Texas 2025 - 89th Regular

Texas House Bill HB5311 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	89R16083 AB-D
2	2	By: Talarico H.B. No. 5311
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to establishing the Texas Care Plan Medicaid buy-in
10	10	program to provide health benefit plan coverage to certain persons
11	11	in this state.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	SECTION 1. Subchapter H, Chapter 532, Government Code, as
14	14	effective April 1, 2025, is amended by adding Section 532.0354 to
15	15	read as follows:
16	16	Sec. 532.0354. TEXAS CARE PLAN MEDICAID BUY-IN PROGRAM.
17	17	(a) In this section, "program" means the Texas Care Plan Medicaid
18	18	buy-in program implemented under this section.
19	19	(b) The executive commissioner shall seek a waiver under
20	20	Section 1115 of the Social Security Act (42 U.S.C. Section 1315) to
21	21	implement the Texas Care Plan Medicaid buy-in program in accordance
22	22	with this section.
23	23	(c) The commission in consultation with the commissioner of
24	24	insurance shall develop the program to allow residents of this
25	25	state to purchase health benefit plan coverage through Medicaid by
26	26	enrolling in a managed care plan offered by a Medicaid managed care
27	27	organization.
28	28	(d) The executive commissioner shall adopt rules for the
29	29	program that:
30	30	(1) establish eligibility requirements for
31	31	participation, including:
32	32	(A) household income limits;
33	33	(B) a requirement that a program participant be
34	34	ineligible for benefits under Medicaid, other than through the
35	35	program; and
36	36	(C) a requirement that a program participant not
37	37	have health benefit coverage under another health benefit plan
38	38	because the participant does not have access to or cannot afford
39	39	coverage through an employer-sponsored health benefit plan; and
40	40	(2) require financial participation by a program
41	41	participant, including a requirement that a program participant
42	42	pay, according to a sliding scale based on household income
43	43	determined in accordance with commission rules that are consistent
44	44	with the cost-sharing reduction eligibility categories provided by
45	45	45 C.F.R. Section 155.305(g), a portion of premiums imposed or
46	46	cost-sharing payments required under the program.
47	47	(e) The program must be designed to leverage enhanced
48	48	federal medical assistance percentage funding available under the
49	49	Patient Protection and Affordable Care Act (Pub. L. No. 111-148) as
50	50	amended by the Health Care and Education Reconciliation Act of 2010
51	51	(Pub. L. No. 111-152).
52	52	(f) The program, including benefits offered under the
53	53	program, must be substantively identical to the Medicaid buy-in
54	54	programs established under Section 532.0353, except:
55	55	(1) to the extent that programmatic differences are
56	56	appropriate because of the populations served by the programs; and
57	57	(2) that a health benefit plan under the program is not
58	58	required to include nonemergency transportation services as
59	59	defined by Section 526.0351.
60	60	SECTION 2. As soon as practicable after the effective date
61	61	of this Act, the executive commissioner of the Health and Human
62	62	Services Commission shall apply for and actively pursue the waiver
63	63	from the Centers for Medicare and Medicaid Services or any other
64	64	federal agency required by Section 532.0354(b), Government Code, as
65	65	added by this Act. The commission may delay implementing Section
66	66	532.0354, Government Code, as added by this Act, until the waiver
67	67	applied for under this section is granted.
68	68	SECTION 3. This Act takes effect immediately if it receives
69	69	a vote of two-thirds of all the members elected to each house, as
70	70	provided by Section 39, Article III, Texas Constitution. If this
71	71	Act does not receive the vote necessary for immediate effect, this
72	72	Act takes effect September 1, 2025.