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A BILL TO BE ENTITLED
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AN ACT
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relating to the period of continuous eligibility and a periodic |
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eligibility review for a child for Medicaid. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 32.0261, Human Resources Code, is |
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amended to read as follows: |
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Sec. 32.0261. CONTINUOUS ELIGIBILITY. (a) This section |
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applies only to a child younger than 19 years of age who is |
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determined eligible for medical assistance under this chapter. |
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(b) The executive commissioner shall adopt rules in |
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accordance with 42 U.S.C. Section 1396a(e)(12), as amended, to |
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provide for two consecutive periods [a period] of continuous |
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eligibility for a child between each certification and |
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recertification of the child's eligibility, subject to Subsections |
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(e) and (g) [under 19 years of age who is determined to be eligible |
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for medical assistance under this chapter]. |
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(c) A [The rules shall provide that the] child remains |
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eligible for medical assistance during the first of the two |
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consecutive periods of continuous eligibility, without additional |
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review by the commission and regardless of changes in the child's |
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household [resources or] income, until [the earlier of: |
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[(1)] the end of the six-month period following the |
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date on which the child's eligibility was determined, except as |
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provided by Subsections (e)(1) and (g) [; or |
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[(2) the child's 19th birthday]. |
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(d) During the sixth month following the date on which a |
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child's eligibility for medical assistance is certified or |
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recertified, the commission shall, in a manner that complies with |
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federal law, including verification plan requirements under 42 |
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C.F.R. Section 435.945(j), review the child's household income |
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using electronic income data available to the commission. Based on |
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the review: |
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(1) the commission shall, if the review indicates that |
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the child's household income does not exceed the maximum income for |
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eligibility for the medical assistance program, provide for a |
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second consecutive period of continuous eligibility for the child |
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until the child's required annual recertification, except as |
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provided by Subsection (g); or |
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(2) the commission may, if the review indicates that |
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the child's household income exceeds the maximum income for |
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eligibility for the medical assistance program, request additional |
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documentation to verify the child's household income in a manner |
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that complies with federal law. |
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(e) If, after reviewing a child's household income under |
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Subsection (d), the commission determines that the household income |
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exceeds the maximum income for eligibility for the medical |
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assistance program, the commission shall continue to provide |
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medical assistance to the child until: |
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(1) the commission provides the child's parent or |
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guardian with a period of not less than 30 days to provide |
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documentation demonstrating that the child's household income does |
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not exceed the maximum income for eligibility; and |
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(2) the child's parent or guardian fails to provide the |
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documentation during the period described by Subdivision (1). |
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(f) If a child's parent or guardian provides to the |
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commission within the period described by Subsection (e) |
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documentation demonstrating that the child's household income does |
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not exceed the maximum income for eligibility for the medical |
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assistance program, the commission shall provide for a second |
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consecutive period of continuous eligibility for the child until |
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the child's required annual recertification, except as provided by |
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Subsection (g). |
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(g) Notwithstanding any other period prescribed by this |
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section, a child's period of continuous eligibility for medical |
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assistance ends on the child's 19th birthday. |
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(h) The commission may not recertify a child's eligibility |
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for medical assistance more frequently than every 12 months as |
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required by federal law. |
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(i) If a child's parent or guardian fails to provide to the |
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commission within the period described by Subsection (e) |
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documentation demonstrating that the child's household income does |
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not exceed the maximum income for eligibility for the medical |
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assistance program, the commission shall provide the child's parent |
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or guardian with written notice of termination following that |
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period. The notice must include a statement that the child may be |
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eligible for enrollment in the child health plan under Chapter 62, |
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Health and Safety Code. |
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(j) In developing the notice, the commission shall consult |
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with health care providers, children's health care advocates, |
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family members of children enrolled in the medical assistance |
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program, and other stakeholders to determine the most user-friendly |
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method to provide the notice to a child's parent or guardian. |
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(k) The executive commissioner may adopt rules as necessary |
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to implement this section. |
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SECTION 2. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 3. This Act takes effect September 1, 2021. |