Express state of application to the county-administered rural medical assistance (CARMA) program required for a medical assistance modification to apply to the CARMA program, and estimate of local fiscal impacts to counties or groups of counties administering CARMA required.

A bill for an act

relating to medical assistance; requiring an express statement of application to the

county-administered rural medical assistance (CARMA) program for a medical

assistance modification to apply to the CARMA program; requiring estimate of

local fiscal impacts to counties or groups of counties administering CARMA;

amending Minnesota Statutes 2025 Supplement, section 256B.695, subdivisions

6, 7.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2025 Supplement, section 256B.695, subdivision 6, is

amended to read:

Subd. 6.

Benefits and services.

(a) Counties or groups of counties administering CARMA

must cover all benefits and services required to be covered by medical assistance under

section
256B.0625
.

(b) Counties or groups of counties administering CARMA may reimburse enrollees

directly for out-of-pocket costs incurred obtaining assessed HRSN services provided by

nontraditional providers who are unable to accept payment via traditional health insurance

methods. Enrollees must not be reimbursed for out-of-pocket costs paid to providers eligible

to enroll.

new text begin

(c) Any modification to the entity administering, or with primary control over the

administration of, a benefit or service required to be covered by medical assistance does

not apply to CARMA unless:

new text end

new text begin

(1) the modification is expressly described in this section; and

new text end

new text begin

(2) the commissioner has published the written estimate of local fiscal impacts described

in paragraph (e).

new text end

new text begin

(d) Any modification to the benefits or services required to be covered by medical

assistance does not apply to CARMA unless:

new text end

new text begin

(1) the modification is expressly described in this section; and

new text end

new text begin

(2) the commissioner has published the written estimate of local fiscal impacts described

in paragraph (e).

new text end

new text begin

(e) Prior to the effective date of a modification described in paragraph (c) or (d), the

commissioner must publish a written estimate of the local fiscal impacts to counties or

groups of counties administering CARMA arising from the modification.

new text end

new text begin

EFFECTIVE DATE.

new text end

new text begin

This section is effective on the effective date of Laws 2025, First

Special Session chapter 3, article 8, section 25.

new text end

Sec. 2.

Minnesota Statutes 2025 Supplement, section 256B.695, subdivision 7, is amended

to read:

Subd. 7.

Payment.

deleted text begin
(a)
deleted text end
The commissioner, in consultation with counties and groups of

counties administering CARMA, must develop a mechanism for making payments to

counties and groups of counties that administer CARMA. The payment mechanism must:

(1) be governed by contracts with terms, including but not limited to payment rates,

amended on an as-needed basis;

(2) pay a full-risk monthly capitation payment for services included in CARMA, including

the cost for administering CARMA benefits and services;

(3) include risk corridors based on minimum loss ratio, total cost of care, or other metrics;

(4) include a settle-up process tied to the risk corridor arrangement allowing a county

or group of counties administering CARMA to retain savings for reinvestment in health

care activities and operations to protect against significant losses that a county or group of

counties administering CARMA or the state might realize, beginning no sooner than after

a county's or group of counties' third year of CARMA operations;

(5) include a collaborative rate-setting process accounting for CARMA experience,

regional experience, and the Department of Human Services fee-for-service experience;

and

(6) be exempt from section
256B.69, subdivisions 5a
, paragraphs (c) and (f), and 5d,

and payment for Medicaid services provided under section
256B.69, subdivision 28
,

paragraph (b), no sooner than three years after CARMA implementation.

deleted text begin

(b) Payments for benefits and services under subdivision 6, paragraph (a), must not

exceed payments that otherwise would have been paid to health plans under medical

assistance for that county or region.

deleted text end

new text begin

EFFECTIVE DATE.

new text end

new text begin

This section is effective on the effective date of Laws 2025, First

Special Session chapter 3, article 8, section 25.

new text end