; or (ii) the Secretary, or the State in such a case, determines that the requirement under subparagraph (A) would cause the MA organization to become insolvent. (E) Definitions In this paragraph: (i) Applicable area The term applicable area means an area in which, at the time the Secretary or the State sends the notification under subparagraph (C), fewer than 3 health insurance issuers offer a qualified health plan through the individual market in the Exchange operating in the State. (ii) Exchange The term Exchange means an American Health Benefit Exchange established under section 1311 or section 1321 of the Patient Protection and Affordable Care Act. (iii) Group market The term group market has the meaning given such term in section 1304 of the Patient Protection and Affordable Care Act. (iv) Health insurance coverage The term health insurance coverage has the meaning given the term in section 2791(b) of the Public Health Service Act. (v) Individual market The term individual market has the meaning given such term in section 1304 of the Patient Protection and Affordable Care Act. (vi) Qualified health plan The term qualified health plan has the meaning given that term in section 1301(a) of the Patient Protection and Affordable Care Act. . (2) Effective date The amendment made by this subsection shall apply to contracts entered into or renewed after December 31, 2019. (b) Requirements for Medicaid managed care organizations (1) In general Section 1903(m)(2)(A) of the Social Security Act ( 42 U.S.C. 1396b(m)(2)(A) ) is amended— (A) in clause (xii), by striking ; and and inserting a semicolon; (B) by realigning the left margin of clause (xiii) to align with the left margin of clause (xii); (C) in clause (xiii), by striking the period at the end and inserting ; and