Sec. 1. Providing flexibility with respect to premium assistance under Medicaid
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Section 1906 of the Social Security Act ( 42 U.S.C. 1396e ) is amended— in subsection (c)(2), by striking such plan. and inserting such group health plan. ; and by inserting after subsection
(c)the following new subsection: Beginning on January 1, 2018, in the case of a State electing the option described in paragraph
(2)of subsection (a), the Secretary may, upon the approval of a State plan amendment submitted by the State, waive the requirement of paragraph
(3)of such subsection to the extent such requirement provides for payment of premiums and deductibles and other cost-sharing obligations with respect to the items and services described in such paragraph furnished to individuals described in paragraph
(3)of this subsection. The Secretary may approve a State plan amendment under this subsection if the Secretary determines that the payment of premiums and deductibles and other cost-sharing obligations under the group health plan or plans involved is cost-effective relative to the amount of expenditures under the State plan, including administrative expenditures, and excluding payments for copayments or coinsurance, that the State would have made to provide comparable coverage of the individuals described in paragraph
(3)involved. For purposes of subparagraph (A), cost-effectiveness shall be determined— on an annual basis by comparing— the amount of expenditures per employer for coverage under the group health plan or plans involved of the individuals described in paragraph
(3)for the preceding 4 calendar quarters; to the average per capita amount of expenditures that the State made under the State plan to provide comparable coverage of such individuals for such calendar quarters; and in the case of individuals described in paragraph
(3)who are parents of children— if the parent is eligible for enrollment in a group health plan, based on the cost of purchasing family coverage under the group health plan; and if the parent is not so eligible, based on the cost of individual coverage for the parent and each child. In this paragraph, the term child has the meaning given such term in section 1902(e)(13)(G). The individuals described in this paragraph are individuals who are under 65 years of age, not pregnant, not entitled to, or enrolled for, benefits under part A of title XVIII, or enrolled for benefits under part B of title XVIII, are not described in subclauses
(I)through
(VII)of section 1902(a)(10)(A)(i), and otherwise entitled to medical assistance under this title. . Section 1906A of the Social Security Act ( 42 U.S.C. 1396e–1 ) is amended by adding at the end the following new subsection: Beginning on January 1, 2018, in the case of a State electing to provide a premium assistance subsidy as described in subsection (a), the Secretary may, upon the approval of a State plan amendment submitted by the State, waive the requirement of subsection
(e)to the extent such requirement provides for payment of premiums and deductibles and other cost-sharing obligations with respect to the items and services described in such subsection furnished to individuals described in paragraph (3). The Secretary may approve a State plan amendment under this subsection if the Secretary determines that the payment of premiums and deductibles and other cost-sharing obligations under the qualified employer-sponsored coverage involved is cost-effective relative to the amount of expenditures under the State plan, including administrative expenditures, and excluding payments for copayments or coinsurance, that the State would have made to provide comparable coverage of the individuals described in paragraph (3)(B) involved. For purposes of subparagraph (A), cost-effectiveness shall be determined— on an annual basis by comparing— the amount of expenditures per employer for coverage under the qualified employer-sponsored coverage involved of the individuals described in paragraph (3)(B) for the preceding 4 calendar quarters; to the average per capita amount of expenditures that the State made under the State plan to provide comparable coverage of such individuals for such calendar quarters; and in the case of individuals described in paragraph
(3)who are parents of individuals under 19 years of age— if the parent is eligible for enrollment in qualified employer-sponsored coverage, based on the cost of purchasing family coverage under such qualified employer-sponsored coverage; and if the parent is not so eligible, based on the cost of individual coverage for the parent and each such individual under 19 years of age. The individuals described in this paragraph are individuals (or the parents of individuals) who are— participating in a premium assistance subsidy under this section for qualified employer-sponsored coverage; and under 65 years of age, not pregnant, not entitled to, or enrolled for, benefits under part A of title XVIII, or enrolled for benefits under part B of title XVIII, and are not described in subclauses
(I)through
(VII)of section 1902(a)(10)(A)(i). .
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- 42 USC 1396e–1
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Sec. 1
Providing flexibility with respect to premium assistance under Medicaid
Cite42 USC 1396e–1
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