EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*hb0297*
HOUSE BILL 297
J5 5lr1017
By: Delegate Kerr
Introduced and read first time: January 9, 2025
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Maryland Health Benefit Exchange – State–Based Young Adult Health 2
Insurance Subsidies Pilot Program – Sunset Repeal 3
FOR the purpose of renaming the State–Based Young Adult Health Insurance Subsidies 4
Pilot Program to be the State–Based Young Adult Health Insurance Subsidies 5
Program; repealing the termination date of certain provisions of law that establish 6
and govern the funding for the Program; and generally relating to the health 7
insurance subsidies for young adults. 8
BY repealing and reenacting, with amendments, 9
Article – Insurance 10
Section 31–107 and 31–122 11
Annotated Code of Maryland 12
(2017 Replacement Volume and 2024 Supplement) 13
BY repealing and reenacting, with amendments, 14
Chapter 778 of the Acts of the General Assembly of 2021, as amended by Chapters 15
256 and 257 of the Acts of the General Assembly of 2023 16
Section 2 17
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 18
That the Laws of Maryland read as follows: 19
Article – Insurance 20
31–107. 21
(a) There is a Maryland Health Benefit Exchange Fund. 22
(b) (1) The purpose of the Fund is to: 23
2 HOUSE BILL 297
(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 11
this subtitle. 12
(2) The operation and administration of the Exchange, the State 13
Reinsurance Program, the State–Based Young Adult Health Insurance Subsidies [Pilot] 14
Program, and the Qualified Resident Enrollment Program may include functions delegated 15
by the Exchange to a third party under law or by contract. 16
(c) The Exchange shall administer the Fund. 17
(d) (1) The Fund is a special, nonlapsing fund that is not subject to § 7–302 of 18
the State Finance and Procurement Article. 19
(2) The State Treasurer shall hold the Fund separately, and the 20
Comptroller shall account for the Fund. 21
(e) The Fund consists of: 22
(1) any user fees or other assessments collected by the Exchange; 23
(2) all revenue deposited into the Fund that is received from the 24
distribution of the premium tax under § 6–103.2 of this article; 25
(3) income from investments made on behalf of the Fund; 26
(4) interest on deposits or investments of money in the Fund; 27
(5) money collected by the Board as a result of legal or other actions taken 28
by the Board on behalf of the Exchange or the Fund; 29
(6) money donated to the Fund; 30
(7) money awarded to the Fund through grants; 31 HOUSE BILL 297 3
(8) any pass–through funds received from the federal government under a 1
waiver approved under § 1332 of the Affordable Care Act; 2
(9) any funds designated by the federal government to provide reinsurance 3
to carriers that offer individual health benefit plans in the State; 4
(10) any funds designated by the State to provide reinsurance to carriers 5
that offer individual health benefit plans in the State; 6
(11) any funds designated by the State to provide State–based health 7
insurance subsidies to young adults in the State; 8
(12) any federal funds received in accordance with § 31–121 of this subtitle 9
for the administration of small business tax credits; and 10
(13) any other money from any other source accepted for the benefit of the 11
Fund. 12
(f) (1) The Fund may be used only: 13
(i) 1. for the operation and administration of the Exchange in 14
carrying out the purposes authorized under this subtitle; 15
2. for the establishment and operation of the State 16
Reinsurance Program; and 17
3. for appropriations to the Health Equity Resource 18
Community Reserve Fund under § 20–1407 of the Health – General Article; 19
(ii) in fiscal years 2021 and 2022, for the Medical Assistance 20
Program within the Medical Care Programs Administration of the Maryland Department 21
of Health; 22
(iii) in fiscal year 2022, for the Senior Prescription Drug Assistance 23
Program established under Title 15, Subtitle 10 of the Health – General Article; and 24
(iv) for the establishment and operation of the State–Based Young 25
Adult Health Insurance Subsidies [Pilot] Program. 26
(2) In each of fiscal years 2023 through 2025, the Governor shall: 27
(i) transfer $15,000,000 to the Health Equity Resource Community 28
Reserve Fund; and 29
4 HOUSE BILL 297
(ii) include the funds transferred in accordance with item (i) of this 1
paragraph in the annual budget bill as an appropriation to the Health Equity Resource 2
Community Reserve Fund under § 20–1407 of the Health – General Article. 3
(g) (1) The Board shall maintain separate accounts within the Fund for 4
Exchange operations, for the State Reinsurance Program, and for the State–Based Young 5
Adult Health Insurance Subsidies [Pilot] Program. 6
(2) Accounts within the Fund shall contain the money that is intended to 7
support the purpose for which each account is designated. 8
(3) Funds received from the distribution of the premium tax under § 9
6–103.2 of this article shall be placed in the account for Exchange operations and may be 10
used only for the purpose of funding the operation and administration of the Exchange. 11
(4) The following funds may be used only for the purposes of funding the 12
State Reinsurance Program: 13
(i) any pass–through funds received from the federal government 14
under a waiver approved under § 1332 of the Affordable Care Act to provide reinsurance to 15
carriers that offer individual health benefit plans in the State; 16
(ii) any funds designated by the federal government to provide 17
reinsurance to carriers that offer individual health benefit plans in the State; 18
(iii) any funds designated by the State to provide reinsurance to 19
carriers that offer individual health benefit plans in the State; and 20
(iv) except as provided in subsection (f) of this section, funds received 21
from the distribution of the assessment under § 6–102.1 of this article. 22
(h) (1) Expenditures from the Fund for the purposes authorized by this 23
subtitle may be made only: 24
(i) with an appropriation from the Fund approved by the General 25
Assembly in the State budget; or 26
(ii) by the budget amendment procedure provided for in Title 7, 27
Subtitle 2 of the State Finance and Procurement Article. 28
(2) Notwithstanding § 7–304 of the State Finance and Procurement Article, 29
if the amount of the distribution from the premium tax under § 6–103.2 of this article 30
exceeds in any State fiscal year the actual expenditures incurred for the operation and 31
administration of the Exchange, funds in the Exchange operations account from the 32
premium tax that remain unspent at the end of the State fiscal year shall revert to the 33
General Fund of the State. 34
HOUSE BILL 297 5
(3) If operating expenses of the Exchange may be charged to either State 1
or non–State fund sources, the non–State funds shall be charged before State funds are 2
charged. 3
(i) (1) The State Treasurer shall invest the money of the Fund in the same 4
manner as other State money may be invested. 5
(2) Any investment earnings of the Fund shall be credited to the Fund. 6
(3) Except as provided in subsection (h)(2) of this section, no part of the 7
Fund may revert or be credited to the General Fund or any special fund of the State. 8
(j) A debt or an obligation of the Fund is not a debt of the State or a pledge of 9
credit of the State. 10
31–122. 11
(a) In this section, [“Pilot Program”] “PROGRAM” means the State–Based Young 12
Adult Health Insurance Subsidies [Pilot] Program. 13
(b) The Exchange, in consultation with the Commissioner and as approved by the 14
Board, shall establish and implement a State–Based Young Adult Health Insurance 15
Subsidies [Pilot] Program to provide subsidies to young adults for the purchase of health 16
benefit plans in the individual health insurance market. 17
(c) The [Pilot] Program required under this section shall be designed to: 18
(1) reduce the amount that young adults pay for health benefit plans in the 19
individual health insurance market; and 20
(2) target young adults who are not directly impacted by the State 21
Reinsurance Program. 22
(d) (1) For EACH calendar [years 2022 through 2025] YEAR, the Exchange, in 23
consultation with the Commissioner and as approved by the Board, shall establish subsidy 24
eligibility and payment parameters for the [Pilot] Program. 25
(2) In determining the subsidy eligibility and payment parameters 26
required under paragraph (1) of this subsection, the Exchange shall consider: 27
(i) young adults at least 18 years old and under the age of 41 years; 28
and 29
(ii) income groups between 133% and 400% of the federal poverty 30
level. 31
6 HOUSE BILL 297
(e) [(1)] Subject to available funds [and paragraph (2) of this subsection], in 1
each [of] fiscal [years 2022 through 2026] YEAR, the Exchange may designate funds from 2
the Fund to be used for the [Pilot] Program so that annual subsidies may be provided to 3
young adults who meet the subsidy eligibility and payment parameters established under 4
subsection (d) of this section. 5
[(2) For each of calendar years 2024 and 2025, the funds designated under 6
paragraph (1) of this subsection may not exceed $20,000,000 plus any unspent funds 7
designated for subsidies for young adults in a previous calendar year.] 8
(f) The Exchange shall adopt regulations implementing the provisions of this 9
section. 10
(g) The Exchange shall adopt regulations to provide a subsidy to cover 100% of 11
the cost of the premium for young adults who have a 0% expected contribution under the 12
subsidy eligibility parameters established under subsection (d) of this section. 13
(h) (1) The Exchange shall track on a monthly basis expenditures on subsidies 14
provided under the [Pilot] Program, including: 15
(i) the average number of young adults receiving subsidies under 16
the [Pilot] Program; and 17
(ii) the average subsidy amount received by young adults under the 18
[Pilot] Program. 19
(2) The Exchange shall track: 20
(i) the impact the [Pilot] Program has on rates in the individual 21
insurance market; and 22
(ii) the impact of covering 100% of the cost of premiums for qualified 23
participants on effectuation rates and termination for nonpayment rates. 24
(3) The information tracked by the Exchange under paragraphs (1) and (2) 25
of this subsection shall be: 26
(i) posted on the website of the Exchange; and 27
(ii) included in the annual report required under § 31–119(d) of this 28
subtitle. 29
Chapter 778 of the Acts of 2021, as amended by Chapters 256 and 257 of 30
the Acts of 2023 31
HOUSE BILL 297 7
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect July 1
1, 2021. [It shall remain effective for a period of 5 years and, at the end of June 30, 2026, 2
this Act, with no further action required by the General Assembly, shall be abrogated and 3
of no further force and effect.] 4
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect July 5
1, 2025. 6