By: Cortez, et al. H.B. No. 290
(Senate Sponsor - Kolkhorst, et al.)
(In the Senate - Received from the House April 19, 2021;
May 18, 2021, read first time and referred to Committee on Health &
Human Services; May 22, 2021, reported adversely, with favorable
Committee Substitute by the following vote: Yeas 9, Nays 0;
May 22, 2021, sent to printer.)
Click here to see the committee vote
COMMITTEE SUBSTITUTE FOR H.B. No. 290 By: Blanco
A BILL TO BE ENTITLED
AN ACT
relating to the period of continuous eligibility and a periodic
eligibility review for a child for Medicaid.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 32.0261, Human Resources Code, is
amended to read as follows:
Sec. 32.0261. CONTINUOUS ELIGIBILITY. (a) This section
applies only to a child younger than 19 years of age who is
determined eligible for medical assistance under this chapter.
(b) The executive commissioner shall adopt rules in
accordance with 42 U.S.C. Section 1396a(e)(12), as amended, to
provide for two consecutive periods of [a period of continuous]
eligibility for a child between each certification and
recertification of the child's eligibility, subject to Subsections
(f) and (h) [under 19 years of age who is determined to be eligible
for medical assistance under this chapter].
(c) The first of the two consecutive periods of eligibility
described by Subsection (b) must be continuous in accordance with
Subsection (d). The second of the two consecutive periods of
eligibility is not continuous and may be affected by changes in a
child's household income, regardless of whether those changes
occurred or whether the commission became aware of the changes
during the first or second of the two consecutive periods of
eligibility.
(d) A [The rules shall provide that the] child remains
eligible for medical assistance during the first of the two
consecutive periods of eligibility, without additional review by
the commission and regardless of changes in the child's household
[resources or] income, until [the earlier of:
[(1)] the end of the six-month period following the
date on which the child's eligibility was determined, except as
provided by Subsections (f)(1) and (h) [; or
[(2) the child's 19th birthday].
(e) During the sixth month following the date on which a
child's eligibility for medical assistance is certified or
recertified, the commission shall, in a manner that complies with
federal law, including verification plan requirements under 42
C.F.R. Section 435.945(j), review the child's household income
using electronic income data available to the commission. The
commission may conduct this review only once during the child's two
consecutive periods of eligibility. Based on the review:
(1) the commission shall, if the review indicates that
the child's household income does not exceed the maximum income for
eligibility for the medical assistance program, provide for a
second consecutive period of eligibility for the child until the
child's required annual recertification, except as provided by
Subsection (h) and subject to Subsection (c); or
(2) the commission may, if the review indicates that
the child's household income exceeds the maximum income for
eligibility for the medical assistance program, request additional
documentation to verify the child's household income in a manner
that complies with federal law.
(f) If, after reviewing a child's household income under
Subsection (e), the commission determines that the household income
exceeds the maximum income for eligibility for the medical
assistance program, the commission shall continue to provide
medical assistance to the child until:
(1) the commission provides the child's parent or
guardian with a period of not less than 30 days to provide
documentation demonstrating that the child's household income does
not exceed the maximum income for eligibility; and
(2) the child's parent or guardian fails to provide the
documentation during the period described by Subdivision (1).
(g) If a child's parent or guardian provides to the
commission within the period described by Subsection (f)
documentation demonstrating that the child's household income does
not exceed the maximum income for eligibility for the medical
assistance program, the commission shall provide for a second
consecutive period of eligibility for the child until the child's
required annual recertification, except as provided by Subsection
(h) and subject to Subsection (c).
(h) Notwithstanding any other period prescribed by this
section, a child's eligibility for medical assistance ends on the
child's 19th birthday.
(i) The commission may not recertify a child's eligibility
for medical assistance more frequently than every 12 months as
required by federal law.
(j) If a child's parent or guardian fails to provide to the
commission within the period described by Subsection (f)
documentation demonstrating that the child's household income does
not exceed the maximum income for eligibility for the medical
assistance program, the commission shall provide the child's parent
or guardian with written notice of termination following that
period. The notice must include a statement that the child may be
eligible for enrollment in the child health plan under Chapter 62,
Health and Safety Code.
(k) In developing the notice, the commission shall consult
with health care providers, children's health care advocates,
family members of children enrolled in the medical assistance
program, and other stakeholders to determine the most user-friendly
method to provide the notice to a child's parent or guardian.
(l) The executive commissioner may adopt rules as necessary
to implement this section.
SECTION 2. 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 3. This Act takes effect September 1, 2021.
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