81R943 KFF-D

By: Dukes H.B. No. 584

A BILL TO BE ENTITLED

AN ACT

relating to health benefits coverage for certain persons under the child health plan, medical assistance, and other programs.

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

SECTION 1. 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 family income is at or below 300 [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 net family income is above 150 percent of the federal poverty level.

SECTION 2. Subtitle C, Title 2, Health and Safety Code, is amended by adding Chapter 65 to read as follows:

CHAPTER 65. DEMONSTRATION PROJECT TO PROVIDE HEALTH BENEFITS PLAN

COVERAGE TO CERTAIN PARENTS

Sec. 65.001. DEFINITIONS. In this chapter:

(1) "Commission" means the Health and Human Services Commission.

(2) "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.

Sec. 65.002. NOT AN ENTITLEMENT. This chapter does not establish an entitlement to assistance in obtaining health benefits.

Sec. 65.003. HEALTH BENEFITS PLAN COVERAGE FOR CERTAIN PARENTS. (a) The executive commissioner shall develop and seek a waiver under Section 1115 of the federal Social Security Act (42 U.S.C. Section 1315) to implement a demonstration project to provide health benefits plan coverage to an individual who:

(1) is the parent of a child receiving medical assistance under Chapter 32, Human Resources Code, or of a child enrolled in the child health plan under Chapter 62;

(2) has a net family income, as defined by Section 62.002, that is equal to or less than 300 percent of the federal poverty level;

(3) is not eligible for medical assistance; and

(4) is not covered by a health benefits plan offering adequate benefits, as determined by the commission.

(b) The demonstration project developed under this section must be designed and administered in a manner that:

(1) qualifies for federal funding; and

(2) is, to the extent practical, substantively identical to the manner in which the child health plan program is administered under Chapter 62, except as otherwise provided by this chapter.

Sec. 65.004. COST-SHARING REQUIREMENTS. The commission shall require that an individual provided health benefits plan coverage under this chapter pay:

(1) 100 percent of the plan premium; and

(2) deductibles, coinsurance, or other cost-sharing payments as determined by the executive commissioner.

Sec. 65.005. BENEFITS COVERAGE REQUIRED. To the extent possible, a health benefits plan offered under this chapter must provide benefits similar to the benefits provided under the child health plan program under Section 62.151.

Sec. 65.006. CROWD-OUT. To the extent allowed by federal law, the demonstration project under this chapter must include provisions designed to discourage:

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

(2) individuals with access to adequate health benefit plan coverage, other than coverage under the health benefits plan offered under this chapter, from electing to not obtain, or to discontinue, that coverage.

Sec. 65.007. RULES. The executive commissioner shall adopt rules as necessary to implement the demonstration project under this chapter.

SECTION 3. Section 32.024(i), Human Resources Code, as amended by Chapters 198 (H.B. 2292) and 1251 (S.B. 1862), Acts of the 78th Legislature, Regular Session, 2003, is reenacted and amended to read as follows:

(i) The [Subject to appropriated state funds, the] department in its adoption of rules shall establish a medically needy program that serves pregnant women, children, and caretakers who have high medical expenses. At a minimum, the program must serve recipients, including adult recipients, in the same manner and at the same level that services were provided to recipients under the medically needy program during the state fiscal biennium ending August 31, 2003.

SECTION 4. Section 32.0261, Human Resources Code, is amended to read as follows:

Sec. 32.0261. CONTINUOUS ELIGIBILITY. The department shall adopt rules in accordance with 42 U.S.C. Section 1396a(e)(12), as amended, to provide for a period of continuous eligibility for a child under 19 years of age who is determined to be eligible for medical assistance under this chapter. The rules shall provide that the child remains eligible for medical assistance, without additional review by the department and regardless of changes in the child's resources or income, until the earlier of:

(1) the first anniversary of [end of the six-month period following] the date on which the child's eligibility was determined; or

(2) the child's 19th birthday.

SECTION 5. (a) In this section:

(1) "Child health plan program" means the state child health plan program established under Chapter 62, Health and Safety Code.

(2) "Commission" means the Health and Human Services Commission.

(3) "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.

(4) "Medicaid" means the medical assistance program under Chapter 32, Human Resources Code.

(b) Not later than September 1, 2010, the executive commissioner by rule shall develop a strategic plan designed to:

(1) intensify community outreach and education relating to the availability of benefits under the child health plan and Medicaid programs; and

(2) reduce the paperwork and other administrative burdens associated with determining eligibility for and enrolling eligible individuals in the child health plan and Medicaid programs.

(c) Not later than September 1, 2011, the commission shall implement the plan developed under Subsection (b) of this section.

SECTION 6. As soon as practicable after the effective date of this Act, the executive commissioner of the Health and Human Services Commission shall apply for and actively pursue the waiver from the federal Centers for Medicare and Medicaid Services or any other federal agency required by Section 65.003, Health and Safety Code, as added by this Act. The commission may delay implementing Chapter 65, Health and Safety Code, as added by this Act, until the waiver applied for under this section is granted.

SECTION 7. Not later than October 1, 2009, the executive commissioner of the Health and Human Services Commission shall adopt rules as necessary under Section 32.024(i), Human Resources Code, as amended by Chapters 198 (H.B. 2292) and 1251 (S.B. 1862), Acts of the 78th Legislature, Regular Session, 2003, and this Act, that, to the extent possible, are substantively identical to the rules relating to the medically needy program that were in effect on August 31, 2003.

SECTION 8. If before implementing any provision of this Act a state agency determines that a waiver or authorization from a federal agency, other than the waiver required by Section 65.003, Health and Safety Code, as added by this Act, 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 9. This Act takes effect September 1, 2009.