89R2042 SCL-F
By: Eckhardt, et al. S.B. No. 359
A BILL TO BE ENTITLED
AN ACT
relating to the coverage and provision of abortion, contraception,
and sterilization under Medicaid and certain health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 32.024(e), Human Resources Code, is
amended to read as follows:
(e) Except as provided by Section 32.03118, the [The]
commission may not authorize the provision of any service to any
person under the program unless federal matching funds are
available to pay the cost of the service.
SECTION 2. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.03118 to read as follows:
Sec. 32.03118. REIMBURSEMENT FOR CERTAIN REPRODUCTIVE
HEALTH SERVICES. (a) Regardless of whether federal matching funds
are available to pay the cost of the services, the commission shall
ensure that medical assistance reimbursement is provided for the
provision of the following services to medical assistance
recipients:
(1) abortion services;
(2) forms of contraception approved by the United
States Food and Drug Administration, including the insertion and
removal of devices; and
(3) voluntary sterilization, including vasectomies.
(b) The commission shall ensure that abortion,
contraception, and sterilization services are provided in
accordance with applicable state and federal law.
(c) Notwithstanding any other law, abortion, contraception,
and sterilization services provided under the medical assistance
program may not be subject to:
(1) a cost-sharing requirement, including a
deductible or coinsurance;
(2) utilization review;
(3) a prior authorization or step-therapy
requirement; or
(4) any restrictions on or delays in coverage.
SECTION 3. The heading to Chapter 1218, Insurance Code, is
amended to read as follows:
CHAPTER 1218. COVERAGE FOR REPRODUCTIVE HEALTH SERVICES [ELECTIVE
ABORTION; PROHIBITIONS AND REQUIREMENTS]
SECTION 4. Sections 1218.001 and 1218.004, Insurance Code,
are amended to read as follows:
Sec. 1218.001. DEFINITIONS [DEFINITION]. In this chapter:
(1) "Abortion" has the meaning assigned[, "elective
abortion" means an abortion, as defined] by Section 245.002, Health
and Safety Code[, other than an abortion performed due to a medical
emergency as defined by Section 171.002, Health and Safety Code].
(2) "Effective pain and anxiety management" means
evidence-based pain and anxiety management, including prescription
anti-anxiety medication, local anesthesia, topical anesthetic,
paracervical block, and minimal and moderate sedation.
Sec. 1218.004. COVERAGE REQUIRED [BY HEALTH BENEFIT
PLAN]. (a) A health benefit plan shall [may] provide coverage for
abortion services, all forms of contraception approved by the
United States Food and Drug Administration, including the insertion
and removal of devices, counseling on effective pain and anxiety
management for the insertion or removal of devices, and provision
of effective pain and anxiety management for the insertion or
removal of devices, and voluntary sterilization, including
vasectomies, in accordance with applicable state and federal law.
(b) Coverage required under this section is not subject to
[elective abortion only if]:
(1) a cost-sharing requirement, including a
deductible or coinsurance [the coverage is provided to an enrollee
separately from other health benefit plan coverage offered by the
health benefit plan issuer];
(2) utilization review [the enrollee pays the premium
for coverage for elective abortion separately from, and in addition
to, the premium for other health benefit plan coverage, if any];
[and]
(3) a prior authorization or step-therapy
requirement; or
(4) any restrictions on or delays in coverage [the
enrollee provides a signature for coverage for elective abortion,
separately and distinct from the signature required for other
health benefit plan coverage, if any, provided to the enrollee by
the health benefit plan issuer].
(c) This section controls over Subchapter C, Chapter 1369,
to the extent of any conflict.
SECTION 5. The following provisions are repealed:
(1) Section 32.005, Health and Safety Code;
(2) Section 32.024(c-1), Human Resources Code;
(3) Sections 1218.003, 1218.005, and 1218.006,
Insurance Code; and
(4) Subtitle M, Title 8, Insurance Code.
SECTION 6. 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 7. Chapter 1218, Insurance Code, as amended by this
Act, applies only to a health benefit plan delivered, issued for
delivery, or renewed on or after January 1, 2026. A health benefit
plan delivered, issued for delivery, or renewed before January 1,
2026, is governed by the law as it existed immediately before the
effective date of this Act, and that law is continued in effect for
that purpose.
SECTION 8. This Act takes effect September 1, 2025.