Relating to a hawk-i program purchase option, and including effective date and contingent implementation provisions

The option would also allow individuals who qualify and choose to purchase coverage through the hawk-i program to use advanced tax credits and cost-sharing credits, if eligible, to purchase the option; to permit the hawk-i program purchase option to be offered through the health insurance marketplace as a coverage option and to be compared with qualified health plans offered through the health insurance marketplace; and notwithstanding the eligibility criterion that a child must be less than years of age under the first specified criterion, allow the hawk-i purchase option to be offered to a child up to years of age. to implement mechanisms to ensure the long-term financial sustainability of the hawk-i program and mitigate any adverse financial impacts to the health insurance marketplace. The mechanisms are to address issues related to minimizing adverse selection, the state financial risk and contribution, and negative impacts to premiums in the individual and group insurance market both inside and outside of the health insurance marketplace. At a minimum, the hawk-i purchase option must include: establishment of an annual per enrollee premium rate similar to the average rate paid by the state to managed care plan contractors under the hawk-i program; establishment of a benefit set equal to the benefits covered under the hawk-i program; establishment of annual open enrollment periods consistent with those for the hawk-i program; the ability of the director of health and human services to adjust the purchase option’s actuarial value to a value no lower than percent; reimbursement mechanisms to address potential reductions in funding for health insurance marketplace operations; and reimbursement mechanisms to address potential increased costs to the hawk-i program. The director of health and human services in collaboration with the commissioner of insurance shall report to the chairpersons and ranking members of the house and senate health and human services committees and the joint appropriations subcommittee on health and human services by September 1, 2023, on the progress of the federal waivers and the results from actuarial and economic analyses that are necessary for a waiver proposal. The report shall also include recommendations regarding any statutory or administrative rule changes necessary to implement the program. The bill takes effect upon enactment. Implementation of any waiver provision that requires a state financial contribution is contingent on further legislative action to approve the state’s contribution.