By: Coleman H.B. No. 2224

A BILL TO BE ENTITLED

AN ACT

relating to eligibility for and the administration of the child health plan program; making an appropriation.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

ARTICLE 1. LEGISLATIVE FINDINGS; APPROPRIATION

SECTION 1.01. FINDINGS. The legislature finds that:

(1) the drastic reductions in funding for the children's health insurance programs and the extensive public policy changes made to the program in the regular session of the 78th Legislature have resulted in devastating effects to the health and well-being of Texas children and their families and to the overall fiscal health of this state;

(2) economic research has proven that reductions in state funding for health care services do more harm than good to the Texas economy because each dollar of state revenue that is eliminated from the children's health insurance programs results in:

(A) an average loss of $2.30 in federal health care funding for Texas and an average loss of approximately $7 in gross state product, $5 in personal income, and $2 in retail sales; and

(B) an increase of $1.60 in the insurance premiums for Texans who have private health insurance, plus a $1.50 increase in those Texans' out-of-pocket health care costs;

(3) as a result of these shortsighted and counterproductive reductions in health care services made by the 78th Legislature, local taxpayers bear the entire cost of health care for persons who are no longer receiving services under the children's health insurance program, often through vastly more expensive visits to hospital emergency rooms, even though the federal government would have paid about 70 percent of the cost of those services through the program;

(4) children in other states have already received over $913.4 million in federal funds that were intended to provide health care coverage for Texas children under the children's health insurance program, which includes $20 million in federal funds scheduled to lapse on March 31, 2007, and this state will lose additional federal funds each year if the state fails to restore state funding and repeal the restrictive eligibility and benefits policies enacted by the 78th Legislature;

(5) restoring benefits under the children's health insurance program and expanding that program to cover more uninsured children will result in healthier future generations of Texans and immeasurable long-term savings for this state;

(6) this state must make its economy stronger and its workforce more productive by improving access to health care through prudent and sound fiscal policies that maximize the availability of federal funds for health care services for uninsured Texans; and

(7) the investment of state resources to maximize receipt of federal funds as described by Subdivision (6) of this section will:

(A) prevent the redistribution to other states of tax dollars that Texans have paid to the federal government;

(B) alleviate the inefficient cost-shifting of health care services for uninsured Texans to local governments; and

(C) stem the escalation of costs being passed on to Texans who have private health insurance.

SECTION 1.02. PURPOSE. As a result of the findings made by the legislature as stated in Section 1.01 of this article, the purposes of this Act are to:

(1) restore funding for the children's health insurance program that was reduced by the 78th Legislature;

(2) reverse restrictive policy changes made by that legislature with respect to the program; and

(3) expand enrollment in the program beyond the enrollment levels that existed before September 1, 2003.

ARTICLE 2. RESTORATION AND EXPANSION OF THE CHILDREN'S HEALTH

INSURANCE PROGRAM

SECTION 2.01. Section 62.002(4), Health and Safety Code, is amended to read as follows:

(4) "Net [Gross] family income" means the [total] amount of income established for a family after reduction for offsets for expenses such as child care and work-related expenses, in accordance with standards applicable under the Medicaid [without consideration of any reduction for offsets that may be available to the family under any other] program.

SECTION 2.02. Subchapter B, Chapter 62, Health and Safety Code, is amended by adding Sections 62.056, 62.057, 62.060, and 62.061 to read as follows:

Sec. 62.056. COMMUNITY OUTREACH CAMPAIGN; TOLL-FREE HOTLINE. (a) The commission shall conduct a community outreach and education campaign to provide information relating to the availability of health benefits for children under this chapter. The commission shall conduct the campaign in a manner that promotes enrollment in, and minimizes duplication of effort among, all state-administered child health programs.

(b) The community outreach campaign must include:

(1) outreach efforts that involve school-based health clinics; and

(2) a toll-free telephone number through which families may obtain information about health benefits coverage for children.

(c) The commission shall contract with community-based organizations or coalitions of community-based organizations to implement the community outreach campaign and shall also promote and encourage voluntary efforts to implement the community outreach campaign. The commission shall procure the contracts through a process designed by the commission to encourage broad participation of organizations, including organizations that target population groups with high levels of uninsured children.

Sec. 62.057. REGIONAL ADVISORY COMMITTEES. (a) The commission shall appoint regional advisory committees to provide recommendations on the operation of the child health plan program.

(b) The advisory committees, to the extent possible, must be composed of representatives of:

(1) hospitals;

(2) insurance companies and health maintenance organizations eligible to offer the health benefits coverage under the child health plan;

(3) primary care providers;

(4) consumer advocates, including advocates for children with special health care needs;

(5) parents of children who are enrolled in the child health plan;

(6) rural health care providers;

(7) specialty health care providers, including pediatric providers;

(8) community-based organizations that provide community outreach under Section 62.056; and

(9) state agencies.

(c) The commission shall establish the regional advisory committees, consistent with Subsection (b), in regions of this state in a manner that ensures geographic representation.

(d) In implementing this section, the commission may use other regional advisory structures, augmented to ensure the representation required by Subsection (b), to the extent necessary to avoid duplication of administrative activities.

(e) The advisory committees shall meet at least quarterly and are subject to Chapter 551, Government Code.

(f) Section 2110.008, Government Code, does not apply to the advisory committees.

Sec. 62.060. AMOUNT OF STATE CONTRIBUTION. (a) Not later than November 1 preceding each regular session of the legislature, the executive commissioner of the commission shall certify to the Legislative Budget Board the amount necessary to draw down the maximum amount of federal money available for the child health plan during the following state fiscal biennium, including any federal money unused from a previous biennium that is available for that biennium.

(b) Each legislative session the legislature shall appropriate to the commission for the purpose of providing services under the child health plan the amount certified under Subsection (a).

Sec. 62.061. EXPENDITURE OF AVAILABLE MONEY. For each state fiscal biennium the commission shall develop a plan to use all federal money available for the state child health plan for that biennium, including money remaining from previous years' allocations of federal money for the plan, by maximizing the number of children provided services under the plan.

SECTION 2.03. Section 62.101(b), Health and Safety Code, is amended to read as follows:

(b) The commission shall establish income eligibility levels consistent with Title XXI, Social Security Act (42 U.S.C. Section 1397aa et seq.), as amended, and any other applicable law or regulations, and subject to the availability of appropriated money, so that a child who is younger than 19 years of age and whose net [gross] family income is at or below 200 percent of the federal poverty level is eligible for health benefits coverage under the program. [In addition, the commission may establish eligibility standards regarding the amount and types of allowable assets for a family whose gross family income is above 150 percent of the federal poverty level.]

SECTION 2.04. Section 62.102, Health and Safety Code, is amended to read as follows:

Sec. 62.102. CONTINUOUS COVERAGE. The commission shall provide that an individual who is determined to be eligible for coverage under the child health plan remains eligible for those benefits until the earlier of:

(1) the end of a period, not to exceed 12 months, [the six month period] following the date of the eligibility determination; or

(2) the individual's 19th birthday.

SECTION 2.05. Section 62.151(b), Health and Safety Code, is amended to read as follows:

(b) In developing the covered benefits, the commission shall consider the health care needs of healthy children and children with special health care needs. The child health plan must provide at least the covered benefits described by the recommended benefits package described for a state-designed child health plan by the Texas House of Representatives Committee on Public Health "CHIP" Interim Report to the Seventy-Sixth Texas Legislature dated December 1998 and the Senate Interim Committee on Children's Health Insurance Report to the Seventy-Sixth Texas Legislature dated December 1, 1998. The child health plan must include at least the covered benefits provided under the plan on June 1, 2003.

SECTION 2.06. Sections 62.154(a) and (d), Health and Safety Code, are amended to read as follows:

(a) To the extent permitted under Title XXI of the Social Security Act (42 U.S.C. Section 1397aa et seq.), as amended, and any other applicable law or regulations, the child health plan must include a waiting period and[. The child health plan] may include copayments and other provisions intended to discourage:

(1) employers and other persons from electing to discontinue offering coverage for children under employee or other group health benefit plans; and

(2) individuals with access to adequate health benefit plan coverage, other than coverage under the child health plan, from electing not to obtain or to discontinue that coverage for a child.

(d) The waiting period required by Subsection (a) must:

(1) extend for a period of 90 days after[:

[(1)] the last date on [first day of the month in] which the applicant was covered under a health benefits plan; and

(2) apply to a child who was covered by a health benefits plan at any time during the 90 days before the date of application for coverage under the child health plan [is enrolled under the child health plan, if the date of enrollment is on or before the 15th day of the month; or

[(2) the first day of the month after which the applicant is enrolled under the child health plan, if the date of enrollment is after the 15th day of the month].

SECTION 2.07. The following laws are repealed:

(1) Section 62.151(f), Health and Safety Code; and

(2) Section 62.153(d), Health and Safety Code.

ARTICLE 3. COMPLIANCE WITH FEDERAL REQUIREMENTS; EFFECTIVE DATE

SECTION 3.01. FEDERAL WAIVER AS PREREQUISITE TO IMPLEMENTATION. If before implementing any provision of this Act a state agency determines that a waiver or authorization from a federal agency is necessary for implementation of that provision, the agency affected by the provision shall request the waiver or authorization and may delay implementing that provision until the waiver or authorization is granted.

SECTION 3.02. EFFECTIVE DATE. Except as otherwise provided by this Act, this Act takes effect September 1, 2007.