[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4128 Introduced in House (IH)]
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115th CONGRESS
1st Session
H. R. 4128
To amend title XIX of the Social Security Act to allow States with
Exchanges with low-insurer participation to offer a Medicaid buy-in
plan, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 25, 2017
Ms. Michelle Lujan Grisham of New Mexico introduced the following bill;
which was referred to the Committee on Energy and Commerce, and in
addition to the Committee on Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to allow States with
Exchanges with low-insurer participation to offer a Medicaid buy-in
plan, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited at the ``Health Care Choice and Affordability
Act''.
SEC. 2. MEDICAID BUY-IN PLANS.
(a) In General.--
(1) Offering on an exchange.--For a plan year beginning on
or after January 1, 2018, notwithstanding any other provision
of law, a Medicaid buy-in State may offer to eligible
individuals with respect to a plan year a Medicaid buy-in plan
in the individual market through an Exchange established under
title I of the Patient Protection and Affordable Care Act for
such plan year.
(2) Premium rates.--
(A) In general.--A Medicaid buy-in State that
offers a Medicaid buy-in plan under paragraph (1) shall
establish premium rates under such plan at a level
calculated to produce revenue equal to the sum of--
(i) the costs of health benefits provided
by the plan; plus
(ii) 10 percent of the administrative costs
related to operating the plan.
(B) Prohibiting discriminatory premiums.--In the
case of a Medicaid buy-in plan, premiums may only vary
to the extent permitted under section 2701(a)(1) of the
Public Health Service Act.
(3) Enrollment.--The enrollment period for a Medicaid buy-
in plan offered under paragraph (1) shall, to the extent
practicable, conform with the enrollment period for qualified
health plans offered through an Exchange.
(4) Federal payment for administrative expenses.--In the
case of a Medicaid buy-in State that offers a Medicaid buy-in
plan under paragraph (1), the Secretary of Health and Human
Services shall pay to such State for each calendar quarter
beginning on or after January 1, 2018, an amount equal to 90
percent of so much of the sums expended during such quarter as
are attributable to administering the Medicaid buy-in plan in
such State.
(b) Premium Tax Credits.--
(1) In general.--Section 36B of the Internal Revenue Code
of 1986 is amended by adding at the end the following new
subsection:
``(h) Application to Individuals Purchasing Medicaid Coverage.--In
the case of any individual enrolled in a Medicaid buy-in plan
subsection (a) shall be applied by substituting for `premium assistance
credit amount of the taxpayer for the taxable year' the following: `the
lesser of--
```(1) the monthly premiums charged by a Medicaid buy-in
State for a Medicaid buy-in plan that covers the taxpayer, the
taxpayer's spouse, or any dependent (as defined in section 152)
of the taxpayer, or
```(2) the excess (if any) of--
```(A) such monthly premium, over
```(B) an amount equal to 1/12 of the product of
the applicable percentage and the taxpayer's household
income for the taxable year.'.''.
(2) Exception for minimum essential coverage.--Subparagraph
(B) of section 36B(c)(2) of the Internal Revenue Code of 1986
is amended by inserting before the period at the end the
following: ``or eligibility for coverage under a Medicaid buy-
in plan (as defined in section 2(c) of the Health Care Choice
and Affordability Act)''.
(3) Individual mandate.--Clause (ii) of section
5000A(f)(1)(A) of the Internal Revenue Code of 1986 is amended
by inserting before the comma the following: ``including under
a Medicaid buy-in plan (as defined in section 2(c) of the
Health Care Choice and Affordability Act)''.
(4) Advance payment of credit.--
(A) In general.--Advance determinations and
payments of premium tax credits allowable under section
36B of the Internal Revenue Code of 1986 with respect
to an individual enrolled in a Medicaid buy-in plan
shall be allowed, subject to rules similar to the rules
in section 1412 of the Patient Protection and
Affordable Care Act (applied without regard to whether
such plan is a qualified health plan).
(B) Coordination with credit.--Section 36B(f) is
amended by adding at the end the following new
paragraph:
``(4) Medicaid buy-in plans.--For purposes of this
subsection, advance payments under section 2(b)(4)(A) of the
Health Care Choice and Affordability Act shall be treated as
advance payments under section 1412 of the Patient Protection
and Affordable Care Act.''.
(5) Conforming amendment relating to employer
responsibility.--Section 4980H(c)(6) of the Internal Revenue
Code of 1986 is amended by inserting ``, except that for
purposes of subsections (a)(2) and (b)(1)(B), the term
`qualified health plan' shall include a Medicaid buy-in plan
(as defined in section 2(c) of the Health Care Choice and
Affordability Act'' after ``such Act''.
(c) Definitions.--In this section:
(1) Eligible individual.--The term ``eligible individual''
means an individual who will have access to only qualified
health plans issued by one health insurance issuer (as defined
in section 2791 of the Public Health Service Act (42 U.S.C.
300gg-91)) or will have access to no qualified health plans
with respect to a plan year.
(2) Medicaid buy-in state.--The term ``Medicaid buy-in
State'' means a State that has at least one political
subdivision in which fewer than two health insurance issuers
participate in the Federal, Federally facilitated, or State
Exchange established under title I of the Patient Protection
and Affordable Care Act (Public Law 111-148) for such political
subdivision.
(3) Medicaid buy-in plan.--The term ``Medicaid buy-in
plan'' means a health insurance plan that--
(A) is administered by the State agency
administering the State plan under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.) (or a
waiver of such plan); and
(B) consists of benchmark coverage described in
subsection (b)(1) of section 1937 of such Act (42
U.S.C. 1396u-7(b)(1)) or benchmark-equivalent coverage
described in subsection (b)(2) of such section.
(4) Qualified health plan.--The term ``qualified health
plan'' has the meaning given such term in section 1301 of the
Patient Protection and Affordable Care Act (42 U.S.C. 18021).
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