HB 6274

HOUSE BILL NO. 6274
A bill to amend 1939 PA 280, entitled
"The social welfare act,"
(MCL 400.1 to 400.119b) by adding sections 112l, 112m, 112n, 112o, and
112p.
the people of the state of michigan enact:
Sec. 112l. As used in sections 112m to 112p:
(a) "Advisory group" means the stakeholder advisory group
created by the department under section 112p.
(b) "Basic health program" means a program certified by the
United States Secretary of Health and Human Services under 42 USC 18051.
(c) "Blueprint" means the written document described in 42 CFR
600.110.
(d) "Federal poverty guidelines" means the federal poverty
guidelines published annually in the Federal Register by the United States
Department of Health and Human Services under its authority to revise the
poverty line under 42 USC 9902.
(e) "Fund" means the basic health program fund created under
section 112o.
(f) "Standard health plan" means a health plan available
through the basic health program.
Sec. 112m. (1) Not
later than 6 months after the department creates the advisory group under section
112p, the department, in consultation with the advisory group, shall create and
present to the governor and legislature a report containing a proposed basic
health program blueprint.
(2) In developing the blueprint, the department and the advisory group shall
consider and address all of the following objectives:
(a) That the basic health program must serve, at a minimum, an eligible
individual who meets all of the following requirements:
(i) Is not more
than 65 years of age.
(ii) Is not eligible
to enroll in an employer-sponsored health insurance that is affordable as determined
under 26 USC 36B(c)(2)(C).
(iii) Is either of
the following:
(A) A United States citizen with an annual income level at or above 133%
but not greater than 200% of the federal poverty guidelines who does not
qualify for the medical assistance program.
(B) A lawfully present noncitizen with an
annual income level below 200% of the federal poverty guidelines, including an
individual who would qualify for this state's medical assistance program but for
the individual's immigration status or the duration of the individual's
residency in the United States.
(b) Whether an eligible individual for the basic health program has the
option of enrolling in a standard health plan.
(c) Whether an eligible individual for the basic health program is
subject to deductibles, coinsurance, copayments, or other cost-sharing
requirements.
(d) That an eligible individual for the basic health program whose
income is below 133% of the federal poverty guidelines shall not be required to
pay premiums.
(e) That premiums for an eligible individual for the basic health
program whose annual income level is at or above 133% of the federal poverty
guidelines must be based on a sliding scale that ensures that the premiums are
not greater than the premiums an eligible individual would pay for a qualified
health plan purchased on the health insurance exchange minus the premium tax
credit described in 26 USC 36B.
(f) That the cost of the basic health program must be maintained at a
fixed rate of growth annually.
(3) Subject to subsection (4), the department shall develop a basic health
program blueprint and, after presenting the proposed blueprint to the governor
and the legislature, may submit the blueprint to the United States Secretary of
Health and Human Services for certification under 42 USC 18051 and 42 CFR
600.110. The blueprint must include this state's program design choices and a
description of the operations and management of the basic health program and
its compliance with applicable federal requirements. In developing the blueprint,
the department shall consult with the advisory group to advise and assist the
department in identifying program design options expected to improve the
delivery of quality health care to eligible individuals, including, but not
limited to, alternative approaches for achieving the objectives of the basic
health program as described under subsection (2).
(4) The department may not submit the basic health program blueprint for
federal certification until the department has presented the proposed blueprint
to the governor and the legislature.
(5) On certification of the basic health program by the United States
Secretary of Health and Human Services, the department may do all of the
following:
(a) Enter into contracts with managed care organizations, health plans,
or other entities to deliver covered health services to eligible individuals under
the basic health program. Contracts with managed care organizations, health
plans, or other entities must comply with federal basic health program
standards under 42 CFR 600.410 to 600.420, including network adequacy,
nondiscrimination, medical loss ratio of at least 85%, and consumer protection
requirements. The department may request an exception from the 2-plan choice
requirement under 42 CFR 600.420(a) if a geographic region is served by only 1 medical
assistance managed care entity.
(b) Enroll eligible individuals in the basic health program in
accordance with federal and state requirements.
(c) Take any necessary actions to administer the basic health program
consistent with the approved blueprint, federal law, and state law.
(6) Beginning 1 year after the United States Secretary of Health and
Human Services certifies the basic health program, and annually thereafter, the
department shall submit a report to the governor and the legislature that
provides all of the following information:
(a) The number of eligible individuals enrolled in the basic health
program.
(b) Expenditures from the fund.
(c) Premium levels and cost-sharing arrangements.
(d) Health outcomes and access to care for the basic health program
participants.
(e) Any recommendations for legislative action to improve the program.
(f) Enrollment data, including enrollment by federal poverty level band
and immigration status.
(g) Health outcomes, access measures, and coverage churn metrics for
program participants.
(7) The department may promulgate rules as necessary to implement and
administer the basic health program.
Sec. 112n. (1) The department shall
coordinate eligibility and enrollment systems between the medical assistance
program and the basic health program to ensure seamless coverage for
individuals whose income fluctuates near the medical assistance eligibility
threshold. The department shall adopt policies that minimize gaps in coverage
and prevent unnecessary disenrollment.
(2) If an
individual becomes ineligible for the medical assistance program but is
eligible for the basic health program, the department shall, to the extent
permitted by federal law, automatically enroll the individual in a standard
health plan under the basic health program, unless the individual affirmatively
opts out.
(3) Cost-sharing
requirements for standard health plans offered through the basic health program
may include reduced deductibles and copayments. Cost-sharing requirements are
as follows:
(a) No
premiums or cost-sharing for an eligible individual with a household income
below 133% of the federal poverty guidelines.
(b) For an
eligible individual with a household income of 133% to 200% of the federal
poverty guidelines, premiums and cost-sharing must comply with federal basic health
program requirements and do not exceed what the individual would have paid for
qualified health plan coverage after applicable premium tax credits and
cost-sharing reductions.
(4) The
department shall ensure that an eligible individual is not disenrolled from the
basic health program for failure to pay premiums until at least a 90-day grace
period has passed and reasonable efforts to notify and assist the eligible
individual have been made.
(5) The
department shall publish an annual report on the department's website detailing
revenues, expenditures, enrollment trends, and program performance metrics for
the basic health program.
(6) The
department shall provide a 12-month continuous eligibility for an eligible
individual, unless the eligible individual reaches 65 years of age, moves out
of this state, or voluntarily disenrolls.
(7) If an eligible
individual transitions from the medical assistance program to the basic health
program, the department shall provide an opt-out notice to the eligible
individual before automatic enrollment in a standard health plan.
Sec. 112o. (1)
The basic health program fund is created in the state treasury. The basic
health program fund is a trust fund. The department shall appoint trustees,
including the state treasurer, the chief financial officer of the department,
and this state's medical assistance director, to oversee the fund.
(2) The state treasurer shall credit to the fund federal money received
under 42 USC 18051 and any state appropriations for the basic health program.
(3) Money in the fund at the close of the fiscal year must remain in the
fund and not lapse to the general fund.
(4) The department is the administrator of the fund for auditing
purposes. The department shall conduct an independent audit of the fund at
least once every 3 years and maintain all records in accordance with state and federal
medical assistance requirements.
(5) The department shall expend money from the fund, on appropriation,
only to plan,
implement, and administer the basic health program. The trustees shall certify
annually that fund expenditures comply with 42 CFR 600.710 and are used
exclusively for the basic health program.
(6) The
department shall publish an annual trust fund report detailing revenues,
expenditures, and the fund balance within 10 days of the trustees' approval.
Sec. 112p. (1) Not
later than 6 months after the effective date of the amendatory act that added
this section, the department shall create an advisory group that consists of,
at a minimum, all of the following individuals:
(a) An advocate for low-income individuals and families.
(b) A consumer health care advocate.
(c) A representative of health care provider groups.
(d) A representative of community-based or nonprofit organizations that
serve the eligible individuals' population.
(e) A representative of the health insurance industry.
(2) The advisory group shall review the basic health program blueprint,
assist the department with public comment processes and stakeholder engagement,
and advise the department on implementation and program improvements.