The New York State Senate

                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 6791--A

                       2019-2020 Regular Sessions

                          I N  A S S E M B L Y

                             March 20, 2019
                               ___________

Introduced by M. of A. CRUZ, ORTIZ, AUBRY, ARROYO, ROZIC, SIMON, COLTON,
  DICKENS, BLAKE, HEVESI, MOSLEY, REYES, JAFFEE, FALL, EPSTEIN, CARROLL,
  RAMOS,  COOK,  D'URSO,  D. ROSENTHAL, RIVERA, GLICK, FERNANDEZ -- read
  once and referred to the Committee on Health -- committee  discharged,
  bill  amended,  ordered  reprinted  as amended and recommitted to said
  committee

AN ACT to amend the public health law, in relation to authorizing  indi-
  viduals  to participate in the NY State of Health, the official health
  plan marketplace without providing information  regarding  citizenship
  or  lawful residency in the United States or requesting or receiving a
  state or federal subsidy

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Subdivision 10 of section 268-a of the public health law,
as added by section 2 of part T of chapter 57 of the laws  of  2019,  is
amended to read as follows:
  10.  "Qualified  individual"  means,  with respect to qualified health
plans, an individual, including a minor, who:
  (a) is eligible to enroll in a qualified health plan offered to  indi-
viduals through the Marketplace;
  (b) resides in this state; AND
  (c)  at the time of enrollment, is not incarcerated, other than incar-
ceration pending the disposition of charges[; and
  (d) is, and is reasonably expected to be, for the  entire  period  for
which  enrollment  is sought, a citizen or national of the United States
or an alien lawfully present in the United States].
  § 2. Paragraph (a) of subdivision 1 of section  268-c  of  the  public
health law, as added by section 2 of part T of chapter 57 of the laws of
2019, is amended to read as follows:
  (a) Perform eligibility determinations for federal and state insurance
affordability  programs  including medical assistance in accordance with

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.

                                                           LBD10805-07-9

A. 6791--A                          2

section three hundred sixty-six of the social services law, child health
plus in accordance with section twenty-five hundred eleven of this chap-
ter, the basic health program in accordance with section  three  hundred
sixty-nine-gg  of the social services law, premium tax credits and cost-
sharing reductions and qualified health plans in accordance with  appli-
cable  law  and  other  health  insurance  programs as determined by the
commissioner. SUCH ELIGIBILITY DETERMINATIONS SHALL ALLOW ANY  QUALIFIED
INDIVIDUAL  TO PARTICIPATE IN A QUALIFIED HEALTH PLAN WHO PAYS ALL ASSO-
CIATED COSTS WITHOUT REQUESTING OR RECEIVING A STATE OR FEDERAL SUBSIDY;
  § 3. Section 268-g of the public health law is amended by  adding  two
new subdivisions 4 and 5 to read as follows:
  4. THE COMMISSIONER IS AUTHORIZED AND DIRECTED TO SEEK A FEDERAL WAIV-
ER  ALLOWING  QUALIFIED  INDIVIDUALS  WHO  PAY  ALL  ASSOCIATED COSTS OF
PARTICIPATING IN A QUALIFIED HEALTH PLAN  WITHOUT  A  STATE  OR  FEDERAL
SUBSIDY.
  5.  (A)  THE COMMISSIONER SHALL UTILIZE THE FOLLOWING FORMULA TO AVOID
THE USE OF ANY FEDERAL FUNDS FOR QUALIFIED INDIVIDUALS WHO PAY ALL ASSO-
CIATED COSTS OF PARTICIPATING IN A QUALIFIED HEALTH PLAN WITHOUT A STATE
OR FEDERAL SUBSIDY:
  (I) THE AVERAGE TOTAL AMOUNT EXPENDED PER MEMBER SHALL  BE  DETERMINED
BY  DIVIDING  THE  FEDERAL ADMINISTRATIVE FUNDING AMOUNT PROVIDED TO THE
STATE FOR THE MARKETPLACE AS A HEALTH  BENEFIT  EXCHANGE  BY  THE  TOTAL
NUMBER OF ENROLLEES IN THE MARKETPLACE;
  (II)  THE AVERAGE TOTAL AMOUNT EXPENDED PER MEMBER DETERMINED PURSUANT
TO SUBPARAGRAPH (I) OF THIS PARAGRAPH SHALL BE MULTIPLIED BY THE  NUMBER
OF  QUALIFIED  INDIVIDUALS WHO PAY ALL ASSOCIATED COSTS OF PARTICIPATING
IN A QUALIFIED HEALTH PLAN WITHOUT A STATE OR FEDERAL SUBSIDY TO  DETER-
MINE THE TOTAL REIMBURSEMENT AMOUNT;
  (III) THE STATE SHALL REIMBURSE THE FEDERAL GOVERNMENT ANNUALLY BY THE
TOTAL  REIMBURSEMENT  AMOUNT DETERMINED PURSUANT TO SUBPARAGRAPH (II) OF
THIS PARAGRAPH.
  (B) THE TOTAL REIMBURSEMENT AMOUNT DETERMINED PURSUANT TO SUBPARAGRAPH
(II) OF PARAGRAPH (A) OF THIS  SUBDIVISION  SHALL  BE  PROVIDED  TO  THE
MARKETPLACE  BY  AN  ANNUAL ALLOCATION TO THE INDIGENT CARE FUNDS IN THE
ANNUAL STATE BUDGET.
  § 4. Section 206 of the public health law is amended by adding  a  new
subdivision 31 to read as follows:
  31. THE COMMISSIONER SHALL PROMULGATE RULES AND REGULATIONS TO PROTECT
AND  MAINTAIN  THE  CONFIDENTIALITY  OF  PARTICIPANTS IN THE NY STATE OF
HEALTH, THE OFFICIAL HEALTH PLAN MARKETPLACE WHO DO NOT PROVIDE A SOCIAL
SECURITY NUMBER OR PROOF OF LEGAL STATUS IN THE UNITED STATES.
  § 5. This act shall take effect immediately.