89R16083 AB-D
By: Talarico H.B. No. 5311
A BILL TO BE ENTITLED
AN ACT
relating to establishing the Texas Care Plan Medicaid buy-in
program to provide health benefit plan coverage to certain persons
in this state.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter H, Chapter 532, Government Code, as
effective April 1, 2025, is amended by adding Section 532.0354 to
read as follows:
Sec. 532.0354. TEXAS CARE PLAN MEDICAID BUY-IN PROGRAM.
(a) In this section, "program" means the Texas Care Plan Medicaid
buy-in program implemented under this section.
(b) The executive commissioner shall seek a waiver under
Section 1115 of the Social Security Act (42 U.S.C. Section 1315) to
implement the Texas Care Plan Medicaid buy-in program in accordance
with this section.
(c) The commission in consultation with the commissioner of
insurance shall develop the program to allow residents of this
state to purchase health benefit plan coverage through Medicaid by
enrolling in a managed care plan offered by a Medicaid managed care
organization.
(d) The executive commissioner shall adopt rules for the
program that:
(1) establish eligibility requirements for
participation, including:
(A) household income limits;
(B) a requirement that a program participant be
ineligible for benefits under Medicaid, other than through the
program; and
(C) a requirement that a program participant not
have health benefit coverage under another health benefit plan
because the participant does not have access to or cannot afford
coverage through an employer-sponsored health benefit plan; and
(2) require financial participation by a program
participant, including a requirement that a program participant
pay, according to a sliding scale based on household income
determined in accordance with commission rules that are consistent
with the cost-sharing reduction eligibility categories provided by
45 C.F.R. Section 155.305(g), a portion of premiums imposed or
cost-sharing payments required under the program.
(e) The program must be designed to leverage 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).
(f) The program, including benefits offered under the
program, must be substantively identical to the Medicaid buy-in
programs established under Section 532.0353, except:
(1) to the extent that programmatic differences are
appropriate because of the populations served by the programs; and
(2) that a health benefit plan under the program is not
required to include nonemergency transportation services as
defined by Section 526.0351.
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 the waiver
from the Centers for Medicare and Medicaid Services or any other
federal agency required by Section 532.0354(b), Government Code, as
added by this Act. The commission may delay implementing Section
532.0354, Government Code, as added by this Act, until the waiver
applied for under this section is granted.
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, 2025.