By: Rodriguez S.B. No. 1039
A BILL TO BE ENTITLED
AN ACT
relating to seeking federal authorization to provide health benefit
plan coverage to certain low-income individuals through the private
marketplace.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle I, Title 4, Government Code, is amended
by adding Chapter 540 to read as follows:
CHAPTER 540. FEDERAL WAIVER FOR HEALTH BENEFIT PLAN COVERAGE
THROUGH PRIVATE MARKETPLACE
Sec. 540.001. DEFINITIONS. In this chapter:
(1) "Expansion population" means residents of this
state:
(A) who were not eligible to receive benefits
under the eligibility criteria for the Medicaid program in effect
on December 31, 2013; and
(B) for whom 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
Medicaid benefits.
(2) "Medicaid program" means the medical assistance
program established under Title XIX, Social Security Act (42 U.S.C.
Section 1396 et seq.).
Sec. 540.002. FEDERAL AUTHORIZATION FOR HEALTH BENEFIT PLAN
COVERAGE THROUGH PRIVATE MARKETPLACE. (a) Notwithstanding any
other law, the executive commissioner shall seek a waiver under
Section 1115 of the Social Security Act (42 U.S.C. Section 1396 et
seq.) to the state Medicaid plan to develop and implement a program
to assist the expansion population with obtaining health benefit
plan coverage through the private marketplace. The terms of a
waiver under this section must:
(1) provide for the implementation of sliding scale
subsidies:
(A) based on an individual's ability to pay; and
(B) designed to assist eligible individuals with
purchasing a health benefit plan from credible health benefit plan
issuers;
(2) require the implementation of health savings
accounts and point-of-service cost-sharing by individuals meant to
encourage the appropriate use of health care benefits and wellness;
(3) include personal responsibility requirements for
individuals enrolled in the program, including incentives for
seeking and maintaining employment;
(4) impose financial penalties on individuals
enrolled in the program for inappropriate use of hospital emergency
room services for non-emergent care;
(5) provide for implementation of a small-employer
subsidy designed to encourage those employers to provide health
benefit coverage options as a benefit to employees who are members
of the expansion population; and
(6) be designed to establish a transparent process for
determining the cost savings realized under the waiver by local
governments and local property taxpayers that result from reduced
costs associated with providing indigent care services.
(b) The executive commissioner shall adopt rules necessary
to implement this section.
SECTION 2. Not later than December 1, 2015, the executive
commissioner of the Health and Human Services Commission shall
adopt rules necessary to implement Section 540.002, Government
Code, as added by this Act.
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, 2015.