Texas HB 51: Relating to a "Texas Way" to reforming and addressing issues related to the Medicaid program, including the creation of an alternative program designed to ensure health benefit plan coverage to certain low-income individuals through the private marketplace.

Bill Text

By:AAReynolds H.B.ANo.A51
A BILL TO BE ENTITLED
AN ACT
relating to a "Texas Way" to reforming and addressing issues
related to the Medicaid program, including the creation of an
alternative program designed to ensure health benefit plan coverage
to certain low-income individuals through the private marketplace.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
ARTICLE 1. BLOCK GRANT FUNDING SYSTEM FOR STATE MEDICAID PROGRAM
SECTIONA1.01.AASubtitle I, Title 4, Government Code, is
amended by adding Chapter 540 to read as follows:
CHAPTER 540. BLOCK GRANT FUNDING SYSTEM FOR STATE MEDICAID PROGRAM
SUBCHAPTER A. GENERAL PROVISIONS
Sec.A540.0001.AADEFINITIONS. Notwithstanding Section
531.001, in this chapter:
(1)AA"Health benefit exchange" means an American Health
Benefit Exchange administered by the federal government or an
exchange created under Section 1311(b) of the Patient Protection
and Affordable Care Act (42 U.S.C. Section 18031(b)).
(2)AA"Medicaid program" means the medical assistance
program established and operated under Title XIX, Social Security
Act (42 U.S.C. Section 1396 et seq.).
(3)AA"State Medicaid program" means the medical
assistance program provided by this state under the Medicaid
program.
Sec.A540.0002.AAFEDERAL AUTHORIZATION TO REFORM MEDICAID
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REQUIRED. If the federal government establishes, through
conversion or otherwise, a block grant funding system for the
Medicaid program or otherwise authorizes the state Medicaid program
to operate under a block grant funding system, including under a
Medicaid program waiver, the commission, in cooperation with
applicable health and human services agencies, shall, subject to
Section 540.0003, administer and operate the state Medicaid program
in accordance with this chapter.
Sec.A540.0003.AACONFLICT WITH OTHER LAW. To the extent of a
conflict between a provision of this chapter and:
(1)AAanother provision of state law, the provision of
this chapter controls, subject to Section 540A.0002(b); and
(2)AAa provision of federal law or any authorization
described under Section 540.0002, the federal law or authorization
controls.
Sec.A540.0004.AAESTABLISHMENT OF REFORMED STATE MEDICAID
PROGRAM. The commission shall establish a state Medicaid program
that provides benefits under a risk-based Medicaid managed care
model.
Sec.A540.0005.AARULES. The executive commissioner shall
adopt rules necessary to implement this chapter.
SUBCHAPTER B. ACUTE CARE
Sec.A540.0051.AAELIGIBILITY FOR MEDICAID ACUTE CARE. (a) An
individual is eligible to receive acute care benefits under the
state Medicaid program if the individual:
(1)AAhas a household income at or below 100 percent of
the federal poverty level;
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(2)AAis under 19 years of age and:
(A)AAis receiving Supplemental Security Income
(SSI) under 42 U.S.C. Section 1381 et seq.; or
(B)AAis in foster care or resides in another
residential care setting under the conservatorship of the
Department of Family and Protective Services; or
(3)AAmeets the eligibility requirements that were in
effect in this state on August 31, 2021.
(b)AAThe commission shall provide acute care benefits under
the state Medicaid program to each individual eligible under this
section through the most cost-effective means, as determined by the
commission.
(c)AAIf an individual is not eligible for the state Medicaid
program under Subsection (a), the commission shall refer the
individual to the program established under Chapter 540A that helps
connect eligible residents with health benefit plan coverage
through private market solutions, a health benefit exchange, or any
other resource the commission determines appropriate.
Sec.A540.0052.AAMEDICAID SLIDING SCALE SUBSIDIES. (a) An
individual who is eligible for the state Medicaid program under
Section 540.0051 may receive a Medicaid sliding scale subsidy to
purchase a health benefit plan from an authorized health benefit
plan issuer.
(b)AAA sliding scale subsidy provided to an individual under
this section must:
(1)AAbe based on:
(A)AAthe average premium in the market; and
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(B)Aa realistic assessment of the individual’s
ability to pay a portion of the premium; and
(2)AAinclude an enhancement for individuals who choose
a high deductible health plan with a health savings account.
(c)AAThe commission shall ensure that counselors are made
available to individuals receiving a subsidy to advise the
individuals on selecting a health benefit plan that meets the
individuals’ needs.
(d)AAAn individual receiving a subsidy under this section is
responsible for paying:
(1)AAany difference between the premium costs
associated with the purchase of a health benefit plan and the amount
of the individual’s subsidy under this section; and
(2)AAany copayments associated with the health be