WES MOORE, Governor Ch. 841
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Chapter 841
(Senate Bill 705)
AN ACT concerning
Health Insurance – Qualified Resident Enrollment Program
(Access to Care Act)
FOR the purpose of requiring the Maryland Health Benefit Exchange to establish and
implement the Qualified Resident Enrollment Program to facilitate the enrollment
of qualified residents in qualified plans; providing that the operation and
administration of the Program may include functions delegated by the Maryland
Exchange to a third party; providing that the implementation of the Program is
contingent on approval of a certain waiver application amendment; and generally
relating to the Qualified Resident Enrollment Program.
BY repealing and reenacting, without amendments,
Article – Insurance
Section 31–101(a) and 31–108(a)
Annotated Code of Maryland
(2017 Replacement Volume and 2023 Supplement)
BY adding to
Article – Insurance
Section 31–101(u–1), 31–123, and 31–124
Annotated Code of Maryland
(2017 Replacement Volume and 2023 Supplement)
BY repealing and reenacting, with amendments,
Article – Insurance
Section 31–107, 31–108(b)(1), and 31–115(b)(7)
Annotated Code of Maryland
(2017 Replacement Volume and 2023 Supplement)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
That the Laws of Maryland read as follows:
Article – Insurance
31–101.
(a) In this subtitle the following words have the meanings indicated.
(U–1) “QUALIFIED RESIDENT ” MEANS AN INDIVIDUAL , INCLUDING A MINOR ,
REGARDLESS OF IMMIGR ATION STATUS, WHO AT THE TIME OF E NROLLMENT : Ch. 841 2024 LAWS OF MARYLAND
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(1) IS SEEKING TO ENROLL IN A QUALIFIED PLAN OFFERED TO
INDIVIDUALS THROUGH THE EXCHANGE;
(2) RESIDES IN THE STATE;
(3) IS NOT INCARCERATED , OTHER THAN INCARCERA TION PENDING
DISPOSITION OF CHARG ES; AND
(4) IS NOT ELIGIBLE FOR THE FEDERAL PREMIUM TAX CREDIT, THE
MARYLAND MEDICAL ASSISTANCE PROGRAM, MEDICARE, THE MARYLAND
CHILDREN’S HEALTH PLAN, OR EMPLOYER –SPONSORED MI NIMUM ESSENTIAL
COVERAGE.
31–107.
(a) There is a Maryland Health Benefit Exchange Fund.
(b) (1) The purpose of the Fund is to:
(i) provide funding for the operation and administration of the
Exchange in carrying out the purposes of the Exchange under this subtitle;
(ii) provide funding for the establishment and operation of the State
Reinsurance Program authorized under this subtitle;
(iii) provide funding for the Medical Assistance Program and the
Senior Prescription Drug Assistance Program;
(iv) provide funding for the establishment and operation of Health
Equity Resource Communities under Title 20, Subtitle 14 of the Health – General Article;
and
(v) provide funding for the establishment and operation of the
State–Based Young Adult Health Insurance Subsidies Pilot Program authorized under this
subtitle.
(2) The operation and administration of the Exchange, the State
Reinsurance Program, [and] the State–Based Young Adult Health Insurance Subsidies
Pilot Program, AND THE QUALIFIED RESIDENT ENROLLMENT PROGRAM may include
functions delegated by the Exchange to a third party under law or by contract.
(c) The Exchange shall administer the Fund.
WES MOORE, Governor Ch. 841
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(d) (1) The Fund is a special, nonlapsing fund that is not subject to § 7–302 of
the State Finance and Procurement Article.
(2) The State Treasurer shall hold the Fund separately, and the
Comptroller shall account for the Fund.
(e) The Fund consists of:
(1) any user fees or other assessments collected by the Exchange;
(2) all revenue deposited into the Fund that is received from the
distribution of the premium tax under § 6–103.2 of this article;
(3) income from investments made on behalf of the Fund;
(4) interest on deposits or investments of money in the Fund;
(5) money collected by the Board as a result of legal or other actions taken
by the Board on behalf of the Exchange or the Fund;
(6) money donated to the Fund;
(7) money awarded to the Fund through grants;
(8) any pass–through funds received from the federal government under a
waiver approved under § 1332 of the Affordable Care Act;
(9) any funds designated by the federal government to provide reinsurance
to carriers that offer individual health benefit plans in the State;
(10) any funds designated by the State to provide reinsurance to carriers
that offer individual health benefit plans in the State;
(11) any funds designated by the State to provide State–based health
insurance subsidies to young adults in the State;
(12) any federal funds received in accordance with § 31–121 of this subtitle
for the administration of small business tax credits; and
(13) any other money from any other source accepted for the benefit of the
Fund.
(f) (1) The Fund may be used only:
(i) 1. for the operation and administration of the Exchange in
carrying out the purposes authorized under this subtitle; Ch. 841 2024 LAWS OF MARYLAND
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2. for the establishment and operation of the State
Reinsurance Program; and
3. for appropriations to the Health Equity Resource
Community Reserve Fund under § 20–1407 of the Health – General Article;
(ii) in fiscal years 2021 and 2022, for the Medical Assistance
Program within the Medical Care Programs Administration of the Maryland Department
of Health;
(iii) in fiscal year 2022, for the Senior Prescription Drug Assistance
Program established under Title 15, Subtitle 10 of the Health – General Article; and
(iv) for the establishment and operation of the State–Based Young
Adult Health Insurance Subsidies Pilot Program.
(2) In each of fiscal years 2023 through 2025, the Governor shall:
(i) transfer $15,000,000 to the Health Equity Resource Community
Reserve Fund; and
(ii) include the funds transferred in accordance with item (i) of this
paragraph in the annual budget bill as an appropriation to the Health Equity Resource
Community Reserve Fund under § 20–1407 of the Health – General Article.
(g) (1) The Board shall maintain separate accounts within the Fund for
Exchange operations, for the State Reinsurance Program, and for the State–Based Young
Adult Health Insurance Subsidies Pilot Program.
(2) Accounts within the Fund shall contain the money that is intended to
support the purpose for which each account is designated.
(3) Funds received from the distribution of the premium tax under §
6–103.2 of this article shall be placed in the account for Exchange operations and may be
used only for the purpose of funding the operation and administration of the Exchange.
(4) The following funds may be used only for the purposes of funding the
State Reinsurance Program:
(i) any pass–through funds received from the federal government
under a waiver approved under § 1332 of the Affordable Care Act to provide reinsurance to
carriers that offer individual health benefit plans in the State;
(ii) any funds designated by the federal government to provide
reinsurance to carriers that offer individual health benefit plans in the State; WES MOORE, Governor Ch. 841
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(iii) any funds designated by the State to provide reinsurance to
carriers that offer individual health benefit plans in the State; and
(iv) except as provided in subsection (f) of this section, funds received
from the distribution of the assessment under § 6–102.1 of this article.
(h) (1) Expenditures from the Fund for the purposes authorized by this
subtitle may be made only:
(i) with an appropriation from the Fund approved by the General
Assembly in the State budget; or
(ii) by the budget amendment procedure provided for in Title 7,
Subtitle 2 of the State Finance and Procurement Article.
(2) Notwithstanding § 7–304 of the State Finance and Procurement Article,
if the amount of the distribution from the premium tax under § 6–103.2 of this article
exceeds in any State fiscal year the actual expenditures incurred for the operation and
administration of the Exchange, funds in the Exchange operations account from the
premium tax that remain unspent at the end of the State fiscal year shall revert to the
General Fund of the State.
(3) If operating expenses of the Exchange may be charged to either State
or non–State fund sources, the non–State funds shall be charged before State funds are
charged.
(i) (1) The State Treasurer shall invest the money of the Fund in the same
manner as other State money may be invested.
(2) Any investment earnings of the Fund shall be credited to the Fund.
(3) Except as provided in subsection (h)(2) of this section, no part of the
Fund may revert or be credited to the General Fund or any special fund of the State.
(j) A debt or an obligation of the Fund is not a debt of the State or a pledge of
credit of the State.
31–108.
(a) On or before January 1, 2014, the functions and operations of the Exchange
shall include at a minimum all functions required by § 1311(d)(4) of the Affordable Care
Act.
(b) In compliance with § 1311(d)(4) of the Affordable Care Act, the Exchange
shall: Ch. 841 2024 LAWS OF MARYLAND
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(1) make qualified plans available to qualified individuals, QUALIFIED
RESIDENTS, and qualified employers;
31–115.
(b) To be certified as a qualified health plan, a health benefit plan shall:
(7) be in the interest of qualified individuals, QUALIFIED RESIDENTS , and
qualified employers, as determined by the Exchange;
31–123.
(A) ON OR BEFORE JULY 1, 2025, THE EXCHANGE, IN CONSULTATION WITH
THE COMMISSIONER A ND AS APPROVED BY TH E BOARD, SHALL SUBMIT A STATE
INNOVATION WAIVER APPLICATION AM ENDMENT UNDER § 1332 OF THE
AFFORDABLE CARE ACT TO ESTABLISH A QUALIFIED RESIDENT ENROLLMENT
PROGRAM AND , IF AVAILABLE , SEEK FEDERAL PASS –THROUGH FUNDING
RESULTING FROM THE I MPLEMENTATION OF A QUALIFIED RESIDENT ENROLLMENT
PROGRAM.
(B) ON OR BEFORE DECEMBER 31, 2025, THE COMMISSIONER MAY WAIV E
ANY NOTIFICATION OR OTHER REQUIREMENTS T HAT APPLY TO A CARRI ER UNDER
THIS ARTICLE IN CALE NDAR YEAR 2025 DUE TO THE IMPLEMENT ATION OF A WAIVER
APPROVED UNDER § 1332 OF THE AFFORDABLE CARE ACT.
31–124.
(A) THE EXCHANGE, IN CONSULTATION WITH THE COMMISSIONER AND AS
APPROVED BY THE BOARD, SHALL ESTABLISH AND IMPLEMENT A QUALIFIED
RESIDENT ENROLLMENT PROGRAM:
(1) TO FACILITATE THE EN ROLLMENT OF QUALIFIE D RESIDENTS IN
QUALIFIED PLANS ;
(2) THAT, AS NECESSARY , MEETS THE REQUIREMEN TS OF A WAIVER
APPROVED UNDER § 1332 OF THE AFFORDABLE CARE ACT; AND
(3) THAT IS CONSISTENT W ITH FEDERAL AND STATE LAW.
(B) THE QUALIFIED RESIDENT ENROLLMENT PROGRAM SHALL BE
DESIGNED TO MAKE IND IVIDUAL MARKET INSUR ANCE COVERAGE OFFERE D
THROUGH THE EXCHANGE AVAILABLE TO QUALIFIED RESIDENTS ALLOW QUALIFIED
RESIDENTS TO PURCHAS E QUALIFIED PLANS ON THE INDIVIDUAL EXCHANGE. WES MOORE, Governor Ch. 841
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(C) (1) THE IMPLEMENTATION OF THE QUALIFIED RESIDENT
ENROLLMENT PROGRAM SHALL BE CONT INGENT ON APPROVAL F ROM THE U.S.
SECRETARY OF HEALTH AND HUMAN SERVICES AND THE U.S. SECRETARY OF THE
TREASURY OF A STATE INNOVATION WAIVER APPLICATION AM ENDMENT UNDER §
1332 OF THE AFFORDABLE CARE ACT.
(2) WITHIN 6 MONTHS BEFORE A FISC AL YEAR IN WHICH THE
EXCHANGE IMPLEMENTS T HE QUALIFIED RESIDENT ENROLLMENT PROGRAM, THE
EXCHANGE SHALL SUBMIT A REPORT TO THE GENERAL ASSEMBLY, IN ACCORDANCE
WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE, ON ITS PLAN TO IMPLE MENT
THE PROGRAM, INCLUDING:
(I) THE AMOUNT AND SOURC E OF THE FUNDING FOR THE
PROGRAM;
(II) THE PARAMETERS OF TH E PROGRAM;
(III) THE NUMBER OF INDIVI DUALS ANTICIPATED TO BE
ASSISTED THROUGH PARTICIPATE IN THE PROGRAM; AND
(IV) THE AMOUNT OF PREMIU MS ANTICIPATED TO BE PAID BY
PARTICIPANTS UNDER T HE PROGRAM; AND
(IV) (V) IF THE EXCHANGE IS AUTHORIZE D TO PROVIDE
SUBSIDIES GENERAL ASSEMBLY AUTHORIZES F UNDING TO SUBSIDIZE PREMIUMS
UNDER THE PROGRAM, THE PARAMETERS OF TH E SUBSIDIES.
(D) ON OR BEFORE JANUARY 1, 2026, THE EXCHANGE SHALL ADOPT
REGULATIONS TO CARRY OUT THIS SECTION .
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect
October 1, 2024.
Approved by the Governor, May 16, 2024.