S.B. 251





Chief Sponsor: Brian E. Shiozawa

House Sponsor: ____________

             7      LONG TITLE
             8      General Description:
             9          This bill establishes a health care premium partnership program to provide an
             10      individual who does not currently qualify for Medicaid and who is below 100% of the
             11      federal poverty level with a premium subsidy to enroll in a health benefit plan.
             12      Highlighted Provisions:
             13          This bill:
             14          .    defines terms;
             15          .    establishes a new premium partnership program to provide an individual who is not
             16      currently eligible for Medicaid and who is below 100% of the federal poverty level
             17      with a premium subsidy to enroll in a health benefit plan;
             18          .    instructs the Utah Department of Health to obtain from the Centers for Medicare
             19      and Medicaid Services within the United States Department of Health and Human
             20      Services waivers from federal law necessary to implement the premium partnership
             21      program;
             22          .    requires the Utah Department of Health to seek waivers that allow maximum
             23      flexibility in the benefit design, cost sharing requirements, and individual
             24      responsibility requirements of health benefit plans that may be selected by an
             25      eligible individual; and
             26          .    sunsets the premium partnership program if federal participation in the program is
             27      reduced.

             28      Money Appropriated in this Bill:
             29          None
             30      Other Special Clauses:
             31          None
             32      Utah Code Sections Affected:
             33      AMENDS:
             34           26-18-18 , as enacted by Laws of Utah 2013, Chapter 477
             36      Be it enacted by the Legislature of the state of Utah:
             37          Section 1. Section 26-18-18 is amended to read:
             38           26-18-18. Utah Premium Partnership expansion.
             39          (1) For purposes of this section:
             40          (a) "Medically frail" shall be determined by the department based on:
             41          (i) 42 C.F.R. 440.315; and
             42          (ii) an automated assessment adopted by the department in consultation with the
             43      Department of Workforce Services.
             44          (b) "Optional expansion population" means individuals who:
             45          (i) do not qualify for the Medicaid program; and
             46          (ii) the Centers for Medicare and Medicaid Services within the United States
             47      Department of Health and Human Services would otherwise determine are eligible for funding
             48      at the enhanced Federal Medical Assistance Percentage available under PPACA beginning
             49      January 1, 2014.
             50          (c) PPACA is as defined in Section 31A-1-301 .
             51          (2) The department and the governor shall not expand the [state's] Medicaid program to
             52      the optional expansion population [under PPACA] unless:
             53          [(a) the Health Reform Task Force has completed a thorough analysis of a statewide
             54      charity care system;]
             55          [(b) the department and its contractors have:]
             56          [(i) completed a thorough analysis of the impact to the state of expanding the state's
             57      Medicaid program to optional populations under PPACA; and]
             58          [(ii) made the analysis conducted under Subsection (2)(b)(i) available to the public;]

             59          [(c)] (a) the governor or the governor's designee has reported the intention to expand
             60      the [state] Medicaid program [under PPACA] to the Legislature in compliance with the
             61      legislative review process in Sections 63M-1-2505.5 and 26-18-3 ; and
             62          [(d) notwithstanding Subsection 63J-5-103 (2), the governor submits the request for
             63      expansion of the Medicaid program for optional populations to the Legislature under the high
             64      impact federal funds request process required by Section 63J-5-204 , Legislative review and
             65      approval of certain federal funds request.]
             66          (b) the department establishes a premium partnership program, as provided in
             67      Subsection (3), that focuses on enrolling individuals health benefit plans rather than
             68      government administered health care.
             69          (3) The department shall amend the state Medicaid plan and obtain from the Centers
             70      for Medicare and Medicaid Services within the United States Department of Health and
             71      Human Services waivers from federal statutory and regulatory law necessary to implement a
             72      plan to:
             73          (a) provide a premium subsidy to an individual who is:
             74          (i) below 100% of the federal poverty level;
             75          (ii) in the optional expansion population; and
             76          (iii) not medically frail;
             77          (b) obtain the enhanced federal financial participation for the optional expansion
             78      population up to 100% of the federal poverty level, as described in PPACA, Subsection
             79      2001(a)(3);
             80          (c) for individuals described in Subsection (3)(a), establish a mechanism for an
             81      individual to:
             82          (i) select a health benefit plan using the premium subsidy offered under Subsection
             83      (3)(a); or
             84          (ii) if the individual is offered employer sponsored health insurance, enroll in the
             85      employer sponsored coverage;
             86          (d) seek maximum flexibility for the benefit design of the health benefit plans that an
             87      individual described in Subsection (3)(a) may select;
             88          (e) seek maximum flexibility for individual responsibility, cost sharing, and wellness
             89      programs incorporated into the health benefit plans an individual described in Subsection (3)(a)

             90      may select; and
             91          (f) offer coverage in accordance with 42 C.F.R. 440.315 to an individual who is in the
             92      optional expansion population, medically frail, and below 100% of the federal poverty level.
             93          (4) The premium subsidy program and benefits provided to the optional expansion
             94      population under this section are repealed on the date of a certification by the executive
             95      director that:
             96          (a) Congress has taken an action that will reduce the federal financial participation for
             97      the expansion population; and
             98          (b) the reduction in federal financial participation exceeds the reductions described in
             99      PPACA, Subsection 2001(a)(3).

Legislative Review Note
    as of 2-19-14 12:39 PM

Office of Legislative Research and General Counsel

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