relating to BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.6    Section 1. Minnesota Statutes 2012, section 16A.724, subdivision 3, is amended to read:
1.7    Subd. 3. MinnesotaCare federal receipts. Receipts received as a result of federal
1.8participation pertaining to administrative costs of the Minnesota health care reform waiver
1.9shall be deposited as nondedicated revenue in the health care access fund. Receipts
1.10received as a result of federal participation pertaining to grants shall be deposited in the
1.11federal fund and shall offset health care access funds for payments to providers. All federal
1.12funding received by Minnesota for implementation and administration of MinnesotaCare
1.13as a basic health program, as authorized in section 1331 of the Affordable Care Act
1.14(Public Law 111-148, as amended by Public Law 111-152), is dedicated to that program
1.15and shall be deposited into the health care access fund. Federal funding that is received for
1.16implementing and administering MinnesotaCare as a basic health program and deposited in
1.17the fund shall be used only for that program to purchase health care coverage for enrollees
1.18and reduce enrollee premiums and cost-sharing or provide additional enrollee benefits.
1.19EFFECTIVE DATE.This section is effective January 1, 2015.

1.20    Sec. 2. Minnesota Statutes 2012, section 254B.04, subdivision 1, is amended to read:
1.21    Subdivision 1. Eligibility. (a) Persons eligible for benefits under Code of Federal
1.22Regulations, title 25, part 20, persons eligible for medical assistance benefits under
1.23sections 256B.055, 256B.056, and 256B.057, subdivisions 1, 2, 5, and 6, or who meet
1.24the income standards of section 256B.056, subdivision 4, and persons eligible for general
1.25assistance medical care under section 256D.03, subdivision 3, are entitled to chemical
1.26dependency fund services. State money appropriated for this paragraph must be placed in
1.27a separate account established for this purpose.
1.28Persons with dependent children who are determined to be in need of chemical
1.29dependency treatment pursuant to an assessment under section 626.556, subdivision 10, or
1.30a case plan under section 260C.201, subdivision 6, or 260C.212, shall be assisted by the
1.31local agency to access needed treatment services. Treatment services must be appropriate
1.32for the individual or family, which may include long-term care treatment or treatment in a
1.33facility that allows the dependent children to stay in the treatment facility. The county
1.34shall pay for out-of-home placement costs, if applicable.
2.1(b) A person not entitled to services under paragraph (a), but with family income
2.2that is less than 215 percent of the federal poverty guidelines for the applicable family
2.3size, shall be eligible to receive chemical dependency fund services within the limit
2.4of funds appropriated for this group for the fiscal year. If notified by the state agency
2.5of limited funds, a county must give preferential treatment to persons with dependent
2.6children who are in need of chemical dependency treatment pursuant to an assessment
2.7under section 626.556, subdivision 10, or a case plan under section 260C.201, subdivision
2.86 , or 260C.212. A county may spend money from its own sources to serve persons under
2.9this paragraph. State money appropriated for this paragraph must be placed in a separate
2.10account established for this purpose.
2.11(c) Persons whose income is between 215 percent and 412 percent of the federal
2.12poverty guidelines for the applicable family size shall be eligible for chemical dependency
2.13services on a sliding fee basis, within the limit of funds appropriated for this group for the
2.14fiscal year. Persons eligible under this paragraph must contribute to the cost of services
2.15according to the sliding fee scale established under subdivision 3. A county may spend
2.16money from its own sources to provide services to persons under this paragraph. State
2.17money appropriated for this paragraph must be placed in a separate account established
2.18for this purpose.

2.19    Sec. 3. Minnesota Statutes 2012, section 256.01, is amended by adding a subdivision
2.20to read:
2.21    Subd. 35. Federal approval. (a) The commissioner shall seek federal authority
2.22from the U.S. Department of Health and Human Services necessary to operate a health
2.23coverage program for Minnesotans with incomes up to 275 percent of the federal poverty
2.24guidelines (FPG). The proposal shall seek to secure all federal funding available from at
2.25least the following services:
2.26(1) all premium tax credits and cost sharing subsidies available under United States
2.27Code, title 26, section 36B, and United States Code, title 42, section 18071, for individuals
2.28with incomes above 133 percent and at or below 275 percent of the federal poverty
2.29guidelines who would otherwise be enrolled in the Minnesota Insurance Marketplace as
2.30defined in section 62V.02;
2.31(2) Medicaid funding; and
2.32(3) other funding sources identified by the commissioner that support coverage or
2.33care redesign in Minnesota.
3.1(b) Funding received shall be used to design and implement a health coverage
3.2program that creates a single streamlined program and meets the needs of Minnesotans with
3.3incomes up to 275 percent of the federal poverty guidelines. The program must incorporate:
3.4(1) payment reform characteristics included in the health care delivery system and
3.5accountable care organization payment models;
3.6(2) flexibility in benefit set design such that benefits can be targeted to meet enrollee
3.7needs in different income and health status situations and can provide a more seamless
3.8transition from public to private health care coverage;
3.9(3) flexibility in co-payment or premium structures to incent patients to seek high
3.10quality, low cost care settings; and
3.11(4) flexibility in premium structures to ease the transition from public to private
3.12health care coverage.
3.13(c) The commissioner shall develop and submit a proposal consistent with the above
3.14criteria and shall seek all federal authority necessary to implement the health coverage
3.15program. In developing the request, the commissioner shall consult with appropriate
3.16stakeholder groups and consumers.
3.17(d) The commissioner is authorized to seek any available waivers or federal
3.18approvals to accomplish the goals under paragraph (b) prior to 2017.
3.19(e) The commissioner shall report to the chairs and ranking minority members of
3.20the legislative committees with jurisdiction over health and human services policy and
3.21financing by January 15, 2015, on the progress of receiving a federal waiver and shall
3.22make recommendations on any legislative changes necessary to accomplish the project
3.23in this subdivision. Any implementation of the waiver that requires a state financial
3.24contribution shall be contingent on legislative action approving the contribution.
3.25(f) The commissioner is authorized to accept and expend federal funds that support
3.26the purposes of this subdivision.

3.27    Sec. 4. Minnesota Statutes 2012, section 256B.02, is amended by adding a subdivision
3.28to read:
3.29    Subd. 18. Caretaker relative. "Caretaker relative" means a relative, by blood,
3.30adoption, or marriage, of a child under age 19 with whom the child is living and who
3.31assumes primary responsibility for the child's care.
3.32EFFECTIVE DATE.This section is effective January 1, 2014.

3.33    Sec. 5. Minnesota Statutes 2012, section 256B.02, is amended by adding a subdivision
3.34to read:
4.1    Subd. 19. Insurance affordability program. "Insurance affordability program"
4.2means one of the following programs:
4.3(1) medical assistance under this chapter;
4.4(2) a program that provides advance payments of the premium tax credits established
4.5under section 36B of the Internal Revenue Code or cost-sharing reductions established
4.6under section 1402 of the Affordable Care Act;
4.7(3) MinnesotaCare as defined in chapter 256L; and
4.8(4) a Basic Health Plan as defined in section 1331 of the Affordable Care Act.
4.9EFFECTIVE DATE.This section is effective the day following final enactment.

4.10    Sec. 6. Minnesota Statutes 2012, section 256B.04, subdivision 18, is amended to read:
4.11    Subd. 18. Applications for medical assistance. (a) The state agency may take
4.12 shall accept applications for medical assistance and conduct eligibility determinations for
4.13MinnesotaCare enrollees by telephone, via mail, in-person, online via an Internet Web
4.14site, and through other commonly available electronic means.
4.15    (b) The commissioner of human services shall modify the Minnesota health care
4.16programs application form to add a question asking applicants whether they have ever
4.17served in the United States military.
4.18    (c) For each individual who submits an application or whose eligibility is subject to
4.19renewal or whose eligibility is being redetermined pursuant to a change in circumstances,
4.20if the agency determines the individual is not eligible for medical assistance, the agency
4.21shall determine potential eligibility for other insurance affordability programs.
4.22EFFECTIVE DATE.This section is effective January 1, 2014.

4.23    Sec. 7. Minnesota Statutes 2012, section 256B.055, subdivision 3a, is amended to read:
4.24    Subd. 3a. Families with children. Beginning July 1, 2002, Medical assistance may
4.25be paid for a person who is a child under the age of 18, or age 18 if a full-time student
4.26in a secondary school, or in the equivalent level of vocational or technical training, and
4.27reasonably expected to complete the program before reaching age 19; the parent or
4.28stepparent of a dependent child under the age of 19, including a pregnant woman; or a
4.29caretaker relative of a dependent child under the age of 19.
4.30EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
4.31approval, whichever is later. The commissioner of human services shall notify the revisor
4.32of statutes when federal approval is obtained.

5.1    Sec. 8. Minnesota Statutes 2012, section 256B.055, subdivision 6, is amended to read:
5.2    Subd. 6. Pregnant women; needy unborn child. Medical assistance may be paid
5.3for a pregnant woman who has written verification of a positive pregnancy test from a
5.4physician or licensed registered nurse, who meets the other eligibility criteria of this
5.5section and whose unborn child would be eligible as a needy child under subdivision 10 if
5.6born and living with the woman. In accordance with Code of Federal Regulations, title
5.742, section 435.956, the commissioner must accept self-attestation of pregnancy unless
5.8the agency has information that is not reasonably compatible with such attestation. For
5.9purposes of this subdivision, a woman is considered pregnant for 60 days postpartum.
5.10EFFECTIVE DATE.This section is effective January 1, 2014.

5.11    Sec. 9. Minnesota Statutes 2012, section 256B.055, subdivision 10, is amended to read:
5.12    Subd. 10. Infants. Medical assistance may be paid for an infant less than one year
5.13of age, whose mother was eligible for and receiving medical assistance at the time of birth
5.14or who is less than two years of age and is in a family with countable income that is equal
5.15to or less than the income standard established under section 256B.057, subdivision 1.
5.16EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
5.17approval, whichever is later. The commissioner of human services shall notify the revisor
5.18of statutes when federal approval is obtained.

5.19    Sec. 10. Minnesota Statutes 2012, section 256B.055, subdivision 15, is amended to read:
5.20    Subd. 15. Adults without children. Medical assistance may be paid for a person
5.21who is:
5.22(1) at least age 21 and under age 65;
5.23(2) not pregnant;
5.24(3) not entitled to Medicare Part A or enrolled in Medicare Part B under Title XVIII
5.25of the Social Security Act;
5.26(4) not an adult in a family with children as defined in section 256L.01, subdivision
5.273a ; and not otherwise eligible under subdivision 7 as a person who meets the categorical
5.28eligibility requirements of the supplemental security income program;
5.29(5) not enrolled under subdivision 7 as a person who would meet the categorical
5.30eligibility requirements of the supplemental security income program except for excess
5.31income or assets; and
5.32(5) (6) not described in another subdivision of this section.
5.33EFFECTIVE DATE.This section is effective January 1, 2014.

6.1    Sec. 11. Minnesota Statutes 2012, section 256B.055, is amended by adding a
6.2subdivision to read:
6.3    Subd. 17. Adults who were in foster care at the age of 18. Medical assistance may
6.4be paid for a person under 26 years of age who was in foster care under the commissioner's
6.5responsibility on the date of attaining 18 years of age, and who was enrolled in medical
6.6assistance under the state plan or a waiver of the plan while in foster care, in accordance
6.7with section 2004 of the Affordable Care Act.
6.8EFFECTIVE DATE.This section is effective January 1, 2014.

6.9    Sec. 12. Minnesota Statutes 2012, section 256B.056, subdivision 1, is amended to read:
6.10    Subdivision 1. Residency. To be eligible for medical assistance, a person must
6.11reside in Minnesota, or, if absent from the state, be deemed to be a resident of Minnesota,
6.12 in accordance with the rules of the state agency Code of Federal Regulations, title 42,
6.13section 435.403.
6.14EFFECTIVE DATE.This section is effective January 1, 2014.

6.15    Sec. 13. Minnesota Statutes 2012, section 256B.056, subdivision 1c, is amended to read:
6.16    Subd. 1c. Families with children income methodology. (a)(1) [Expired, 1Sp2003
6.17c 14 art 12 s 17]
6.18(2) For applications processed within one calendar month prior to July 1, 2003,
6.19eligibility shall be determined by applying the income standards and methodologies in
6.20effect prior to July 1, 2003, for any months in the six-month budget period before July
6.211, 2003, and the income standards and methodologies in effect on July 1, 2003, for any
6.22months in the six-month budget period on or after that date. The income standards for
6.23each month shall be added together and compared to the applicant's total countable income
6.24for the six-month budget period to determine eligibility.
6.25(3) For children ages one through 18 whose eligibility is determined under section
6.26256B.057, subdivision 2, the following deductions shall be applied to income counted
6.27toward the child's eligibility as allowed under the state's AFDC plan in effect as of July
6.2816, 1996: $90 work expense, dependent care, and child support paid under court order.
6.29This clause is effective October 1, 2003.
6.30(b) For families with children whose eligibility is determined using the standard
6.31specified in section 256B.056, subdivision 4, paragraph (c), 17 percent of countable
6.32earned income shall be disregarded for up to four months and the following deductions
6.33shall be applied to each individual's income counted toward eligibility as allowed under
7.1the state's AFDC plan in effect as of July 16, 1996: dependent care and child support paid
7.2under court order.
7.3(c) If the four-month disregard in paragraph (b) has been applied to the wage
7.4earner's income for four months, the disregard shall not be applied again until the wage
7.5earner's income has not been considered in determining medical assistance eligibility for
7.612 consecutive months.
7.7(d)(b) The commissioner shall adjust the income standards under this section each
7.8July 1 by the annual update of the federal poverty guidelines following publication by the
7.9United States Department of Health and Human Services except that the income standards
7.10shall not go below those in effect on July 1, 2009.
7.11(e) (c) For children age 18 or under, annual gifts of $2,000 or less by a tax-exempt
7.12organization to or for the benefit of the child with a life-threatening illness must be
7.13disregarded from income.

7.14    Sec. 14. Minnesota Statutes 2012, section 256B.056, subdivision 3, is amended to read:
7.15    Subd. 3. Asset limitations for certain individuals and families. (a) To be
7.16eligible for medical assistance, a person must not individually own more than $3,000 in
7.17assets, or if a member of a household with two family members, husband and wife, or
7.18parent and child, the household must not own more than $6,000 in assets, plus $200 for
7.19each additional legal dependent. In addition to these maximum amounts, an eligible
7.20individual or family may accrue interest on these amounts, but they must be reduced to the
7.21maximum at the time of an eligibility redetermination. The accumulation of the clothing
7.22and personal needs allowance according to section 256B.35 must also be reduced to the
7.23maximum at the time of the eligibility redetermination. The value of assets that are not
7.24considered in determining eligibility for medical assistance is the value of those assets
7.25excluded under the supplemental security income program for aged, blind, and disabled
7.26persons, with the following exceptions:
7.27(1) household goods and personal effects are not considered;
7.28(2) capital and operating assets of a trade or business that the local agency determines
7.29are necessary to the person's ability to earn an income are not considered;
7.30(3) motor vehicles are excluded to the same extent excluded by the supplemental
7.31security income program;
7.32(4) assets designated as burial expenses are excluded to the same extent excluded by
7.33the supplemental security income program. Burial expenses funded by annuity contracts
7.34or life insurance policies must irrevocably designate the individual's estate as contingent
7.35beneficiary to the extent proceeds are not used for payment of selected burial expenses;
8.1(5) for a person who no longer qualifies as an employed person with a disability due
8.2to loss of earnings, assets allowed while eligible for medical assistance under section
8.3256B.057, subdivision 9 , are not considered for 12 months, beginning with the first month
8.4of ineligibility as an employed person with a disability, to the extent that the person's total
8.5assets remain within the allowed limits of section 256B.057, subdivision 9, paragraph (d);
8.6    (6) when a person enrolled in medical assistance under section 256B.057, subdivision
8.79 , is age 65 or older and has been enrolled during each of the 24 consecutive months
8.8before the person's 65th birthday, the assets owned by the person and the person's spouse
8.9must be disregarded, up to the limits of section 256B.057, subdivision 9, paragraph (d),
8.10when determining eligibility for medical assistance under section 256B.055, subdivision
8.117 . The income of a spouse of a person enrolled in medical assistance under section
8.12256B.057, subdivision 9 , during each of the 24 consecutive months before the person's
8.1365th birthday must be disregarded when determining eligibility for medical assistance
8.14under section 256B.055, subdivision 7. Persons eligible under this clause are not subject to
8.15the provisions in section 256B.059. A person whose 65th birthday occurs in 2012 or 2013
8.16is required to have qualified for medical assistance under section 256B.057, subdivision 9,
8.17prior to age 65 for at least 20 months in the 24 months prior to reaching age 65; and
8.18(7) effective July 1, 2009, certain assets owned by American Indians are excluded as
8.19required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
8.20Law 111-5. For purposes of this clause, an American Indian is any person who meets the
8.21definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
8.22(b) No asset limit shall apply to persons eligible under section 256B.055, subdivision
8.2315.
8.24EFFECTIVE DATE.This section is effective January 1, 2014.

8.25    Sec. 15. Minnesota Statutes 2012, section 256B.056, subdivision 4, as amended by
8.26Laws 2013, chapter 1, section 5, is amended to read:
8.27    Subd. 4. Income. (a) To be eligible for medical assistance, a person eligible under
8.28section 256B.055, subdivisions 7, 7a, and 12, may have income up to 100 percent of
8.29the federal poverty guidelines. Effective January 1, 2000, and each successive January,
8.30recipients of supplemental security income may have an income up to the supplemental
8.31security income standard in effect on that date.
8.32(b) To be eligible for medical assistance, families and children may have an income
8.33up to 133-1/3 percent of the AFDC income standard in effect under the July 16, 1996,
8.34AFDC state plan. Effective July 1, 2000, the base AFDC standard in effect on July 16,
8.351996, shall be increased by three percent.
9.1(c) (b) Effective January 1, 2014, to be eligible for medical assistance, under section
9.2256B.055, subdivision 3a , a parent or caretaker relative may have an income up to 133
9.3percent of the federal poverty guidelines for the household size.
9.4(d) (c) To be eligible for medical assistance under section 256B.055, subdivision
9.515 , a person may have an income up to 133 percent of federal poverty guidelines for
9.6the household size.
9.7(e) (d) To be eligible for medical assistance under section 256B.055, subdivision
9.816 , a child age 19 to 20 may have an income up to 133 percent of the federal poverty
9.9guidelines for the household size.
9.10(f) (e) To be eligible for medical assistance under section 256B.055, subdivision
9.113a, a child under age 19 may have income up to 275 percent of the federal poverty
9.12guidelines for the household size or an equivalent standard when converted using modified
9.13adjusted gross income methodology as required under the Affordable Care Act. Children
9.14who are enrolled in medical assistance as of December 31, 2013, and are determined
9.15ineligible for medical assistance because of the elimination of income disregards under
9.16modified adjusted gross income methodology as defined in subdivision 1a of this section
9.17remain eligible for medical assistance under the Children's Health Insurance Program
9.18Reauthorization Act of 2009 (Public Law 111-3) until the date of their next regularly
9.19scheduled eligibility redetermination as required in section 256B.056, subdivision 7a.
9.20(f) In computing income to determine eligibility of persons under paragraphs (a) to
9.21(e) who are not residents of long-term care facilities, the commissioner shall disregard
9.22increases in income as required by Public Laws 94-566, section 503; 99-272; and 99-509.
9.23For persons eligible under paragraph (a), veteran aid and attendance benefits and Veterans
9.24Administration unusual medical expense payments are considered income to the recipient.

9.25    Sec. 16. Minnesota Statutes 2012, section 256B.056, subdivision 5c, is amended to read:
9.26    Subd. 5c. Excess income standard. (a) The excess income standard for families
9.27with children parents and caretaker relatives, pregnant women, infants, and children ages
9.28two through 20 is the standard specified in subdivision 4, paragraph (c).
9.29(b) The excess income standard for a person whose eligibility is based on blindness,
9.30disability, or age of 65 or more years is 70 percent of the federal poverty guidelines for the
9.31family size. Effective July 1, 2002, the excess income standard for this paragraph shall
9.32equal 75 percent of the federal poverty guidelines.
9.33EFFECTIVE DATE.This section is effective January 1, 2014.

10.1    Sec. 17. Minnesota Statutes 2012, section 256B.056, is amended by adding a
10.2subdivision to read:
10.3    Subd. 7a. Periodic renewal of eligibility. (a) The commissioner shall make an
10.4annual redetermination of eligibility based on information contained in the enrollee's case
10.5file and other information available to the agency, including but not limited to information
10.6accessed through an electronic database, without requiring the enrollee to submit any
10.7information when sufficient data is available for the agency to renew eligibility.
10.8(b) If the commissioner cannot renew eligibility in accordance with paragraph (a),
10.9the commissioner must provide the enrollee with a prepopulated renewal form containing
10.10eligibility information available to the agency and permit the enrollee to submit the form
10.11with any corrections or additional information to the agency and sign the renewal form via
10.12any of the modes of submission specified in section 256B.04, subdivision 18.
10.13(c) An enrollee who is terminated for failure to complete the renewal process may
10.14subsequently submit the renewal form and required information within four months after
10.15the date of termination and have coverage reinstated without a lapse, if otherwise eligible
10.16under this chapter.
10.17(d) Notwithstanding paragraph (a), individuals eligible under subdivision 5 shall be
10.18required to renew eligibility every six months.
10.19EFFECTIVE DATE.This section is effective January 1, 2014.

10.20    Sec. 18. Minnesota Statutes 2012, section 256B.056, subdivision 10, is amended to read:
10.21    Subd. 10. Eligibility verification. (a) The commissioner shall require women who
10.22are applying for the continuation of medical assistance coverage following the end of the
10.2360-day postpartum period to update their income and asset information and to submit
10.24any required income or asset verification.
10.25    (b) The commissioner shall determine the eligibility of private-sector health care
10.26coverage for infants less than one year of age eligible under section 256B.055, subdivision
10.2710 , or 256B.057, subdivision 1, paragraph (d), and shall pay for private-sector coverage
10.28if this is determined to be cost-effective.
10.29    (c) The commissioner shall verify assets and income for all applicants, and for all
10.30recipients upon renewal.
10.31    (d) The commissioner shall utilize information obtained through the electronic
10.32service established by the secretary of the United States Department of Health and Human
10.33Services and other available electronic data sources in Code of Federal Regulations, title
10.3442, sections 435.940 to 435.956, to verify eligibility requirements. The commissioner
10.35shall establish standards to define when information obtained electronically is reasonably
11.1compatible with information provided by applicants and enrollees, including use of
11.2self-attestation, to accomplish real-time eligibility determinations and maintain program
11.3integrity.
11.4EFFECTIVE DATE.This section is effective January 1, 2014.

11.5    Sec. 19. Minnesota Statutes 2012, section 256B.057, subdivision 1, is amended to read:
11.6    Subdivision 1. Infants and pregnant women. (a)(1) An infant less than one year
11.7 two years of age or a pregnant woman who has written verification of a positive pregnancy
11.8test from a physician or licensed registered nurse is eligible for medical assistance if the
11.9individual's countable family household income is equal to or less than 275 percent of the
11.10federal poverty guideline for the same family household size or an equivalent standard
11.11when converted using modified adjusted gross income methodology as required under
11.12the Affordable Care Act. For purposes of this subdivision, "countable family income"
11.13means the amount of income considered available using the methodology of the AFDC
11.14program under the state's AFDC plan as of July 16, 1996, as required by the Personal
11.15Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), Public
11.16Law 104-193, except for the earned income disregard and employment deductions.
11.17    (2) For applications processed within one calendar month prior to the effective date,
11.18eligibility shall be determined by applying the income standards and methodologies in
11.19effect prior to the effective date for any months in the six-month budget period before
11.20that date and the income standards and methodologies in effect on the effective date for
11.21any months in the six-month budget period on or after that date. The income standards
11.22for each month shall be added together and compared to the applicant's total countable
11.23income for the six-month budget period to determine eligibility.
11.24    (b)(1) [Expired, 1Sp2003 c 14 art 12 s 19]
11.25    (2) For applications processed within one calendar month prior to July 1, 2003,
11.26eligibility shall be determined by applying the income standards and methodologies in
11.27effect prior to July 1, 2003, for any months in the six-month budget period before July 1,
11.282003, and the income standards and methodologies in effect on the expiration date for any
11.29months in the six-month budget period on or after July 1, 2003. The income standards
11.30for each month shall be added together and compared to the applicant's total countable
11.31income for the six-month budget period to determine eligibility.
11.32    (3) An amount equal to the amount of earned income exceeding 275 percent of
11.33the federal poverty guideline, up to a maximum of the amount by which the combined
11.34total of 185 percent of the federal poverty guideline plus the earned income disregards
11.35and deductions allowed under the state's AFDC plan as of July 16, 1996, as required
12.1by the Personal Responsibility and Work Opportunity Act of 1996 (PRWORA), Public
12.2Law 104-193, exceeds 275 percent of the federal poverty guideline will be deducted for
12.3pregnant women and infants less than one year of age.
12.4    (c) Dependent care and child support paid under court order shall be deducted from
12.5the countable income of pregnant women.
12.6    (d) (b) An infant born to a woman who was eligible for and receiving medical
12.7assistance on the date of the child's birth shall continue to be eligible for medical assistance
12.8without redetermination until the child's first birthday.
12.9EFFECTIVE DATE.This section is effective January 1, 2014.

12.10    Sec. 20. Minnesota Statutes 2012, section 256B.057, subdivision 10, is amended to read:
12.11    Subd. 10. Certain persons needing treatment for breast or cervical cancer. (a)
12.12Medical assistance may be paid for a person who:
12.13(1) has been screened for breast or cervical cancer by the Minnesota breast and
12.14cervical cancer control program, and program funds have been used to pay for the person's
12.15screening;
12.16(2) according to the person's treating health professional, needs treatment, including
12.17diagnostic services necessary to determine the extent and proper course of treatment, for
12.18breast or cervical cancer, including precancerous conditions and early stage cancer;
12.19(3) meets the income eligibility guidelines for the Minnesota breast and cervical
12.20cancer control program;
12.21(4) is under age 65;
12.22(5) is not otherwise eligible for medical assistance under United States Code, title
12.2342, section 1396a(a)(10)(A)(i); and
12.24(6) is not otherwise covered under creditable coverage, as defined under United
12.25States Code, title 42, section 1396a(aa).
12.26(b) Medical assistance provided for an eligible person under this subdivision shall
12.27be limited to services provided during the period that the person receives treatment for
12.28breast or cervical cancer.
12.29(c) A person meeting the criteria in paragraph (a) is eligible for medical assistance
12.30without meeting the eligibility criteria relating to income and assets in section 256B.056,
12.31subdivisions 1a to 5b 5a.

12.32    Sec. 21. Minnesota Statutes 2012, section 256B.057, is amended by adding a
12.33subdivision to read:
13.1    Subd. 12. Presumptive eligibility determinations made by qualified hospitals.
13.2The commissioner shall establish a process to qualify hospitals that are participating
13.3providers under the medical assistance program to determine presumptive eligibility for
13.4medical assistance for applicants who may have a basis of eligibility using the modified
13.5adjusted gross income methodology as defined in section 256B.056, subdivision 1a,
13.6paragraph (b), clause (1).
13.7EFFECTIVE DATE.This section is effective January 1, 2014.

13.8    Sec. 22. Minnesota Statutes 2012, section 256B.059, subdivision 1, is amended to read:
13.9    Subdivision 1. Definitions. (a) For purposes of this section and sections 256B.058
13.10and 256B.0595, the terms defined in this subdivision have the meanings given them.
13.11    (b) "Community spouse" means the spouse of an institutionalized spouse.
13.12    (c) "Spousal share" means one-half of the total value of all assets, to the extent that
13.13either the institutionalized spouse or the community spouse had an ownership interest at
13.14the time of the first continuous period of institutionalization.
13.15    (d) "Assets otherwise available to the community spouse" means assets individually
13.16or jointly owned by the community spouse, other than assets excluded by subdivision 5,
13.17paragraph (c).
13.18    (e) "Community spouse asset allowance" is the value of assets that can be transferred
13.19under subdivision 3.
13.20    (f) "Institutionalized spouse" means a person who is:
13.21    (1) in a hospital, nursing facility, or intermediate care facility for persons with
13.22developmental disabilities, or receiving home and community-based services under section
13.23256B.0915 , 256B.092, or 256B.49 and is expected to remain in the facility or institution
13.24or receive the home and community-based services for at least 30 consecutive days; and
13.25    (2) married to a person who is not in a hospital, nursing facility, or intermediate
13.26care facility for persons with developmental disabilities, and is not receiving home and
13.27community-based services under section 256B.0915, 256B.092, or 256B.49.
13.28    (g) "For the sole benefit of" means no other individual or entity can benefit in any
13.29way from the assets or income at the time of a transfer or at any time in the future.
13.30    (h) "Continuous period of institutionalization" means a 30-consecutive-day period
13.31of time in which a person is expected to stay in a medical or long-term care facility, or
13.32receive home and community-based services that would qualify for coverage under the
13.33elderly waiver (EW) or alternative care (AC) programs section 256B.0913, 256B.0915,
13.34256B.092, or 256B.49. For a stay in a facility, the 30-consecutive-day period begins
13.35on the date of entry into a medical or long-term care facility. For receipt of home and
14.1community-based services, the 30-consecutive-day period begins on the date that the
14.2following conditions are met:
14.3    (1) the person is receiving services that meet the nursing facility level of care
14.4determined by a long-term care consultation;
14.5    (2) the person has received the long-term care consultation within the past 60 days;
14.6    (3) the services are paid by the EW program under section 256B.0915 or the AC
14.7program under section 256B.0913, 256B.0915, 256B.092, or 256B.49 or would qualify
14.8for payment under the EW or AC programs those sections if the person were otherwise
14.9eligible for either program, and but for the receipt of such services the person would have
14.10resided in a nursing facility; and
14.11    (4) the services are provided by a licensed provider qualified to provide home and
14.12community-based services.
14.13EFFECTIVE DATE.This section is effective January 1, 2014.

14.14    Sec. 23. Minnesota Statutes 2012, section 256B.06, subdivision 4, is amended to read:
14.15    Subd. 4. Citizenship requirements. (a) Eligibility for medical assistance is limited
14.16to citizens of the United States, qualified noncitizens as defined in this subdivision, and
14.17other persons residing lawfully in the United States. Citizens or nationals of the United
14.18States must cooperate in obtaining satisfactory documentary evidence of citizenship or
14.19nationality according to the requirements of the federal Deficit Reduction Act of 2005,
14.20Public Law 109-171.
14.21(b) "Qualified noncitizen" means a person who meets one of the following
14.22immigration criteria:
14.23(1) admitted for lawful permanent residence according to United States Code, title 8;
14.24(2) admitted to the United States as a refugee according to United States Code,
14.25title 8, section 1157;
14.26(3) granted asylum according to United States Code, title 8, section 1158;
14.27(4) granted withholding of deportation according to United States Code, title 8,
14.28section 1253(h);
14.29(5) paroled for a period of at least one year according to United States Code, title 8,
14.30section 1182(d)(5);
14.31(6) granted conditional entrant status according to United States Code, title 8,
14.32section 1153(a)(7);
14.33(7) determined to be a battered noncitizen by the United States Attorney General
14.34according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
14.35title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
15.1(8) is a child of a noncitizen determined to be a battered noncitizen by the United
15.2States Attorney General according to the Illegal Immigration Reform and Immigrant
15.3Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill,
15.4Public Law 104-200; or
15.5(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
15.6Law 96-422, the Refugee Education Assistance Act of 1980.
15.7(c) All qualified noncitizens who were residing in the United States before August
15.822, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for
15.9medical assistance with federal financial participation.
15.10(d) Beginning December 1, 1996, qualified noncitizens who entered the United
15.11States on or after August 22, 1996, and who otherwise meet the eligibility requirements
15.12of this chapter are eligible for medical assistance with federal participation for five years
15.13if they meet one of the following criteria:
15.14(1) refugees admitted to the United States according to United States Code, title 8,
15.15section 1157;
15.16(2) persons granted asylum according to United States Code, title 8, section 1158;
15.17(3) persons granted withholding of deportation according to United States Code,
15.18title 8, section 1253(h);
15.19(4) veterans of the United States armed forces with an honorable discharge for
15.20a reason other than noncitizen status, their spouses and unmarried minor dependent
15.21children; or
15.22(5) persons on active duty in the United States armed forces, other than for training,
15.23their spouses and unmarried minor dependent children.
15.24 Beginning July 1, 2010, children and pregnant women who are noncitizens
15.25described in paragraph (b) or who are lawfully present in the United States as defined
15.26in Code of Federal Regulations, title 8, section 103.12, and who otherwise meet
15.27eligibility requirements of this chapter, are eligible for medical assistance with federal
15.28financial participation as provided by the federal Children's Health Insurance Program
15.29Reauthorization Act of 2009, Public Law 111-3.
15.30(e) Nonimmigrants who otherwise meet the eligibility requirements of this chapter
15.31are eligible for the benefits as provided in paragraphs (f) to (h). For purposes of this
15.32subdivision, a "nonimmigrant" is a person in one of the classes listed in United States
15.33Code, title 8, section 1101(a)(15).
15.34(f) Payment shall also be made for care and services that are furnished to noncitizens,
15.35regardless of immigration status, who otherwise meet the eligibility requirements of
16.1this chapter, if such care and services are necessary for the treatment of an emergency
16.2medical condition.
16.3(g) For purposes of this subdivision, the term "emergency medical condition" means
16.4a medical condition that meets the requirements of United States Code, title 42, section
16.51396b(v).
16.6(h)(1) Notwithstanding paragraph (g), services that are necessary for the treatment
16.7of an emergency medical condition are limited to the following:
16.8(i) services delivered in an emergency room or by an ambulance service licensed
16.9under chapter 144E that are directly related to the treatment of an emergency medical
16.10condition;
16.11(ii) services delivered in an inpatient hospital setting following admission from an
16.12emergency room or clinic for an acute emergency condition; and
16.13(iii) follow-up services that are directly related to the original service provided
16.14to treat the emergency medical condition and are covered by the global payment made
16.15to the provider.
16.16    (2) Services for the treatment of emergency medical conditions do not include:
16.17(i) services delivered in an emergency room or inpatient setting to treat a
16.18nonemergency condition;
16.19(ii) organ transplants, stem cell transplants, and related care;
16.20(iii) services for routine prenatal care;
16.21(iv) continuing care, including long-term care, nursing facility services, home health
16.22care, adult day care, day training, or supportive living services;
16.23(v) elective surgery;
16.24(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as
16.25part of an emergency room visit;
16.26(vii) preventative health care and family planning services;
16.27(viii) dialysis;
16.28(ix) chemotherapy or therapeutic radiation services;
16.29(x) rehabilitation services;
16.30(xi) physical, occupational, or speech therapy;
16.31(xii) transportation services;
16.32(xiii) case management;
16.33(xiv) prosthetics, orthotics, durable medical equipment, or medical supplies;
16.34(xv) dental services;
16.35(xvi) hospice care;
16.36(xvii) audiology services and hearing aids;
17.1(xviii) podiatry services;
17.2(xix) chiropractic services;
17.3(xx) immunizations;
17.4(xxi) vision services and eyeglasses;
17.5(xxii) waiver services;
17.6(xxiii) individualized education programs; or
17.7(xxiv) chemical dependency treatment.
17.8(i) Beginning July 1, 2009, Pregnant noncitizens who are undocumented,
17.9nonimmigrants, or lawfully present in the United States as defined in Code of Federal
17.10Regulations, title 8, section 103.12, ineligible for federally funded medical assistance
17.11because of immigration status are not covered by a group health plan or health insurance
17.12coverage according to Code of Federal Regulations, title 42, section 457.310, and who
17.13otherwise meet the eligibility requirements of this chapter, are eligible for medical
17.14assistance through the period of pregnancy, including labor and delivery, and 60 days
17.15postpartum, to the extent federal funds are available under title XXI of the Social Security
17.16Act, and the state children's health insurance program.
17.17(j) Beginning October 1, 2003, persons who are receiving care and rehabilitation
17.18services from a nonprofit center established to serve victims of torture and are otherwise
17.19ineligible for medical assistance under this chapter are eligible for medical assistance
17.20without federal financial participation. These individuals are eligible only for the period
17.21during which they are receiving services from the center. Individuals eligible under this
17.22paragraph shall not be required to participate in prepaid medical assistance.
17.23EFFECTIVE DATE.This section is effective January 1, 2014.

17.24    Sec. 24. Minnesota Statutes 2012, section 256B.0755, subdivision 3, is amended to read:
17.25    Subd. 3. Accountability. (a) Health care delivery systems must accept responsibility
17.26for the quality of care based on standards established under subdivision 1, paragraph (b),
17.27clause (10), and the cost of care or utilization of services provided to its enrollees under
17.28subdivision 1, paragraph (b), clause (1).
17.29(b) A health care delivery system may contract and coordinate with providers and
17.30clinics for the delivery of services and shall contract with community health clinics,
17.31federally qualified health centers, community mental health centers or programs, county
17.32agencies, and rural clinics to the extent practicable.
17.33(c) A health care delivery system must demonstrate how its services will be
17.34coordinated with other services affecting its attributed patients' health, quality of care, and
17.35cost of care that are provided by other providers and county agencies in the local service
18.1area. The health care delivery system must document how other providers and counties,
18.2including county-based purchasing plans, will provide services to attributed patients of
18.3the health care delivery system, and how it will address applicable local needs, priorities,
18.4and public health goals. As part of this documentation, the health care delivery system
18.5must describe the involvement of local providers and counties, including county-based
18.6purchasing plans, in developing the application to participate in the demonstration project.
18.7EFFECTIVE DATE.This section is effective July 1, 2013, and applies to health
18.8care delivery system contracts entered into or after that date.

18.9    Sec. 25. Minnesota Statutes 2012, section 256B.694, is amended to read:
18.10256B.694 SOLE-SOURCE OR SINGLE-PLAN MANAGED CARE
18.11CONTRACT.
18.12    (a) MS 2010 [Expired, 2008 c 364 s 10]
18.13    (b) The commissioner shall consider, and may approve, contracting on a
18.14single-health plan basis with other county-based purchasing plans, or with other qualified
18.15health plans that have coordination arrangements with counties, to serve persons with a
18.16disability who voluntarily enroll enrolled in state public health care programs, in order
18.17to promote better coordination or integration of health care services, social services and
18.18other community-based services, provided that all requirements applicable to health plan
18.19purchasing, including those in section 256B.69, subdivision 23, are satisfied. Nothing in
18.20this paragraph supersedes or modifies the requirements in paragraph (a).

18.21    Sec. 26. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
18.22to read:
18.23    Subd. 1b. Affordable Care Act. "Affordable Care Act" means Public Law 111-148,
18.24as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public
18.25Law 111-152), and any amendments to, or regulations or guidance issued under, those acts.

18.26    Sec. 27. Minnesota Statutes 2012, section 256L.01, subdivision 3a, is amended to read:
18.27    Subd. 3a. Family with children. (a) "Family with children" means:
18.28(1) parents and their children residing in the same household; or
18.29(2) grandparents, foster parents, relative caretakers as defined in the medical
18.30assistance program, or legal guardians; and their wards who are children residing in the
18.31same household. "Family" has the meaning given for family and family size as defined
18.32in Code of Federal Regulations, title 26, section 1.36B-1.
19.1(b) The term includes children who are temporarily absent from the household in
19.2settings such as schools, camps, or parenting time with noncustodial parents.
19.3EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
19.4approval, whichever is later. The commissioner of human services shall notify the revisor
19.5of statutes when federal approval is obtained.

19.6    Sec. 28. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
19.7to read:
19.8    Subd. 4b. Minnesota Insurance Marketplace. "Minnesota Insurance Marketplace"
19.9means the Minnesota Insurance Marketplace as defined in section 62V.02.

19.10    Sec. 29. Minnesota Statutes 2012, section 256L.01, subdivision 5, is amended to read:
19.11    Subd. 5. Income. (a) "Income" has the meaning given for earned and unearned
19.12income for families and children in the medical assistance program, according to the
19.13state's aid to families with dependent children plan in effect as of July 16, 1996. The
19.14definition does not include medical assistance income methodologies and deeming
19.15requirements. The earned income of full-time and part-time students under age 19 is
19.16not counted as income. Public assistance payments and supplemental security income
19.17are not excluded income modified adjusted gross income, as defined in Code of Federal
19.18Regulations, title 26, section 1.36B-1.
19.19(b) For purposes of this subdivision, and unless otherwise specified in this section,
19.20the commissioner shall use reasonable methods to calculate gross earned and unearned
19.21income including, but not limited to, projecting income based on income received within
19.22the past 30 days, the last 90 days, or the last 12 months.
19.23EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
19.24approval, whichever is later. The commissioner of human services shall notify the revisor
19.25of statutes when federal approval is obtained.

19.26    Sec. 30. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
19.27to read:
19.28    Subd. 8. Participating entity. "Participating entity" means a health carrier as
19.29defined in section 62A.01, subdivision 2; a county-based purchasing plan established
19.30under section 256B.692; an accountable care organization or other entity operating a
19.31health care delivery systems demonstration project authorized under section 256B.0755;
19.32an entity operating a county integrated health care delivery network pilot project
20.1authorized under section 256B.0756; or a network of health care providers established to
20.2offer services under MinnesotaCare.
20.3EFFECTIVE DATE.This section is effective January 1, 2015.

20.4    Sec. 31. Minnesota Statutes 2012, section 256L.02, subdivision 2, is amended to read:
20.5    Subd. 2. Commissioner's duties. (a) The commissioner shall establish an office
20.6for the state administration of this plan. The plan shall be used to provide covered health
20.7services for eligible persons. Payment for these services shall be made to all eligible
20.8providers participating entities under contract with the commissioner. The commissioner
20.9shall adopt rules to administer the MinnesotaCare program. The commissioner shall
20.10establish marketing efforts to encourage potentially eligible persons to receive information
20.11about the program and about other medical care programs administered or supervised by
20.12the Department of Human Services.
20.13(b) A toll-free telephone number and Web site must be used to provide information
20.14about medical programs and to promote access to the covered services.
20.15EFFECTIVE DATE.Paragraph (a) is effective January 1, 2015. Paragraph (b) is
20.16effective January 1, 2014.

20.17    Sec. 32. Minnesota Statutes 2012, section 256L.02, is amended by adding a subdivision
20.18to read:
20.19    Subd. 6. Federal approval. (a) The commissioner of human services shall seek
20.20federal approval to implement the MinnesotaCare program under this chapter as a basic
20.21health program. In any agreement with the Centers for Medicare and Medicaid Services
20.22to operate MinnesotaCare as a basic health program, the commissioner shall seek to
20.23include procedures to ensure that federal funding is predictable, stable, and sufficient
20.24to sustain ongoing operation of MinnesotaCare. These procedures must address issues
20.25related to the timing of federal payments, payment reconciliation, enrollee risk adjustment,
20.26and minimization of state financial risk. The commissioner shall consult with the
20.27commissioner of Minnesota Management and Budget, when developing the proposal for
20.28establishing MinnesotaCare as a basic health program to be submitted to the Centers for
20.29Medicare and Medicaid Services.
20.30(b) The commissioner of human services, in consultation with the commissioner
20.31of Minnesota Management and Budget, shall work with the Centers for Medicare and
20.32Medicaid Services to establish a process for reconciliation and adjustment of federal
20.33payments that balances state and federal liability over time. The commissioner of human
21.1services shall request that the United States secretary of health and human services hold
21.2the state, and enrollees, harmless in the reconciliation process for the first three years, to
21.3allow the state to develop a statistically valid methodology for predicting enrollment
21.4trends and their net effect on federal payments.
21.5(c) The commissioner of human services, through December 31, 2015, may modify
21.6the MinnesotaCare program as specified in this chapter, if it is necessary to enhance
21.7health benefits, expand provider access, or reduce cost-sharing and premiums in order
21.8to comply with the terms and conditions of federal approval as a basic health program.
21.9The commissioner may not reduce benefits, impose greater limits on access to providers,
21.10or increase cost-sharing and premiums by enrollees under the authority granted by this
21.11paragraph. If the commissioner modifies the terms and requirements for MinnesotaCare
21.12under this paragraph, the commissioner shall provide the legislature with notice of
21.13implementation of the modifications at least ten working days before notifying enrollees
21.14and participating entities. The costs of any changes to the program necessary to comply
21.15with federal approval shall not become part of the program's base funding for purposes of
21.16future budget forecasts.
21.17EFFECTIVE DATE.This section is effective the day following final enactment.

21.18    Sec. 33. Minnesota Statutes 2012, section 256L.02, is amended by adding a subdivision
21.19to read:
21.20    Subd. 7. Coordination with Minnesota Insurance Marketplace. MinnesotaCare
21.21shall be considered a public health care program for purposes of chapter 62V.
21.22EFFECTIVE DATE.This section is effective January 1, 2014.

21.23    Sec. 34. Minnesota Statutes 2012, section 256L.03, subdivision 1, is amended to read:
21.24    Subdivision 1. Covered health services. (a) "Covered health services" means the
21.25health services reimbursed under chapter 256B, with the exception of inpatient hospital
21.26services, special education services, private duty nursing services, adult dental care
21.27services other than services covered under section 256B.0625, subdivision 9, orthodontic
21.28services, nonemergency medical transportation services, personal care assistance and case
21.29management services, and nursing home or intermediate care facilities services, inpatient
21.30mental health services, and chemical dependency services.
21.31    (b) No public funds shall be used for coverage of abortion under MinnesotaCare
21.32except where the life of the female would be endangered or substantial and irreversible
22.1impairment of a major bodily function would result if the fetus were carried to term; or
22.2where the pregnancy is the result of rape or incest.
22.3    (c) Covered health services shall be expanded as provided in this section.
22.4EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
22.5approval, whichever is later. The commissioner of human services shall notify the revisor
22.6of statutes when federal approval is obtained.

22.7    Sec. 35. Minnesota Statutes 2012, section 256L.03, subdivision 1a, is amended to read:
22.8    Subd. 1a. Pregnant women and Children; MinnesotaCare health care reform
22.9waiver. Beginning January 1, 1999, Children and pregnant women are eligible for coverage
22.10of all services that are eligible for reimbursement under the medical assistance program
22.11according to chapter 256B, except that abortion services under MinnesotaCare shall be
22.12limited as provided under subdivision 1. Pregnant women and Children are exempt from
22.13the provisions of subdivision 5, regarding co-payments. Pregnant women and Children
22.14who are lawfully residing in the United States but who are not "qualified noncitizens" under
22.15title IV of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996,
22.16Public Law 104-193, Statutes at Large, volume 110, page 2105, are eligible for coverage
22.17of all services provided under the medical assistance program according to chapter 256B.
22.18EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
22.19approval, whichever is later. The commissioner of human services shall notify the revisor
22.20of statutes when federal approval is obtained.

22.21    Sec. 36. Minnesota Statutes 2012, section 256L.03, subdivision 3, is amended to read:
22.22    Subd. 3. Inpatient hospital services. (a) Covered health services shall include
22.23inpatient hospital services, including inpatient hospital mental health services and inpatient
22.24hospital and residential chemical dependency treatment, subject to those limitations
22.25necessary to coordinate the provision of these services with eligibility under the medical
22.26assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under
22.27section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and
22.282 , with family gross income that exceeds 200 percent of the federal poverty guidelines or
22.29215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not
22.30pregnant, is subject to an annual limit of $10,000.
22.31    (b) Admissions for inpatient hospital services paid for under section 256L.11,
22.32subdivision 3 , must be certified as medically necessary in accordance with Minnesota
22.33Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):
23.1    (1) all admissions must be certified, except those authorized under rules established
23.2under section 254A.03, subdivision 3, or approved under Medicare; and
23.3    (2) payment under section 256L.11, subdivision 3, shall be reduced by five percent
23.4for admissions for which certification is requested more than 30 days after the day of
23.5admission. The hospital may not seek payment from the enrollee for the amount of the
23.6payment reduction under this clause.
23.7EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
23.8approval, whichever is later. The commissioner of human services shall notify the revisor
23.9of statutes when federal approval is obtained.

23.10    Sec. 37. Minnesota Statutes 2012, section 256L.03, is amended by adding a subdivision
23.11to read:
23.12    Subd. 4b. Loss ratio. Health coverage provided through the MinnesotaCare
23.13program must have a medical loss ratio of at least 85 percent, as defined using the loss
23.14ratio methodology described in section 1001 of the Affordable Care Act.
23.15EFFECTIVE DATE.This section is effective January 1, 2015.

23.16    Sec. 38. Minnesota Statutes 2012, section 256L.03, subdivision 5, is amended to read:
23.17    Subd. 5. Cost-sharing. (a) Except as otherwise provided in paragraphs (b) and (c)
23.18 this subdivision, the MinnesotaCare benefit plan shall include the following cost-sharing
23.19requirements for all enrollees:
23.20    (1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
23.21subject to an annual inpatient out-of-pocket maximum of $1,000 per individual;
23.22    (2) (1) $3 per prescription for adult enrollees;
23.23    (3) (2) $25 for eyeglasses for adult enrollees;
23.24    (4) (3) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means
23.25an episode of service which is required because of a recipient's symptoms, diagnosis, or
23.26established illness, and which is delivered in an ambulatory setting by a physician or
23.27physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
23.28audiologist, optician, or optometrist;
23.29    (5) (4) $6 for nonemergency visits to a hospital-based emergency room for services
23.30provided through December 31, 2010, and $3.50 effective January 1, 2011; and
23.31(6) (5) a family deductible equal to the maximum amount allowed under Code of
23.32Federal Regulations, title 42, part 447.54.
24.1    (b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
24.2children under the age of 21.
24.3    (c) (b) Paragraph (a) does not apply to pregnant women and children under the
24.4age of 21.
24.5    (d) (c) Paragraph (a), clause (4) (3), does not apply to mental health services.
24.6    (e) Adult enrollees with family gross income that exceeds 200 percent of the federal
24.7poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009,
24.8and who are not pregnant shall be financially responsible for the coinsurance amount, if
24.9applicable, and amounts which exceed the $10,000 inpatient hospital benefit limit.
24.10    (f) When a MinnesotaCare enrollee becomes a member of a prepaid health plan,
24.11or changes from one prepaid health plan to another during a calendar year, any charges
24.12submitted towards the $10,000 annual inpatient benefit limit, and any out-of-pocket
24.13expenses incurred by the enrollee for inpatient services, that were submitted or incurred
24.14prior to enrollment, or prior to the change in health plans, shall be disregarded.
24.15(g) (d) MinnesotaCare reimbursements to fee-for-service providers and payments to
24.16managed care plans or county-based purchasing plans shall not be increased as a result of
24.17the reduction of the co-payments in paragraph (a), clause (5) (4), effective January 1, 2011.
24.18(h) (e) The commissioner, through the contracting process under section 256L.12,
24.19may allow managed care plans and county-based purchasing plans to waive the family
24.20deductible under paragraph (a), clause (6) (5). The value of the family deductible shall not
24.21be included in the capitation payment to managed care plans and county-based purchasing
24.22plans. Managed care plans and county-based purchasing plans shall certify annually to the
24.23commissioner the dollar value of the family deductible.
24.24EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
24.25approval, whichever is later. The commissioner of human services shall notify the revisor
24.26of statutes when federal approval is obtained.

24.27    Sec. 39. Minnesota Statutes 2012, section 256L.03, subdivision 6, is amended to read:
24.28    Subd. 6. Lien. When the state agency provides, pays for, or becomes liable for
24.29covered health services, the agency shall have a lien for the cost of the covered health
24.30services upon any and all causes of action accruing to the enrollee, or to the enrollee's
24.31legal representatives, as a result of the occurrence that necessitated the payment for the
24.32covered health services. All liens under this section shall be subject to the provisions
24.33of section 256.015. For purposes of this subdivision, "state agency" includes prepaid
24.34health plans participating entities, under contract with the commissioner according to
25.1sections 256B.69, 256D.03, subdivision 4, paragraph (c), and 256L.12; and county-based
25.2purchasing entities under section 256B.692 section 256L.121.
25.3EFFECTIVE DATE.This section is effective January 1, 2015.

25.4    Sec. 40. Minnesota Statutes 2012, section 256L.04, subdivision 1, is amended to read:
25.5    Subdivision 1. Families with children. (a) Families with children with family
25.6income above 133 percent of the federal poverty guidelines and equal to or less than
25.7275 200 percent of the federal poverty guidelines for the applicable family size shall be
25.8eligible for MinnesotaCare according to this section. All other provisions of sections
25.9256L.01 to 256L.18, including the insurance-related barriers to enrollment under section
25.10256L.07, shall apply unless otherwise specified.
25.11    (b) Parents who enroll in the MinnesotaCare program must also enroll their children,
25.12if the children are eligible. Children may be enrolled separately without enrollment by
25.13parents. However, if one parent in the household enrolls, both parents must enroll, unless
25.14other insurance is available. If one child from a family is enrolled, all children must
25.15be enrolled, unless other insurance is available. If one spouse in a household enrolls,
25.16the other spouse in the household must also enroll, unless other insurance is available.
25.17Families cannot choose to enroll only certain uninsured members.
25.18    (c) Beginning October 1, 2003, the dependent sibling definition no longer applies
25.19to the MinnesotaCare program. These persons are no longer counted in the parental
25.20household and may apply as a separate household.
25.21    (d) Parents are not eligible for MinnesotaCare if their gross income exceeds $57,500.
25.22(e) Children deemed eligible for MinnesotaCare under section 256L.07, subdivision
25.238 , are exempt from the eligibility requirements of this subdivision.
25.24EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
25.25approval, whichever is later. The commissioner of human services shall notify the revisor
25.26of statutes when federal approval is obtained.

25.27    Sec. 41. Minnesota Statutes 2012, section 256L.04, is amended by adding a subdivision
25.28to read:
25.29    Subd. 1c. General requirements. To be eligible for coverage under MinnesotaCare,
25.30a person must meet the eligibility requirements of this section. A person eligible for
25.31MinnesotaCare shall not be considered a qualified individual under section 1312 of the
25.32Affordable Care Act, and is not eligible for enrollment in a qualified health plan offered
25.33through the Minnesota Insurance Marketplace under chapter 62V.
26.1EFFECTIVE DATE.This section is effective January 1, 2014.

26.2    Sec. 42. Minnesota Statutes 2012, section 256L.04, subdivision 7, is amended to read:
26.3    Subd. 7. Single adults and households with no children. (a) The definition of
26.4eligible persons includes all individuals and households families with no children who
26.5have gross family incomes that are above 133 percent and equal to or less than 200 percent
26.6of the federal poverty guidelines for the applicable family size.
26.7    (b) Effective July 1, 2009, the definition of eligible persons includes all individuals
26.8and households with no children who have gross family incomes that are equal to or less
26.9than 250 percent of the federal poverty guidelines.
26.10EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
26.11approval, whichever is later. The commissioner of human services shall notify the revisor
26.12of statutes when federal approval is obtained.

26.13    Sec. 43. Minnesota Statutes 2012, section 256L.04, subdivision 8, is amended to read:
26.14    Subd. 8. Applicants potentially eligible for medical assistance. (a) Individuals
26.15who receive supplemental security income or retirement, survivors, or disability benefits
26.16due to a disability, or other disability-based pension, who qualify under subdivision 7, but
26.17who are potentially eligible for medical assistance without a spenddown shall be allowed
26.18to enroll in MinnesotaCare for a period of 60 days, so long as the applicant meets all other
26.19conditions of eligibility. The commissioner shall identify and refer the applications of
26.20such individuals to their county social service agency. The county and the commissioner
26.21shall cooperate to ensure that the individuals obtain medical assistance coverage for any
26.22months for which they are eligible.
26.23(b) The enrollee must cooperate with the county social service agency in determining
26.24medical assistance eligibility within the 60-day enrollment period. Enrollees who do not
26.25cooperate with medical assistance within the 60-day enrollment period shall be disenrolled
26.26from the plan within one calendar month. Persons disenrolled for nonapplication for
26.27medical assistance may not reenroll until they have obtained a medical assistance
26.28eligibility determination. Persons disenrolled for noncooperation with medical assistance
26.29may not reenroll until they have cooperated with the county agency and have obtained a
26.30medical assistance eligibility determination.
26.31(c) Beginning January 1, 2000, Counties that choose to become MinnesotaCare
26.32enrollment sites shall consider MinnesotaCare applications to also be applications for
26.33medical assistance. Applicants who are potentially eligible for medical assistance, except
27.1for those described in paragraph (a), may choose to enroll in either MinnesotaCare or
27.2medical assistance.
27.3(d) The commissioner shall redetermine provider payments made under
27.4MinnesotaCare to the appropriate medical assistance payments for those enrollees who
27.5subsequently become eligible for medical assistance.
27.6EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
27.7approval, whichever is later. The commissioner of human services shall notify the revisor
27.8of statutes when federal approval is obtained.

27.9    Sec. 44. Minnesota Statutes 2012, section 256L.04, subdivision 10, is amended to read:
27.10    Subd. 10. Citizenship requirements. (a) Eligibility for MinnesotaCare is limited to
27.11citizens or nationals of the United States, qualified noncitizens, and other persons residing
27.12 lawfully in the United States present noncitizens as defined in Code of Federal Regulations,
27.13title 8, section 103.12. Undocumented noncitizens and nonimmigrants are ineligible for
27.14MinnesotaCare. For purposes of this subdivision, a nonimmigrant is an individual in one
27.15or more of the classes listed in United States Code, title 8, section 1101(a)(15), and an
27.16undocumented noncitizen is an individual who resides in the United States without the
27.17approval or acquiescence of the United States Citizenship and Immigration Services.
27.18Families with children who are citizens or nationals of the United States must cooperate in
27.19obtaining satisfactory documentary evidence of citizenship or nationality according to the
27.20requirements of the federal Deficit Reduction Act of 2005, Public Law 109-171.
27.21(b) Notwithstanding subdivisions 1 and 7, eligible persons include families and
27.22individuals who are lawfully present and ineligible for medical assistance by reason of
27.23immigration status and who have incomes equal to or less than 200 percent of federal
27.24poverty guidelines.
27.25EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
27.26approval, whichever is later. The commissioner of human services shall notify the revisor
27.27of statutes when federal approval is obtained.

27.28    Sec. 45. Minnesota Statutes 2012, section 256L.04, subdivision 12, is amended to read:
27.29    Subd. 12. Persons in detention. Beginning January 1, 1999, An applicant or
27.30enrollee residing in a correctional or detention facility is not eligible for MinnesotaCare,
27.31unless the applicant or enrollee is awaiting disposition of charges. An enrollee residing in
27.32a correctional or detention facility is not eligible at renewal of eligibility under section
27.33256L.05, subdivision 3a.
28.1EFFECTIVE DATE.This section is effective January 1, 2014.

28.2    Sec. 46. Minnesota Statutes 2012, section 256L.04, is amended by adding a subdivision
28.3to read:
28.4    Subd. 14. Coordination with medical assistance. (a) Individuals eligible for
28.5medical assistance under chapter 256B are not eligible for MinnesotaCare under this
28.6section.
28.7(b) The commissioner shall coordinate eligibility and coverage to ensure that
28.8individuals transitioning between medical assistance and MinnesotaCare have seamless
28.9eligibility and access to health care services.
28.10EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
28.11approval, whichever is later. The commissioner of human services shall notify the revisor
28.12of statutes when federal approval is obtained.

28.13    Sec. 47. Minnesota Statutes 2012, section 256L.05, subdivision 1, is amended to read:
28.14    Subdivision 1. Application assistance and information availability. (a) Applicants
28.15may submit applications online, in person, by mail, or by phone in accordance with the
28.16Affordable Care Act, and by any other means by which medical assistance applications
28.17may be submitted. Applicants may submit applications through the Minnesota Insurance
28.18Marketplace or through the MinnesotaCare program. Applications and application
28.19assistance must be made available at provider offices, local human services agencies,
28.20school districts, public and private elementary schools in which 25 percent or more of
28.21the students receive free or reduced price lunches, community health offices, Women,
28.22Infants and Children (WIC) program sites, Head Start program sites, public housing
28.23councils, crisis nurseries, child care centers, early childhood education and preschool
28.24program sites, legal aid offices, and libraries, and at any other locations at which medical
28.25assistance applications must be made available. These sites may accept applications and
28.26forward the forms to the commissioner or local county human services agencies that
28.27choose to participate as an enrollment site. Otherwise, applicants may apply directly to the
28.28commissioner or to participating local county human services agencies.
28.29(b) Application assistance must be available for applicants choosing to file an online
28.30application through the Minnesota Insurance Marketplace.
28.31EFFECTIVE DATE.This section is effective January 1, 2014.

28.32    Sec. 48. Minnesota Statutes 2012, section 256L.05, subdivision 2, is amended to read:
29.1    Subd. 2. Commissioner's duties. The commissioner or county agency shall use
29.2electronic verification through the Minnesota Insurance Marketplace as the primary
29.3method of income verification. If there is a discrepancy between reported income
29.4and electronically verified income, an individual may be required to submit additional
29.5verification to the extent permitted under the Affordable Care Act. In addition, the
29.6commissioner shall perform random audits to verify reported income and eligibility. The
29.7commissioner may execute data sharing arrangements with the Department of Revenue
29.8and any other governmental agency in order to perform income verification related to
29.9eligibility and premium payment under the MinnesotaCare program.
29.10EFFECTIVE DATE.This section is effective January 1, 2014.

29.11    Sec. 49. Minnesota Statutes 2012, section 256L.05, subdivision 3, is amended to read:
29.12    Subd. 3. Effective date of coverage. (a) The effective date of coverage is the
29.13first day of the month following the month in which eligibility is approved and the first
29.14premium payment has been received. As provided in section 256B.057, coverage for
29.15newborns is automatic from the date of birth and must be coordinated with other health
29.16coverage. The effective date of coverage for eligible newly adoptive children added to a
29.17family receiving covered health services is the month of placement. The effective date
29.18of coverage for other new members added to the family is the first day of the month
29.19following the month in which the change is reported. All eligibility criteria must be met
29.20by the family at the time the new family member is added. The income of the new family
29.21member is included with the family's modified adjusted gross income and the adjusted
29.22premium begins in the month the new family member is added.
29.23(b) The initial premium must be received by the last working day of the month for
29.24coverage to begin the first day of the following month.
29.25(c) Benefits are not available until the day following discharge if an enrollee is
29.26hospitalized on the first day of coverage.
29.27(d) (c) Notwithstanding any other law to the contrary, benefits under sections
29.28256L.01 to 256L.18 are secondary to a plan of insurance or benefit program under which
29.29an eligible person may have coverage and the commissioner shall use cost avoidance
29.30techniques to ensure coordination of any other health coverage for eligible persons. The
29.31commissioner shall identify eligible persons who may have coverage or benefits under
29.32other plans of insurance or who become eligible for medical assistance.
29.33(e) (d) The effective date of coverage for individuals or families who are exempt
29.34from paying premiums under section 256L.15, subdivision 1, paragraph (d), is the first
30.1day of the month following the month in which verification of American Indian status
30.2is received or eligibility is approved, whichever is later.
30.3(f) (e) The effective date of coverage for children eligible under section 256L.07,
30.4subdivision 8, is the first day of the month following the date of termination from foster
30.5care or release from a juvenile residential correctional facility.
30.6EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
30.7approval, whichever is later. The commissioner of human services shall notify the revisor
30.8of statutes when federal approval is obtained.

30.9    Sec. 50. Minnesota Statutes 2012, section 256L.05, subdivision 3c, is amended to read:
30.10    Subd. 3c. Retroactive coverage. Notwithstanding subdivision 3, the effective
30.11date of coverage shall be the first day of the month following termination from medical
30.12assistance for families and individuals who are eligible for MinnesotaCare and who
30.13submitted a written request for retroactive MinnesotaCare coverage with a completed
30.14application within 30 days of the mailing of notification of termination from medical
30.15assistance. The applicant must provide all required verifications within 30 days of the
30.16written request for verification. For retroactive coverage, premiums must be paid in full
30.17for any retroactive month, current month, and next month within 30 days of the premium
30.18billing. General assistance medical care recipients may qualify for retroactive coverage
30.19under this subdivision at six-month renewal.
30.20EFFECTIVE DATE.This section is effective January 1, 2014.

30.21    Sec. 51. Minnesota Statutes 2012, section 256L.06, subdivision 3, is amended to read:
30.22    Subd. 3. Commissioner's duties and payment. (a) Premiums are dedicated to the
30.23commissioner for MinnesotaCare.
30.24    (b) The commissioner shall develop and implement procedures to: (1) require
30.25enrollees to report changes in income; (2) adjust sliding scale premium payments, based
30.26upon both increases and decreases in enrollee income, at the time the change in income
30.27is reported; and (3) disenroll enrollees from MinnesotaCare for failure to pay required
30.28premiums. Failure to pay includes payment with a dishonored check, a returned automatic
30.29bank withdrawal, or a refused credit card or debit card payment. The commissioner may
30.30demand a guaranteed form of payment, including a cashier's check or a money order, as
30.31the only means to replace a dishonored, returned, or refused payment.
30.32    (c) Premiums are calculated on a calendar month basis and may be paid on a
30.33monthly, quarterly, or semiannual basis, with the first payment due upon notice from the
31.1commissioner of the premium amount required. The commissioner shall inform applicants
31.2and enrollees of these premium payment options. Premium payment is required before
31.3enrollment is complete and to maintain eligibility in MinnesotaCare. Premium payments
31.4received before noon are credited the same day. Premium payments received after noon
31.5are credited on the next working day.
31.6    (d) Nonpayment of the premium will result in disenrollment from the plan effective
31.7for the calendar month for which the premium was due. Persons disenrolled for
31.8nonpayment or who voluntarily terminate coverage from the program may not reenroll
31.9until four calendar months have elapsed. Persons disenrolled for nonpayment who pay
31.10all past due premiums as well as current premiums due, including premiums due for the
31.11period of disenrollment, within 20 days of disenrollment, shall be reenrolled retroactively
31.12to the first day of disenrollment. Persons disenrolled for nonpayment or who voluntarily
31.13terminate coverage from the program may not reenroll for four calendar months unless
31.14the person demonstrates good cause for nonpayment. Good cause does not exist if a
31.15person chooses to pay other family expenses instead of the premium. The commissioner
31.16shall define good cause in rule.
31.17EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
31.18approval, whichever is later. The commissioner of human services shall notify the revisor
31.19of statutes when federal approval is obtained.

31.20    Sec. 52. Minnesota Statutes 2012, section 256L.07, subdivision 1, is amended to read:
31.21    Subdivision 1. General requirements. (a) Children enrolled in the original
31.22children's health plan as of September 30, 1992, children who enrolled in the
31.23MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
31.24article 4, section 17, and children who have family gross incomes that are equal to or
31.25less than 200 percent of the federal poverty guidelines are eligible without meeting the
31.26requirements of subdivision 2 and the four-month requirement in subdivision 3, as long as
31.27they maintain continuous coverage in the MinnesotaCare program or medical assistance.
31.28    Parents Families and individuals enrolled in MinnesotaCare under section 256L.04,
31.29subdivision 1 , whose income increases above 275 200 percent of the federal poverty
31.30guidelines, are no longer eligible for the program and shall be disenrolled by the
31.31commissioner. Beginning January 1, 2008, Individuals enrolled in MinnesotaCare under
31.32section 256L.04, subdivision 7, whose income increases above 200 percent of the federal
31.33poverty guidelines or 250 percent of the federal poverty guidelines on or after July 1,
31.342009, are no longer eligible for the program and shall be disenrolled by the commissioner.
31.35 For persons disenrolled under this subdivision, MinnesotaCare coverage terminates the
32.1last day of the calendar month following the month in which the commissioner determines
32.2that the income of a family or individual exceeds program income limits.
32.3    (b) Children may remain enrolled in MinnesotaCare if their gross family income as
32.4defined in section 256L.01, subdivision 4, is greater than 275 percent of federal poverty
32.5guidelines. The premium for children remaining eligible under this paragraph shall be the
32.6maximum premium determined under section 256L.15, subdivision 2, paragraph (b).
32.7    (c) Notwithstanding paragraph (a), parents are not eligible for MinnesotaCare if
32.8gross household income exceeds $57,500 for the 12-month period of eligibility.
32.9EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
32.10approval, whichever is later. The commissioner of human services shall notify the revisor
32.11of statutes when federal approval is obtained.

32.12    Sec. 53. Minnesota Statutes 2012, section 256L.07, subdivision 2, is amended to read:
32.13    Subd. 2. Must not have access to employer-subsidized minimum essential
32.14 coverage. (a) To be eligible, a family or individual must not have access to subsidized
32.15health coverage through an employer and must not have had access to employer-subsidized
32.16coverage through a current employer for 18 months prior to application or reapplication.
32.17A family or individual whose employer-subsidized coverage is lost due to an employer
32.18terminating health care coverage as an employee benefit during the previous 18 months is
32.19not eligible that is affordable and provides minimum value as defined in Code of Federal
32.20Regulations, title 26, section 1.36B-2.
32.21(b) This subdivision does not apply to a family or individual who was enrolled
32.22in MinnesotaCare within six months or less of reapplication and who no longer has
32.23employer-subsidized coverage due to the employer terminating health care coverage as an
32.24employee benefit. This subdivision does not apply to children with family gross incomes
32.25that are equal to or less than 200 percent of federal poverty guidelines.
32.26(c) For purposes of this requirement, subsidized health coverage means health
32.27coverage for which the employer pays at least 50 percent of the cost of coverage for
32.28the employee or dependent, or a higher percentage as specified by the commissioner.
32.29Children are eligible for employer-subsidized coverage through either parent, including
32.30the noncustodial parent. The commissioner must treat employer contributions to Internal
32.31Revenue Code Section 125 plans and any other employer benefits intended to pay
32.32health care costs as qualified employer subsidies toward the cost of health coverage for
32.33employees for purposes of this subdivision.
33.1EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
33.2approval, whichever is later. The commissioner of human services shall notify the revisor
33.3of statutes when federal approval is obtained.

33.4    Sec. 54. Minnesota Statutes 2012, section 256L.07, subdivision 3, is amended to read:
33.5    Subd. 3. Other health coverage. (a) Families and individuals enrolled in the
33.6MinnesotaCare program must have no To be eligible, a family must not have minimum
33.7essential health coverage while enrolled, as defined by section 5000A of the Internal
33.8Revenue Code. Children with family gross incomes equal to or greater than 200 percent
33.9of federal poverty guidelines, and adults, must have had no health coverage for at least
33.10four months prior to application and renewal. Children enrolled in the original children's
33.11health plan and children in families with income equal to or less than 200 percent of the
33.12federal poverty guidelines, who have other health insurance, are eligible if the coverage:
33.13(1) lacks two or more of the following:
33.14(i) basic hospital insurance;
33.15(ii) medical-surgical insurance;
33.16(iii) prescription drug coverage;
33.17(iv) dental coverage; or
33.18(v) vision coverage;
33.19(2) requires a deductible of $100 or more per person per year; or
33.20(3) lacks coverage because the child has exceeded the maximum coverage for a
33.21particular diagnosis or the policy excludes a particular diagnosis.
33.22The commissioner may change this eligibility criterion for sliding scale premiums
33.23in order to remain within the limits of available appropriations. The requirement of no
33.24health coverage does not apply to newborns.
33.25(b) Coverage purchased as provided under section 256L.031, subdivision 2, medical
33.26assistance, and the Civilian Health and Medical Program of the Uniformed Service,
33.27CHAMPUS, or other coverage provided under United States Code, title 10, subtitle A,
33.28part II, chapter 55, are not considered insurance or health coverage for purposes of the
33.29four-month requirement described in this subdivision.
33.30(c) (b) For purposes of this subdivision, an applicant or enrollee who is entitled to
33.31Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social
33.32Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered
33.33to have minimum essential health coverage. An applicant or enrollee who is entitled to
33.34premium-free Medicare Part A may not refuse to apply for or enroll in Medicare coverage
33.35to establish eligibility for MinnesotaCare.
34.1(d) Applicants who were recipients of medical assistance within one month of
34.2application must meet the provisions of this subdivision and subdivision 2.
34.3(e) Cost-effective health insurance that was paid for by medical assistance is not
34.4considered health coverage for purposes of the four-month requirement under this
34.5section, except if the insurance continued after medical assistance no longer considered it
34.6cost-effective or after medical assistance closed.
34.7EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
34.8approval, whichever is later. The commissioner of human services shall notify the revisor
34.9of statutes when federal approval is obtained.

34.10    Sec. 55. Minnesota Statutes 2012, section 256L.09, subdivision 2, is amended to read:
34.11    Subd. 2. Residency requirement. To be eligible for health coverage under the
34.12MinnesotaCare program, pregnant women, individuals, and families with children must
34.13meet the residency requirements as provided by Code of Federal Regulations, title 42,
34.14section 435.403, except that the provisions of section 256B.056, subdivision 1, shall apply
34.15upon receipt of federal approval.
34.16EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
34.17approval, whichever is later. The commissioner of human services shall notify the revisor
34.18of statutes when federal approval is obtained.

34.19    Sec. 56. Minnesota Statutes 2012, section 256L.11, subdivision 1, is amended to read:
34.20    Subdivision 1. Medical assistance rate to be used. (a) Payment to providers
34.21under sections 256L.01 to 256L.11 this chapter shall be at the same rates and conditions
34.22established for medical assistance, except as provided in subdivisions 2 to 6 this section.
34.23(b) Effective for services provided on or after July 1, 2009, total payments for basic
34.24care services shall be reduced by three percent, in accordance with section 256B.766.
34.25Payments made to managed care and county-based purchasing plans shall be reduced for
34.26services provided on or after October 1, 2009, to reflect this reduction.
34.27(c) Effective for services provided on or after July 1, 2009, payment rates for
34.28physician and professional services shall be reduced as described under section 256B.76,
34.29subdivision 1, paragraph (c). Payments made to managed care and county-based
34.30purchasing plans shall be reduced for services provided on or after October 1, 2009,
34.31to reflect this reduction.
34.32EFFECTIVE DATE.This section is effective January 1, 2015.

35.1    Sec. 57. Minnesota Statutes 2012, section 256L.11, is amended by adding a subdivision
35.2to read:
35.3    Subd. 1a. Rate increases. Notwithstanding subdivision 1, effective for services
35.4provided on or after January 1, 2015, the commissioner shall increase payments for
35.5basic care services, physician and professional services, and dental services by three
35.6percent from the rates in effect for the MinnesotaCare program on December 31, 2014.
35.7Payments to participating entities established through the competitive process under
35.8section 256L.121 must reflect this increase.

35.9    Sec. 58. Minnesota Statutes 2012, section 256L.11, subdivision 3, is amended to read:
35.10    Subd. 3. Inpatient hospital services. Inpatient hospital services provided under
35.11section 256L.03, subdivision 3, shall be paid for as provided in subdivisions 4 to 6 at the
35.12medical assistance rate.
35.13EFFECTIVE DATE.This section is effective January 1, 2014.

35.14    Sec. 59. [256L.121] SERVICE DELIVERY.
35.15    Subdivision 1. Competitive process. The commissioner of human services shall
35.16establish a competitive process for entering into contracts with participating entities for
35.17the offering of standard health plans through MinnesotaCare. Coverage through standard
35.18health plans must be available to enrollees beginning January 1, 2015. Each standard health
35.19plan must cover the health services listed in, and meet the requirements of, section 256L.03.
35.20The competitive process must meet the requirements of section 1331 of the Affordable
35.21Care Act and be designed to ensure enrollee access to high-quality health care coverage
35.22options. The commissioner, to the extent feasible, shall seek to ensure that enrollees have
35.23a choice of coverage from more than one participating entity within a geographic area.
35.24    Subd. 2. Other requirements for participating entities. The commissioner shall
35.25require participating entities, as a condition of contract, to document to the commissioner:
35.26(1) the provision of culturally and linguistically appropriate services, including
35.27marketing materials, to MinnesotaCare enrollees; and
35.28(2) the inclusion in provider networks of providers designated as essential
35.29community providers under section 62Q.19.
35.30    Subd. 3. Coordination with state-administered health programs. The
35.31commissioner shall coordinate the administration of the MinnesotaCare program with
35.32medical assistance to maximize efficiency and improve the continuity of care. This
35.33includes, but is not limited to:
36.1(1) establishing geographic areas for MinnesotaCare that are consistent with the
36.2geographic areas of the medical assistance program, within which participating entities
36.3may offer health plans;
36.4(2) requiring, as a condition of participation in MinnesotaCare, participating entities
36.5to also participate in the medical assistance program;
36.6(3) providing MinnesotaCare enrollees, to the extent possible, with the option to
36.7remain in the same health plan and provider network, if they later become eligible for
36.8medical assistance or coverage through the Minnesota Insurance Marketplace; and
36.9(4) establishing requirements and criteria for selection that ensure that covered
36.10health care services will be coordinated with local public health, social services, long-term
36.11care services, mental health services, and other local services affecting enrollees' health,
36.12access, and quality of care.
36.13EFFECTIVE DATE.This section is effective the day following final enactment.

36.14    Sec. 60. Minnesota Statutes 2012, section 256L.15, subdivision 1, is amended to read:
36.15    Subdivision 1. Premium determination. (a) Families with children and individuals
36.16shall pay a premium determined according to subdivision 2.
36.17    (b) Pregnant women and children under age two are exempt from the provisions
36.18of section 256L.06, subdivision 3, paragraph (b), clause (3), requiring disenrollment
36.19for failure to pay premiums. For pregnant women, this exemption continues until the
36.20first day of the month following the 60th day postpartum. Women who remain enrolled
36.21during pregnancy or the postpartum period, despite nonpayment of premiums, shall be
36.22disenrolled on the first of the month following the 60th day postpartum for the penalty
36.23period that otherwise applies under section 256L.06, unless they begin paying premiums.
36.24    (c) (b) Members of the military and their families who meet the eligibility criteria
36.25for MinnesotaCare upon eligibility approval made within 24 months following the end
36.26of the member's tour of active duty shall have their premiums paid by the commissioner.
36.27The effective date of coverage for an individual or family who meets the criteria of this
36.28paragraph shall be the first day of the month following the month in which eligibility is
36.29approved. This exemption applies for 12 months.
36.30(d) (c) Beginning July 1, 2009, American Indians enrolled in MinnesotaCare and
36.31their families shall have their premiums waived by the commissioner in accordance with
36.32section 5006 of the American Recovery and Reinvestment Act of 2009, Public Law 111-5.
36.33An individual must document status as an American Indian, as defined under Code of
36.34Federal Regulations, title 42, section 447.50, to qualify for the waiver of premiums.
37.1EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
37.2approval, whichever is later. The commissioner of human services shall notify the revisor
37.3of statutes when federal approval is obtained.

37.4    Sec. 61. Minnesota Statutes 2012, section 256L.15, subdivision 2, is amended to read:
37.5    Subd. 2. Sliding fee scale; monthly gross individual or family income. (a) The
37.6commissioner shall establish a sliding fee scale to determine the percentage of monthly
37.7gross individual or family income that households at different income levels must pay to
37.8obtain coverage through the MinnesotaCare program. The sliding fee scale must be based
37.9on the enrollee's monthly gross individual or family income. The sliding fee scale must
37.10contain separate tables based on enrollment of one, two, or three or more persons. Until
37.11June 30, 2009, the sliding fee scale begins with a premium of 1.5 percent of monthly gross
37.12individual or family income for individuals or families with incomes below the limits for
37.13the medical assistance program for families and children in effect on January 1, 1999, and
37.14proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and
37.158.8 percent. These percentages are matched to evenly spaced income steps ranging from
37.16the medical assistance income limit for families and children in effect on January 1, 1999,
37.17to 275 200 percent of the federal poverty guidelines for the applicable family size, up to a
37.18family size of five. The sliding fee scale for a family of five must be used for families of
37.19more than five. The sliding fee scale and percentages are not subject to the provisions of
37.20chapter 14. If a family or individual reports increased income after enrollment, premiums
37.21shall be adjusted at the time the change in income is reported.
37.22    (b) Children in families whose gross income is above 275 percent of the federal
37.23poverty guidelines shall pay the maximum premium. The maximum premium is defined
37.24as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare
37.25cases paid the maximum premium, the total revenue would equal the total cost of
37.26MinnesotaCare medical coverage and administration. In this calculation, administrative
37.27costs shall be assumed to equal ten percent of the total. The costs of medical coverage
37.28for pregnant women and children under age two and the enrollees in these groups shall
37.29be excluded from the total. The maximum premium for two enrollees shall be twice the
37.30maximum premium for one, and the maximum premium for three or more enrollees shall
37.31be three times the maximum premium for one.
37.32    (c) Beginning July 1, 2009, (b) MinnesotaCare enrollees shall pay premiums
37.33according to the premium scale specified in paragraph (d) (c), with the exception that
37.34children in families with income at or below 200 percent of the federal poverty guidelines
38.1shall pay no premiums. For purposes of paragraph (d) (c), "minimum" means a monthly
38.2premium of $4.
38.3    (d) the following premium scale is established for individuals and families with
38.4gross family incomes of 275 percent of the federal poverty guidelines or less:

38.5	Federal Poverty Guideline Range	Percent of Average Gross Monthly Income
38.6	0-45%	minimum
38.7 38.8	46-54%	$4 or 1.1% of family income, whichever is greater
38.9	55-81%	1.6%
38.10	82-109%	2.2%
38.11	110-136%	2.9%
38.12	137-164%	3.6%
38.13	165-191%	4.6%
38.14	192-219%	5.6%
38.15	220-248%	6.5%
38.16	249-275%	7.2%

38.17(c) Effective January 1, 2014, the following premium scale is established for
38.18individuals and families with incomes of 200 percent of federal poverty guidelines or less:

38.19	Federal Poverty Guideline Range	Percent of Average Gross Monthly Income
38.20	0-45%	minimum
38.21 38.22	46-54%	$4 or .25% of family income, whichever is greater
38.23	55-81%	.5%
38.24	82-109%	1.0%
38.25	110-136%	1.5%
38.26	137-164%	2.0%
38.27	165-191%	2.5%
38.28	192-200%	3.0%

38.29EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
38.30approval, whichever is later. The commissioner of human services shall notify the revisor
38.31of statutes when federal approval is obtained.

38.32    Sec. 62. Laws 2013, chapter 1, section 1, is amended to read:
38.33    Section 1. Minnesota Statutes 2012, section 256B.02, is amended by adding a
38.34subdivision to read:
38.35    Subd. 17. Affordable Care Act or ACA. "Affordable Care Act" or "ACA" means
38.36Public Law 111-148, as amended by the federal Health Care and Education Reconciliation
38.37Act of 2010 (Public Law 111-152), and any amendments to, or regulations or guidance
38.38issued under, those acts.
39.1EFFECTIVE DATE.This section is effective July 1, 2013.

39.2    Sec. 63. DETERMINATION OF FUNDING ADEQUACY FOR
39.3MINNESOTACARE.
39.4The commissioners of revenue and Minnesota Management and Budget, in
39.5consultation with the commissioner of human services, shall conduct an assessment of
39.6health care taxes, including the gross premiums tax, the provider tax, and Medicaid
39.7surcharges, and their relationship to the long-term solvency of the health care access
39.8fund, as part of the state revenue and expenditure forecast in November 2013. The
39.9commissioners shall determine the amount of state funding that will be required after
39.10December 31, 2019, in addition to the federal payments made available under section 1331
39.11of the Affordable Care Act, for the MinnesotaCare program. The commissioners shall
39.12evaluate the stability and likelihood of long-term federal funding for the MinnesotaCare
39.13program under section 1331. The commissioners shall report the results of this
39.14assessment to the chairs and ranking minority members of the legislative committees with
39.15jurisdiction over human services, finances, and taxes by January 15, 2014, along with
39.16recommendations for changes to state revenue for the health care access fund, if state
39.17funding continues to be required beyond December 31, 2019.

39.18    Sec. 64. REVISOR'S INSTRUCTION.
39.19The revisor shall remove cross-references to the sections repealed in this act
39.20wherever they appear in Minnesota Statutes and Minnesota Rules and make changes
39.21necessary to correct the punctuation, grammar, or structure of the remaining text and
39.22preserve its meaning.

39.23    Sec. 65. REPEALER.
39.24(a) Minnesota Statutes 2012, sections 256L.01, subdivision 4a; 256L.02, subdivision
39.253; 256L.031; 256L.04, subdivisions 1b, 7a, and 9; and 256L.11, subdivisions 2a, 5, and
39.266, are repealed, effective January 1, 2014.
39.27(b) Minnesota Statutes 2012, sections 256L.01, subdivisions 3 and 3a; 256L.03,
39.28subdivisions 3 and 4; 256L.04, subdivisions 1b and 2a; 256L.07, subdivisions 1, 4, 5, 8,
39.29and 9; 256L.09, subdivisions 1, 4, 5, 6, and 7; 256L.11, subdivisions 2a and 6; 256L.12,
39.30subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9a, and 9b; and 256L.17, subdivisions 1, 2, 3, 4, and
39.315, are repealed effective January 1, 2015.
39.32(c) Minnesota Statutes 2012, sections 256B.055, subdivisions 3, 5, and 10b;
39.33256B.056, subdivision 5b; and 256B.057, subdivisions 1c and 2, are repealed.