bill creating the Texas Care Plan Medicaid buy-in

The text as introduced · 541 words

89R16083 AB-D

By: Talarico
H.B. No. 5311

A BILL TO BE ENTITLED

AN ACT

relating to establishing the Texas Care Plan Medicaid buy-in

program to provide health benefit plan coverage to certain persons

in this state.

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

SECTION 1. Subchapter H, Chapter 532, Government Code, as

effective April 1, 2025, is amended by adding Section 532.0354 to

read as follows:

Sec. 532.0354. TEXAS CARE PLAN MEDICAID BUY-IN PROGRAM.

(a) In this section, "program" means the Texas Care Plan Medicaid

buy-in program implemented under this section.

(b) The executive commissioner shall seek a waiver under

Section 1115 of the Social Security Act (42 U.S.C. Section 1315) to

implement the Texas Care Plan Medicaid buy-in program in accordance

with this section.

(c) The commission in consultation with the commissioner of

insurance shall develop the program to allow residents of this

state to purchase health benefit plan coverage through Medicaid by

enrolling in a managed care plan offered by a Medicaid managed care

organization.

(d) The executive commissioner shall adopt rules for the

program that:

(1) establish eligibility requirements for

participation, including:

(A) household income limits;

(B) a requirement that a program participant be

ineligible for benefits under Medicaid, other than through the

program; and

(C) a requirement that a program participant not

have health benefit coverage under another health benefit plan

because the participant does not have access to or cannot afford

coverage through an employer-sponsored health benefit plan; and

(2) require financial participation by a program

participant, including a requirement that a program participant

pay, according to a sliding scale based on household income

determined in accordance with commission rules that are consistent

with the cost-sharing reduction eligibility categories provided by

45 C.F.R. Section 155.305(g), a portion of premiums imposed or

cost-sharing payments required under the program.

(e) The program must be designed to leverage enhanced

federal medical assistance percentage funding available under the

Patient Protection and Affordable Care Act (Pub. L. No. 111-148) as

amended by the Health Care and Education Reconciliation Act of 2010

(Pub. L. No. 111-152).

(f) The program, including benefits offered under the

program, must be substantively identical to the Medicaid buy-in

programs established under Section 532.0353, except:

(1) to the extent that programmatic differences are

appropriate because of the populations served by the programs; and

(2) that a health benefit plan under the program is not

required to include nonemergency transportation services as

defined by Section 526.0351.

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 the waiver

from the Centers for Medicare and Medicaid Services or any other

federal agency required by Section 532.0354(b), Government Code, as

added by this Act. The commission may delay implementing Section

532.0354, Government Code, as added by 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.