Sec. 2. Medicaid buy-in option

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Section 1902 of the Social Security Act ( 42 U.S.C. 1396a ) is amended— in subsection (a)(10)— in subparagraph (A)(ii)— in subclause (XXI), by striking ; or and inserting a semicolon; in subclause (XXII), by adding or at the end; and by adding at the end the following new subclause: beginning January 1, 2020, who are residents of the State and are not concurrently enrolled in another health insurance coverage plan, subject, in the case of individuals described in subsection

(qq)and notwithstanding section 1916 (except for subsection

(k)of such section), to payment of premiums or other cost-sharing charges; ; and in the matter following subparagraph (G), in clause (XV), by inserting or subsection

(qq)after described in subparagraph (A)(i)(VIII) ; and by adding at the end the following new subsection: Individuals described in this subsection are individuals who are— described in subclause (XXIII) of subsection (a)(10)(A)(ii); and are not described in any other subclause of such subsection or any other provision in this Act which provides for eligibility for medical assistance. . Section 1902(k)(1) of the Social Security Act ( 42 U.S.C. 1396a(k)(1) ) is amended by inserting or an individual described in subsection

(qq)after an individual described in subclause

(VIII)of subsection (a)(10)(A)(i) each place it appears. Section 1903(i)(26) of the Social Security Act ( 42 U.S.C. 1396b(i)(26) ) is amended by striking individuals described in subclause

(VIII)of subsection (a)(10)(A)(i) and inserting individuals described in subsection (a)(10)(A)(i)(VIII) or

(qq)of section 1902 . Section 1903(a) of the Social Security Act ( 42 U.S.C. 1396b(a) ) is amended— by redesignating paragraph

(7)as paragraph (8); and by inserting after paragraph

(6)the following new paragraph: an amount equal to 90 percent of the sums expended during such quarter which are attributable to reasonable administrative expenses related to the administration of a Medicaid buy-in program for individuals described in section 1902(a)(10)(A)(ii)(XXIII); plus . For purposes of section 1903(a)(1) of the Social Security Act ( 42 U.S.C. 1396b(a)(1) ), for any fiscal quarter during which a State collects premiums, cost-sharing, or similar charges under subsection

(k)of section 1916 of such Act ( 42 U.S.C. 1396o ) (as added by this Act), including any advance payments of premium tax credits under section 1412 of the Patient Protection and Affordable Care Act or payments for cost-sharing reductions under section 1402 of such Act that are received by the State, the total amount expended during such quarter as medical assistance for individuals who buy into Medicaid coverage under subclause (XXIII) of section 1902(a)(10)(A)(ii) of the Social Security Act (as added by this Act) shall be reduced by the amount of such premiums or charges. Each State that collects premiums or similar charges under subsection

(k)of section 1916 of the Social Security Act ( 42 U.S.C. 1396o ) (as added by this Act) in a fiscal year shall pay to the Secretary of Health and Human Services, at such time and in such form and manner as the Secretary shall specify, an amount equal to 50 percent of the amount, if any, by which— the total amount of such premiums and charges collected by the State for such year; exceeds the total amount expended by the State during such year as medical assistance for individuals who buy into Medicaid coverage under subclause (XXIII) of section 1902(a)(10)(A)(ii) of such Act (as added by this Act). Section 1916 of the Social Security Act ( 42 U.S.C. 1396o ) is amended by adding at the end the following new subsection: Subject to paragraph (2), with respect to individuals who are eligible for medical assistance under subsection (a)(10)(A)(ii)(XXIII) of section 1902 and are described in subsection

(qq)of such section, a State may— impose premiums, deductibles, cost-sharing, or other similar charges that are actuarially fair; and vary the premium rate imposed on an individual based only on the factors described in section 2701(a)(1)(A) of the Public Health Service Act and subject to the same limitations on the weight which may be given to such factors under such section. The total amount of premiums imposed for a year under this subsection with respect to all individuals described in paragraph

(1)in a family shall not exceed an amount equal to 9.5 percent of the family’s household income (as defined in section 36B(d)(2) of the Internal Revenue Code of 1986) for the year involved. The cost-sharing limitations described in section 1302(c) of the Patient Protection and Affordable Care Act shall apply to cost-sharing (as defined in such section) for medical assistance provided under section 1902(a)(10)(A)(ii)(XXIII) in the same manner as such limitations apply to cost-sharing under qualified health plans under title I of such Act. Individuals provided medical assistance under section 1902(a)(10)(A)(ii)(XXIII) and subject to cost-sharing under this subsection are eligible for cost-sharing reductions under section 1402 of the Patient Protection and Affordable Care Act (subject to the income eligibility threshold in subsection (b)(2) of such section), and in applying such section— enrollment in a State plan under section 1902(a)(10)(A)(ii)(XXIII) shall be treated as coverage under a qualified health plan in the silver level of coverage in the individual market offered through an Exchange established for or by the State under title I of the Patient Protection and Affordable Care Act; and the State agency administering such plan shall be treated as the issuer of such plan. If an individual is eligible for medical assistance under subsection (a)(10)(A)(ii)(XXIII) of section 1902 and is not described in subsection

(qq)of such section, a State— shall not impose premiums and cost-sharing on the individual under this subsection; and may impose premiums and cost-sharing on the individual to the extent allowed by another provision of this Act (other than section 1902(a)(10)(A)(ii)(XXIII)) which provides for eligibility for medical assistance, but only if the individual is described in such other provision. An individual who is required to pay premiums under this subsection for a year for medical assistance shall be eligible for a premium assistance credit under section 36B of the Internal Revenue Code to the same extent that such individual would be eligible for a premium assistance credit under such section if such individual had paid the same amount in premiums for coverage under a qualified health plan for such year. . Section 1932(a)(1)(A)(i) of the Social Security Act ( 42 U.S.C. 1396u–2(a)(1)(A)(i) ) is amended by inserting , including an individual who is eligible for such assistance after buying into such coverage under section 1902(a)(10)(A)(ii)(XXIII), after the State plan under this title . A State that has elected to allow individuals to buy into Medicaid coverage under section 1902(a)(10)(A)(ii)(XXIII) of the Social Security Act (as added by this Act) shall allow individuals to enroll in such coverage through the Federal, federally facilitated, or State Exchange established pursuant to title I of the Patient Protection and Affordable Care Act. A State may limit the enrollment of individuals into Medicaid coverage under section 1902(a)(10)(A)(ii)(XXIII) of the Social Security Act (as added by this Act) to the enrollment periods provided for under section 1311(c)(6) of the Patient Protection and Affordable Care Act. Section 36B of the Internal Revenue Code of 1986 is amended— in subsection (b)(3)(B), by adding at the end the following new sentence: If an applicable taxpayer resides in a rating area in which no silver plan is offered on the individual market but the taxpayer buys into Medicaid coverage under section 1902(a)(10)(A)(ii)(XXIII) of the Social Security Act, such Medicaid coverage shall be deemed to be the applicable second lowest cost silver plan with respect to such taxpayer. ; and by adding at the end the following new subsection: In the case of any individual who buys into Medicaid coverage under section 1902(a)(10)(A)(ii)(XXIII) of the Social Security Act, this section shall be applied with the following modifications: The amount determined under subsection (b)(2)(A) shall be increased by the amount of the monthly premiums paid for such coverage. Subsection (c)(2)(A)(i) shall be applied by treating coverage under the Medicaid program under title XIX of the Social Security Act in the same manner as a qualified health plan that was enrolled in through an Exchange. In applying subsection (c)(2)(B)— an individual shall not be considered to be eligible for minimum essential coverage described in section 5000A(f)(1)(A)(ii) by reason of eligibility for medical assistance under a State Medicaid program under section 1902(a)(10)(A)(ii)(XXIII); and an individual who is not covered by minimum essential coverage described in section 5000A(f)(1)(B) shall not be considered to be eligible for such coverage. . The Secretary of Health and Human Services, in consultation with the Secretary of the Treasury, shall establish a program under which— upon request of a State agency administering a State Medicaid program under title XIX of the Social Security Act, advance determinations are made in a manner similar to advanced determinations under section 1412 of the Patient Protection and Affordable Care Act with respect to the income eligibility of individuals enrolling in such program for the premium tax credit allowable under section 36B of the Internal Revenue Code of 1986 and the cost-sharing reductions under section 1402 of the Patient Protection and Affordable Care Act; the Secretary notifies— the State agency administering the program and the Secretary of the Treasury of the advance determinations; and the Secretary of the Treasury of the name and employer identification number of each employer with respect to whom 1 or more employees of the employer were determined to be eligible for the premium tax credit under section 36B of the Internal Revenue Code of 1986 and the cost-sharing reductions under section 1402 of the Patient Protection and Affordable Care Act because— the employer did not provide minimum essential coverage; or the employer provided such minimum essential coverage but it was determined under section 36B(c)(2)(C) of such Code to either be unaffordable to the employee or not provide the required minimum actuarial value; and the Secretary of the Treasury makes advance payments of such credit or reductions to the State agency administering the program in order to reduce the premiums payable by individuals eligible for such credit. Rules similar to subsections

(b)and

(c)of section 1412 of the Patient Protection and Affordable Care Act shall apply for purposes of this subsection. Section 36B of the Internal Revenue Code of 1986 is amended by inserting and under section 2(g)(2) of the after State Public Option Act section 1412 of the Patient Protection and Affordable Care Act each place it appears in subsections (f)(1), (f)(2), and (g)(1). Section 36B(f)(3) of such Code is amended by adding at the end the following flush sentence: In the case of any coverage under the Medicaid program under title XIX of the Social Security Act for which a credit under this section is allowable by reason of subsection (h), the State agency administering the Medicaid program shall be treated as an Exchange for purposes of this paragraph and subparagraph

(A)shall not apply. . Paragraph

(6)of section 4980H(c) of the Internal Revenue Code of 1986 is amended by inserting , except that for purposes of subsections (a)(2) and (b)(2), the term after qualified health plan shall include any plan described in section 36B(h) such Act . Section 1902(a)(10) of the Social Security Act ( 42 U.S.C. 1396a(a)(10) ), as amended by subsection (a), is further amended, in the matter following subparagraph (G)— by striking and

(XVII)and inserting ,

(XVII); and by inserting , and (XVIII) the medical assistance made available to an individual described in subparagraph (A)(ii)(XXIII) shall be limited to medical assistance described in subsection (k)(1) before the semicolon. Section 1903(f)(4) of the Social Security Act ( 42 U.S.C. 1396b(f)(4) ) is amended by inserting 1902(a)(10)(A)(ii)(XXIII), after 1902(a)(10)(A)(ii)(XXII), . Section 1905(a) of the Social Security Act ( 42 U.S.C. 1396d(a) ) is amended, in the matter preceding paragraph (1)— by striking or at the end of clause (xvi); by inserting or at the end of clause (xvii); and by inserting after clause

(xvii)the following new clause: individuals described in section 1902(a)(10)(A)(ii)(XXIII), . Section 1916A(a)(1) of the Social Security Act ( 42 U.S.C. 1396o–1(a)(1) ) is amended by striking or

(j)and inserting (j), or

(k). Section 1937(a)(1)(B) of the Social Security Act ( 42 U.S.C. 1396u–7(a)(1)(B) ) is amended by inserting , subclause (XXIII) of section 1902(a)(10)(A)(ii), after 1902(a)(10)(A)(i) .

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