HB891 - Relating to a "Texas solution" 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; requiring a fee.

  89R384 MM-F     By: Lalani H.B. No. 891       A BILL TO BE ENTITLED   AN ACT   relating to a "Texas solution" 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;   requiring a fee.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:   ARTICLE 1.  BLOCK GRANT FUNDING SYSTEM FOR STATE MEDICAID PROGRAM          SECTION 1.01.  Subtitle I, Title 4, Government Code, is   amended by adding Chapter 532A to read as follows:   CHAPTER 532A.   BLOCK GRANT FUNDING SYSTEM FOR STATE MEDICAID   PROGRAM   SUBCHAPTER A. GENERAL PROVISIONS           Sec.   532A.0001.     DEFINITIONS. Notwithstanding Section   521.0001, in this chapter:                 (1)     "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)     "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)     "State Medicaid program" means the medical   assistance program provided by this state under the Medicaid   program.           Sec.   532A.0002.     FEDERAL AUTHORIZATION TO REFORM MEDICAID   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 532A.0003, administer and operate the state Medicaid   program in accordance with this chapter.           Sec.   532A.0003.     CONFLICT WITH OTHER LAW. To the extent of a   conflict between a provision of this chapter and:                 (1)     another provision of state law, the provision of   this chapter controls, subject to Section 545A.0002(b); and                 (2)     a provision of federal law or any authorization   described under Section 532A.0002, the federal law or authorization   controls.           Sec.   532A.0004.     ESTABLISHMENT 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.   532A.0005.     RULES. The executive commissioner shall   adopt rules necessary to implement this chapter.   SUBCHAPTER B.   ACUTE CARE           Sec.   532A.0051.     ELIGIBILITY FOR MEDICAID ACUTE CARE. (a)     An individual is eligible to receive acute care benefits under the   state Medicaid program if the individual:                 (1)     has a household income at or below 100 percent of   the federal poverty level;                 (2)  is under 19 years of age and:                       (A)     is receiving Supplemental Security Income   (SSI) under 42 U.S.C. Section 1381 et seq.; or                       (B)     is in foster care or resides in another   residential care setting under the conservatorship of the   Department of Family and Protective Services; or                 (3)     meets the eligibility requirements that were in   effect in this state on August 31, 2025.           (b)     The 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)     If 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 545A 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.   532A.0052.     MEDICAID SLIDING SCALE SUBSIDIES. (a)   An   individual who is eligible for the state Medicaid program under   Section 532A.0051 may receive a Medicaid sliding scale subsidy to   purchase a health benefit plan from an authorized health benefit   plan issuer.           (b)     A sliding scale subsidy provided to an individual under   this section must:                 (1)  be based on:                       (A)  the average premium in the market; and                       (B)   a realistic assessment of the individual's   ability to pay a portion of the premium; and                 (2)     include an enhancement for individuals who choose   a high deductible health plan with a health savings account.           (c)     The 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)     An individual receiving a subsidy under this section is   responsible for paying:                 (1)     any 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)     any copayments associated with the health benefit   plan, except to the extent the individual receives an additional   subsidy under Section 532A.0053 to pay the copayments.           (e)     If the amount of a subsidy received by an individual   under this section exceeds the premium costs associated with the   individual's purchase of a health benefit plan, the individual may   deposit the excess amount in a health savings account that may be   used only in the manner described by Section 532A.0054(b).           Sec.   532A.0053.     ADDITIONAL COST-SHARING SUBSIDIES. In   addition to providing a subsidy to an individual under Section   532A.0052, the commission shall provide additional subsidies for   coinsurance payments, copayments, deductibles, and other   cost-sharing requirements associated with the individual's health   benefit plan.   The commission shall provide the additional   subsidies on a sliding scale based on income.           Sec.   532A.0054.     DELIVERY OF SUBSIDIES; HEALTH SAVINGS   ACCOUNTS.   (a)   The commission shall determine the most appropriate   manner for delivering and administering subsidies provided under   Sections 532A.0052 and 532A.0053. In determining the most   appropriate manner, the commission shall consider depositing   subsidy amounts for an individual in a health savings account   established for that individual.           (b)     A health savings account established under this section   may be used only to:                 (1)     pay health benefit plan premiums and cost-sharing   amounts; and                 (2)     if appropriate, purchase health care-related   goods and services.           Sec.   532A.0055.     MEDICAID HEALTH BENEFIT PLAN ISSUERS AND   MINIMUM COVERAGE. The commission shall allow any health benefit   plan issuer authorized to write health benefit plans in this state   to participate in the state Medicaid program.   The commission in   consultation with the commissioner of insurance shall establish   minimum coverage requirements for a health benefit plan to be   eligible for purchase under the state Medicaid program, subject to   the requirements specified by this chapter.           Sec.   532A.0056.     REINSURANCE FOR PARTICIPATING HEALTH   BENEFIT PLAN ISSUERS.   (a)   The commission in consultation with the   commissioner of insurance shall study a reinsurance program to   reinsure participating health benefit plan issuers.           (b)     In examining options for a reinsurance program, the   commission and the commissioner of insurance shall consider a plan   design under which:                 (1)     a participating health benefit plan is not charged   a premium for the reinsurance; and                 (2)     the health benefit plan issuer retains risk on a   sliding scale.   SUBCHAPTER C. LONG-TERM SERVICES AND SUPPORTS           Sec.   532A.0101.     PLAN TO REFORM DELIVERY OF LONG-TERM   SERVICES AND SUPPORTS.   The commission shall develop a   comprehensive plan to reform the delivery of long-term services and   supports that is designed to achieve the following objectives under   the state Medicaid program or any other program created as an   alternative to the state Medicaid program:                 (1)  encourage consumer direction;                 (2)  simplify and streamline the provision of services;                 (3)     provide flexibility to design benefits packages   that meet the needs of individuals receiving long-term services and   supports under the program;                 (4)     improve the cost-effectiveness and sustainability   of the provision of long-term services and supports;                 (5)  reduce reliance on institutional settings; and                 (6)     encourage cost-sharing by family members when   appropriate.   ARTICLE 2. IMMEDIATE REFORM: PROGRAM TO ENSURE HEALTH BENEFIT   COVERAGE FOR CERTAIN INDIVIDUALS THROUGH PRIVATE MARKETPLACE          SECTION 2.01.  Subtitle I, Title 4, Government Code, is   amended by adding Chapter 545A to read as follows:   CHAPTER 545A.   PROGRAM TO ENSURE HEALTH BENEFIT PLAN COVERAGE FOR   CERTAIN INDIVIDUALS THROUGH PRIVATE MARKET SOLUTIONS   SUBCHAPTER A. GENERAL PROVISIONS           Sec.   545A.0001.     DEFINITION. In this chapter, "state   Medicaid program" has the meaning assigned by Section 532A.0001.           Sec.   545A.0002.     CONFLICT WITH OTHER LAW. (a)   Except as   provided by Subsection (b), to the extent of a conflict between a   provision of this chapter and:                 (1)     another provision of state law, the provision of   this chapter controls; and                 (2)     a provision of federal law or any authorization   described under Subchapter B, the federal law or authorization   controls.           (b)     The program operated under this chapter is in addition   to the state Medicaid program operated under Chapter 32, Human   Resources Code, or under a block grant funding system under Chapter   532A.           Sec.   545A.0003.     PROGRAM FOR HEALTH BENEFIT PLAN COVERAGE   THROUGH [Text truncated for display. Full text available on Congress.gov.]