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A BILL TO BE ENTITLED
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AN ACT
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relating to implementation of an express lane option for |
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determining eligibility and enrolling certain individuals in |
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Medicaid or the child health plan program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 62.1011, Health and Safety Code, is |
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amended to read as follows: |
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Sec. 62.1011. VERIFICATION OF INCOME. (a) Except as |
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provided by Subsection (b) and subject to Subsection (c), the [The] |
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commission shall continue employing methods of verifying the |
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individual incomes of the individuals considered in the calculation |
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of an applicant's household income. |
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(b) The commission shall verify income under this section |
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unless the applicant reports a household income that exceeds the |
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income eligibility level established under Section 62.101(b). |
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(c) The commission may verify income using the verification |
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process described in Section 62.1012. |
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SECTION 2. Subchapter C, Chapter 62, Health and Safety |
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Code, is amended by adding Section 62.1012 to read as follows: |
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Sec. 62.1012. EXPRESS LANE OPTION ELIGIBILITY; ENROLLMENT. |
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(a) In this section: |
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(1) "Express lane agency" means a governmental entity |
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that: |
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(A) determines eligibility for assistance under |
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a public assistance program of this state; and |
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(B) is designated by the executive commissioner |
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as capable of making determinations of one or more eligibility |
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requirements under the child health plan program. |
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(2) "Public assistance program" includes: |
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(A) the Medicaid program under Chapter 32, Human |
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Resources Code; |
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(B) the financial assistance program under |
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Chapter 31, Human Resources Code; |
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(C) the nutritional assistance programs under |
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Chapter 33, Human Resources Code, including the supplemental |
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nutrition assistance program under that chapter; and |
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(D) other programs identified by the commission. |
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(b) Notwithstanding any other law and in accordance with |
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Sections 1902(e)(13) and 2107(e)(1)(H) of the Social Security Act |
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(42 U.S.C. Sections 1396a(e)(13) and 1397gg(e)(1)(H)), the |
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commission shall implement an express lane option under which the |
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commission may rely on findings made by an express lane agency, |
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including a division of an express lane agency, in determining a |
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child's eligibility for coverage under the child health plan, |
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including a child's eligibility for reenrollment in the plan. The |
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commission shall use express lane eligibility by evaluating data |
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received from an applicant under other public assistance programs |
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to determine the applicant's eligibility for coverage under the |
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child health plan. |
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(c) In accordance with Section 1902(e)(13)(D) of the Social |
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Security Act (42 U.S.C. Section 1396a(e)(13)(D)), the commission |
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shall enroll in the child health plan program a child who is |
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determined to be eligible for the program under this section, |
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except that the child may only be enrolled in the program if the |
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child's parent, legal guardian, or custodial relative |
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affirmatively consents to the enrollment. The consent: |
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(1) must be provided in accordance with identity |
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verification standards the commission establishes; and |
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(2) may be provided: |
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(A) orally; |
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(B) by telephone; |
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(C) in writing, including: |
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(i) by electronic signature; or |
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(ii) in an application for coverage or |
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benefits under a public assistance program; or |
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(D) by any other manner the commission determines |
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appropriate. |
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(d) The commission and each express lane agency shall |
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include in each application for coverage or benefits under a public |
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assistance program, including any online application, and on the |
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commission's or agency's Internet website a conspicuous notice |
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clearly explaining that: |
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(1) the information disclosed in the application may |
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be used to determine a child's eligibility for coverage under the |
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child health plan program using the express lane option implemented |
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under this section; |
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(2) the child's parent, legal guardian, or custodial |
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relative may elect not to have the information disclosed for that |
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purpose; and |
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(3) the child's parent, legal guardian, or custodial |
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relative must provide affirmative consent before the child may be |
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enrolled in the child health plan program using the express lane |
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option implemented under this section. |
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(e) In accordance with 42 C.F.R. Section 457.340(e), the |
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commission shall provide to the parent, legal guardian, or |
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custodial relative of a child determined eligible for coverage |
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under the child health plan program using the express lane option |
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implemented under this section notice of that determination. The |
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notice may be provided by mail, e-mail, or any other manner the |
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commission determines appropriate. |
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SECTION 3. Sections 32.026(e) and (g), Human Resources |
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Code, are amended to read as follows: |
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(e) The executive commissioner shall permit a |
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recertification review of the eligibility and need for medical |
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assistance of a child under 19 years of age to be conducted by |
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telephone or mail instead of through a personal appearance at an |
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office, unless the commission determines that the information |
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needed to verify eligibility cannot be obtained in that manner or |
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may be obtained in the manner specified by Section 32.026102. The |
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executive commissioner by rule may develop procedures to determine |
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whether there is a need for a recertification review of a child |
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described by this subsection to be conducted through a personal |
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interview with a commission representative. Procedures developed |
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under this subsection shall be based on objective, risk-based |
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factors and conditions and shall focus on a targeted group of |
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recertification reviews for which there is a high probability that |
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eligibility will not be recertified. |
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(g) Notwithstanding any other provision of this code, the |
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commission may use information obtained from a third party to |
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verify the assets and resources of a person for purposes of |
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determining the person's eligibility and need for medical |
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assistance to the extent that verification is applicable under |
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federal law. Third-party information includes information |
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obtained from: |
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(1) a consumer reporting agency, as defined by Section |
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20.01, Business & Commerce Code; |
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(2) an appraisal district; [or] |
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(3) the Texas Department of Motor Vehicles vehicle |
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registration record database; or |
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(4) an express lane agency as defined by Section |
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32.026102. |
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SECTION 4. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Section 32.026102 to read as follows: |
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Sec. 32.026102. EXPRESS LANE OPTION ELIGIBILITY; |
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ENROLLMENT. (a) In this section: |
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(1) "Express lane agency" means a governmental entity |
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that: |
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(A) determines eligibility for assistance under |
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a public assistance program of this state; and |
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(B) is designated by the executive commissioner |
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as capable of making determinations of one or more eligibility |
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requirements under the medical assistance program. |
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(2) "Public assistance program" includes: |
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(A) the child health plan program under Chapters |
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62 and 63, Health and Safety Code; |
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(B) the financial assistance program under |
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Chapter 31; |
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(C) the nutritional assistance programs under |
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Chapter 33, including the supplemental nutrition assistance |
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program under that chapter; and |
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(D) other programs identified by the commission. |
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(b) Notwithstanding any other law and in accordance with |
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Section 1902(e)(13) of the Social Security Act (42 U.S.C. Section |
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1396a(e)(13)), the commission shall implement an express lane |
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option under which the commission may rely on findings made by an |
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express lane agency, including a division of an express lane |
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agency, in determining a child's eligibility for medical |
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assistance, including the recertification of a child's eligibility |
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for medical assistance benefits. The commission shall use express |
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lane eligibility by evaluating data received from an applicant |
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under other public assistance programs to determine the applicant's |
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eligibility for benefits under the medical assistance program. |
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(c) In accordance with Section 1902(e)(13)(D) of the Social |
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Security Act (42 U.S.C. Section 1396a(e)(13)(D)), the commission |
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shall enroll in the medical assistance program a child who is |
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determined to be eligible for the program under this section, |
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except that the child may only be enrolled in the program if the |
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child's parent, legal guardian, or custodial relative |
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affirmatively consents to the enrollment. The consent: |
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(1) must be provided in accordance with identity |
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verification standards the commission establishes; and |
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(2) may be provided: |
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(A) orally; |
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(B) by telephone; |
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(C) in writing, including: |
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(i) by electronic signature; or |
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(ii) in an application for coverage or |
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benefits under a public assistance program; or |
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(D) by any other manner the commission determines |
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appropriate. |
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(d) The commission and each express lane agency shall |
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include in each application for coverage or benefits under a public |
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assistance program, including any online application, and on the |
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commission's or agency's Internet website a conspicuous notice |
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clearly explaining that: |
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(1) the information disclosed in the application may |
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be used to determine a child's eligibility for medical assistance |
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benefits using the express lane option implemented under this |
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section; |
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(2) the child's parent, legal guardian, or custodial |
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relative may elect not to have the information disclosed for that |
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purpose; and |
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(3) the child's parent, legal guardian, or custodial |
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relative must provide affirmative consent before the child may be |
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enrolled in the medical assistance program using the express lane |
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option implemented under this section. |
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(e) In accordance with 42 C.F.R. Section 435.917, the |
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commission shall provide to the parent, legal guardian, or |
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custodial relative of a child determined eligible for benefits |
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under the medical assistance program using the express lane option |
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implemented under this section notice of that determination. The |
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notice may be provided by mail, e-mail, or any other manner the |
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commission determines appropriate. |
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SECTION 5. 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 6. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect on the 91st day after the last day of the |
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legislative session. |