§ 19a-754c — Covered Connecticut program. Waivers. Prior approval. Reports.

Connecticut § 19a-754c

• Jurisdiction: Connecticut
• Title 19a: Public Health and Well-Being
• Ch. 368dd: Office of Health Strategy

Text

(a) For the purposes of this section: (1) “Affordable Care Act” has the same meaning as provided in section 38a-1080 ; (2) “Covered Connecticut program” means the program established under subsection (b) of this section; (3) “Exchange” has the same meaning as provided in section 38a-1080 ; (4) “Health carrier” has the same meaning as provided in section 38a-1080 ; (5) “Individual market” has the same meaning as provided in 42 USC 18024(a), as amended from time to time; (6) “Office of Health Strategy” means the Office of Health Strategy established under section 19a-754a ; and (7) “Silver level” has the same meaning as provided in 42 USC 18022(d), as amended from time to time. (b) There is established within the Department of Social Services the Covered Connecticut program for the purpose of reducing the state's uninsured rate. The Commissioner of Social Services shall administer said program in consultation with the Office of Health Strategy, Insurance Commissioner and exchange, and, as part of said program, the Department of Social Services shall: (1) Provide premium and cost-sharing subsidies that are sufficient to ensure fully subsidized coverage: (A) On and after July 1, 2021, for parents and needy caretaker relatives, and their tax dependents not older than twenty-six years of age, who (i) are eligible for premium and cost-sharing subsidies for a qualified health plan, (ii) are ineligible for Medicaid because their income exceeds the Medicaid income limits under chapter 319v, (iii) have household income up to one hundred seventy-five per cent of the federal poverty level, (iv) are receiving coverage under a qualified health plan offered through the exchange in the individual market at a silver level of coverage, and (v) are utilizing the full amount of applicable premium subsidies for such plan; (B) On and after July 1, 2021, for the following additional family members of parents and caretaker relatives receiving coverage under such qualified health plan, provided the requirements of subparagraph (A) of subdivision (1) of this subsection are met: (i) A child over twenty-six years of age who is permanently and totally disabled, as defined by the Internal Revenue Service pursuant to 26 USC 152, or (ii) a child who is over the age of twenty-six and is incapable of self-sustaining employment by reason of mental or physical handicap and is chiefly dependent upon the parent or caretaker relative for support and maintenance, as described in sections 38a-489 and 38a-512a , or (iii) a child or stepchild receiving coverage under such qualified health plan as described in sections 38a-497 and 38a-512b ; (C) On and after July 1, 2022, for all parents, needy caretaker relatives and low-income adults who (i) are at least nineteen but not more than sixty-four years of age, (ii) are eligible for premium and cost-sharing subsidies for a qualified health plan, (iii) are ineligible for Medicaid because their income exceeds the Medicaid income limits under chapter 319v, (iv) have household income up to one hundred seventy-five per cent of the federal poverty level, (v) are receiving coverage under a qualified health plan offered through the exchange in the individual market at a silver level of coverage, and (vi) are utilizing the full amount of applicable premium subsidies for such plan; and (D) On and after July 1, 2022, for the following additional family members of parents, caretaker relatives, and adults receiving coverage under such qualified health plan, provided the requirements of subparagraph (C) of subdivision (1) of this subsection are met: (i) A child over twenty-six years of age who is permanently and totally disabled, as defined by the Internal Revenue Service pursuant to 26 USC 152, or (ii) a child who is over the age of twenty-six and is incapable of self-sustaining employment by reason of mental or physical handicap and is chiefly dependent upon the parent or caretaker relative for support and maintenance, as described in sections 38a-489 and 38a-512a , or (iii) a child or stepchild, as described in sections 38a-497 and 38a-512b . (2) Not earlier than July 1, 2022, provide dental and nonemergency medical transportation services, as provided under chapter 319v, to all eligible individuals described in subdivision (1) of this subsection; (3) Establish procedures to, on a quarterly basis, pay in reimbursement to each health carrier offering the qualified health plan described in subparagraph (A) or (B) of subdivision (1) of this subsection, as applicable, the premium and cost-sharing subsidies required under subdivision (1) of this subsection to ensure fully subsidized coverage; and (4) Consult with the Office of Health Strategy and Insurance Commissioner for the purposes set forth in section 17b-312 . (c) (1) The Office of Health Strategy may, subject to the approval required under subdivision (3) of this subsection, seek a waiver pursuant to Section 1332 of the Affordable Care Act, as amended from time to time, to advance the purpose of the Covered Connecticut program. The Office of Health Strategy shall implement such waiver if the federal government issues such waiver. (2) The Office of Health Strategy shall submit a report, in accordance with section 11-4a , to the joint standing committees of the General Assembly having cognizance of matters relating to appropriations, human services and insurance containing any proposed waiver described in subdivision (1) of this subsection before seeking such waiver from the federal government. (3) Not later than thirty days after the Office of Health Strategy submits a report under subdivision (2) of this subsection, the joint standing committees of the General Assembly having cognizance of matters relating to appropriations, human services and insurance shall convene a joint public hearing on the proposed waiver contained in the report submitted pursuant to subdivision (2) of this subsection, separately vote to approve or reject such proposed waiver and advise the Office of Health Strategy of their approval or rejection of such proposed waiver. If any committee takes no action on such proposed waiver within the thirty-day period, the proposed waiver shall be deemed rejected. (d) The benefits and subsidies provided for individuals as part of the Covered Connecticut program shall not be considered income for such individuals for the purposes of chapter 229. (e) Not later than January 1, 2022, every six months thereafter through January 1, 2024, and annually after January 1, 2024, the Commissioner of Social Services shall submit a report, in accordance with section 11-4a , to the joint standing committees of the General Assembly having cognizance of matters relating to appropriations, human services and insurance. Such report shall contain a description of the operations and finances of, and progress made by, the Covered Connecticut program for the immediately preceding reporting period. (f) Notwithstanding any provision of this section, the Covered Connecticut program shall only include in-network health care providers and in-network services, unless the health carrier's network is deemed by the Insurance Commissioner to be inadequate. Benefits described in subsection (b) of this section and cost-sharing available to all eligible individuals pursuant to subdivision (1) of subsection (b) of this section shall only apply if such eligible individuals use in-network health care providers or in-network facilities.

Legislative History

(June Sp. Sess. P.A. 21-2, S. 16; P.A. 22-118, S. 252; P.A. 24-138, S. 16.) History: June Sp. Sess. P.A. 21-2 effective June 23, 2021; P.A. 22-118 substituted Department of Social Services for Office of Health Strategy throughout, amended Subsec. (b)(1) by substituting “a qualified health plan” for “the benchmark qualified health plan” and adding clause (v) and Subpara. (B) re utilization of premium subsidies and additional qualified family members, redesignating existing Subpara. (B) as Subpara. (C) and removing “nonpregnant” before “low-income adults”, changing age limits from age 18 to 64 to age 19 to 64, inserting clause (vi) and Subpara. (D), amended Subsec. (b)(2) by substituting individuals qualified pursuant to Subdiv. (1) for parents, needy caretaker relatives and non-pregnant adults who met certain criteria and amended Subsec. (e) by eliminating six-month reports as of January 1, 2024, and requiring annual reports thereafter, effective May 7, 2022; P.A. 24-138 added Subsec. (f) re Covered Connecticut program only includes in-network providers and in-network services unless network deemed inadequate by Insurance Commissioner, and cost-sharing available under Subsec. (b)(1) only applies if eligible individuals use in-network providers or in-network facilities.