Sec. 201. Federal grants for State insurance expenditures
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Subject to the succeeding provisions of this section, each State shall receive from the Secretary of Health and Human Services (in this subtitle referred to as the Secretary ) a grant for the State’s providing for the use, in connection with providing health benefits coverage, of a qualifying high-risk pool or a reinsurance pool or other risk-adjustment mechanism used for the purpose of subsidizing the purchase of private health insurance. There are hereby appropriated, out of any funds in the Treasury not otherwise appropriated, $1,000,000,000 for each of fiscal years 2016, 2017, and 2018 for grants under this section.
Such amount shall be divided among the States as determined by the Secretary. Nothing in this section shall be construed as preventing a State from using funding under section 2745 of the Public Health Service Act for purposes of funding reinsurance or other risk mechanisms. Funding under subsection
(a)may only be used for the following: A qualifying high-risk pool created before the date of the enactment of this Act that only covers high-risk populations and individuals (and their spouse and dependents) receiving a health care tax credit under section 35 of the Internal Revenue Code of 1986 for a limited period of time as determined by the Secretary or under section 2741 of Public Health Service Act. A qualifying high-risk pool created on or after such date that only covers populations and individuals described in subparagraph
(A)if the pool— offers at least the option of one or more high-deductible plan options, in combination with a contribution into a health savings account; offers multiple competing health plan options; and covers only high-risk populations. A reinsurance pool, or other risk-adjustment mechanism, created before the date of the enactment of this Act that only covers populations and individuals described in paragraph (1)(A). A reinsurance pool or other risk-adjustment mechanism created on or after such date that provides reinsurance only covers populations and individuals described in paragraph (1)(A) and only on a prospective basis under which a health insurance issuer cedes covered lives to the pool in exchange for payment of a reinsurance premium. Nothing in this section shall be construed as preventing a State from using funds available to transition from an existing high-risk pool to a reinsurance pool. With respect to any amounts made available to the States under this section, the Secretary shall set aside a portion of such amounts that shall only be available for the following activities by such States: Providing guaranteed availability of individual health insurance coverage to certain individuals with prior group coverage under part B of title XXVII of the Public Health Service Act. A reduction in premium trends, actual premiums, or other cost-sharing requirements. An expansion or broadening of the pool of high-risk individuals eligible for coverage. States that adopt the Model Health Plan for Uninsurable Individuals Act of the National Association of Insurance Commissioners (if and when updated by such Association). The Secretary may request such Association to update such Model Health Plan as needed by 2015. The requirements of this subsection, for the availability of bonus payments to a State under subsection (d), are as follows, in the case of an individual who is covered under a high-risk pool or other pool or mechanism described in subsection
(b)operating in the State for which funds under this section may be applied: The premiums imposed for coverage of each individual under health insurance coverage offered through such pool or mechanism may not exceed (on an annual basis) the following: If the adjusted gross income (as defined in section 62 of the Internal Revenue Code of 1986) of all individuals in the individual’s family does not exceed the poverty line (as defined in section 673(2) of the Community Services Block Grant Act ( 42 U.S.C. 9902(2) ), including any revision required by such section) applicable to a family of the size involved, 2 percent of such income. If such adjusted gross income for all individuals in the individual’s family exceeds such applicable poverty line, the sum of— 2 percent of such applicable poverty line; and 10 percent of the amount of such income that exceeds such applicable poverty line. There shall be a limit on the annual out-of-pocket expenditures (including annual premiums) for each individual for coverage under such pool or mechanism equal to twice the maximum allowable premiums for such individual permitted under paragraph (1). The Secretary shall provide for the administration of this section and may establish such terms and conditions, including the requirement of an application, as may be appropriate to carry out this section. Nothing in this section shall be construed as requiring a State to operate a reinsurance pool (or other risk-adjustment mechanism) under this section or as preventing a State from operating such a pool or mechanism through one or more private entities. In this section: The term qualifying high-risk pool means any qualified high-risk pool (as defined in subsection (g)(1)(A) of section 2745 of the Public Health Service Act ) that meets the conditions to receive a grant under section (b)(1) of such section. The term reinsurance pool or other risk-adjustment mechanism means any State-based risk spreading mechanism to subsidize the purchase of private health insurance for the high-risk population. The term high-risk population means— individuals who, by reason of the existence or history of a medical condition, are able to acquire health coverage only at rates which are at least 150 percent of the standard risk rates for such coverage (in a non-community-rated non-guaranteed issue State), and individuals who are provided health coverage by a high-risk pool. The term State includes the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Section 2745(d)(2) of the Public Health Service Act ( 42 U.S.C. 300gg–45(d)(2) ) is amended— in the heading, by inserting after and 2016 through 2018 ; and 2010 by inserting and for each of fiscal years 2016 through 2018 after for each of fiscal years 2007 through 2010 . Funds made available under this section shall not be used for the purpose of subsidizing the purchase of private health insurance on or after October 1, 2018.
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- 42 USC 300gg–45(d)(2)
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