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2003 - Requirement to Offer Premium Assistance for Employer-Sponsored Insurance

 
Implementation Status 
Statutory Text 

Summary

Amends the existing CHIPRA-authorized premium assistance option delineated at section 1906A of the SSA for Medicaid-covered children with an additional option (as opposed to a requirement as was originally envisioned in the legislation per the changes delineated at section 10203(b)(2) of the Senate Manager’s Amendment) to apply this provision more broadly to all Medicaid beneficiaries (not only children).  The option, which is effective January 1, 2014, allows states to offer premium assistance and wrap-around benefits to Medicaid enrollees with access to employer-sponsored insurance (ESI) provided that offering such a subsidy is determined to be cost-effective.

Implementation Status

 
Summary 
Statutory Text 

On January 14, 2013, CMS issued a proposed rule in which it proposed to authorize premium assistance programs to support enrollment of individuals eligible for Medicaid and CHIP in plans in the individual market, including enrollment in QHPs in the Exchange, citing consistency with statutory authority delineated at section 10203(b) of the Senate Manager’s Amendment.  See also the corresponding informational bulletin on the underlying regulation

Statutory Text

 
Implementation Status 
Summary 

SEC. 2003. REQUIREMENT TO OFFER PREMIUM ASSISTANCE FOR EMPLOYER-SPONSORED INSURANCE. (a) IN GENERAL.—Section 1906A of such Act (42 U.S.C. 1396e– 1) is amended— (1) in subsection (a)— (A) by striking ‘‘may elect to’’ and inserting ‘‘shall’’; [Subparagraph (B) of section 10203(b)(2), p. 849, provides: ‘‘This Act shall be applied without regard to subparagraph (A) of section 2003(a)(1) of this Act and that subparagraph and the amendment made by that subparagraph are hereby deemed null, void, and of no effect.’’] (B) by striking ‘‘under age 19’’; and (C) by inserting ‘‘, in the case of an individual under age 19,’’ after ‘‘(and’’; (2) in subsection (c), in the first sentence, by striking ‘‘under age 19’’; and (3) in subsection (d)— (A) in paragraph (2)— (i) in the first sentence, by striking ‘‘under age 19’’; and (ii) by striking the third sentence and inserting ‘‘A State may not require, as a condition of an individual (or the individual’s parent) being or remaining eligible for medical assistance under this title, that the individual (or the individual’s parent) apply for enrollment in qualified employer-sponsored coverage under this section.’’; and (B) in paragraph (3), by striking ‘‘the parent of an individual under age 19’’ and inserting ‘‘an individual (or the parent of an individual)’’; and (4) in subsection (e), by striking ‘‘under age 19’’ each place it appears. (b) CONFORMING AMENDMENT.—The heading for section 1906A of such Act (42 U.S.C. 1396e–1) is amended by striking ‘‘OPTION FOR CHILDREN’’. (c) EFFECTIVE DATE.—The amendments made by this section take effect on January 1, 2014.

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