Lalani’s bill for a veterans health coverage program

The text as introduced · 1,368 words

89R7660 CMO-D

By: Lalani
H.B. No. 4639

A BILL TO BE ENTITLED

AN ACT

relating to the development and implementation of a veterans health

care coverage program to assist certain veterans in obtaining

health care coverage.

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

SECTION 1. Subtitle I, Title 4, Government Code, is amended

by adding Chapter 550A to read as follows:

CHAPTER 550A. VETERANS HEALTH CARE COVERAGE PROGRAM

Sec. 550A.0001. DEFINITIONS. In this chapter:

(1) "Eligible individual" means a veteran who is

eligible to participate in the program.

(2) "Participant" means a veteran who is enrolled in

the program.

(3) "Program" means the veterans health care coverage

program established under this chapter.

(4) "Veteran" has the meaning assigned by Section

411.1951.

Sec. 550A.0002. FEDERAL AUTHORIZATION FOR PROGRAM. (a)

The executive commissioner shall seek a waiver under Section 1115

of the federal Social Security Act (42 U.S.C. Section 1315) to

obtain any federal money available for implementing the program to

assist eligible individuals in obtaining health care coverage.

(b) The terms of the waiver the executive commissioner seeks

must:

(1) be designed to:

(A) provide financial assistance for eligible

individuals to obtain health care coverage, including coverage for

mental health services; and

(B) encourage participants to seek employment

opportunities, including through programs operated by the Texas

Workforce Commission; and

(2) allow for the operation of the program consistent

with the requirements of this chapter, except to the extent

deviation from the requirements is necessary to obtain federal

authorization of the waiver.

Sec. 550A.0003. FUNDING. Subject to approval of the waiver

described by Section 550A.0002, the commission shall implement the

program using federal money obtained for that purpose.

Sec. 550A.0004. NOT AN ENTITLEMENT. This chapter does not

establish an entitlement to financial assistance for obtaining

health care coverage under the program for eligible individuals.

Sec. 550A.0005. PROGRAM PROMOTION AND ADMINISTRATION. The

commission shall promote and provide information on the program to

veterans who are potentially eligible to participate in the

program. The commission shall ensure the program's promotion is

designed in a manner to reach as many veterans as possible.

Sec. 550A.0006. ELIGIBILITY REQUIREMENTS. An individual is

eligible to participate in the program if:

(1) the individual:

(A) is a resident of this state;

(B) is a veteran;

(C) is 19 years of age or older but younger than

65 years of age; and

(D) applying the eligibility criteria in effect

in this state on December 31, 2024, is not eligible for Medicaid;

and

(2) federal money is available to provide benefits to

the individual under the program.

Sec. 550A.0007. COMMISSION'S AUTHORITY RELATED TO

ELIGIBILITY AND MEDICAID COORDINATION. The commission may:

(1) accept applications for program participation and

implement program eligibility screening and enrollment procedures;

(2) resolve grievances related to eligibility

determinations; and

(3) to the extent possible, coordinate the program

with Medicaid.

Sec. 550A.0008. APPLICATION FORM AND PROCEDURES. (a) The

executive commissioner shall adopt an application form and

application procedures for the program. The form and procedures

may be coordinated with Medicaid forms and procedures to ensure

there is a single consolidated application process to seek health

care coverage under the program or Medicaid.

(b) To the extent possible, the commission shall make the

application form available in languages other than English.

(c) The executive commissioner may permit a veteran to apply

by mail, over the telephone, or through the Internet.

Sec. 550A.0009. ELIGIBILITY SCREENING AND ENROLLMENT. (a)

The executive commissioner shall adopt eligibility screening and

enrollment procedures or use the Texas Integrated Enrollment

Services eligibility determination system or a compatible system to

screen veterans and enroll eligible individuals in the program.

(b) The eligibility screening and enrollment procedures

must ensure that a veteran applying for the program who appears

eligible for Medicaid is identified and assisted with obtaining

Medicaid coverage. If the veteran is denied Medicaid coverage but

is otherwise determined eligible to participate in the program, the

commission shall enroll the veteran in the program without

additional application or qualification.

(c) Not later than the 30th day after the date a veteran

submits a complete application form, the commission shall ensure

that the veteran's eligibility to participate in the program is

determined and that the veteran is enrolled in the program if

eligible.

Sec. 550A.0010. ELIGIBILITY REDETERMINATION AND

DISENROLLMENT. (a) The commission shall redetermine a

participant's eligibility to participate in the program during the

12th month following the date the participant is initially enrolled

in the program or was most recently redetermined eligible for the

program. The commission shall ensure the eligibility

redetermination process is as seamless and contains as little

administrative burden for the participant as possible to facilitate

the participant's successful eligibility redetermination.

(b) Not later than the 60th day before the expiration of a

participant's coverage period, the commission shall take all

reasonable steps to notify the participant regarding the

eligibility redetermination process and request documentation

necessary to redetermine the participant's eligibility.

(c) The commission shall disenroll a participant from the

program if:

(1) the participant does not submit the requested

eligibility redetermination documentation before the last day of

the participant's coverage period; or

(2) the commission, based on the submitted

documentation, determines the participant is no longer eligible to

participate in the program.

Sec. 550A.0011. SLIDING SCALE SUBSIDIES. (a) The

commission shall ensure a participant receives a sliding scale

subsidy under the program to purchase health benefit coverage.

(b) A sliding scale subsidy provided to a participant must:

(1) be based on:

(A) the average health benefit coverage premium

in the market; and

(B) a realistic assessment of the participant's

ability to pay a portion of the premium; and

(2) include an enhancement for participants who choose

a high deductible health plan with a health savings account.

(c) The commission shall ensure that counselors are made

available to participants to advise the participants on selecting

health benefit coverage that meets the participant's needs.

(d) A participant is responsible for paying:

(1) any difference between the premium costs

associated with the purchase of health benefit coverage and the

amount of the participant's subsidy under this section; and

(2) any copayments associated with the health benefit

coverage, except to the extent the individual receives an

additional subsidy under Section 550A.0012 to pay the copayments.

(e) If the amount of a subsidy a participant receives under

this section exceeds the premium costs associated with the

participant's purchase of health benefit coverage, the participant

may deposit the excess amount in a health savings account that may

be used only in the manner described by Section 550A.0013(b).

Sec. 550A.0012. ADDITIONAL COST-SHARING SUBSIDIES. In

addition to providing a subsidy to a participant under Section

550A.0011, the commission shall provide additional subsidies for

coinsurance payments, copayments, deductibles, and other

cost-sharing requirements associated with the participant's health

benefit coverage. The commission shall provide the additional

subsidies on a sliding scale based on income.

Sec. 550A.0013. DELIVERY OF SUBSIDIES; HEALTH SAVINGS

ACCOUNTS. (a) The commission shall determine the most appropriate

manner for delivering and administering subsidies provided under

Sections 550A.0011 and 550A.0012. In determining the most

appropriate manner, the commission shall consider depositing

subsidy amounts for a participant in a health savings account

established for that participant.

(b) A health savings account established under this section

may be used only to:

(1) pay health benefit coverage premiums and

cost-sharing amounts; and

(2) if appropriate, purchase health care-related

goods and services.

Sec. 550A.0014. RULEMAKING AUTHORITY. The commission shall

adopt rules as necessary to implement the program.

SECTION 2. As soon as practicable after the effective date

of this Act, the executive commissioner of the Health and Human

Services Commission shall apply for and actively pursue from the

federal Centers for Medicare and Medicaid Services or another

appropriate federal agency the waiver required by Section

550A.0002, Government Code, as added by this Act. The commission

may delay implementing this Act until the waiver applied for under

this section is granted.

SECTION 3. This Act takes effect immediately if it receives

a vote of two-thirds of all the members elected to each house, as

provided by Section 39, Article III, Texas Constitution. If this

Act does not receive the vote necessary for immediate effect, this

Act takes effect September 1, 2025.