AN ACT CONCERNING A MEDICAID PUBLIC OPTION.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) (Effective from passage) (a) Not later than January 1, 2020, the Commissioner of Social Services, in consultation with the Office of Health Strategy, established pursuant to section 19a-754a of the general statutes, and the Health Care Cabinet, established pursuant to section 19a-725 of the general statutes, shall establish and implement a Medicaid public option plan that shall be known as HUSKY E. The HUSKY E plan shall:

(1) Include, but not be limited to, the ten essential health benefits required pursuant to 42 USC 18022;

(2) Enroll only persons not otherwise eligible for Medicaid pursuant to HUSKY A, B, C or D, as defined in section 17b-290 of the general statutes, as amended by this act;

(3) Be funded by premiums assessed by the commissioner on enrollees after an actuarial analysis, and, if requested by the commissioner and approved by the federal government, federal premium tax credits and cost-sharing subsidies;

(4) Maximize access to necessary health services, as determined by the commissioner, by applying any excess of funds received over plan costs to increased reimbursement rates for providers; and

(5) Provide for defined enrollment periods aligned with enrollment periods adopted pursuant to section 38a-1084 of the general statutes.

(b) The commissioner, in consultation with the Office of Health Strategy and the Health Care Cabinet, shall take steps to ensure the HUSKY E plan does not diminish the long-term sustainability of or negatively impact the Medicaid program or the Connecticut Health Insurance Exchange, established pursuant to section 38a-1081 of the general statutes.

(c) In developing the HUSKY E plan, the commissioner, in consultation with the Office of Health Strategy and the Health Care Cabinet, shall study whether the state should (1) apply for a state innovation waiver under 42 USC 18052 to allow eligible persons who enroll in the HUSKY E plan to use tax credits and cost-sharing subsidies towards their premiums, (2) charge HUSKY E enrollees copayments and deductibles and, if so, in what amounts, and (3) sell the HUSKY E plan on the Connecticut Health Insurance Exchange as a qualified health plan pursuant to 42 USC 18021. Not later than January 1, 2019, the commissioner shall submit a report on the results of the study in accordance with the provisions of section 11-4a of the general statutes to the joint standing committees of the General Assembly having cognizance of matters relating to appropriations and the budgets of state agencies, human services and insurance.

Sec. 2. (NEW) (Effective from passage) Not later than February 1, 2019, the commissioner shall submit the HUSKY E plan, and any federal waiver application, if required, for the establishment and implementation of the plan, to the joint standing committees of the General Assembly having cognizance of matters relating to appropriations and the budgets of state agencies, human services and insurance.

(b) Not later than thirty days after the date of their receipt of such plan and any required waiver application, the joint standing committees shall hold a public hearing. At the conclusion of a public hearing held in accordance with the provisions of this section, the joint standing committees shall advise the commissioner of their approval, denial or modifications, if any, of the plan and any required waiver application.

(c) If the joint standing committees do not concur, the committee chairpersons shall appoint a committee of conference which shall be composed of three members from each joint standing committee. At least one member appointed from each joint standing committee shall be a member of the minority party. The report of the committee of conference shall be made to each joint standing committee, which shall vote to accept or reject the report. The report of the committee of conference may not be amended.

(d) If a joint standing committee rejects the report of the committee of conference, that joint standing committee shall notify the commissioner of the rejection and the commissioner's plan and any required waiver application, shall be deemed approved. If the joint standing committees accept the report, the committee having cognizance of matters relating to appropriations and the budgets of state agencies shall advise the commissioner of their approval, denial or modifications, if any, of the commissioner's plan and any required waiver application. If the joint standing committees do not so advise the commissioner during the thirty-day period, the plan and any required waiver application, shall be deemed approved.

Sec. 3. Section 17b-261 of the 2018 supplement to the general statutes is amended by adding subsection (l) as follows (Effective from passage):

(NEW) (l) Notwithstanding the provisions of this section, the Commissioner of Social Services shall establish and implement a Medicaid public option plan that shall be known as HUSKY E not later than January 1, 2020. The plan shall be open to persons who do not qualify for HUSKY A, B, C or D, as defined in section 17b-290, as amended by this act, and shall be funded by premiums assessed by the commissioner on enrollees.

Sec. 4. Section 17b-290 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

As used in sections 1 to 3, inclusive, of this act, this section and sections 17b-292, 17b-294a, 17b-295, 17b-297a, 17b-297b and 17b-300:

(1) "Applicant" means an individual over the age of eighteen years who is a natural or adoptive parent, a legal guardian, a caretaker relative, foster parent or stepparent with whom the child resides and shall include a child who is eighteen years of age or emancipated in accordance with the provisions of sections 46b-150 to 46b-150e, inclusive, and who is applying on his own behalf or on behalf of a minor dependent for coverage under such plan;

(2) "Child" means an individual under nineteen years of age;

(3) "Coinsurance" means the sharing of health care expenses by the insured and an insurer in a specified ratio;

(4) "Commissioner" means the Commissioner of Social Services;

(5) "Copayment" means a payment made on behalf of a member for a specified service under HUSKY B;

(6) "Cost sharing" means arrangements made on behalf of a member whereby an applicant pays a portion of the cost of health services, sharing costs with the state and includes copayments, premiums, deductibles and coinsurance;

(7) "Deductible" means the amount of out-of-pocket expenses that would be paid for health services on behalf of a member before becoming payable by the insurer;

(8) "Department" means the Department of Social Services;

(9) "Durable medical equipment" means equipment that meets all of the following requirements:

(A) Can withstand repeated use;

(B) Is primarily and customarily used to serve a medical purpose;

(C) Generally is not useful to a person in the absence of an illness or injury; and

(D) Is nondisposable;

(10) "Eligible beneficiary" means a child who meets the requirements in section 17b-292, and the requirements specified in Section 2110(b)(2)(B) of the Social Security Act as amended by Section 10203(b)(2)(D) of the Affordable Care Act;

(11) "Household" has the same meaning as provided in 42 CFR 435.603;

(12) "Household income" has the same meaning as provided in 42 CFR 435.603;

(13) "HUSKY A" means Medicaid provided to children, caretaker relatives and pregnant and postpartum women pursuant to section 17b-261, as amended by this act, or 17b-277;

(14) "HUSKY B" means the health coverage for children established pursuant to the provisions of sections 17b-290, 17b-292, 17b-294a, 17b-295, 17b-297a, 17b-297b and 17b-300;

(15) "HUSKY C" means Medicaid provided to individuals who are sixty-five years of age or older or who are blind or have a disability;

(16) "HUSKY D" or "Medicaid Coverage for the Lowest Income Populations program" means Medicaid provided to nonpregnant low-income adults who are age eighteen to sixty-four, as authorized pursuant to section 17b-8a;

(17) "HUSKY E" means the Medicaid public option plan that provides coverage to persons not otherwise eligible for Medicaid through HUSKY A, B, C or D, and is funded by premiums assessed on enrollees;

[(17)] (18) "HUSKY Health" means the combined HUSKY A, HUSKY B, HUSKY C, [and] HUSKY D and HUSKY E programs, that provide medical coverage to eligible children, parents, relative caregivers, persons age sixty-five or older, individuals with disabilities, low-income adults, and pregnant women;

[(18)] (19) "HUSKY Plus" means the supplemental health program established pursuant to section 17b-294a for medically eligible members of HUSKY B whose medical needs cannot be accommodated within the basic benefit package offered to members. HUSKY Plus shall supplement coverage for those medically eligible members with intensive physical health needs;

[(19)] (20) "Member" means an eligible beneficiary who receives services under HUSKY A, B, C, [or] D or E;

[(20)] (21) "Parent" means a natural parent, stepparent, adoptive parent, guardian or custodian of a child;

[(21)] (22) "Premium" means any required payment made by an individual to offset the cost under HUSKY B;

[(22)] (23) "Qualified entity" means any entity: (A) Eligible for payments under a state plan approved under Medicaid and which provides medical services under HUSKY A, or (B) that is a qualified entity, as defined in 42 USC 1396r-1a, as amended by Section 708 of Public Law 106-554, and that is determined by the commissioner to be capable of making the determination of eligibility. The commissioner shall provide qualified entities with such forms or information on filing an application electronically as is necessary for an application to be made on behalf of a child under HUSKY A and information on how to assist parents, guardians and other persons in completing and filing such forms or electronic application;

[(23)] (24) "WIC" means the federal Special Supplemental Food Program for Women, Infants and Children administered by the Department of Public Health pursuant to section 19a-59c.

Statement of Purpose:

To establish a Medicaid public option in which persons not otherwise eligible for Medicaid can buy coverage.

[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]