Amend Floor Amendment No. 38 on page 48 of the amendment 
packet by striking everything following "Medicaid Reform Waiver." 
and substituting the following:
	"Contingent on findings that a Medicaid reform waiver is cost 
effective and feasible, the Health and Human Services Commission 
shall seek a Medicaid reform waiver or waivers from the Centers for 
Medicare and Medicaid Services that protect the interests of Texas 
Medicaid recipients and taxpayers by incorporating the following 
principles:
	(a)  efficiently leverage state, local, federal and other 
funding to:        
		(1)  increase state flexibility in its use of Medicaid 
funding by authorizing tailored benefit plans designed to manage 
health conditions, not reduce plan benefits for any Medicaid 
recipient population;
		(2)  allow the state to be a more prudent purchaser and 
payer of health care ensuring positive health outcomes while 
pursuing value-conscious pricing;
		(3)  build on private market approaches and 
insurance-based premiums by establishing multi-share programs 
and/or low income pools that create more private coverage;
		(4)  reduce the state's uninsured through market-based 
solutions coupled with best state practices to maximize federal 
funds; and
		(5)  promote the transition of consumers from public 
insurance to private insurance by guaranteeing that any pooling of 
disproportionate share hospital (DSH) and upper payment limit (UPL) 
funds will include inflation and population growth factors.
	(b)  support the increased personal planning and investments 
in long term care needs;
	(c)  support consumer empowerment and choice by authorizing 
Health Savings Accounts, Premium Assistance, Health Insurance 
Premium Payment (HIPP) programs, or "Opt-out" programs that:
		(1)  include a provision requiring that the Health and 
Human Services Commission first determine that it is cost 
effective;
		(2)  either exempt recipients under age 21 or 
explicitly require that the program be designed to protect and 
promote children's access to preventive care and medical 
treatments; and
		(3)  guarantee that recipient participation is 
voluntary, and guarantee that a prompt return to regular Medicaid 
coverage is allowed on request by the recipient.
	(d)  create incentives for healthier behaviors by 
establishing programs that provide positive rewards for healthy 
behaviors, and not punitive incentives;
	(e)  align state policy and financial incentives by creating 
a more transparent, systematic, and efficient approach for 
allocating available funding within the health care system; and
	(f)  solicit broad-based stakeholder input.                                    
	Further it is the intent of the Legislature that any Medicaid 
reform waiver(s) sought from the federal government will not 
include a waiver of children's comprehensive health care under 
Early and Periodic Screening, Diagnosis and Treatment (EPSDT).  The 
authority of the Health and Human Services Commission to impose any 
cost-sharing policies on Medicaid recipients is limited to 
non-emergent ER use co-payments.  The Legislature also recognizes 
the unique needs of the state's rural providers, trauma centers, 
and primary care residency programs.