EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb0705*
SENATE BILL 705
J5 4lr2888
CF HB 728
By: Senators Hayes and Lam
Introduced and read first time: January 30, 2024
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 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
Section 31–101(u–1), 31–123, and 31–124 18
Annotated Code of Maryland 19
(2017 Replacement Volume and 2023 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 2023 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 705
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 PLAN OFFERED TO 6
INDIVIDUALS THROUGH 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 PREMIUM 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. 29
SENATE BILL 705 3
(2) The operation and administration of the Exchange, th e State 1
Reinsurance Program, [and] the State–Based Young Adult Health Insurance Subsidies 2
Pilot Program, AND THE QUALIFIED RESIDENT ENROLLMENT PROGRAM may include 3
functions delegated by the Exchange to a third party under law or by contract. 4
(c) The Exchange shall administer the Fund. 5
(d) (1) The Fund is a special, nonlapsing fund that is not subject to § 7–302 of 6
the State Finance and Procurement Article. 7
(2) The State Treasurer shall hold the Fund separately, and the 8
Comptroller shall account for the Fund. 9
(e) The Fund consists of: 10
(1) any user fees or other assessments collected by the Exchange; 11
(2) all revenue deposited into the Fund that is received from the 12
distribution of the premium tax under § 6–103.2 of this article; 13
(3) income from investments made on behalf of the Fund; 14
(4) interest on deposits or investments of money in the Fund; 15
(5) money collected by the Board as a result of legal or other actions taken 16
by the Board on behalf of the Exchange or the Fund; 17
(6) money donated to the Fund; 18
(7) money awarded to the Fund through grants; 19
(8) any pass–through funds received from the federal government under a 20
waiver approved under § 1332 of the Affordable Care Act; 21
(9) any funds designated by the federal government to provide reinsurance 22
to carriers that offer individual health benefit plans in the State; 23
(10) any funds designated by the State to provide reinsurance to carriers 24
that offer individual health benefit plans in the State; 25
(11) any funds designated by the State to provide State–based health 26
insurance subsidies to young adults in the State; 27
(12) any federal funds received in accordance with § 31–121 of this subtitle 28
for the administration of small business tax credits; and 29
4 SENATE BILL 705
(13) any other money from any other source accepted for the benefit of the 1
Fund. 2
(f) (1) The Fund may be used only: 3
(i) 1. for the operation and administration of the Exchange in 4
carrying out the purposes authorized under this subtitle; 5
2. for the establishment and operation of the State 6
Reinsurance Program; and 7
3. for appropriations to the Health Equity Resource 8
Community Reserve Fund under § 20–1407 of the Health – General Article; 9
(ii) in fiscal years 2021 and 2022, for the Medical Assistance 10
Program within the Medical Care Programs Administration of the Maryland Department 11
of Health; 12
(iii) in fiscal year 2022, for the Senior Prescription Drug Assistance 13
Program established under Title 15, Subtitle 10 of the Health – General Article; and 14
(iv) for the establishment and operation of the State–Based Young 15
Adult Health Insurance Subsidies Pilot Program. 16
(2) In each of fiscal years 2023 through 2025, the Governor shall: 17
(i) transfer $15,000,000 to the Health Equity Resource Community 18
Reserve Fund; and 19
(ii) include the funds transferred in accordance with item (i) of this 20
paragraph in the annual budget bill as an appropriation to the Health Equity Resource 21
Community Reserve Fund under § 20–1407 of the Health – General Article. 22
(g) (1) The Board shall maintain separate accounts within the Fund for 23
Exchange operations, for the State Reinsurance Program, and for the State–Based Young 24
Adult Health Insurance Subsidies Pilot Program. 25
(2) Accounts within the Fund shall contain the money that is intended to 26
support the purpose for which each account is designated. 27
(3) Funds received from the distribution of the premium tax under § 28
6–103.2 of this article shall be placed in the account for Exchange operations and may be 29
used only for the purpose of funding the operation and administration of the Exchange. 30
(4) The following funds may be used only for the purposes of funding the 31
State Reinsurance Program: 32
SENATE BILL 705 5
(i) any pass–through funds received from the federal government 1
under a waiver approved under § 1332 of the Affordable Care Act to provide reinsurance to 2
carriers that offer individual health benefit plans in the State; 3
(ii) any funds designated by the federal government to provide 4
reinsurance to carriers that offer individual health benefit plans in the State; 5
(iii) any funds designated by the State to provide reinsurance to 6
carriers that offer individual health benefit plans in the State; and 7
(iv) except as provided in subsection (f) of this section, funds received 8
from the distribution of the assessment under § 6–102.1 of this article. 9
(h) (1) Expenditures from the Fund for the purposes authorized by this 10
subtitle may be made only: 11
(i) with an appropriation from the Fund approved by the General 12
Assembly in the State budget; or 13
(ii) by the budget amendment procedure provided for in Title 7, 14
Subtitle 2 of the State Finance and Procurement Article. 15
(2) Notwithstanding § 7–304 of the State Finance and Procurement Article, 16
if the amount of the distribution from the premium tax under § 6–103.2 of this article 17
exceeds in any State fiscal year the actual expenditures incurred for the operation and 18
administration of the Exchange, funds in the Exchange operations account from the 19
premium tax that remain unspent at the end of the State fiscal year shall revert to the 20
General Fund of the State. 21
(3) If operating expenses of the Exchange may be charged to either State 22
or non–State fund sources, the non–State funds shall be charged before State funds are 23
charged. 24
(i) (1) The State Treasurer shall invest the money of the Fund in the same 25
manner as other State money may be invested. 26
(2) Any investment earnings of the Fund shall be credited to the Fund. 27
(3) Except as provided in subsection (h)(2) of this section, no part of the 28
Fund may revert or be credited to the General Fund or any special fund of the State. 29
(j) A debt or an obligation of the Fund is not a debt of the State or a pledge of 30
credit of the State. 31
31–108. 32
6 SENATE BILL 705
(a) On or before January 1, 2014, the functions and operations of the Exchange 1
shall include at a minimum all functions required by § 1311(d)(4) of the Affordable Care 2
Act. 3
(b) In compliance with § 1311(d)(4) of the Affordable Care Act, the Exchange 4
shall: 5
(1) make qualified plans available to qualified individuals, QUALIFIED 6
RESIDENTS, and qualified employers; 7
31–115. 8
(b) To be certified as a qualified health plan, a health benefit plan shall: 9
(7) be in the interest of qualified individuals, QUALIFIED RESIDENTS , and 10
qualified employers, as determined by the Exchange; 11
31–123. 12
(A) ON OR BEFORE JULY 1, 2025, THE EXCHANGE, IN CONSULTATION WITH 13
THE COMMISSIONER AND AS A PPROVED BY THE BOARD, SHALL SUBMIT A STATE 14
INNOVATION WAIVER APPLICATION AM ENDMENT UNDER § 1332 OF THE 15
AFFORDABLE CARE ACT TO ESTABLISH A QUALIFIED RESIDENT ENROLLMENT 16
PROGRAM AND SEEK FEDE RAL PASS–THROUGH FUNDING RESU LTING FROM THE 17
IMPLEMENTATION OF A QUALIFIED RESIDENT ENROLLMENT PROGRAM. 18
(B) ON OR BEFORE DECEMBER 31, 2025, THE COMMISSIONER MAY WAIV E 19
ANY NOTIFICATION OR OTHER REQUIREME NTS THAT APPLY TO A CARRIER UNDER 20
THIS ARTICLE IN CALE NDAR YEAR 2025 DUE TO THE IMPLEMENT ATION OF A WAIVER 21
APPROVED UNDER § 1332 OF THE AFFORDABLE CARE ACT. 22
31–124. 23
(A) THE EXCHANGE, IN CONSULTATION WITH THE COMMISSIONER AND AS 24
APPROVED BY THE BOARD, SHALL ESTABLISH AND IMPLEMENT A QUALIFIED 25
RESIDENT ENROLLMENT PROGRAM: 26
(1) TO FACILITATE THE EN ROLLMENT OF QUALIFIE D RESIDENTS IN 27
QUALIFIED PLANS ; 28
(2) THAT, AS NECESSARY, MEETS THE REQUIREMEN TS OF A WAIVER 29
APPROVED UNDER § 1332 OF THE AFFORDABLE CARE ACT; AND 30
(3) THAT IS CONSISTENT W ITH FEDERAL AND STATE LAW. 31
SENATE BILL 705 7
(B) THE QUALIFIED RESIDENT ENROLLMENT PROGRAM SHALL BE 1
DESIGNED TO MAKE IND IVIDUAL MARKET INSUR ANCE COVE RAGE OFFERED 2
THROUGH THE EXCHANGE AVAILABLE TO QUALIFIED RESIDENTS . 3
(C) (1) THE IMPLEMENTATION OF THE QUALIFIED RESIDENT 4
ENROLLMENT PROGRAM SHALL BE CONT INGENT ON APPROVAL F ROM THE U.S. 5
SECRETARY OF HEALTH AND HUMAN SERVICES AND THE U.S. SECRETARY OF THE 6
TREASURY OF A STATE INNOVATION WAIVER APPLICATION AM ENDMENT UNDER § 7
1332 OF THE AFFORDABLE CARE ACT. 8
(2) WITHIN 6 MONTHS BEFORE A FISC AL YEAR IN WHICH THE 9
EXCHANGE IMPLEMENTS T HE QUALIFIED RESIDENT ENROLLMENT PROGRAM, THE 10
EXCHANGE SHALL SUBMIT A REPORT TO THE GENERAL ASSEMBLY, IN ACCORDANCE 11
WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE, ON ITS PLAN TO IMPLE MENT 12
THE PROGRAM, INCLUDING: 13
(I) THE AMOUNT AND SOURC E OF THE FUNDING FOR THE 14
PROGRAM; 15
(II) THE PARAMETERS OF TH E PROGRAM; 16
(III) THE NUMBER OF INDIVI DUALS ANTICIPATED TO BE 17
ASSISTED THROUGH THE PROGRAM; AND 18
(IV) IF THE EXCHANGE IS AUTHORIZE D TO PROVIDE SUBSIDI ES 19
UNDER THE PROGRAM, THE PARAMETERS OF TH E SUBSIDIES. 20
(D) ON OR BEFORE JANUARY 1, 2026, THE EXCHANGE SHALL ADOPT 21
REGULATIONS TO CARRY OUT THIS SECTION . 22
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 23
October 1, 2024. 24