,,ii #aaf? ,,congress #a/ ,session ,s4 #hgc ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,m>* #bf1 #bjai,mr4 ,br[n 7= himself1 ,ms4 ,baldw91 ,ms4 ,w>r51 & ,mr4 ,:iteh\se7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to am5d titles ,,xix & ,,xxi ( ! ,social ,security ,act to provide = #ab-mon? cont9u\s enrollm5t "u ,m$icaid & ! ,*ildr5's ,heal? ,insurance ,program1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,/abilize ,m$icaid & ,,*ip ,cov]age ,act ( #bjai4 #b4 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,e ye> millions ( p are enroll$ 9 ,m$icaid & ! ,*ildr5's ,heal? ,insurance ,program 79 ?is section ref]r$ to z ,,*ip71 b subsequ5tly lose _! cov]age1 despite /ill be+ eligible1 because ( ineffici5t & cumb]some pap]work & logi/ical requirem5ts4 7#b7 ,data %[ t ! typical enrollee receives ,m$icaid cov]age = ab\t #c_/d ( ! ye> & t cov]age p]iods are l[] = non-eld]ly1 non-disabl$ adults ?an = ^? ) disabilities1 s5iors1 & *ildr54 7#c7 ,m$icaid enrollees ) cov]age disruption are m likely to be hospitaliz$ = illnesses1 l a/hma1 diabetes1 or c>diovascul> disease1 t c be effectively manag$ ?r\gh ongo+ prim>y m$ical c>e & m$ication1 are less likely to be scre5$ = brea/ canc]1 & may h poor] canc] outcomes4 7#d7 ,*ildr5 enroll$ 9 ,,*ip also exp]i5ce disruptions 9 heal? cov]age & c>e4 ,= example1 dur+ j a #a-ye> p]iod1 ov] #a_/c ( ,,*ip enrollees 7 also enroll$ 9 a ,/ate's ,m$icaid program4 ,transitions betwe5 ,m$icaid & ,,*ip c cause disruptions 9 c>e because ! heal? c>e cov]age & p>ticipat+ provid]s v>y betwe5 ! two programs4 7#e7 ,int]ruptions 9 cov]age c impair ! receipt ( effective prim>y c>e & lead to exp5sive hospitalizations or em]g5cy room visits4 7#f7 ,unnecess>y enrollm5t1 dis5rollm5t1 & re5rollm5t 9 ,m$icaid & ,,*ip result 9 high] adm9i/rative exp5ses = re5rollm5t & result 9 m p un9sur$ at any giv5 "t4 7#g7 ,/able cov]age "u ,m$icaid & ,,*ip l[]s av]age mon?ly m$ical co/s4 ,cont9u\s enrollm5t also p]mits bett] prev5tion & disease managem5t1 lead+ to few] s]i\s illnesses & hospitalizations4 7#h7 ,*ildr5 ) /able cov]age are less likely to h unmet m$ical ne$s1 all[+ *ildr5 to receive ! prev5tive c>e t is necess>y to help !m gr[ into heal?y adults4 #c4 #ab-mon? cont9u\s enrollm5t 7a7 ,requirem5t ( #ab-,mon? cont9u\s enrollm5t "u m$icaid 7#a7 ,9 g5]al ,section #aijb7;e77#ab7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e771 is am5d$ to read z foll[s3 7#ab7 #ab-mon? cont9u\s enrollm5t 7,a7 ,9 g5]al ,not)/&+ any o!r provision ( ?is title1 a ,/ate plan approv$ "u ?is title or "u any waiv] ( su* plan approv$ pursuant to section #aaae or section #aiae1 %all provide t an individual :o is det]m9$ to be eligible = b5efits "u su* plan 7or waiv]7 %all be consid]$ to meet ! eligibility requirem5ts met on ! date ( application & %all rema9 eligible & enroll$ = su* b5efits ?r\gh ! end ( ! mon? 9 :i* ! #ab-mon? p]iod 7beg9n+ on ! date ( det]m9ation ( eligibility7 ends4 7,b7 ,promot+ ret5tion ( eligible & enroll$ p]sons beyond #ab mon?s ,! ,secret>y %all-- 7i7 id5tify me?ods t promote ! ret5tion ( individuals :o are enroll$ "u ! ,/ate plan or "u a waiv] ( su* plan & :o rema9 eligible = m$ical assi/ance beyond ! #ab-mon? p]iod describ$ 9 subp>agraph 7,a72 & 7ii7 actively promote ! adoption ( su* enrollm5t ret5tion me?ods by ,/ates1 :i* %all include1 b n be limit$ to1 issu+ guidance & develop+ res\rces on ,/ate be/ practices4 7,c7 ,enrollm5t & ret5tion report+ 7i7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,/abilize ,m$icaid & ,,*ip ,cov]age ,act ( #bjai1 ! ,secret>y %all publi% ! proc$ures t ,/ates are expect$ to use to provide annual enrollm5t & ret5tion reports beg9n+ n lat] ?an #b ye>s aft] ! date ( enactm5t ( su* ,act4 7ii7 ,/ate report+ requirem5ts ,at a m9imum1 ! report+ proc$ures publi%$ "u clause 7i7 %all include a description ( ,/ate eligibility crit]ia & enrollm5t proc$ures "u ?is title & data reg>d+ enrollm5t & ret5tion us+ /&>diz$ report+ =mats det]m9$ by ! ,secret>y4 7iii7 ,secret>y report & publication 7,i7 ,9 g5]al ,! ,secret>y annually %all publi% enrollm5t & ret5tion p]=mance results = all ,/ates n lat] ?an #f mon?s aft] ! deadl9e = ea* annual ,/ate enrollm5t & ret5tion report+ p]iod4 7,,ii7 ,e/imat$ enrollm5t cont9uity ratios ,ea* annual report publi%$ by ! ,secret>y "u subclause 7,i7 %all include e/imates ( ,m$icaid enrollm5t cont9uity ratios = ea* ,/ate 9 accordance ) ! requirem5ts ( subclause 7,,iii74 7,,iii7 ,requirem5ts ,! ,secret>y %all develop bo? ov]all enrollm5t cont9uity ratios = all enrollees & sep>ate enrollm5t cont9uity ratios = ea* ( ! foll[+ categories3 7aa7 ,*ildr54 7bb7 ,individuals ^: eligibility category is relat$ to hav+ atta9$ age #fe4 7cc7 ,individuals ^: eligibility category is relat$ to disability or bl9dness4 7dd7 ,individuals ^: eligibility category is relat$ to _! /atus z p>5ts & c>etak] relatives ( *ildr5 "u #ai or :o are o!rwise n eld]ly1 bl9d or disabl$ adults4 4 7b7 ,requirem5t ( #ab-,mon? cont9u\s enrollm5t "u ,,*ip 7#a7 ,9 g5]al ,section #bajb7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;bb7b77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#f7 ,requirem5t = #ab-mon? cont9u\s enrollm5t ,not)/&+ any o!r provision ( ?is title1 a ,/ate *ild heal? plan t provides *ild heal? assi/ance "u ?is title ?r\gh a means o!r ?an t describ$ 9 section #baja7;a77#b71 %all provide t an individual :o is det]m9$ to be eligible = b5efits "u su* plan %all be consid]$ to meet ! eligibility requirem5ts met on ! date ( application & %all rema9 eligible & enroll$ = su* b5efits ?r\gh ! end ( ! mon? 9 :i* ! #ab-mon? p]iod 7beg9n+ on ! date ( det]m9ation ( eligibility7 ends4 4 7#b7 ,con=m+ am5dm5ts 7,a7 ,enrollm5t & ret5tion provisions ,section #baje7;a77#d77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7a77#d77;,a77 is am5d$-- 7i7 by /rik+ has elect$ ! option ( & ins]t+ is 9 compliance ) ! requirem5t =2 & 7ii7 by /rik+ apply+ su* policy "u its ,/ate *ild heal? plan "u ?is title & ins]t+ 9 compliance ) section #bajb7;b74 7,b7 ,application ( m$icaid ret5tion & report+ requirem5ts ,section #bajg7;e77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77 is am5d$-- 7i7 by r$esignat+ subp>agraphs 7,g7 ?r\gh 7,s7 z subp>agraphs 7,h7 ?r\gh 7,t71 respectively2 & 7ii7 by ins]t+ aft] subp>agraph 7,f71 ! foll[+3 7,g7 ,subp>agraphs 7,b7 & 7,c7 ( section #aijb7;e77#ab7 7relat+ to promotion ( enrollm5t beyond #ab mon?s & report+ requirem5ts77)\t reg>d to items 7bb71 7cc71 & 7dd7 ( subp>agraph 7,c77iii77,,iii7 ( t section74 4 7c7 ,effective date 7#a7 ,9 g5]al ,except z provid$ 9 p>agraph 7#b7 or 7#c71 ! am5dm5ts made by subsections 7a7 & 7b7 %all apply to det]m9ations 7& r$et]m9ations7 ( eligibility made on or aft] ! date t is #ah mon?s aft] ! date ( ! enactm5t ( ?is ,act4 7#b7 ,ext5sion ( effective date = /ate law am5dm5t ,9 ! case ( a ,/ate plan "u title ,,xix or ,/ate *ild heal? plan "u title ,,xxi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq42 #db ,u4,s4,c4 #acig;aa et seq47 :i* ! ,secret>y ( ,heal? & ,human ,s]vices det]m9es requires ,/ate legislation 7o!r ?an legislation appropriat+ funds7 9 ord] = ! respective plan to meet ! additional requirem5ts impos$ by ! am5dm5ts made by subsections 7a7 or 7b71 respectively1 ! respective plan %all n be reg>d$ z fail+ to comply ) ! requirem5ts ( su* title solely on ! basis ( its failure to meet su* applicable additional requirem5ts be=e ! fir/ day ( ! fir/ cal5d> qu>t] beg9n+ aft] ! close ( ! fir/ regul> session ( ! ,/ate legislature t beg9s aft] ! date ( enactm5t ( ?is ,act4 ,= purposes ( ! previ\s s5t5ce1 9 ! case ( a ,/ate t has a #b-ye> legislative session1 ea* ye> ( ! session is consid]$ to be a sep>ate regul> session ( ! ,/ate legislature4 7#c7 ,option to implem5t #ab-mon? cont9u\s eligibility prior to effective date ,a ,/ate may elect ?r\gh a ,/ate plan am5dm5t "u title ,,xix or ,,xxi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq42 #db ,u4,s4,c4 #acig;aa et seq47 to apply ! am5dm5ts made by subsection 7a7 or 7b71 respectively1 on any date prior to ! #ah-mon? date specifi$ 9 p>agraph 7#a71 b n soon] ?an ! date ( ! enactm5t ( ?is ,act4 #d4 ,prev5t+ ! application "u *ip ( cov]age wait+ p]iods 7a7 ,9 g5]al ,section #bajb7;b77#a77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;bb7b77#a77;,b77 is am5d$-- 7#a7 9 clause 7iii7-- 7,a7 by /rik+ 9 ! case ( & ins]t+ 9 ! case ( a t>get$ l[-income *ild 7includ+ a *ild provid$ d5tal-only supplem5tal cov]age "u section #baaj7;b77#e77 or 9 ! case ( 2 & 7,b7 by add+ & aft] ! semicolon2 7#b7 by /rik+ clause 7iv72 & 7#c7 by r$esignat+ clause 7v7 z clause 7iv74 7b7 ,con=m+ am5dm5ts ,section #baje7;c77#aj7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7c77#aj77 is am5d$ by /rik+ subp>agraph 7,f7 & r$esignat+ subp>agraphs 7,g7 ?r\gh 7,m7 z subp>agraphs 7,f7 ?r\gh 7,l71 respectively4 7c7 ,effective date ,! am5dm5ts made by ?is section %all take effect on ! date ( enactm5t ( ?is ,act4 #e4 ,m$icaid p]=mance bonuses = enrollm5t & ret5tion improvem5ts = c]ta9 individuals ,section #aijc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7bb7 ,p]=mance bonuses = enrollm5t & ret5tion ( l[-,income individuals 7#a7 ,9 g5]al ,a ,/ate may qualify = p]=mance bonuses relat$ to ! enrollm5t & ret5tion ( individuals 7includ+ *ildr57 describ$ 9 section #aijb7;e77#ab77;,c77iii77,,iii74 ,= purposes ( ?is p>agraph1 a ,/ate meets ! condition ( ?is p>agraph = su* individuals if1 = ea* category ( individuals specifi$ 9 section #aijb7;e77#ab77;,c77iii77,,iii71 ! ,/ate is implem5t+ at lea/ #c ( ! foll[+ enrollm5t & ret5tion provisions 7treat+ ea* subp>agraph z a sep>ate enrollm5t & ret5tion provision7 ?r\gh\t ! entire fiscal ye>3 7,a7 ,align+ treatm5t ( income "u m$icaid ) t ( o!r insurance af=dability programs ,! ,/ate implem5ts policies1 includ+ prorat+ income ov] annual p]iods1 s z to align its treatm5t ( income = purposes ( a det]m9ation ( eligibility = m$ical assi/ance ) t ( o!r af=dability insurance programs ) ! goal ( elim9at+ inconsi/5t det]m9ations among ^! programs4 7,b7 ,ma9ta9+ cov]age = individuals dur+ p]iods ( transition ,! ,/ate implem5ts ! foll[+ policies3 7i7 ,9 g5]al ,^u det]m9ation t an individual is no long] eligible = m$ical assi/ance1 ! ,/ate implem5ts policies to ma9ta9 eligibility = m$ical assi/ance1 includ+ enrollm5t 9 ! manag$ c>e organization 9 :i* ! individual 0 enroll$ at ! "t ( ! det]m9ation ( ineligibility1 dur+ ! p]iod ( "t 9 :i*-- 7,i7 eligibility-relat$ in=mation is transmitt$ to ! o!r insurance af=dability programs2 7,,ii7 a det]m9ation is made z to = :i* o!r insurance af=dability program ! individual is eligible1 if any2 & 7,,iii7 cov]age 9 su* program & any relat$ manag$ c>e organization becomes effective4 7ii7 ,manag$ c>e organization cont9uity ,! ,/ate implem5ts policies to enroll ! individual 9 ! manag$ c>e organization 9 :i* ! individual 0 a memb] prior to ! loss ( m$ical assi/ance eligibility1 if su* manag$ c>e organization p>ticipates 9 ! o!r insurance af=dability program1 unless ! individual volunt>ily selects a sep>ate manag$ c>e organization4 7,c7 ,enhanc$ data-%>+ betwe5 ! /ate & an am]ican heal? b5efit ex*ange & ag5cies ,! ,/ate utilizes f9d+s f an ,am]ican ,heal? ,b5efit ,ex*ange1 an ,express ,lane ,ag5cy 7z id5tifi$ by ! ,/ate & z describ$ 9 section #aijb7;e77#ac77;,f771 ! ,social ,security ,adm9i/ration1 or o!r ag5cies adm9i/]+ employm5t1 educational1 or social s]vices programs z id5tifi$ by ! ,/ate1 to docum5t income1 resid5cy1 age1 or o!r relevant in=mation 9 det]m9+ or r5ew+ eligibility4 7,d7 ,eligibility bas$ on p5d+ /atus ,! ,/ate ma9ta9s eligibility = enrollees ^: r5ewal /atus has n yet be5 det]m9$ & = :om eligibility bas$ on alt]native eligibility crit]ia has n yet be5 rul$ out4 7,e7 ,default re5rollm5t 9 manag$ c>e organization ,9 ! case ( individuals :o are det]m9$ to be eligible = m$ical assi/ance "u ?is title aft] ! loss ( eligibility = few] ?an #f mon?s1 & :o previ\sly _h be5 memb]s ( a manag$ c>e organization1 ! ,/ate re-enrolls ! individual 9 ! manag$ c>e organization 9 :i* ! individual 0 a memb] prior to ! loss ( eligibility1 unless ! individual volunt>ily selects a sep>ate manag$ c>e organization4 7#b7 ,p]=mance bonus paym5t to support #ab-mon? cont9u\s enrollm5t = m$icaid enrollees 7,a7 ,au?ority to make bonus paym5ts 7i7 ,9 g5]al ,! ,secret>y %all make a bonus paym5t = fiscal ye>s beg9n+ ) ! fir/ fiscal ye> t beg9s on or aft] ! date t is #c ye>s aft] ! date ( enactm5t ( ! ,/abilize ,m$icaid & ,,*ip ,cov]age ,act ( #bjai1 & annually !reaft] to ! ext5t !re are funds available "u p>agraph 7#c77;,a71 to ea* ,/ate t satisfies ! requirem5ts ( subp>agraph 7,b74 7ii7 ,regulations ,paym5ts to ,/ates "u ?is subsection = a fiscal ye> %all be allocat$ annually among eligible ,/ates 9 accordance ) regulations promulgat$ by ! ,secret>y n lat] ?an ! date t is #f mon?s prior to ,octob] #a ( ! fir/ fiscal ye> = :i* paym5ts are made "u ?is p>agraph4 7iii7 ,tim+ ,a paym5t to a ,/ate "u ?is subsection = a fiscal ye> %all be made z a s+le paym5t n lat] ?an ! la/ day ( ! fir/ cal5d> qu>t] ( ! succe$+ fiscal ye>4 7,b7 ,/ate eligibility = bonus paym5ts ,a ,/ate %all be eligible = bonus paym5ts "u ?is subsection if-- 7i7 ! ,/ate has adopt$ at lea/ #c ( ! #e policies describ$ 9 subp>agraphs 7,a7 ?r\gh 7,e7 ( p>agraph 7#a7 = ea* category ( individuals specifi$ 9 section #aijb7;e77#ab77;,c77iii77,,iii72 & 7ii7 ! ,/ate is able to demon/rate improvem5t 9 ! cont9uity ( enrollm5t by *ild1 ag$1 bl9d1 & disabl$1 & adult populations1 comp>$ to ! ,/ate's basel9e p]=mance ) respect to cont9uity ( enrollm5t = su* populations 9 fiscal ye> #bjai or1 su* lat] ye> z ! ,secret>y1 by regulation1 %all specify4 7#c7 ,am\nts available = paym5ts 7,a7 ,9 g5]al ,! total am\nt ( bonus paym5ts made "u ?is subsection = all fiscal ye>s %all be equal to #ejj1jjj1jjj1 to be available until exp5d$4 7,b7 ,budget au?ority ,?is p>agraph con/itutes budget au?ority 9 advance ( appropriations ,acts & repres5ts ! obligation ( ! ,secret>y to provide = ! paym5t ( am\nts provid$ "u ?is p>agraph4 7#d7 ,uses ( enrollm5t & ret5tion p]=mance bonuses ,no?+ 9 ?is subsection %all prohibit a ,/ate f e/abli%+ crit]ia :i* w\ld p]mit ! ,/ate to di/ribute a portion ( ! proce$s ( any bonus paym5ts receiv$ pursuant to ?is subsection to f9ancially support provid]s & manag$ c>e entities p>ticipat+ "u ! ,/ate plan or "u a waiv] ( su* plan :o h contribut$ to improv$ enrollm5t & ret5tion activities4 4