S930

An Act concerning minimum essential health insurance coverage, amending P.L.2018, c.24 and P.L.2022, c.39, and repealing P.L.2018, c.31.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. Section 10 of P.L.2018, c.24 (C.17B:27A-10.10) is amended to read as follows:

10. a. The New Jersey Health Insurance Premium Security Fund is hereby created in the State Treasury for the purposes of [this act] P.L.2018, c.24 (C.17B:27A-10.1 et seq.). This fund shall be the repository for monies collected pursuant to [this act] P.L.2018, c.24 (C.17B:27A-10.1 et seq.) and other monies received as grants in support of [this act] P.L.2018, c.24 (C.17B:27A-10.1 et seq.), or monies otherwise appropriated or directed to be remitted to the fund. The establishment of this fund, the funding sources contained herein, and the plan shall be contingent upon approval from the United States Secretary of Health and Human Services and the United States Secretary of the Treasury of a State Innovation Waiver application pursuant to section 1332 of the Affordable Care Act (42 U.S.C. s.18052) and the commissioner's acceptance of any approval as provided in section 9 of [this act] P.L.2018, c.24 (C.17B:27A-10.9).

b. All interest earned on the moneys that have been deposited into the fund shall be retained in the fund and used for purposes consistent with the fund.

c. The fund shall be funded to levels based upon actuarial analysis to stabilize or reduce premiums rates in the individual market achieving between a 10% and 20% reduction in what indicated rates would be for the applicable benefit year without the plan and to cover all necessary administrative costs of the reinsurance provided by the plan.

d. The fund shall be fully funded in accordance with this section by:

(1) [All funds collected by the State pursuant to P.L.2018, c.31 (C.54A:11-1 et seq.)] (Deleted by amendment, P.L. , c. ) (pending before the Legislature as this bill);

(2) Federal payments received as a result of any waiver of requirements granted or other arrangements agreed to by the United States Secretary of Health and Human Services or other appropriate federal officials; and

(3) For the purpose of providing the funds necessary to carry out the provisions of [this act] P.L.2018, c.24 (C.17B:27A-10.1 et seq.), and in amounts sufficient to ensure funding levels as required by [this act] P.L.2018, c.24 (C.17B:27A-10.1 et seq.) after the monies received pursuant to paragraphs (1) and (2) of this subsection, there shall be appropriated annually out of the General Fund of the State an amount as the board, in consultation with the commissioner, determines necessary to fully fund the plan to accomplish the objectives of [this act] P.L.2018, c.24 (C.17B:27A-10.1 et seq.). The board, in consultation with the commissioner, shall calculate the amount necessary to cover the submitted reinsurance requests taking into account all federal waiver payments and other monies in the fund. The board shall issue an order memorializing those amounts and requesting the Legislature to appropriate that amount to the fund.

e. Moneys in the fund shall only be used for the purposes established in [this act] P.L.2018, c.24 (C.17B:27A-10.1 et seq.).

(cf: P.L.2018, c.24, s.10)

2. Section 1 of P.L.2022, c.39 (C.17B:27A-59.1) is amended to read as follows:

1. As used in this act:

"Commissioner" means the Commissioner of Banking and Insurance.

"Department" means the Department of Banking and Insurance.

"Insurance affordability assistance" means:

(1) the State Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.);

(2) the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.);

(3) premium tax credits; or

(4) cost-sharing reductions.

"Premium tax credits" means the tax credits described in section 36B of the Internal Revenue Code.

"Program" means the New Jersey Easy Enrollment Health Insurance Program established pursuant to this act.

"Individual" means an individual who is identified through a State income tax return under section 6 of this act as not having minimum essential coverage.

“Minimum essential coverage” means the same as defined in 26 U.S.C. s.5000A(f)(1).

(cf: P.L.2022, c.39, s.1)

3. Section 2 of P.L.2022, c.39 (C.17B:27A-59.2) is amended to read as follows:

2. a. The Department of Banking and Insurance shall establish and have the authority to operate the New Jersey Easy Enrollment Health Insurance Program. The department shall integrate the program with the State-based exchange established pursuant to P.L.2019, c.141 (C.17B:27A-57 et seq.), and may enter into an agreement with a third party for operation of the program. The purpose of the program shall be to:

(1) establish a State-based reporting system to provide information about the health insurance status of State residents through the use of State income tax returns and approved eFile vendors to identify individuals without minimum essential coverage and determine whether the individual is interested in obtaining minimum essential coverage;

(2) determine or assess, as feasible, whether an individual who is interested in obtaining minimum essential coverage qualifies for insurance affordability assistance;

(3) proactively contact an individual who is interested in obtaining minimum essential coverage to assist in enrolling the individual in insurance affordability assistance and minimum essential coverage; and

(4) maximize enrollment of eligible individuals in insurance affordability assistance and minimum essential coverage to improve access to care and reduce insurance costs for all residents of the State.

b. The Commissioner of Banking and Insurance, in coordination with the Commissioner of Human Services, the Commissioner of Labor and Workforce Development, and the State Treasurer, shall develop and implement systems, policies, and practices that encourage, facilitate, and streamline determination of eligibility for insurance affordability assistance and enrollment in minimum essential coverage to achieve the purposes of the program.

c. To facilitate the most efficient implementation of the program, the Commissioner of Banking and Insurance, the Commissioner of Human Services, the Commissioner of Labor and Workforce Development, and the State Treasurer may enter into agreements, adopt regulations and guidelines, establish accounts, conduct trainings, provide public information, educate tax preparers, and take any other steps as may be necessary to accomplish the purpose of the program.

d. Notwithstanding the provisions of subsection a. of R.S.54:50-8 to the contrary, the State Treasurer shall share with the Commissioner of Banking and Insurance the taxpayer information that is necessary for the purposes of this act [and P.L.2018, c.31 (C.54A:11-1 et seq.)].

e. The Commissioners of Human Services and Banking and Insurance shall apply and secure any State plan amendments or necessary waivers from the federal Department of Health and Human Services in order to implement the provisions of this act.

(cf: P.L.2022, c.39, s.2)

4. Section 6 of P.L.2022, c.39 (C.17B:27A-59.6) is amended to read as follows:

6. a. If a State income tax return indicates that an individual is not covered under minimum essential coverage at the time the tax return is filed, [consistent with the provisions of P.L.2018, c.31 (C.54A:11-1 et seq.),] the tax return shall include the following information as to each such individual included in the tax return:

(1) the age of each individual;

(2) election by the individual filing the tax return of one of the two checkoff boxes described in subsection c. of this section for each individual included in the tax return;

(3) if the individual who files a tax return chooses the checkoff box described in paragraph (3) of subsection c. of this section, any information determined by the department as essential to determining eligibility for insurance affordability assistance for the individual filing the tax return or any individual included in the tax return, if the information:

(a) is not available from a reliable third-party data source;

(b) is not otherwise required to be provided on the return; and

(4) notification of the potential waiver of the State shared responsibility tax pursuant to subsection d. of this section.

b. For an individual who files a tax return and chooses the checkoff box described in paragraph (3) of subsection c. of this section, the return or separate form shall facilitate the collection of contact information, including a phone number, electronic mail address, and mailing address, from the individual who filed the tax return and provide an option to indicate the individual's preferred method for the department to contact the individual who filed the tax return to facilitate either determination of eligibility for insurance affordability assistance or enrollment in minimum essential coverage.

c. (1) In accordance with this section, the State Treasurer shall include with the income tax return form a separate form that is required only for individuals who file a tax return indicating that an individual included in the tax return is not covered under minimum essential coverage at the time the tax return is filed.

(2) The separate form shall include two checkoff boxes as described in paragraphs (3) and (4) of this subsection for each individual included in the tax return and the information described in paragraphs (2) and (3) of subsection a. and in subsection b. of this section.

(3) One checkoff box shall give an individual who files a tax return the choice to have the department:

(a) based on information in the individual's tax return, determine eligibility for insurance affordability assistance for the individual filing the tax return and any other individual included in that tax return who does not have minimum essential coverage; and
(b) obtain additional data that may be relevant to determine eligibility for insurance affordability assistance for the individual filing the tax return and any other individual included in that tax return who does not have minimum essential coverage.

(4) One checkoff box shall allow an individual who files a tax return the choice to not have the department make the determination described in paragraph (3) of this subsection for the individual filing the tax return and any other individual included in that tax return who does not have minimum essential coverage.

(5) The State Treasurer, in consultation with the Department of Banking and Insurance, shall:

(a) develop language for the checkoff boxes described in paragraphs (3) and (4) of this subsection;

(b) develop language for the instructions for the State income tax return that includes a description of the effects of choosing the checkoff boxes described in paragraphs (3) and (4) of this subsection, including the purposes for which the information disclosed under this section may be used; and

(c) ensure that the language developed under subparagraph (a) of this paragraph is as simple, clear, and easy to understand as possible.

(6) If an individual who files a tax return makes the election described in paragraph (3) of this subsection, the State Treasurer shall convey to the department all eligibility-relevant information contained on the return for all individuals included in that tax return.

d. [The State Treasurer shall waive the State shared responsibility tax imposed pursuant to section 3 of P.L.2018, c.31 (C.54A:11-3) applicable to months of the year that the tax return is filed for any taxpayer who chooses the checkoff box described in paragraph (3) of subsection c. of this section. If the taxpayer fails to enroll in minimum essential coverage and maintain that coverage in each month following the enrollment period, the taxpayer shall be liable for any payments to which the taxpayer would have otherwise been subject.] (Deleted by amendment, P.L. , c. ) (pending before the Legislature as this bill).

e. [The State Treasurer shall coordinate the requirements of this subsection with the requirements of the "New Jersey Health Insurance Market Preservation Act," P.L.2018, c.31 (C.54A:11-1 et seq.)] (Deleted by amendment, P.L. , c. ) (pending before the Legislature as this bill).

(cf: P.L.2022, c.39, s.6)

5. P.L.2018, c.31 (C.54A:11-1 through C.54A:11-10) is repealed.

6. This act shall take effect immediately.

STATEMENT

This bill repeals the “New Jersey Health Insurance Market Preservation Act” which requires most individuals, other than those who qualify for certain exemptions, to obtain health insurance or pay a penalty. Existing law requires every resident taxpayer of the State to obtain health insurance coverage that qualifies as “minimum essential coverage.” This bill repeals that requirement.

In addition, the bill removes a provision of existing law funding the New Jersey Health Insurance Premium Security Fund, in part, from the penalties collected from those who do not meet the State’s minimum essential coverage requirement.