100520.5.
(a) The Health Care Affordability Reserve Fund is hereby created in the State Treasury.(b) Notwithstanding any other law, the Controller may use the funds in the Health Care Affordability Reserve Fund for cashflow loans to the General Fund as provided in Sections 16310 and 16381.
(c) Upon the enactment of the Budget Act of 2021, and upon order of the Director of Finance, the Controller shall transfer three hundred thirty-three million four hundred thirty-nine thousand dollars ($333,439,000) from the General Fund to the Health Care Affordability Reserve Fund.
(d) Upon appropriation by the Legislature, the Health Care Affordability Reserve Fund shall be utilized, in addition to any other appropriations made by the Legislature for the same purpose, for the purpose of health care affordability programs operated by the California Health Benefit Exchange.
(e) The California Health Benefit Exchange has conducted, in consultation with stakeholders and the Legislature, a study to develop options for providing health care affordability assistance. It is the intent of the Legislature in adding this subdivision to enable the Exchange to implement that affordability assistance. It is further the intent of the Legislature that the affordability assistance both maximize federal financial assistance and be in addition to that assistance.
(1) The affordability assistance provided by the Exchange shall reduce cost sharing, including copays, coinsurance, and maximum out-of-pocket costs, if enhanced federal premium subsidies consistent with the federal American Rescue Plan Act of 2021 (Public Law 117-2) are made available for the 2023 and 2024 calendar years, and shall eliminate deductibles for all benefits. benefits to the extent feasible.
(2)The cost-sharing assistance provided to an enrollee with income under 200 percent of the federal poverty level shall not have an actuarial value of less than 94 percent.
(3)The cost sharing assistance provided to an enrollee with income between 200 percent to 300 percent, inclusive, of the federal poverty level shall have an actuarial value of at least 90 percent and shall be scaled to income, with an enrollee at the lowest income receiving the most help.
(4)The cost-sharing assistance provided to an enrollee with income between 301 percent to 400 percent, inclusive, of the federal poverty level shall have an actuarial value of at least 85 percent and shall be scaled to income, with an enrollee at the lowest income receiving the most help.
(5)For an enrollee with income over 400 percent of the federal poverty level, actuarial assistance may have an actuarial value of as much as 80 percent, depending on available funding.
(6)
(2) The Exchange shall adopt standard benefit designs consistent with this subdivision.