HB5311 - Relating to establishing the Texas Care Plan Medicaid buy-in program to provide health benefit plan coverage to certain persons in this state.

  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.