Title: Health Care Choice and Affordability Act
Policy area: Health

Summary:
Health Care Choice and Affordability Act
This bill allows a state to offer a Medicaid buy-in option for qualifying individuals on health insurance exchanges, if the state has at least one political subdivision in which fewer than two health insurers participate in such exchanges.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4128 Introduced in House (IH)]

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115th CONGRESS
  1st Session
                                H. R. 4128

  To amend title XIX of the Social Security Act to allow States with 
  Exchanges with low-insurer participation to offer a Medicaid buy-in 
                     plan, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 25, 2017

Ms. Michelle Lujan Grisham of New Mexico introduced the following bill; 
  which was referred to the Committee on Energy and Commerce, and in 
    addition to the Committee on Ways and Means, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL


 
  To amend title XIX of the Social Security Act to allow States with 
  Exchanges with low-insurer participation to offer a Medicaid buy-in 
                     plan, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited at the ``Health Care Choice and Affordability 
Act''.

SEC. 2. MEDICAID BUY-IN PLANS.

    (a) In General.--
            (1) Offering on an exchange.--For a plan year beginning on 
        or after January 1, 2018, notwithstanding any other provision 
        of law, a Medicaid buy-in State may offer to eligible 
        individuals with respect to a plan year a Medicaid buy-in plan 
        in the individual market through an Exchange established under 
        title I of the Patient Protection and Affordable Care Act for 
        such plan year.
            (2) Premium rates.--
                    (A) In general.--A Medicaid buy-in State that 
                offers a Medicaid buy-in plan under paragraph (1) shall 
                establish premium rates under such plan at a level 
                calculated to produce revenue equal to the sum of--
                            (i) the costs of health benefits provided 
                        by the plan; plus
                            (ii) 10 percent of the administrative costs 
                        related to operating the plan.
                    (B) Prohibiting discriminatory premiums.--In the 
                case of a Medicaid buy-in plan, premiums may only vary 
                to the extent permitted under section 2701(a)(1) of the 
                Public Health Service Act.
            (3) Enrollment.--The enrollment period for a Medicaid buy-
        in plan offered under paragraph (1) shall, to the extent 
        practicable, conform with the enrollment period for qualified 
        health plans offered through an Exchange.
            (4) Federal payment for administrative expenses.--In the 
        case of a Medicaid buy-in State that offers a Medicaid buy-in 
        plan under paragraph (1), the Secretary of Health and Human 
        Services shall pay to such State for each calendar quarter 
        beginning on or after January 1, 2018, an amount equal to 90 
        percent of so much of the sums expended during such quarter as 
        are attributable to administering the Medicaid buy-in plan in 
        such State.
    (b) Premium Tax Credits.--
            (1) In general.--Section 36B of the Internal Revenue Code 
        of 1986 is amended by adding at the end the following new 
        subsection:
    ``(h) Application to Individuals Purchasing Medicaid Coverage.--In 
the case of any individual enrolled in a Medicaid buy-in plan 
subsection (a) shall be applied by substituting for `premium assistance 
credit amount of the taxpayer for the taxable year' the following: `the 
lesser of--
            ```(1) the monthly premiums charged by a Medicaid buy-in 
        State for a Medicaid buy-in plan that covers the taxpayer, the 
        taxpayer's spouse, or any dependent (as defined in section 152) 
        of the taxpayer, or
            ```(2) the excess (if any) of--
                    ```(A) such monthly premium, over
                    ```(B) an amount equal to 1/12 of the product of 
                the applicable percentage and the taxpayer's household 
                income for the taxable year.'.''.
            (2) Exception for minimum essential coverage.--Subparagraph 
        (B) of section 36B(c)(2) of the Internal Revenue Code of 1986 
        is amended by inserting before the period at the end the 
        following: ``or eligibility for coverage under a Medicaid buy-
        in plan (as defined in section 2(c) of the Health Care Choice 
        and Affordability Act)''.
            (3) Individual mandate.--Clause (ii) of section 
        5000A(f)(1)(A) of the Internal Revenue Code of 1986 is amended 
        by inserting before the comma the following: ``including under 
        a Medicaid buy-in plan (as defined in section 2(c) of the 
        Health Care Choice and Affordability Act)''.
            (4) Advance payment of credit.--
                    (A) In general.--Advance determinations and 
                payments of premium tax credits allowable under section 
                36B of the Internal Revenue Code of 1986 with respect 
                to an individual enrolled in a Medicaid buy-in plan 
                shall be allowed, subject to rules similar to the rules 
                in section 1412 of the Patient Protection and 
                Affordable Care Act (applied without regard to whether 
                such plan is a qualified health plan).
                    (B) Coordination with credit.--Section 36B(f) is 
                amended by adding at the end the following new 
                paragraph:
            ``(4) Medicaid buy-in plans.--For purposes of this 
        subsection, advance payments under section 2(b)(4)(A) of the 
        Health Care Choice and Affordability Act shall be treated as 
        advance payments under section 1412 of the Patient Protection 
        and Affordable Care Act.''.
            (5) Conforming amendment relating to employer 
        responsibility.--Section 4980H(c)(6) of the Internal Revenue 
        Code of 1986 is amended by inserting ``, except that for 
        purposes of subsections (a)(2) and (b)(1)(B), the term 
        `qualified health plan' shall include a Medicaid buy-in plan 
        (as defined in section 2(c) of the Health Care Choice and 
        Affordability Act'' after ``such Act''.
    (c) Definitions.--In this section:
            (1) Eligible individual.--The term ``eligible individual'' 
        means an individual who will have access to only qualified 
        health plans issued by one health insurance issuer (as defined 
        in section 2791 of the Public Health Service Act (42 U.S.C. 
        300gg-91)) or will have access to no qualified health plans 
        with respect to a plan year.
            (2) Medicaid buy-in state.--The term ``Medicaid buy-in 
        State'' means a State that has at least one political 
        subdivision in which fewer than two health insurance issuers 
        participate in the Federal, Federally facilitated, or State 
        Exchange established under title I of the Patient Protection 
        and Affordable Care Act (Public Law 111-148) for such political 
        subdivision.
            (3) Medicaid buy-in plan.--The term ``Medicaid buy-in 
        plan'' means a health insurance plan that--
                    (A) is administered by the State agency 
                administering the State plan under title XIX of the 
                Social Security Act (42 U.S.C. 1396 et seq.) (or a 
                waiver of such plan); and
                    (B) consists of benchmark coverage described in 
                subsection (b)(1) of section 1937 of such Act (42 
                U.S.C. 1396u-7(b)(1)) or benchmark-equivalent coverage 
                described in subsection (b)(2) of such section.
            (4) Qualified health plan.--The term ``qualified health 
        plan'' has the meaning given such term in section 1301 of the 
        Patient Protection and Affordable Care Act (42 U.S.C. 18021).
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