Premium and cost-sharing assistance for health plans through the Medical Assistance program. (FE)

Qualified health plans may require cost-sharing, such as deductibles or copayments, and the ACA provides certain individuals who purchase specific plans through an exchange with reductions in cost-sharing. The ACA also provides financial assistance through an enhanced federal medical assistance percentage (FMAP) to states that expand their Medicaid programs. The enhanced FMAP under the ACA applies to certain newly eligible individuals whose family income level is up to 133 percent of the FPL.

This bill requires DHS to create a premium assistance program to pay premiums and any cost-sharing amounts to assist eligible parents or caretaker relatives and eligible childless adults in purchasing coverage through a qualified health plan offered through an American health benefit exchange. Eligible parents or caretaker relatives and eligible childless adults are those who would otherwise be eligible for BC+ or BC+ Core except that their family income exceeds the eligibility requirements for BC+ or BC+ Core but does not exceed 133 percent of the FPL. The bill also requires that DHS ensure that individuals who become eligible for BC+ or BC+ Core while having coverage under a qualified health plan that is offered by an insurer that also offers a managed care plan for the MA program are allowed to transition from the qualified health plan to the managed care plan. DHS must also ensure that eligible parents, caretaker relatives, and childless adults are allowed to enroll in qualified health plans throughout the year and not solely during open enrollment periods determined by the federal government.

DHS is required to submit a request for any necessary approval to the federal government to implement the premium assistance program and to qualify for the highest available enhanced FMAP for eligible childless adults, parents, and caretaker relatives in the premium assistance program, childless adults eligible for BC+ Core, and, if considered newly eligible under the ACA, parents and caretaker relatives eligible for BC+. If DHS does not receive federal approval for the premium assistance program or does not qualify, or ceases to qualify, for an enhanced FMAP, DHS must submit a cost analysis to the Joint Committee on Finance (JCF). If JCF approves of eliminating the premium assistance program, DHS is not required to implement the premium assistance program.