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A BILL TO BE ENTITLED
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AN ACT
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relating to presumptive eligibility for Medicaid and the child |
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health plan program for certain children. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 62.101, Health and Safety Code, is |
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amended by adding Subsections (d) and (e) to read as follows: |
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(d) As authorized by 42 U.S.C. Section 1397gg, the executive |
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commissioner shall adopt rules providing for the determination and |
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certification of presumptive eligibility for the child health plan |
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program of a child under 19 years of age who applies for and meets |
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the basic eligibility requirements for the child health plan |
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program. |
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(e) The rules adopted under Subsection (d) must: |
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(1) allow only a juvenile facility for the placement, |
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detention, or commitment of a child under Title 3, Family Code, to |
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serve as a qualified entity and make a presumptive eligibility |
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determination for the child health plan program for a child; and |
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(2) identify the services and benefits, which must |
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include mental health and substance abuse services, prescription |
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drug benefits, and primary care services, that a child who is |
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presumptively eligible for the child health plan program may |
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receive under that program. |
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SECTION 2. Section 62.154(b), Health and Safety Code, as |
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amended by S.B. No. 219, Acts of the 84th Legislature, Regular |
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Session, 2015, is amended to read as follows: |
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(b) A child is not subject to a waiting period adopted under |
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Subsection (a) if: |
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(1) the family lost coverage for the child as a result |
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of: |
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(A) termination of employment because of a layoff |
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or business closing; |
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(B) termination of continuation coverage under |
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the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L. |
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No. 99-272); |
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(C) change in marital status of a parent of the |
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child; |
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(D) termination of the child's Medicaid |
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eligibility because: |
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(i) the child's family's earnings or |
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resources increased; or |
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(ii) the child reached an age at which |
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Medicaid coverage is not available; or |
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(E) a similar circumstance resulting in the |
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involuntary loss of coverage; |
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(2) the family terminated health benefits plan |
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coverage for the child because the cost to the child's family for |
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the coverage exceeded 9.5 percent of the family's household income; |
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(3) the child has access to group-based health |
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benefits plan coverage and is required to participate in the health |
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insurance premium payment reimbursement program administered by |
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the commission; |
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(4) the child is certified as presumptively eligible |
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for the child health plan program under rules adopted under Section |
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62.101(d); |
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(5) the commission has determined that other grounds |
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exist for a good cause exception; or |
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(6) [(5)] federal law provides that the child is not |
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subject to a waiting period adopted under Subsection (a). |
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SECTION 3. Section 32.026, Human Resources Code, is amended |
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by adding Subsections (h), (i), and (j) to read as follows: |
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(h) As authorized by 42 U.S.C. Section 1396r-1a, the |
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executive commissioner shall adopt rules providing for the |
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determination and certification of presumptive eligibility for |
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medical assistance for a child under 19 years of age who applies for |
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and meets the basic eligibility requirements for medical |
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assistance. |
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(i) The rules adopted under Subsection (h) must: |
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(1) allow only a juvenile facility for the placement, |
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detention, or commitment of a child under Title 3, Family Code, to |
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serve as a qualified entity and make a presumptive eligibility |
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determination for the medical assistance program for a child, |
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unless the presumptive eligibility determination is being made in |
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accordance with rules adopted under Subsection (b) or Section |
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32.024(y), or in accordance with 42 U.S.C. Section 1396a(a)(47); |
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and |
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(2) identify the services and benefits, which must |
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include mental health and substance abuse services, prescription |
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drug benefits, and primary care services, that a child who is |
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presumptively eligible for medical assistance may receive under the |
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medical assistance program. |
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(j) Subsections (h) and (i) do not affect the presumptive |
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eligibility of a person under Subsection (b), Section 32.024(y), or |
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42 U.S.C. Section 1396a(a)(47), including an authorized person's |
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ability to make a presumptive eligibility determination under the |
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medical assistance program or an applicant's eligibility under |
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those provisions. |
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SECTION 4. The executive commissioner of the Health and |
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Human Services Commission shall adopt the rules required by Section |
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62.101(d), Health and Safety Code, as added by this Act, and Section |
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32.026(h), Human Resources Code, as added by this Act, not later |
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than January 1, 2016. |
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SECTION 5. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 6. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2015. |