By: Bucy H.B. No. 36
A BILL TO BE ENTITLED
AN ACT
relating to implementation of an express lane option for
determining eligibility and enrolling certain individuals in
Medicaid or the child health plan program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 62.1011, Health and Safety Code, is
amended to read as follows:
Sec. 62.1011. VERIFICATION OF INCOME. (a) Except as
provided by Subsection (b) and subject to Subsection (c), the [The]
commission shall continue employing methods of verifying the
individual incomes of the individuals considered in the calculation
of an applicant's household income.
(b) The commission shall verify income under this section
unless the applicant reports a household income that exceeds the
income eligibility level established under Section 62.101(b).
(c) The commission may verify income using the verification
process described in Section 62.1012.
SECTION 2. Subchapter C, Chapter 62, Health and Safety
Code, is amended by adding Section 62.1012 to read as follows:
Sec. 62.1012. EXPRESS LANE OPTION ELIGIBILITY; ENROLLMENT.
(a) In this section:
(1) "Express lane agency" means a governmental entity
that:
(A) determines eligibility for assistance under
a public assistance program of this state; and
(B) is designated by the executive commissioner
as capable of making determinations of one or more eligibility
requirements under the child health plan program.
(2) "Public assistance program" includes:
(A) the Medicaid program under Chapter 32, Human
Resources Code;
(B) the financial assistance program under
Chapter 31, Human Resources Code;
(C) the nutritional assistance programs under
Chapter 33, Human Resources Code, including the supplemental
nutrition assistance program under that chapter; and
(D) other programs identified by the commission.
(b) Notwithstanding any other law and in accordance with
Sections 1902(e)(13) and 2107(e)(1)(H) of the Social Security Act
(42 U.S.C. Sections 1396a(e)(13) and 1397gg(e)(1)(H)), the
commission shall implement an express lane option under which the
commission may rely on findings made by an express lane agency,
including a division of an express lane agency, in determining a
child's eligibility for coverage under the child health plan,
including a child's eligibility for reenrollment in the plan. The
commission shall use express lane eligibility by evaluating data
received from an applicant under other public assistance programs
to determine the applicant's eligibility for coverage under the
child health plan.
(c) In accordance with Section 1902(e)(13)(D) of the Social
Security Act (42 U.S.C. Section 1396a(e)(13)(D)), the commission
shall enroll in the child health plan program a child who is
determined to be eligible for the program under this section,
except that the child may only be enrolled in the program if the
child's parent, legal guardian, or custodial relative
affirmatively consents to the enrollment. The consent:
(1) must be provided in accordance with identity
verification standards the commission establishes; and
(2) may be provided:
(A) orally;
(B) by telephone;
(C) in writing, including:
(i) by electronic signature; or
(ii) in an application for coverage or
benefits under a public assistance program; or
(D) by any other manner the commission determines
appropriate.
(d) The commission and each express lane agency shall
include in each application for coverage or benefits under a public
assistance program, including any online application, and on the
commission's or agency's Internet website a conspicuous notice
clearly explaining that:
(1) the information disclosed in the application may
be used to determine a child's eligibility for coverage under the
child health plan program using the express lane option implemented
under this section;
(2) the child's parent, legal guardian, or custodial
relative may elect not to have the information disclosed for that
purpose; and
(3) the child's parent, legal guardian, or custodial
relative must provide affirmative consent before the child may be
enrolled in the child health plan program using the express lane
option implemented under this section.
(e) In accordance with 42 C.F.R. Section 457.340(e), the
commission shall provide to the parent, legal guardian, or
custodial relative of a child determined eligible for coverage
under the child health plan program using the express lane option
implemented under this section notice of that determination. The
notice may be provided by mail, e-mail, or any other manner the
commission determines appropriate.
SECTION 3. Sections 32.026(e) and (g), Human Resources
Code, are amended to read as follows:
(e) The executive commissioner shall permit a
recertification review of the eligibility and need for medical
assistance of a child under 19 years of age to be conducted by
telephone or mail instead of through a personal appearance at an
office, unless the commission determines that the information
needed to verify eligibility cannot be obtained in that manner or
may be obtained in the manner specified by Section 32.026102. The
executive commissioner by rule may develop procedures to determine
whether there is a need for a recertification review of a child
described by this subsection to be conducted through a personal
interview with a commission representative. Procedures developed
under this subsection shall be based on objective, risk-based
factors and conditions and shall focus on a targeted group of
recertification reviews for which there is a high probability that
eligibility will not be recertified.
(g) Notwithstanding any other provision of this code, the
commission may use information obtained from a third party to
verify the assets and resources of a person for purposes of
determining the person's eligibility and need for medical
assistance to the extent that verification is applicable under
federal law. Third-party information includes information
obtained from:
(1) a consumer reporting agency, as defined by Section
20.01, Business & Commerce Code;
(2) an appraisal district; [or]
(3) the Texas Department of Motor Vehicles vehicle
registration record database; or
(4) an express lane agency as defined by Section
32.026102.
SECTION 4. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.026102 to read as follows:
Sec. 32.026102. EXPRESS LANE OPTION ELIGIBILITY;
ENROLLMENT. (a) In this section:
(1) "Express lane agency" means a governmental entity
that:
(A) determines eligibility for assistance under
a public assistance program of this state; and
(B) is designated by the executive commissioner
as capable of making determinations of one or more eligibility
requirements under the medical assistance program.
(2) "Public assistance program" includes:
(A) the child health plan program under Chapters
62 and 63, Health and Safety Code;
(B) the financial assistance program under
Chapter 31;
(C) the nutritional assistance programs under
Chapter 33, including the supplemental nutrition assistance
program under that chapter; and
(D) other programs identified by the commission.
(b) Notwithstanding any other law and in accordance with
Section 1902(e)(13) of the Social Security Act (42 U.S.C. Section
1396a(e)(13)), the commission shall implement an express lane
option under which the commission may rely on findings made by an
express lane agency, including a division of an express lane
agency, in determining a child's eligibility for medical
assistance, including the recertification of a child's eligibility
for medical assistance benefits. The commission shall use express
lane eligibility by evaluating data received from an applicant
under other public assistance programs to determine the applicant's
eligibility for benefits under the medical assistance program.
(c) In accordance with Section 1902(e)(13)(D) of the Social
Security Act (42 U.S.C. Section 1396a(e)(13)(D)), the commission
shall enroll in the medical assistance program a child who is
determined to be eligible for the program under this section,
except that the child may only be enrolled in the program if the
child's parent, legal guardian, or custodial relative
affirmatively consents to the enrollment. The consent:
(1) must be provided in accordance with identity
verification standards the commission establishes; and
(2) may be provided:
(A) orally;
(B) by telephone;
(C) in writing, including:
(i) by electronic signature; or
(ii) in an application for coverage or
benefits under a public assistance program; or
(D) by any other manner the commission determines
appropriate.
(d) The commission and each express lane agency shall
include in each application for coverage or benefits under a public
assistance program, including any online application, and on the
commission's or agency's Internet website a conspicuous notice
clearly explaining that:
(1) the information disclosed in the application may
be used to determine a child's eligibility for medical assistance
benefits using the express lane option implemented under this
section;
(2) the child's parent, legal guardian, or custodial
relative may elect not to have the information disclosed for that
purpose; and
(3) the child's parent, legal guardian, or custodial
relative must provide affirmative consent before the child may be
enrolled in the medical assistance program using the express lane
option implemented under this section.
(e) In accordance with 42 C.F.R. Section 435.917, the
commission shall provide to the parent, legal guardian, or
custodial relative of a child determined eligible for benefits
under the medical assistance program using the express lane option
implemented under this section notice of that determination. The
notice may be provided by mail, e-mail, or any other manner the
commission determines appropriate.
SECTION 5. 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 6. 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 on the 91st day after the last day of the
legislative session.