When Marylanders file their state tax returns next year, they'll face an extra question: Do you have health insurance?

The state will use the answers to guide low-income residents into Medicaid or subsidized health plans — a first-of-its-kind program that health advocates hope to replicate in other states.

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The bill that created the “Maryland Easy Enrollment Health Program” was among more than 180 pieces of legislation passed by state lawmakers that Gov. Larry Hogan, a Republican, signed into law during a State House ceremony on Monday.

Under another, the minimum age for buying tobacco and nicotine products — including e-cigarettes and vape pens — will go from 18 to 21 years in October. The law is intended to reduce access that teenagers have to nicotine and tobacco.

The legislation was championed by health organizations, the Legislative Black Caucus of Maryland and Democratic legislative leaders. The law has an exception that allows individuals with a military identification who are 18, 19 or 20 to buy tobacco and nicotine products.

Bill would use tax returns to identify and help Marylanders without health insurance

Maryland would use state tax forms to identify uninsured residents and refer them to options for no-cost or low-cost health care under a bill moving forward in the General Assembly.

Proponents of the tax return question believe it could help at least 100,000 Marylanders enroll in no-cost or low-cost health insurance.

For those who answer that they don’t have insurance, the state would review the financial information on the tax return. Those who are eligible for Medicaid — the government insurance program for the poor and disabled — would automatically be enrolled.

Those who make too much to qualify for Medicaid would be referred to the state’s health exchange, where people can buy health insurance, often with the help of government subsidies. Health advocates believe there are many such people who don’t realize that they can get help under the Affordable Care Act in buying insurance.

“People will be shocked to find out what they’re eligible for,” said Stan Dorn, a senior fellow at the national advocacy group Families USA.

Frederick Isasi, executive director of Families USA, said his group will take Maryland’s idea to other states, in hopes of replicating it. He sees the program as a “win win” that costs very little money to steer more people into health insurance. That benefits both the individuals themselves, as well as others, because having more people insured keeps insurance and health costs down, Isasi said.

Isasi said the Maryland program will “cut through the confusion” of the national debate over health care.

“It’s a phenomenal model,” he said.

It’s expected to cost the state $295,000 in the first year to update the tax forms, then just $45,000 per year after that, according to state analysts. With more people enrolling in Medicaid, that budget will likely increase as well, according to analysts.

While the final version of the bill was lauded, it started out as a different — and more controversial — measure that would have imposed a fee on Maryland residents without health insurance. Those without insurance could have used that fee towards buying a health insurance plan.

The new law will create a work group to study how the program is going and whether a fee should be imposed on those without insurance. Vincent DeMarco of the Maryland Citizens’ Health Initiative said the idea is: “Let’s try this approach and see how it works.”

DeMarco, whose group lobbied for the bill, said the result was a “very big deal.” The state Senate passed it unanimously and House of Delegates gave it overwhelming approval. It was sponsored by Sen. Brian Feldman of Montgomery County and Del. Joseline Peña-Melnyk of Prince George’s County, both Democrats.

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Before the federal Affordable Care Act was passed, about 12 percent to 13 percent of Marylanders lacked health insurance. That number has been brought down to about 6 percent, and DeMarco hopes the tax return program will cut the number of uninsured even further.

Other bills Hogan signed into law alongside Senate President Thomas V. Mike Miller and House Speaker Adrienne Jones, both Democrats, include:

Laura and Reid’s Law

This law creates enhanced prison penalties for those convicted of crimes of violence against pregnant women.

The bill was named for Laura Wallen, a Howard County teacher who was murdered in 2017, allegedly by her boyfriend, who later died by suicide before his trial. Wallen was pregnant at the time, and her family believes she would have named her child Reid.

Drug treatment in jail

Jails and prisons will be required to offer approved medications to treat detainees and inmates for heroin and opioid addiction.

The new law also requires jails and prisons to screen individuals for mental health and substance use issues.

Technology high schools

The state can start planning for three more Pathways in Early Technology Early College High School programs, better known as “P-TECH” schools. There are eight such schools in Baltimore and the counties of Allegany, Baltimore, Montgomery and Prince George’s.

Students in P-TECH programs earn both a high school diploma and associate’s degree while gaining experience in technology industries.

“P-TECH is one of the most creative and effective approaches to education I have seen,” Hogan said in a statement.

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