds received in accordance with § 31–121 of this subtitle 7
for the administration of small business tax credits; and 8
(13) any other money from any other source accepted for the benefit of the 9
Fund. 10
(f) (1) The Fund may be used only: 11
(i) 1. for the operation and administration of the Exchange in 12
carrying out the purposes authorized under this subtitle; 13
2. for the establishment and operation of the State 14
Reinsurance Program; and 15
3. for appropriations to the Health Equity Resource 16
Community Reserve Fund under § 20–1407 of the Health – General Article; 17
(ii) in fiscal years 2021 and 2022, for the Medical Assistance 18
Program within the Medical Care Programs Administration of the Maryland Department 19
of Health; 20
(iii) in fiscal year 2022, for the Senior Prescription Drug Assistance 21
Program established under Title 15, Subtitle 10 of the Health – General Article; and 22
(iv) for the establishment and operation of the State–Based Young 23
Adult Health Insurance Subsidies Pilot Program. 24
(2) In each of fiscal years 2023 through 2025, the Governor shall: 25
(i) transfer $15,000,000 to the Health Equity Resource Community 26
Reserve Fund; and 27
(ii) include the funds transferred in accordance with item (i) of this 28
paragraph in the annual budget bill as an appropriation to the Health Equity Resource 29
Community Reserve Fund under § 20–1407 of the Health – General Article. 30
HOUSE BILL 728 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. 3
(2) Accounts within the Fund shall contain the money that is intended to 4
support the purpose for which each account is designated. 5
(3) Funds received from the distribution of the premium tax under § 6
6–103.2 of this article shall be placed in the account for Exchange operations and may be 7
used only for the purpose of funding the operation and administration of the Exchange. 8
(4) The following funds may be used only for the purposes of funding the 9
State Reinsurance Program: 10
(i) any pass–through funds received from the federal government 11
under a waiver approved under § 1332 of the Affordable Care Act to provide reinsurance to 12
carriers that offer individual health benefit plans in the State; 13
(ii) any funds designated by the federal government to provide 14
reinsurance to carriers that offer individual health benefit plans in the State; 15
(iii) any funds designated by the State to provide reinsurance to 16
carriers that offer individual health benefit plans in the State; and 17
(iv) except as provided in subsection (f) of this section, funds received 18
from the distribution of the assessment under § 6–102.1 of this article. 19
(h) (1) Expenditures from the Fund for the purposes authorized by this 20
subtitle may be made only: 21
(i) with an appropriation from the Fund approved by the General 22
Assembly in the State budget; or 23
(ii) by the budget amendment procedure provided for in Title 7, 24
Subtitle 2 of the State Finance and Procurement Article. 25
(2) Notwithstanding § 7–304 of the State Finance and Procurement Article, 26
if the amount of the distribution from the premium tax under § 6–103.2 of this article 27
exceeds in any State fiscal year the actual expenditures incurred for the operation and 28
administration of the Exchange, funds in the Exchange operations account from the 29
premium tax that remain unspent at the end of the State fiscal year shall revert to the 30
General Fund of the State. 31
(3) If operating expenses of the Exchange may be charged to either State 32
or non–State fund sources, the non–State funds shall be charged before State funds are 33
charged. 34
6 HOUSE BILL 728
(i) (1) The State Treasurer shall invest the money of the Fund in the same 1
manner as other State money may be invested. 2
(2) Any investment earnings of the Fund shall be credited to the Fund. 3
(3) Except as provided in subsection (h)(2) of this section, no part of the 4
Fund may revert or be credited to the General Fund or any special fund of the State. 5
(j) A debt or an obligation of the Fund is not a debt of the State or a pledge of 6
credit of the State. 7
31–108. 8
(a) On or before January 1, 2014, the functions and operations of the Exchange 9
shall include at a minimum all functions required by § 1311(d)(4) of the Affordable Care 10
Act. 11
(b) In compliance with § 1311(d)(4) of the Affordable Care Act, the Exchange 12
shall: 13
(1) make qualified plans available to qualified individuals, QUALIFIED 14
RESIDENTS, and qualified employers; 15
31–115. 16
(b) To be certified as a qualified health plan, a health benefit plan shall: 17
(7) be in the interest of qualified individuals, QUALIFIED RESIDENTS , and 18
qualified employers, as determined by the Exchange; 19
31–123. 20
(A) ON OR BEFORE JULY 1, 2025, THE EXCHANGE, IN CONSULTATION WITH 21
THE COMMISSIONER AND AS APPR OVED BY THE BOARD, SHALL SUBMIT A STATE 22
INNOVATION WAIVER APPLICATION AM ENDMENT UNDER § 1332 OF THE 23
AFFORDABLE CARE ACT TO ESTABLISH A QUALIFIED RESIDENT ENROLLMENT 24
PROGRAM AND , IF AVAILABLE , SEEK FEDERAL PASS –THROUGH FUNDING 25
RESULTING FROM THE IMPLEMENTAT ION OF A QUALIFIED RESIDENT ENROLLMENT 26
PROGRAM. 27
(B) ON OR BEFORE DECEMBER 31, 2025, 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 2025 DUE TO THE IMPLEMEN TATION OF A WAIVER 30
APPROVED UNDER § 1332 OF THE AFFORDABLE CARE ACT. 31
31–124. 32 HOUSE BILL 728 7
(A) THE EXCHANGE, IN CONSULTATION WITH THE COMMISSIONER AND AS 1
APPROVED BY THE BOARD, SHALL ESTABLISH AND IMPLEMENT A QUALIFIED 2
RESIDENT ENROLLMENT PROGRAM: 3
(1) TO FACILITATE THE ENROLLMENT OF QUALIFIED RESIDENTS IN 4
QUALIFIED PLANS ; 5
(2) THAT, AS NECESSARY , MEETS THE REQUIREMEN TS OF A WAIVER 6
APPROVED UNDER § 1332 OF THE AFFORDABLE CARE ACT; AND 7
(3) THAT IS CONSISTENT W ITH FEDERAL AND STATE LAW. 8
(B) THE QUALIFIED RESIDENT ENROLLMENT PROGRAM SHALL BE 9
DESIGNED TO MAKE IND IVIDUAL MARKET INSUR ANCE COVERAGE OFFERE D 10
THROUGH THE EXCHANGE AVAILABLE TO QUALIFIED RESIDENTS ALLOW QUALIFIED 11
RESIDENTS TO PURCHAS E QUALIFIED PLANS ON THE INDIVIDUAL EXCHANGE. 12
(C) (1) THE IMPLEMENTATION OF THE QUALIFIED RESIDENT 13
ENROLLMENT PROGRAM SHALL BE CONT INGENT ON APPROVAL F ROM THE U.S. 14
SECRETARY OF HEALTH AND HUMAN SERVICES AND THE U.S. SECRETARY OF THE 15
TREASURY OF A STATE INNOVATION WAIVER APPLICATION AM ENDMENT UNDER § 16
1332 OF THE AFFORDABLE CARE ACT. 17
(2) WITHIN 6 MONTHS BEFORE A FISC AL YEAR IN WHICH THE 18
EXCHANGE IMPLEMENTS T HE QUALIFIED RESIDENT ENROLLMENT PROGRAM, THE 19
EXCHANGE SHALL SUBMIT A REPORT TO THE GENERAL ASSEMBLY, IN ACCORDANCE 20
WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE, ON ITS PLAN TO IMPLE MENT 21
THE PROGRAM, INCLUDING: 22
(I) THE AMOUNT AND SOURC E OF THE FUNDING FOR THE 23
PROGRAM; 24
(II) THE PARAMETERS OF TH E PROGRAM; 25
(III) THE NUMBER OF INDIVI DUALS ANTICIPATED TO BE 26
ASSISTED THROUGH PARTICIPATE IN THE PROGRAM; AND 27
(IV) THE AMOUNT OF PREMIU MS ANTICIPATED TO BE PAID BY 28
PARTICIPANTS UNDER T HE PROGRAM; AND 29
(IV) (V) IF THE EXCHANGE IS AUTHORIZE D TO PROVIDE 30
SUBSIDIES GENERAL ASSEMBLY AUTHORIZES F UNDING TO SUBSIDIZE PREMIUMS 31
UNDER THE PROGRAM, THE PARAMETERS OF TH E SUBSIDIES. 32 8 HOUSE BILL 728
(D) ON OR BEFORE JANUARY 1, 2026, THE EXCHANGE SHALL ADOPT 1
REGULATIONS TO CARRY OUT THIS SECTION . 2
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 3
October 1, 2024. 4
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.