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A BILL TO BE ENTITLED
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AN ACT
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relating to the administration and funding of and eligibility for |
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the child health plan, medical assistance, and other programs. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Sections 62.101(b) and (b-1), Health and Safety |
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Code, are amended to read as follows: |
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(b) The commission shall establish income eligibility |
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levels consistent with Title XXI, Social Security Act (42 U.S.C. |
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Section 1397aa et seq.), as amended, and any other applicable law or |
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regulations, and subject to the availability of appropriated money, |
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so that a child who is younger than 19 years of age and whose net |
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family income is at or below 300 [200] percent of the federal |
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poverty level is eligible for health benefits coverage under the |
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program. In addition, the commission may establish eligibility |
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standards regarding the amount and types of allowable assets for a |
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family whose net family income is above 250 [150] percent of the |
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federal poverty level. |
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(b-1) The eligibility standards adopted under Subsection |
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(b) related to allowable assets: |
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(1) must allow a family to own at least $20,000 |
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[$10,000] in allowable assets; and |
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(2) may not in calculating the amount of allowable |
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assets under Subdivision (1) consider: |
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(A) the value of one vehicle that qualifies for |
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an exemption under commission rule based on its use; |
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(B) the value of a second or subsequent vehicle |
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that qualifies for an exemption under commission rule based on its |
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use if: |
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(i) the vehicle is worth $18,000 or less; or |
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(ii) the vehicle has been modified to |
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provide transportation for a household member with a disability; |
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(C) if no vehicle qualifies for an exemption |
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based on its use under commission rule, the [first $18,000 of] value |
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of the highest valued vehicle; or |
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(D) the first $7,500 of value of any vehicle not |
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described by Paragraph (A), (B), or (C). |
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SECTION 2. Section 62.102(a), Health and Safety Code, is |
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amended to read as follows: |
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(a) The [Subject to a review under Subsection (b), the] |
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commission shall provide that an individual who is determined to be |
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eligible for coverage under the child health plan remains eligible |
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for those benefits until the earlier of: |
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(1) the end of a period not to exceed 12 months, |
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beginning the first day of the month following the date of the |
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eligibility determination; or |
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(2) the individual's 19th birthday. |
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SECTION 3. Section 62.153, Health and Safety Code, is |
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amended by amending Subsections (a) and (c) and adding Subsections |
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(a-1) and (a-2) to read as follows: |
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(a) To the extent permitted under 42 U.S.C. Section 1397cc, |
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as amended, and any other applicable law or regulations, the |
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commission shall require enrollees whose net family incomes are at |
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or below 200 percent of the federal poverty level to share the cost |
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of the child health plan, including provisions requiring enrollees |
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under the child health plan to pay: |
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(1) a copayment for services provided under the plan; |
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(2) an enrollment fee; or |
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(3) a portion of the plan premium. |
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(a-1) The commission shall require enrollees whose net |
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family incomes are greater than 200 percent but not greater than 300 |
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percent of the federal poverty level to pay a share of the cost of |
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the child health plan through copayments, fees, and a portion of the |
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plan premium. The total amount of the share required to be paid |
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must: |
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(1) include a portion of the plan premium set at an |
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amount determined by the commission that is approximately equal to |
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2.5 percent of an enrollee's net family income; |
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(2) exceed the amount required to be paid by enrollees |
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described by Subsection (a), but the total amount required to be |
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paid may not exceed five percent of an enrollee's net family income; |
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and |
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(3) increase incrementally, as determined by the |
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commission, as an enrollee's net family income increases. |
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(a-2) In establishing the cost required to be paid by an |
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enrollee described by Subsection (a-1) as a portion of the plan |
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premium, the commission shall ensure that the cost progressively |
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increases as the number of children in the enrollee's family |
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provided coverage increases. |
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(c) The [If cost-sharing provisions imposed under
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Subsection (a) include requirements that enrollees pay a portion of
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the plan premium, the] commission shall specify the manner of |
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payment for any portion of the plan premium required to be paid by |
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an enrollee under this section [in which the premium is paid]. The |
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commission may require that the premium be paid to the [Texas
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Department of] Health and Human Services Commission, the [Texas] |
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Department of State Health [Human] Services, or the health plan |
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provider. The commission shall develop an option for an enrollee to |
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pay monthly premiums using direct debits to bank accounts or credit |
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cards. |
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SECTION 4. Section 62.154, Health and Safety Code, is |
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amended by amending Subsection (d) and adding Subsection (e) to |
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read as follows: |
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(d) The waiting period required by Subsection (a) for a |
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child whose net family income is at or below 200 percent of the |
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federal poverty level must: |
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(1) extend for a period of 90 days after the last date |
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on which the applicant was covered under a health benefits plan; and |
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(2) apply to a child who was covered by a health |
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benefits plan at any time during the 90 days before the date of |
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application for coverage under the child health plan. |
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(e) The waiting period required by Subsection (a) for a |
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child whose net family income is greater than 200 percent but not |
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greater than 300 percent of the federal poverty level must: |
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(1) extend for a period of 180 days after the last |
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date on which the applicant was covered under a health benefits |
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plan; and |
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(2) apply to a child who was covered by a health |
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benefits plan at any time during the 180 days before the date of |
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application for coverage under the child health plan. |
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SECTION 5. Chapter 62, Health and Safety Code, is amended by |
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adding Subchapter F to read as follows: |
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SUBCHAPTER F. BUY-IN OPTION |
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Sec. 62.251. BUY-IN OPTION FOR CERTAIN CHILDREN. The |
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executive commissioner shall develop and implement a buy-in option |
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in accordance with this subchapter under which children whose net |
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family incomes exceed 300 percent, but do not exceed 400 percent, of |
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the federal poverty level are eligible to purchase health benefits |
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coverage similar to coverage available under the child health plan |
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program. |
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Sec. 62.252. RULES; ELIGIBILITY AND COST-SHARING. (a) The |
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executive commissioner shall adopt rules in accordance with federal |
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law that apply to a child for whom health benefits coverage is |
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purchased under this subchapter. The rules must: |
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(1) establish eligibility requirements, including a |
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requirement that a child must lack access to adequate health |
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benefits plan coverage through an employer-sponsored group health |
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benefits plan; |
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(2) ensure that premiums: |
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(A) are set at a level designed to cover the costs |
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of coverage for children participating in the buy-in option under |
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this subchapter; and |
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(B) progressively increase as the number of |
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children in the enrollee's family provided coverage increases; |
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(3) require payment of 100 percent of health benefits |
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plan premiums, fees to offset administrative costs incurred under |
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this subchapter, and additional deductibles, coinsurance, or other |
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cost-sharing payments as determined by the executive commissioner; |
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(4) provide for a waiting period comparable to the |
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waiting period required under Section 62.154(e); and |
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(5) include an option for an enrollee to pay monthly |
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premiums using direct debits to bank accounts or credit cards. |
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(a-1) The rules adopted under Subsection (a)(1) must |
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provide that a child is eligible for health benefits coverage under |
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this subchapter if the child was eligible for the child health plan |
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program under Section 62.101 and enrolled in the program, but the |
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child's enrollment was not renewed because, at the time of the |
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eligibility redetermination, the child's net family income |
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exceeded the limit specified by Section 62.101. |
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(b) Notwithstanding any other provision of this chapter, |
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the executive commissioner may establish rules, benefit coverage, |
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and procedures for children for whom health benefits coverage is |
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purchased under this subchapter that differ from the rules, benefit |
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coverage, and procedures generally applicable to the child health |
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plan program. |
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Sec. 62.253. CROWD-OUT. To the extent allowed by federal |
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law, the buy-in option developed under this subchapter must include |
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provisions designed to discourage: |
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(1) employers and other persons from electing to |
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discontinue offering health benefits plan coverage for employees' |
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children under employee or other group health benefits plans; and |
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(2) individuals with access to adequate health |
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benefits plan coverage for their children through an |
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employer-sponsored group health benefits plan, as determined by the |
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executive commissioner, from electing not to obtain, or to |
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discontinue, that coverage. |
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Sec. 62.254. POINT-OF-SERVICE COPAYMENT. The commission |
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shall establish point-of-service copayments for the buy-in option |
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developed under this subchapter that are higher than |
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point-of-service copayments required for a child whose net family |
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income is at or below 300 percent of the federal poverty level. |
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Sec. 62.255. LOCK-OUT. (a) In this section, "lock-out |
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period" means a period after coverage is terminated for nonpayment |
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of premiums, during which a child may not be re-enrolled in the |
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child health plan program. |
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(b) The commission shall include a lock-out period for the |
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buy-in option developed under this subchapter for the purpose of |
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providing a disincentive for a parent to drop a child's coverage |
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when a child is healthy and re-enroll only when health care needs |
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occur. |
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SECTION 6. Sections 62.002(2) and (4), Health and Safety |
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Code, are amended to read as follows: |
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(2) "Executive commissioner" or "commissioner |
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[Commissioner]" means the executive commissioner of the Health |
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[health] and Human Services Commission [human services]. |
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(4) "Net family income" means the amount of income |
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established for a family after reduction for offsets for child care |
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expenses and child support payments, in accordance with standards |
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applicable under the Medicaid program. |
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SECTION 7. 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. EXCLUSION OF COLLEGE SAVINGS PLANS. For |
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purposes of determining whether a child meets family income and |
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resource requirements for eligibility for the child health plan, |
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the commission may not consider as income or resources a right to |
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assets held in or a right to receive payments or benefits under any |
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of the following: |
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(1) any fund or plan established under Subchapter F or |
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H, Chapter 54, Education Code, including an interest in a prepaid |
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tuition contract; |
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(2) any fund or plan established under Subchapter G, |
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Chapter 54, Education Code, including an interest in a savings |
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trust account; or |
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(3) any qualified tuition program of any state that |
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meets the requirements of Section 529, Internal Revenue Code of |
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1986. |
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SECTION 8. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.0992 to read as follows: |
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Sec. 531.0992. COMMUNITY OUTREACH FOR BENEFITS PROGRAMS. |
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(a) In this section, "benefits program" includes: |
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(1) the child health plan program; |
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(2) the financial assistance program under Chapter 31, |
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Human Resources Code; |
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(3) the medical assistance program under Chapter 32, |
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Human Resources Code, including long-term care services provided |
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under the program; and |
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(4) the food stamp program under Chapter 33, Human |
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Resources Code. |
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(b) The commission shall improve the effectiveness of |
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community outreach efforts with respect to benefits programs. To |
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improve that effectiveness, the commission shall: |
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(1) increase the capacity of existing outreach efforts |
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implemented through community-based organizations by providing |
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those organizations with adequate resources to: |
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(A) educate the public about benefits programs; |
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(B) provide assistance to the public in |
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completing applications for eligibility or recertification of |
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eligibility and obtaining required documentation for applications; |
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and |
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(C) assist applicants in resolving problems |
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encountered during the eligibility determination process; |
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(2) establish a partnership with stakeholders who will |
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provide outreach and application assistance by: |
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(A) fostering the exchange of information |
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regarding, and promoting, best practices for obtaining health |
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benefits coverage for children; |
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(B) assisting the commission in designing and |
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implementing processes to reduce procedural denials; and |
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(C) disseminating successful outreach models |
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across this state under which entities such as hospitals, school |
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districts, and local businesses partner to identify children |
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without health benefits coverage; and |
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(3) focus the outreach efforts particularly on |
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enrolling eligible persons in the child health plan program and the |
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medical assistance program under Chapter 32, Human Resources Code. |
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(c) The partnership established under Subsection (b)(2) |
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must include entities that contract with the commission to perform |
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child health plan and medical assistance program eligibility |
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determination and enrollment functions, community-based |
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organizations that contract with the commission, health benefit |
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plan providers, Texas Health Steps program contractors, health care |
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providers, consumer advocates, and other interested stakeholders. |
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(d) The commission may also improve the effectiveness of |
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community outreach efforts with respect to benefits programs by |
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contracting with one or more persons to provide outreach and |
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application assistance for the programs. The commission shall |
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require each potential contractor under this subsection to indicate |
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the person's interest in writing before submitting a proposal for a |
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contract. If more than one person from a geographic area determined |
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by the commission submits a letter of interest, the commission |
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shall encourage the persons from that area to collaborate on a |
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proposal for a contract. |
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(e) To the extent practicable, the commission shall give |
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preference in awarding contracts under Subsection (d) to proposals |
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submitted by collaborations that include multiple entities with |
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experience in serving a variety of populations, including |
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populations that more commonly enroll in or receive benefits under |
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benefits programs. |
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SECTION 9. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.02417 to read as follows: |
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Sec. 531.02417. RECEIPT OF TEMPORARY INCREASED MEDICAID |
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FMAP AND DSH ALLOTMENT. (a) In this section: |
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(1) "DSH allotment" means the federal funding |
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allotment provided under the disproportionate share hospital |
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supplemental payment program. |
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(2) "Medicaid FMAP" means the federal medical |
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assistance percentage by which state Medicaid expenditures are |
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matched with federal funds. |
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(b) The commission shall take all actions necessary to |
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qualify this state for the temporary increase in the Medicaid FMAP |
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authorized by Section 5001, American Recovery and Reinvestment Act |
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of 2009 (Pub. L. No. 111-5), and for the temporary increase in this |
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state's DSH allotment authorized by Section 5002, American Recovery |
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and Reinvestment Act of 2009 (Pub. L. No. 111-5). |
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SECTION 10. Subchapter D, Chapter 62, Health and Safety |
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Code, is amended by adding Section 62.160 to read as follows: |
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Sec. 62.160. PROSPECTIVE PAYMENT SYSTEM FOR CERTAIN |
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SERVICES. (a) In this section: |
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(1) "Federally-qualified health center" has the |
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meaning assigned by Section 1905(l)(2)(B), Social Security Act (42 |
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U.S.C. Section 1396d(l)(2)(B)). |
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(2) "Federally-qualified health center services" has |
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the meaning assigned by Section 1905(l)(2)(A), Social Security Act |
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(42 U.S.C. Section 1396d(l)(2)(A)). |
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(3) "Rural health clinic" and "rural health clinic |
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services" have the meanings assigned by Section 1905(l)(1), Social |
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Security Act (42 U.S.C. Section 1396d(l)(1)). |
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(b) The commission shall apply the prospective payment |
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system established under Section 1902bb, Social Security Act (42 |
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U.S.C. Section 1396a(bb)), in providing child health plan coverage |
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for rural health clinic services provided through rural health |
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clinics and federally-qualified health center services provided |
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through federally-qualified health centers in accordance with |
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Section 2107(e)(1), Social Security Act (42 U.S.C. Section |
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1397gg(e)(1)). |
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SECTION 11. Subchapter A, Chapter 31, Human Resources Code, |
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is amended by adding Section 31.0039 to read as follows: |
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Sec. 31.0039. EXCLUSION OF COLLEGE SAVINGS PLANS. For |
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purposes of determining the amount of financial assistance granted |
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to an individual under this chapter for the support of dependent |
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children or determining whether the family meets household income |
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and resource requirements for financial assistance under this |
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chapter, the department may not consider the right to assets held in |
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or the right to receive payments or benefits under any of the |
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following: |
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(1) any fund or plan established under Subchapter F or |
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H, Chapter 54, Education Code, including an interest in a prepaid |
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tuition contract; |
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(2) any fund or plan established under Subchapter G, |
|
Chapter 54, Education Code, including an interest in a savings |
|
trust account; or |
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(3) any qualified tuition program of any state that |
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meets the requirements of Section 529, Internal Revenue Code of |
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1986. |
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SECTION 12. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Section 32.02611 to read as follows: |
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Sec. 32.02611. EXCLUSION OF COLLEGE SAVINGS PLANS. (a) |
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Except as provided by Subsection (b), in determining eligibility |
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and need for medical assistance, the department may not consider as |
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assets or resources a right to assets held in or a right to receive |
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payments or benefits under any of the following: |
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(1) any fund or plan established under Subchapter F or |
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H, Chapter 54, Education Code, including an interest in a prepaid |
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tuition contract; |
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(2) any fund or plan established under Subchapter G, |
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Chapter 54, Education Code, including an interest in a savings |
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trust account; or |
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(3) any qualified tuition program of any state that |
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meets the requirements of Section 529, Internal Revenue Code of |
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1986. |
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(b) In determining eligibility and need for medical |
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assistance for an applicant who may be eligible on the basis of the |
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applicant's eligibility for medical assistance for the aged, blind, |
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or disabled under 42 U.S.C. Section 1396a(a)(10) the department may |
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consider as assets or resources a right to assets held in or a right |
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to receive payments or benefits under any fund, plan, or tuition |
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program described by Subsection (a). |
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(c) Notwithstanding Subsection (b), the department shall |
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seek a federal waiver authorizing the department to exclude, for |
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purposes of determining the eligibility of an applicant described |
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by that subsection, the right to assets held in or a right to |
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receive payments or benefits under any fund, plan, or tuition |
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program described by Subsection (a) if the fund, plan, or tuition |
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program was established before the 21st birthday of the beneficiary |
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of the fund, plan, or tuition program. |
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SECTION 13. (a) In this section: |
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(1) "Child health plan program" means the state child |
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health plan program established under Chapter 62, Health and Safety |
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Code. |
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(2) "Commission" means the Health and Human Services |
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Commission. |
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(3) "Executive commissioner" means the executive |
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commissioner of the Health and Human Services Commission. |
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(4) "Medicaid" means the medical assistance program |
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under Chapter 32, Human Resources Code. |
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(b) Not later than September 1, 2010, the executive |
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commissioner by rule shall develop a strategic plan designed to: |
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(1) intensify community outreach and education |
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relating to the availability of benefits under the child health |
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plan and Medicaid programs; and |
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(2) reduce the paperwork and other administrative |
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burdens associated with determining eligibility for and enrolling |
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eligible individuals in the child health plan program and Medicaid. |
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(c) Not later than September 1, 2011, the commission shall |
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implement the plan developed under Subsection (b) of this section. |
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SECTION 14. Sections 62.102(b) and (c) and 62.151(f), |
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Health and Safety Code, are repealed. |
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SECTION 15. Not later than January 1, 2010, the executive |
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commissioner of the Health and Human Services Commission shall |
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adopt rules as necessary to implement Subchapter F, Chapter 62, |
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Health and Safety Code, as added by this Act. |
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SECTION 16. The changes in law made by this Act apply to an |
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initial determination of eligibility or a recertification of |
|
eligibility for the child health plan program under Chapter 62, |
|
Health and Safety Code, the financial assistance program under |
|
Chapter 31, Human Resources Code, the medical assistance program |
|
under Chapter 32, Human Resources Code, or the food stamp program |
|
under Chapter 33, Human Resources Code, made on or after September |
|
1, 2009. |
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SECTION 17. 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. |
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SECTION 18. This Act takes effect September 1, 2009. |