HB 1146 Summary

• Directs the Division of Medicaid to submit applications to CMS by December 31, 2024 for waivers and state plan amendments to expand Medicaid coverage to individuals at or below 100% of federal poverty level.

• Establishes a Section 1115 waiver program to provide coverage to uninsured individuals with income between 101-200% of federal poverty level through individual qualified health insurance plans or employer health insurance with state premium assistance.

• Creates premium assistance scaled by income: 100% of premiums for 101-150% FPL, 75% for 151-175% FPL, and 50% for 176-200% FPL, with copayment limits of $400 or 2% of income annually.

• Requires applicants to receive annual wellness visits to maintain full premium assistance (failure results in maximum 50% reduction but not loss of coverage).

• If CMS has not approved requested waivers by December 31, 2025, Medicaid eligibility automatically expands to include all populations and essential health benefits under the Affordable Care Act.