June 11, 2013, Introduced by Senator CASWELL and referred to the Committee on Appropriations.
A bill to create a low-income health plan; to create a low-
income health plan trust fund; to provide for the powers and duties
of certain state and local governmental officers and entities; to
allow for the promulgation of rules; and to promote the
availability and affordability of health coverage in this state.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 1. (1) This act shall be known and may be cited as the
"Michigan low-income health plan act".
(2) As used in this act, the words and phrases defined in
sections 3 to 7 have the meanings ascribed to them in those
sections.
Sec. 3. (1) "Covered primary care benefits" means the health
care treatment and services that are covered under the plan as
established by the director under section 11.
(2) "Department" means the department of community health.
(3) "Director" means the director of the department.
(4) "Eligible individual" means an individual who meets all of
the following:
(a) Is a resident.
(b) Is not eligible to enroll in medicaid, medicare, or the
state children's health insurance program authorized under title
XIX of the social security act, 42 USC 1396 to 1396w-5.
(c) Has household income that does not exceed 100% of the
federal poverty line, for the size of the family involved.
(d) Is not eligible for minimum essential coverage, as defined
in section 5000A(f) of the internal revenue code of 1986, 26 USC
5000A, or is eligible for an employer-sponsored plan that is not
affordable coverage as determined under section 5000A(e)(2) of the
internal revenue code of 1986, 26 USC 5000A.
(e) Has not attained age 65 as of the beginning of the plan
year.
(f) Is not eligible for benefits through the United States
department of veterans affairs.
(5) "Exchange" means an American health benefit exchange
operating in this state pursuant to the federal act.
Sec. 5. (1) "Federal act" means the patient protection and
affordable care act, Public Law 111-148, as amended by the health
care and education reconciliation act of 2010, Public Law 111-152.
(2) "Federal poverty line" means the poverty line published
periodically 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.
(3) "Fund" means the Michigan low-income plan trust fund
created in section 9.
(4) "Health plan" or "plan" means the Michigan low-income
health plan created under section 11.
Sec. 7. (1) "Medicaid" or "medical assistance program" means
the program of medical assistance provided under the social welfare
act, 1939 PA 280, MCL 400.1 to 400.119b, and title XIX of the
social security act, 42 USC 1396 to 1396w-5.
(2) "Medicaid contracted health plan" means that term as
defined in section 106 of the social welfare act, 1939 PA 280, MCL
400.106.
(3) "Medicare" means the federal medicare program established
under title XVIII of the social security act, 42 USC 1395 to
1395kkk-1.
(4) "Member" means an eligible individual who is enrolled in
the health plan and who fulfills all conditions of participation in
the plan as provided in this act or established by the department
under this act.
(5) "Resident" means an individual who voluntarily lives in
this state with the intention of making his or her home in this
state and not for a temporary purpose and who is not receiving
public assistance from another state.
Sec. 9. (1) The Michigan low-income plan trust fund is created
within the state treasury.
(2) The state treasurer may receive money or other assets from
any source for deposit into the fund. The state treasurer shall
direct the investment of the fund. The state treasurer shall credit
to the fund interest and earnings from fund investments.
(3) Money in the fund at the close of the fiscal year shall
remain in the fund and shall not lapse to the general fund.
(4) The department is the administrator of the fund for
auditing purposes.
(5) The director shall expend money from the fund only for the
purposes of reducing the premiums and cost-sharing of, or to
provide additional benefits for, eligible individuals enrolled in
the health plan.
Sec. 11. (1) The Michigan low-income health plan is created in
the department. The director shall implement and administer the
health plan so that it is in compliance with this act and is
operational by January 1, 2014. The department may promulgate rules
under the administrative procedures act of 1969, 1969 PA 306, MCL
24.201 to 24.328, that it considers necessary or appropriate under
this act.
(2) The director shall do all of the following under this act:
(a) Implement the plan so that eligible individuals enroll in
the plan through an exchange.
(b) Implement the plan so that eligible individuals are
enrolled in the plan with a medicaid contracted health plan.
(c) Establish or provide for the establishment of an
enrollment process that identifies whether an individual who is
attempting to enroll in the health plan is eligible for enrollment
in any other public or private health benefit coverage plan and
that directs that individual to enroll in that other health benefit
coverage plan.
(d) Implement a financial participation requirement so that
members pay a monthly household premium based on household income
for the size of the family involved as follows:
(i) For a household with income that is 25% or less of the
federal poverty line, a monthly household premium of $5.00.
(ii) For a household with income that is more than 25% and 50%
or less of the federal poverty line, a monthly household premium of
$10.00.
(iii) For a household with income that is more than 50% and 79%
or less of the federal poverty line, a monthly household premium of
$15.00.
(iv) For a household with income that is more than 79% and 100%
or less of the federal poverty line, a monthly household premium of
$20.00.
(e) Implement the plan so that federally qualified health
centers accept as payment in full for a covered primary care
benefit no more than the medical assistance program pays for the
covered primary care benefit.
(f) Implement the plan in a manner that ensures that the plan
is the payor of last resort.
(3) The director shall establish or modify the health care
treatment and services that will be covered primary care benefits,
subject to all of the following:
(a) Except as otherwise specifically provided in this act,
include at a minimum essential health benefits as described in
section 1302(b) of the federal act.
(b) Provide for the coverage of primary care and preventive
services in the same manner as provided for under medicaid
diagnosis related group codes.
(c) Provide for the coverage of prescription drugs and require
the use of generic prescription drugs except in the case of
psychotropic and psychotic drugs.
(d) Provide for the coverage of certain specified outpatient
hospital procedures.
(e) Provide for the coverage of inpatient hospitalization with
coverage limited to an amount not to exceed the amount that would
be payable for that coverage under the medical assistance program.
(f) Provide coverage for substance use disorder treatment
services, which services must be bid out based on performance
objectives established by the department.
(g) Provide coverage for mental health services that must be
obtained through a prepaid inpatient health plan under the medical
assistance program or other method prescribed by the director.
Sec. 12. The department shall transmit all money received
under this act, including all financial participation payments from
members required under section 11, to the state treasurer for
deposit into the fund.
Sec. 13. A medicaid contracted health plan shall comply with
this act to enroll eligible individuals as members of the plan. A
medicaid contracted health plan shall comply with performance
objectives established by the department under this act. The
department shall establish clear performance objectives in order to
ensure success of the plan in this state.
Sec. 15. Upon enrollment, a member shall comply with all
conditions of participation in the plan, including any financial
participation requirements established under this act. A member who
violates this section may be removed from enrollment in the plan.
An individual who is removed from enrollment in the plan is no
longer eligible for covered primary care benefits.
Sec. 17. Beginning April 1, 2015, the department shall
annually report to the legislature regarding its activities under
this act.