bill expanding Medicaid to low-income adults 19 to 64

The text as introduced · 6,312 words

89R1026 JG-D

By: Lalani
H.B. No. 895

A BILL TO BE ENTITLED

AN ACT

relating to the development and implementation of the Live Well

Texas program and the expansion of Medicaid eligibility to provide

health benefit coverage to certain individuals; imposing

penalties.

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

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

by adding Chapters 532A and 532B to read as follows:

CHAPTER 532A. LIVE WELL TEXAS PROGRAM

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 532A.0001. DEFINITIONS. In this chapter:

(1) "Basic plan" means the program health benefit plan

described by Section 532A.0202.

(2) "Eligible individual" means an individual who is

eligible to participate in the program.

(3) "Participant" means an individual who is:

(A) enrolled in a program health benefit plan; or

(B) receiving health care financial assistance

under Subchapter H.

(4) "Plus plan" means the program health benefit plan

described by Section 532A.0203.

(5) "POWER account" means a personal wellness and

responsibility account the commission establishes for a

participant under Section 532A.0251.

(6) "Program" means the Live Well Texas program

established under this chapter.

(7) "Program health benefit plan" includes:

(A) the basic plan; and

(B) the plus plan.

(8) "Program health benefit plan provider" means a

health benefit plan provider that contracts with the commission

under Section 532A.0107 to arrange for the provision of health care

services through a program health benefit plan.

SUBCHAPTER B. FEDERAL WAIVER FOR LIVE WELL TEXAS PROGRAM

Sec. 532A.0051. FEDERAL AUTHORIZATION FOR PROGRAM. (a)

Notwithstanding any other law, the executive commissioner shall

develop and seek a waiver under Section 1115 of the Social Security

Act (42 U.S.C. Section 1315) to the state Medicaid plan to implement

the Live Well Texas program to assist individuals in obtaining

health benefit coverage through a program health benefit plan or

health care financial assistance.

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

under this section must:

(1) be designed to:

(A) provide health benefit coverage options for

eligible individuals;

(B) produce better health outcomes for

participants;

(C) create incentives for participants to

transition from receiving public assistance benefits to achieving

stable employment;

(D) promote personal responsibility and engage

participants in making decisions regarding health care based on

cost and quality;

(E) support participants' self-sufficiency by

requiring unemployed participants to be referred to work search and

job training programs;

(F) support participants who become ineligible

to participate in a program health benefit plan in transitioning to

private health benefit coverage; and

(G) leverage enhanced federal medical assistance

percentage funding to minimize or eliminate the need for a program

enrollment cap; 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. 532A.0052. FUNDING. Subject to approval of the waiver

described by Section 532A.0051, the commission shall implement the

program using 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).

Sec. 532A.0053. NOT AN ENTITLEMENT; TERMINATION OF PROGRAM.

(a) This chapter does not establish an entitlement to health

benefit coverage or health care financial assistance under the

program for eligible individuals.

(b) The program terminates at the time the share of federal

funding for the program 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) is

reduced below 90 percent.

SUBCHAPTER C. PROGRAM ADMINISTRATION

Sec. 532A.0101. PROGRAM OBJECTIVE. The program's principal

objective is to provide primary and preventive health care through

high deductible program health benefit plans to eligible

individuals.

Sec. 532A.0102. PROGRAM PROMOTION. The commission shall

promote and provide information about the program to individuals

who:

(1) are potentially eligible to participate in the

program; and

(2) live in medically underserved areas of this state.

Sec. 532A.0103. COMMISSION'S AUTHORITY RELATED TO HEALTH

BENEFIT PLAN PROVIDER CONTRACTS. The commission may:

(1) enter into contracts with health benefit plan

providers under Section 532A.0107;

(2) monitor program health benefit plan providers

through reporting requirements and other means to ensure contract

performance and quality delivery of services;

(3) monitor the quality of services delivered to

participants through outcome measurements; and

(4) provide payment under the contracts to program

health benefit plan providers.

Sec. 532A.0104. COMMISSION'S AUTHORITY RELATED TO

ELIGIBILITY AND MEDICAID COORDINATION. The commission may:

(1) accept applications for health benefit coverage

under the program 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. 532A.0105. THIRD-PARTY ADMINISTRATOR CONTRACT FOR

PROGRAM IMPLEMENTATION. (a) In administering the program, the

commission may contract with a third-party administrator to provide

enrollment and related services.

(b) If the commission contracts with a third-party

administrator under this section, the commission may:

(1) monitor the third-party administrator through

reporting requirements and other means to ensure contract

performance and quality delivery of services; and

(2) provide payment under the contract to the

third-party administrator.

(c) The executive commissioner shall retain all

policymaking authority over the program.

(d) The commission shall procure each contract with a

third-party administrator, as applicable, through a competitive

procurement process that complies with all federal and state laws.

Sec. 532A.0106. TEXAS DEPARTMENT OF INSURANCE DUTIES. (a)

At the commission's request, the Texas Department of Insurance

shall provide any necessary assistance with the program. The

department shall monitor the quality of the services provided by

program health benefit plan providers and resolve grievances

related to those providers.

(b) The commission and the Texas Department of Insurance may

adopt a memorandum of understanding that addresses the

responsibilities of each agency with respect to the program.

(c) The Texas Department of Insurance, in consultation with

the commission, shall adopt rules as necessary to implement this

section.

Sec. 532A.0107. HEALTH BENEFIT PLAN PROVIDER CONTRACTS.

The commission shall select through a competitive procurement

process that complies with all federal and state laws and contract

with health benefit plan providers to provide health care services

under the program. To be eligible for a contract under this section,

an entity must:

(1) be a Medicaid managed care organization;

(2) hold a certificate of authority issued by the

Texas Department of Insurance that authorizes the entity to provide

the types of health care services offered under the program; and

(3) satisfy, except as provided by this chapter, any

applicable requirement of the Insurance Code or another insurance

law of this state.

Sec. 532A.0108. HEALTH CARE PROVIDERS. (a) A health care

provider who provides health care services under the program must

meet certification and licensure requirements required by

commission rules and other law.

(b) In adopting rules governing the program, the executive

commissioner shall ensure that a health care provider who provides

health care services under the program is reimbursed at a rate that

is at least equal to the rate paid under Medicare for the provision

of the same or substantially similar services.

Sec. 532A.0109. PROHIBITION ON CERTAIN HEALTH CARE

PROVIDERS. The executive commissioner shall adopt rules that

prohibit a health care provider from providing program health care

services for a reasonable period, as determined by the executive

commissioner, if the health care provider:

(1) fails to repay program overpayments; or

(2) owns, controls, manages, or is otherwise

affiliated with and has financial, managerial, or administrative

influence over a health care provider who has been suspended or

prohibited from providing program health care services.

SUBCHAPTER D. ELIGIBILITY FOR PROGRAM HEALTH BENEFIT COVERAGE

Sec. 532A.0151. ELIGIBILITY REQUIREMENTS. (a) An

individual is eligible to enroll in a program health benefit plan

if:

(1) the individual is a resident of this state;

(2) the individual is 19 years of age or older but

younger than 65 years of age;

(3) applying the eligibility criteria in effect in

this state on December 31, 2024, the individual is not eligible for

Medicaid; and

(4) federal matching funds are 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) to provide benefits to the individual under

the federal medical assistance program established under Title XIX,

Social Security Act (42 U.S.C. Section 1396 et seq.).

(b) An individual who is a parent or caretaker relative to

whom 42 C.F.R. Section 435.110 applies is eligible to enroll in a

program health benefit plan.

(c) In determining eligibility for the program, the

commission shall apply the same eligibility criteria regarding

residency and citizenship in effect for Medicaid in this state on

December 31, 2024.

Sec. 532A.0152. CONTINUOUS COVERAGE. The commission shall

ensure that an individual who is initially determined or

redetermined to be eligible to participate in the program and

enroll in a program health benefit plan will remain eligible for

coverage under the plan for a period of 12 months beginning on the

first day of the month following the date eligibility was

determined or redetermined, subject to Section 532A.0252(f).

Sec. 532A.0153. APPLICATION FORM AND PROCEDURES. (a) The

executive commissioner shall adopt an application form and

application procedures for the program. The form and procedures

must be coordinated with forms and procedures under Medicaid to

ensure that there is a single consolidated application process to

seek health benefit 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 an individual to

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

Sec. 532A.0154. 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 individuals and enroll eligible individuals in the program.

(b) The eligibility screening and enrollment procedures

must ensure that an individual applying for the program who appears

eligible for Medicaid is identified and assisted with obtaining

Medicaid coverage. If the individual is denied Medicaid coverage

but is determined eligible to enroll in a program health benefit

plan, the commission shall enroll the individual in a program

health benefit plan of the individual's choosing and for which the

individual is eligible without further application or

qualification.

(c) Not later than the 30th day after the date an individual

submits a complete application form and unless the individual is

identified and assisted with obtaining Medicaid coverage under

Subsection (b), the commission shall ensure that the individual's

eligibility to participate in the program is determined and that

the individual, if eligible, is provided with information on

program health benefit plans and program health benefit plan

providers. The commission shall enroll the individual in the

program health benefit plan and with the program health benefit

plan provider of the individual's choosing in a timely manner, as

determined by the commission.

(d) The executive commissioner may establish enrollment

periods for the program.

Sec. 532A.0155. ELIGIBILITY REDETERMINATION PROCESS;

DISENROLLMENT. (a) Not later than the 90th day before a

participant's coverage period expires, the commission shall notify

the participant regarding the eligibility redetermination process

and request documentation necessary to redetermine the

participant's eligibility.

(b) The commission shall provide written notice of

termination of eligibility to a participant not later than the 30th

day before the date the participant's eligibility will terminate.

The commission shall disenroll the 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 for

the program, subject to Subchapter H.

(c) An individual may submit the requested eligibility

redetermination documentation not later than the 90th day after the

date the commission disenrolls the individual from the program. If

the commission determines that the individual continues to meet

program eligibility requirements, the commission shall reenroll

the individual in the program without any additional application

requirements.

(d) An individual who does not complete the eligibility

redetermination process in accordance with this section and who the

commission disenrolls from the program may not participate in the

program for a period of 180 days beginning on the date of

disenrollment. This subsection does not apply to an individual:

(1) described by Section 532A.0206 or 532A.0208; or

(2) who is:

(A) pregnant; or

(B) younger than 21 years of age.

(e) At the time the commission disenrolls a participant from

the program, the commission shall provide to the participant:

(1) notice that the participant may be eligible to

receive health care financial assistance under Subchapter H in

transitioning to private health benefit coverage; and

(2) information on and the eligibility requirements

for that financial assistance.

SUBCHAPTER E. BASIC AND PLUS PLANS

Sec. 532A.0201. BASIC AND PLUS PLAN COVERAGE GENERALLY.

(a) The basic and plus plans offered under the program must:

(1) comply with this subchapter and coverage

requirements prescribed by other law; and

(2) at a minimum, provide coverage for essential

health benefits required under 42 U.S.C. Section 18022(b).

(b) In modifying covered health benefits under the basic and

plus plans, the executive commissioner shall consider the health

care needs of healthy individuals and individuals with special

health care needs.

(c) The basic and plus plans must allow a participant with a

chronic, disabling, or life-threatening illness to select an

appropriate specialist as the participant's primary care

physician.

Sec. 532A.0202. BASIC PLAN: COVERAGE AND INCOME

ELIGIBILITY. (a) The program must include a basic plan that is

sufficient to meet the basic health care needs of individuals who

enroll in the plan.

(b) The covered health benefits under the basic plan must

include:

(1) primary care physician services;

(2) prenatal and postpartum care;

(3) specialty care physician visits;

(4) home health services, not to exceed 100 visits per

year;

(5) outpatient surgery;

(6) allergy testing;

(7) chemotherapy;

(8) intravenous infusion services;

(9) radiation therapy;

(10) dialysis;

(11) emergency care hospital services;

(12) emergency transportation, including ambulance

and air ambulance;

(13) urgent care clinic services;

(14) hospitalization, including for:

(A) general inpatient hospital care;

(B) inpatient physician services;

(C) inpatient surgical services;

(D) non-cosmetic reconstructive surgery;

(E) a transplant;

(F) treatment for a congenital abnormality;

(G) anesthesia;

(H) hospice care; and

(I) care in a skilled nursing facility for a

period not to exceed 100 days per occurrence;

(15) inpatient and outpatient behavioral health

services;

(16) inpatient, outpatient, and residential substance

use treatment;

(17) prescription drugs, including tobacco cessation

drugs;

(18) inpatient and outpatient rehabilitative and

habilitative care, including physical, occupational, and speech

therapy, not to exceed 60 combined visits per year;

(19) medical equipment, appliances, and assistive

technology, including prosthetics and hearing aids, and the repair,

technical support, and customization needed for individual use;

(20) laboratory and pathology tests and services;

(21) diagnostic imaging, including x-rays, magnetic

resonance imaging, computed tomography, and positron emission

tomography;

(22) preventive care services as described by Section

532A.0204; and

(23) services under the early and periodic screening,

diagnostic, and treatment program for participants who are younger

than 21 years of age.

(c) To be eligible for health care benefits under the basic

plan, an individual who is eligible for the program must have an

annual household income that is equal to or less than 100 percent of

the federal poverty level.

Sec. 532A.0203. PLUS PLAN: COVERAGE AND INCOME ELIGIBILITY.

(a) The program must include a plus plan that includes the covered

health benefits listed in Section 532A.0202 and the following

additional enhanced health benefits:

(1) services related to the treatment of conditions

affecting the temporomandibular joint;

(2) dental care;

(3) vision care;

(4) notwithstanding Section 532A.0202(b)(18),

inpatient and outpatient rehabilitative and habilitative care,

including physical, occupational, and speech therapy, not to exceed

75 combined visits per year;

(5) bariatric surgery; and

(6) other services the commission considers

appropriate.

(b) An individual who is eligible for the program and whose

annual household income exceeds 100 percent of the federal poverty

level will automatically be enrolled in and receive health benefits

under the plus plan. An individual who is eligible for the program

and whose annual household income is equal to or less than 100

percent of the federal poverty level may choose to enroll in the

plus plan.

(c) A participant enrolled in the plus plan is required to

make POWER account contributions in accordance with Section

532A.0252.

Sec. 532A.0204. PREVENTIVE CARE SERVICES. (a) The

commission shall provide to each participant a list of health care

services that qualify as preventive care services based on the

participant's age, gender, and preexisting conditions. In

developing the list, the commission shall consult with the Centers

for Disease Control and Prevention.

(b) A program health benefit plan shall, at no cost to the

participant, provide coverage for:

(1) preventive care services described by 42 U.S.C.

Section 300gg-13; and

(2) a maximum of $500 per year of preventive care

services other than those described by Subdivision (1).

(c) A participant who receives preventive care services not

described by Subsection (b) that are covered under the

participant's program health benefit plan is subject to deductible

and copayment requirements for the services in accordance with the

terms of the plan.

Sec. 532A.0205. COPAYMENTS. (a) A participant enrolled in

the basic plan shall pay a copayment for each covered health benefit

except for a preventive care or family planning service. The

executive commissioner by rule shall adopt a copayment schedule for

basic plan services, subject to Subsection (c).

(b) Except as provided by Subsection (c), a participant

enrolled in the plus plan may not be required to pay a copayment for

a covered service.

(c) A participant enrolled in the basic or plus plan shall

pay a copayment in an amount set by commission rule not to exceed

$25 for nonemergency use of hospital emergency department services

unless:

(1) the participant has met the cost-sharing maximum

for the calendar quarter, as prescribed by commission rule;

(2) the participant is referred to the hospital

emergency department by a health care provider;

(3) the visit is a true emergency, as defined by

commission rule; or

(4) the participant is pregnant.

Sec. 532A.0206. CERTAIN PARTICIPANTS ELIGIBLE FOR STATE

MEDICAID PLAN BENEFITS. (a) A participant described by 42 C.F.R.

Section 440.315 who is enrolled in the basic or plus plan is

entitled to receive under the program all health benefits that

would be available under the state Medicaid plan.

(b) A participant to whom this section applies is subject to

the cost-sharing requirements, including copayment and POWER

account contribution requirements, of the program health benefit

plan in which the participant is enrolled.

(c) The commission shall develop screening measures to

identify participants to which this section applies.

Sec. 532A.0207. PREGNANT PARTICIPANTS. (a) A participant

who becomes pregnant while enrolled in the program and who meets the

eligibility requirements for Medicaid may choose to remain in the

program or enroll in Medicaid.

(b) A pregnant participant described by Subsection (a) who

is enrolled in the basic or plus plan and who remains in the program

is:

(1) notwithstanding Section 532A.0205, not subject to

any cost-sharing requirements, including copayment and POWER

account contribution requirements, of the program health benefit

plan in which the participant is enrolled until the expiration of

the second month following the month in which the pregnancy ends;

(2) entitled to receive as a Medicaid wrap-around

benefit all Medicaid services a pregnant woman enrolled in Medicaid

is entitled to receive, including a pharmacy benefit, when the

participant exceeds coverage limits under the participant's

program health benefit plan or if a service is not covered by the

plan; and

(3) eligible for additional vision and dental care

benefits.

Sec. 532A.0208. PARENTS AND CARETAKER RELATIVES. (a) A

parent or caretaker relative to whom 42 C.F.R. Section 435.110

applies is entitled to receive as a Medicaid wrap-around benefit

all Medicaid services to which the individual would be entitled

under the state Medicaid plan that are not covered under the

individual's program health benefit plan or exceed the plan's

coverage limits.

(b) An individual described by Subsection (a) who chooses to

participate in the program is subject to the cost-sharing

requirements, including copayment and POWER account contribution

requirements, of the program health benefit plan in which the

individual is enrolled.

SUBCHAPTER F. PERSONAL WELLNESS AND RESPONSIBILITY (POWER)

ACCOUNTS

Sec. 532A.0251. ESTABLISHMENT AND OPERATION OF POWER

ACCOUNTS. (a) The commission shall establish a personal wellness

and responsibility (POWER) account for each participant who is

enrolled in a program health benefit plan that is funded with money

contributed in accordance with this subchapter.

(b) The commission shall enable each participant to access

and manage money in and information regarding the participant's

POWER account through an electronic system. The commission may

contract with an entity that has appropriate experience and

expertise to establish, implement, or administer the electronic

system.

(c) Except as otherwise provided by Section 532A.0252, the

commission shall require each participant to contribute to the

participant's POWER account in amounts described by that section.

Sec. 532A.0252. POWER ACCOUNT CONTRIBUTIONS; DEDUCTIBLE.

(a) The executive commissioner by rule shall establish an annual

universal deductible for each participant enrolled in the basic or

plus plan.

(b) To ensure each participant's POWER account contains a

sufficient amount of money at the beginning of a coverage period,

the commission shall, before the beginning of that period, fund

each account with the following amounts:

(1) for a participant enrolled in the basic plan, the

annual universal deductible amount; and

(2) for a participant enrolled in the plus plan, the

difference between the annual universal deductible amount and the

participant's required annual contribution as determined by the

schedule established under Subsection (c).

(c) The executive commissioner by rule shall establish a

graduated annual POWER account contribution schedule for

participants enrolled in the plus plan that:

(1) is based on a participant's annual household

income, with participants whose annual household incomes are less

than the federal poverty level paying progressively less and

participants whose annual household incomes are equal to or greater

than the federal poverty level paying progressively more; and

(2) may not require a participant to contribute more

than a total of five percent of the participant's annual household

income to the participant's POWER account.

(d) A participant's employer may contribute on behalf of the

participant any amount of the participant's annual POWER account

contribution. A nonprofit organization may contribute on behalf of

a participant any amount of the participant's annual POWER account

contribution.

(e) Subject to the contribution cap described by Subsection

(c)(2) and not before the expiration of the participant's first

coverage period, the commission shall require a participant who

uses one or more tobacco products to contribute to the

participant's POWER account an annual POWER account contribution

amount that is one percent more than the participant would

otherwise be required to contribute under the schedule established

under Subsection (c).

(f) An annual POWER account contribution must be paid by or

on behalf of a participant monthly in installments that are at least

equal to one-twelfth of the total required contribution. The

coverage period for a participant whose annual household income

exceeds 100 percent of the federal poverty level may not begin until

the first day of the first month following the month in which the

first monthly installment is received.

Sec. 532A.0253. USE OF POWER ACCOUNT MONEY. A participant

may use money in the participant's POWER account to pay copayments

and deductible costs the participant's program health benefit plan

requires. The commission shall issue to each participant an

electronic payment card that allows the participant to use the card

to pay the program health benefit plan costs.

Sec. 532A.0254. PROGRAM HEALTH BENEFIT PLAN PROVIDER

REWARDS PROGRAM FOR ENGAGEMENT IN CERTAIN HEALTHY BEHAVIORS;

SMOKING CESSATION INITIATIVE. (a) A program health benefit plan

provider shall establish a rewards program through which a

participant receiving health care through a program health benefit

plan the program health benefit plan provider offers may earn money

to be contributed to the participant's POWER account.

(b) Under a rewards program, a program health benefit plan

provider shall contribute money to a participant's POWER account if

the participant engages in certain healthy behaviors. The

executive commissioner by rule shall determine:

(1) the behaviors in which a participant must engage

to receive a contribution, which must include behaviors related to:

(A) completion of a health risk assessment;

(B) smoking cessation; and

(C) as applicable, chronic disease management;

and

(2) the amount of money a program health benefit plan

provider shall contribute for each behavior described by

Subdivision (1).

(c) Subsection (b) does not prevent a program health benefit

plan provider from contributing money to a participant's POWER

account if the participant engages in a behavior not specified by

that subsection or a rule the executive commissioner adopts in

accordance with that subsection. If a program health benefit plan

provider chooses to contribute money under this subsection, the

program health benefit plan provider shall determine the amount of

money to be contributed for the behavior.

(d) A participant may use contributions a program health

benefit plan provider makes under a rewards program to offset a

maximum of 50 percent of the participant's required annual POWER

account contribution the executive commissioner establishes under

Section 532A.0252.

(e) Contributions a program health benefit plan provider

makes under a rewards program that result in a participant's POWER

account balance exceeding the participant's required annual POWER

account contribution may be rolled over into the next coverage

period in accordance with Section 532A.0256.

(f) During the first coverage period of a participant who

uses one or more tobacco products, a program health benefit plan

provider shall actively attempt to engage the participant in and

provide educational materials to the participant on:

(1) smoking cessation activities for which the

participant may receive a monetary contribution under this section;

and

(2) other smoking cessation programs or resources

available to the participant.

Sec. 532A.0255. MONTHLY STATEMENTS. The commission shall

distribute to each participant with a POWER account a monthly

statement that includes information on:

(1) the participant's POWER account activity during

the preceding month, including information on the cost of health

care services delivered to the participant during that month;

(2) the balance of money available in the POWER

account at the time the statement is issued; and

(3) the amount of any contributions due from the

participant.

Sec. 532A.0256. POWER ACCOUNT ROLL OVER. (a) The executive

commissioner by rule shall establish a process in accordance with

this section to roll over money in a participant's POWER account to

the succeeding coverage period. The commission shall calculate the

amount to be rolled over at the time the participant's program

eligibility is redetermined.

(b) For a participant enrolled in the basic plan, the

commission shall calculate the amount to be rolled over to a

subsequent coverage period POWER account from the participant's

current coverage period POWER account based on:

(1) the amount of money remaining in the participant's

POWER account from the current coverage period; and

(2) whether the participant received recommended

preventive care services during the current coverage period.

(c) For a participant enrolled in the plus plan who, as

determined by the commission, timely makes POWER account

contributions in accordance with this subchapter, the commission

shall calculate the amount to be rolled over to a subsequent

coverage period POWER account from the participant's current

coverage period POWER account based on:

(1) the amount of money remaining in the participant's

POWER account from the current coverage period;

(2) the total amount of money the participant

contributed to the participant's POWER account during the current

coverage period; and

(3) whether the participant received recommended

preventive care services during the current coverage period.

(d) Except as provided by Subsection (e), a participant may

use money rolled over into the participant's POWER account for the

succeeding coverage period to offset required annual POWER account

contributions, as applicable, during that coverage period.

(e) A participant enrolled in the basic plan who rolls over

money into the participant's POWER account for the succeeding

coverage period and who chooses to enroll in the plus plan for that

coverage period may use the money rolled over to offset a maximum of

50 percent of the required annual POWER account contributions for

that coverage period.

Sec. 532A.0257. REFUND. If at the end of a participant's

coverage period the participant chooses to cease participating in a

program health benefit plan or is no longer eligible to participate

in a program health benefit plan, or if the commission disenrolls a

participant from the program health benefit plan under Section

532A.0258 for failure to pay required contributions, the commission

shall refund to the participant any money the participant

contributed that remains in the participant's POWER account at the

end of the coverage period or on the disenrollment date.

Sec. 532A.0258. PENALTIES FOR FAILURE TO MAKE POWER ACCOUNT

CONTRIBUTIONS. (a) For a participant whose annual household

income exceeds 100 percent of the federal poverty level and who

fails to make a contribution in accordance with Section 532A.0252,

the commission shall provide a 60-day grace period during which the

participant may make the contribution without penalty. If the

participant fails to make the contribution during the grace period,

the commission shall disenroll the participant from the program

health benefit plan in which the participant is enrolled and the

participant may not reenroll in a program health benefit plan

until:

(1) the 181st day after the disenrollment date; and

(2) the participant pays any debt accrued due to the

participant's failure to make the contribution.

(b) For a participant enrolled in the plus plan whose annual

household income is equal to or less than 100 percent of the federal

poverty level and who fails to make a contribution in accordance

with Section 532A.0252, the commission shall disenroll the

participant from the plus plan and enroll the participant in the

basic plan. A participant enrolled in the basic plan under this

subsection may not change enrollment to the plus plan until the

participant's program eligibility is redetermined.

SUBCHAPTER G. EMPLOYMENT INITIATIVE

Sec. 532A.0301. GATEWAY TO WORK PROGRAM. (a) The

commission shall develop and implement a gateway to work program

to:

(1) integrate existing job training and job search

programs available in this state through the Texas Workforce

Commission or other appropriate state agencies with the Live Well

Texas program; and

(2) provide each participant with general information

on the job training and job search programs.

(b) Under the gateway to work program, the commission shall

refer each participant who is unemployed or working less than 20

hours a week to available job search and job training programs.

SUBCHAPTER H. HEALTH CARE FINANCIAL ASSISTANCE FOR CERTAIN

PARTICIPANTS

Sec. 532A.0351. HEALTH CARE FINANCIAL ASSISTANCE FOR

CONTINUITY OF CARE. (a) The commission shall ensure continuity of

care by providing health care financial assistance in accordance

with and in the manner described by this subchapter for a

participant who:

(1) the commission disenrolls from a program health

benefit plan in accordance with Section 532A.0155 because the

participant's annual household income exceeds the income

eligibility requirements for enrollment in a program health benefit

plan; and

(2) seeks and obtains private health benefit coverage

within 12 months following the date of disenrollment.

(b) To receive health care financial assistance under this

subchapter, a participant must provide to the commission, in the

form and manner the commission requires, documentation showing the

participant has obtained or is actively seeking private health

benefit coverage.

(c) The commission may not impose an upper income

eligibility limit on a participant to receive health care financial

assistance under this subchapter.

Sec. 532A.0352. DURATION AND AMOUNT OF HEALTH CARE

FINANCIAL ASSISTANCE. (a) A participant described by Section

532A.0351 may receive health care financial assistance under this

subchapter until the first anniversary of the date the commission

disenrolled the participant from a program health benefit plan.

(b) Health care financial assistance the commission makes

available to a participant under this subchapter:

(1) may not exceed the amount described by Section

532A.0353; and

(2) may be used only to pay for eligible services

described by Section 532A.0354.

Sec. 532A.0353. BRIDGE ACCOUNT; FUNDING. (a) The

commission shall establish a bridge account for each participant

eligible to receive health care financial assistance under Section

532A.0351. The account is funded with money the commission

contributes in accordance with this section.

(b) The commission shall enable each participant for whom

the commission establishes a bridge account to access and manage

money in and information regarding the participant's account

through an electronic system. The commission may contract with the

same entity described by Section 532A.0251(b) or another entity

with appropriate experience and expertise to establish, implement,

or administer the electronic system.

(c) The commission shall fund each bridge account in an

amount equal to $1,000 using money the commission retains or

recoups:

(1) during the roll over process described by Section

532A.0256;

(2) following the issuance of a refund as described by

Section 532A.0257; or

(3) under Subsection (e).

(d) The commission may not require a participant to

contribute money to the participant's bridge account.

(e) The commission shall retain or recoup any unexpended

money in a participant's bridge account at the end of the period for

which the participant is eligible to receive health care financial

assistance under this subchapter for the purpose of funding another

participant's POWER account under Subchapter F or bridge account

under this subchapter.

Sec. 532A.0354. USE OF BRIDGE ACCOUNT MONEY. (a) The

commission shall issue to each participant for whom the commission

establishes a bridge account an electronic payment card that allows

the participant to use the card to pay costs for eligible services

described by Subsection (b).

(b) A participant may use money in the participant's bridge

account to pay:

(1) premium costs incurred during the private health

benefit coverage enrollment process and coverage period; and

(2) copayments, deductible costs, and coinsurance

associated with the private health benefit coverage the participant

obtains for health care services that would otherwise be

reimbursable under Medicaid.

(c) Costs described by Subsection (b)(2) associated with

eligible services delivered to a participant may be paid by:

(1) a participant using the electronic payment card

issued under Subsection (a); or

(2) a health care provider directly charging and

receiving payment from the participant's bridge account.

Sec. 532A.0355. ENROLLMENT COUNSELING. The commission

shall provide enrollment counseling to an individual who is seeking

private health benefit coverage and who is otherwise eligible to

receive health care financial assistance under this subchapter.

CHAPTER 532B. EXPANDED MEDICAID ELIGIBILITY FOR CERTAIN

INDIVIDUALS

Sec. 532B.0001. APPLICABILITY. This chapter applies only

to an individual who would be eligible to participate in the Live

Well Texas program under Chapter 532A based on the eligibility

requirements described by Section 532A.0151, if the commission were

to establish the program.

Sec. 532B.0002. EXPANDED MEDICAID ELIGIBILITY UNDER

PATIENT PROTECTION AND AFFORDABLE CARE ACT. (a) Except as provided

by Subsection (b) and notwithstanding any other law, the commission

shall provide Medicaid benefits to all individuals who apply for

those benefits and to whom this chapter applies.

(b) After the waiver described by Section 532A.0051 is

approved and the commission implements the Live Well Texas program

under Chapter 532A, the commission shall:

(1) provide health benefit coverage through that

program in accordance with Chapter 532A to individuals to whom this

chapter applies; and

(2) cease providing Medicaid benefits to those

individuals, except as provided by Chapter 532A.

(c) The commission shall:

(1) continue to provide Medicaid benefits to

individuals described by Subsection (a) if the waiver described by

Section 532A.0051 is not approved; and

(2) resume providing Medicaid benefits to individuals

described by Subsection (a) if the Live Well Texas program

implemented under Chapter 532A terminates in accordance with

Section 532A.0053(b).

(d) The executive commissioner shall adopt rules regarding

the provision of Medicaid benefits as required by this section,

including, as applicable, rules on transitioning individuals from

receiving Medicaid benefits under this section to receiving health

benefit coverage under the Live Well Texas program implemented

under Chapter 532A.

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

Centers for Medicare and Medicaid Services or another appropriate

federal agency the waiver as required by Section 532A.0051,

Government Code, as added by this Act. The commission may delay

implementing other provisions of Chapter 532A, Government Code, as

added by this Act, until the waiver applied for under that section

is granted.

SECTION 3. (a) Chapter 532B, Government Code, as added by

this Act, applies only to an initial determination or

recertification of an individual's Medicaid eligibility under

Chapter 32, Human Resources Code, made on or after the

implementation of Chapter 532B, regardless of the date the

individual applied for Medicaid.

(b) As soon as practicable after the effective date of this

Act, the executive commissioner of the Health and Human Services

Commission shall take all necessary actions to expand Medicaid

eligibility in accordance with Chapter 532B, Government Code, as

added by this Act, including notifying appropriate federal agencies

of that expanded eligibility. If before implementing Chapter 532B

a state agency determines that any other waiver or authorization

from a federal agency is necessary for implementation of that

chapter, the agency affected by the chapter shall request the

waiver or authorization and may delay implementing that chapter

until the waiver or authorization is granted.

SECTION 4. 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.