123STA T .6 2 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9al l ind i v id u al s und er a g e 19who are en t itled to m edi c al assistance under this title ( and to the p arent o f such an individual ) who have access to such coverage if the S tate meets the re q uirements of this section .‘ ‘( b ) QUALIF I EDEMP L OY E R- SPO NS ORED C O V ERA G E. — ‘‘(1) I N GENERAL.—Sub j ect to paragraph ( 2 )) , in this para- graph, the term ‘qualified emplo y er-sponsored coverage ’ means a group health plan or health insurance coverage offered through an employer— ‘‘( A ) that qualifies as creditable coverage as a group health plan under section 2 70 1(c)(1) of the P ublic H ealth Service Act
‘‘( B ) for which the employer contribution toward any premium for such coverage is at least 4 0 percent; and ‘‘(C) that is offered to all individuals in a manner that would be considered a nondiscriminatory eligibility classification for purposes of paragraph ( 3 )(A)(ii) of section 10 5 (h) of the Internal R evenue Code of 19 86 (but deter- mined without regard to clause (i) of subparagraph (B) of such paragraph). ‘‘(2) E XC EP T ION.—Such term does not include coverage con- sisting of— ‘‘(A) benefits provided under a health fle x ible spending arrangement (as defined in section 106(c)(2) of the Internal Revenue Code of 1986); or ‘‘(B) a high deductible health plan (as defined in section 223(c)(2) of such Code), without regard to whether the plan is purchased in conjunction with a health savings account (as defined under section 223(d) of such Code). ‘‘(3) T REATMENT AS T H IRD PARTY LIA B ILITY.—The State shall treat the coverage provided under qualified employer-sponsored coverage as a third party liability under section 1902(a)(25). ‘‘(c) PREMIUM ASSISTANCE SUBSIDY.—In this section, the term ‘premium assistance subsidy’ means the amount of the employee contribution for enrollment in the qualified employer-sponsored cov- erage by the individual under age 19 or by the individual’s family. Premium assistance subsidies under this section shall be considered, for purposes of section 1903(a), to be a payment for medical assist- ance. ‘‘(d) V OLUNTARY PARTICIPATION.— ‘‘(1) EMPLOYERS.—Participation by an employer in a pre- mium assistance subsidy offered by a State under this section shall be voluntary. An employer may notify a State that it elects to opt-out of being directly paid a premium assistance subsidy on behalf of an employee. ‘‘(2) BENEFICIARIES.— N o subsidy shall be provided to an individual under age 19 under this section unless the individual (or the individual’s parent) voluntarily elects to receive such a subsidy. A State may not require such an election as a condition of receipt of medical assistance. State may not require, as a condition of an individual under age 19 (or the individual’s parent) being or remaining eligible for medical assistance under this title, apply for enrollment in qualified employer-sponsored coverage under this section. ‘‘(3) O PT-OUT PERMITTED FOR ANY MONTH.—A State shall establish a process for permitting the parent of an individual under age 19 receiving a premium assistance subsidy to Procedu re s.
