| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to a medical assistance opt-out program. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Subchapter B, Chapter 32, Human Resources Code, |
|
|
is amended by adding Section 32.04221 to read as follows: |
|
|
Sec. 32.04221. MEDICAL ASSISTANCE OPT-OUT PROGRAM. (a) In |
|
|
this section: |
|
|
(1) "Commission" means the Health and Human Services |
|
|
Commission. |
|
|
(2) "Executive commissioner" means the executive |
|
|
commissioner of the Health and Human Services Commission. |
|
|
(3) "Group health benefit plan" means a plan described |
|
|
by Section 1207.001, Insurance Code. |
|
|
(b) The commission shall seek a waiver from an appropriate |
|
|
federal agency under which a person who is eligible for or is a |
|
|
recipient of medical assistance may choose to opt out of receiving |
|
|
services under the medical assistance program and instead enroll in |
|
|
a group health benefit plan offered by an employer. |
|
|
(c) Consistent with the terms of the waiver, for a |
|
|
participant in the opt-out program who enrolls in a group health |
|
|
benefit plan offered by an employer, the commission shall provide |
|
|
for payment of the employee's share of the required premiums, |
|
|
except that if the employee's share of the required premiums |
|
|
exceeds the Medicaid premium rate for the participant, as |
|
|
determined by the executive commissioner, the participant shall pay |
|
|
the difference between the required premiums and the Medicaid |
|
|
premium rate. In addition, the participant shall pay all |
|
|
deductibles, copayments, coinsurance, and other cost-sharing |
|
|
obligations imposed on the participant under the group health |
|
|
benefit plan. |
|
|
(d) The commission shall ensure that participation by a |
|
|
person in the opt-out program is on a voluntary basis, and the |
|
|
commission may not require any person to opt out of receiving |
|
|
medical assistance services. |
|
|
(e) A participant in the opt-out program is limited to the |
|
|
health benefits coverage provided under the health benefits plan in |
|
|
which the participant enrolls. The participant may not receive any |
|
|
benefits or services under the medical assistance program other |
|
|
than the premium payment as provided by Subsection (c). |
|
|
(f) The commission shall implement an outreach campaign to |
|
|
educate applicants for and recipients of medical assistance |
|
|
regarding the opt-out program. |
|
|
SECTION 2. 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. This Act takes effect September 1, 2007. |