Manuel Medicaid Waiver Bill Adds Slots, If The Legislature Pays

The text as introduced · 917 words

89R2653 AND-D

By: Manuel
H.B. No. 5220

A BILL TO BE ENTITLED

AN ACT

relating to provision of and access to services for children with

certain health care needs, including access to certain Medicaid

waiver programs.

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

SECTION 1. Subchapter B, Chapter 526, Government Code, as

effective April 1, 2025, is amended by adding Section 526.0061 to

read as follows:

Sec. 526.0061. TEXAS PREGNANCY AND PARENT SUPPORT NETWORK

FOR CERTAIN EXPECTANT PARENTS. (a) In this section, "support

network" means the Texas pregnancy and parent support network

established under Subsection (b).

(b) The commission shall establish a statewide network of

service providers, including third-party patient navigators, for

expectant parents who receive a prenatal diagnosis for their unborn

child of a significant fetal anomaly, rare disorder, or other

chronic, medically complex condition or life-altering disability.

(c) A third-party patient navigator who provides services

under the support network shall:

(1) connect expectant and new parents with support and

advocacy groups and services, including support groups specific to

the diagnosis for their child and relevant to their child's

condition or disability; and

(2) assist expectant and new parents in navigating the

process of accessing and applying for home and community-based

supports and services for their child, including medically

dependent children (MDCP) waiver program diversion slots under

Section 546.0506.

SECTION 2. Section 532.0353, Government Code, as effective

April 1, 2025, is amended by amending Subsection (a) and adding

Subsection (a-1) to read as follows:

(a) The executive commissioner shall develop and implement:

(1) a Medicaid buy-in program for individuals with

disabilities as authorized by the Ticket to Work and Work

Incentives Improvement Act of 1999 (Pub. L. No. 106-170) or the

Balanced Budget Act of 1997 (Pub. L. No. 105-33); and

(2) subject to Subsection (a-1), a Medicaid buy-in

program for children with disabilities described by 42 U.S.C.

Section 1396a(cc)(1) whose family incomes do not exceed 300 percent

of the applicable federal poverty level, as authorized by the

Deficit Reduction Act of 2005 (Pub. L. No. 109-171).

(a-1) Notwithstanding any other law, the executive

commissioner by rule shall increase the maximum family income

prescribed by Subsection (a)(2) for determining eligibility for the

buy-in program to the maximum family income amount allowable,

considering available appropriations for that purpose.

SECTION 3. Subchapter K, Chapter 546, Government Code, as

effective April 1, 2025, is amended by adding Sections 546.05031

and 546.0506 to read as follows:

Sec. 546.05031. ASSESSMENT OF CERTAIN CHILDREN. To the

extent possible, the commission shall enroll a child in the

medically dependent children (MDCP) waiver program if the child:

(1) is on the interest list for the program;

(2) receives Supplemental Security Income (SSI) (42

U.S.C. Section 1381 et seq.); and

(3) meets the program's level of care criteria for

medical necessity for nursing facility care.

Sec. 546.0506. ALLOCATION AND RESERVATION OF DIVERSION

SLOTS. (a) To the extent possible, the commission shall allocate

and reserve a portion of medically dependent children (MDCP) waiver

program slots as diversion slots for children who:

(1) meet the program's level of care criteria for

medical necessity for nursing facility care; and

(2) are at high risk of being placed in an

institutional setting.

(b) A parent may apply for a nursing facility diversion slot

described by Subsection (a) after the child's birth if the newborn

child is determined to be at imminent risk of being placed in an

institutional setting.

SECTION 4. Subchapter B, Chapter 32, Human Resources Code,

is amended by adding Section 32.0521 to read as follows:

Sec. 32.0521. ELIGIBILITY FOR TEXAS HOME LIVING (TxHmL)

WAIVER PROGRAM. (a) In this section, "Section 1915(c) waiver

program" has the meaning assigned by Section 521.0001, Government

Code.

(b) To the extent permitted by federal law, an individual is

financially eligible to participate in the Texas home living

(TxHmL) waiver program if the individual's income is not more than

the special income limit established by the commission for other

Section 1915(c) waiver programs, including the home and

community-based services (HCS) waiver program.

(c) The commission may not require that an individual who

has an approved primary diagnosis of a related condition meet

intelligence quotient criteria to be eligible for the Texas home

living (TxHmL) waiver program.

SECTION 5. As soon as practicable after the effective date

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

Services Commission shall adopt rules necessary to implement the

changes in law made by this Act.

SECTION 6. Notwithstanding any other section of this Act,

in a state fiscal year, the Health and Human Services Commission is

not required to implement a provision in another section of this Act

imposing a duty on the commission to take an action, including a

provision that the commission determines would require adding

additional slots under the medically dependent children (MDCP)

waiver program or the Texas home living (TxHmL) waiver program,

unless money is specifically appropriated to the commission for

that fiscal year to carry out that duty. The commission may

implement the provision in that fiscal year to the extent other

funding is available to the commission for the implementation.

SECTION 7. If before implementing any provision of this Act

a state agency determines that a waiver or authorization from a

federal agency is necessary for implementation of that provision,

the agency affected by the provision shall request the waiver or

authorization and may delay implementing that provision until the

waiver or authorization is granted.

SECTION 8. This Act takes effect September 1, 2025.