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A BILL TO BE ENTITLED
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AN ACT
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relating to establishing the Texas Care Plan Medicaid buy-in |
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program to provide health benefit plan coverage to certain persons |
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in this state. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter H, Chapter 532, Government Code, as |
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effective April 1, 2025, is amended by adding Section 532.0354 to |
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read as follows: |
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Sec. 532.0354. TEXAS CARE PLAN MEDICAID BUY-IN PROGRAM. |
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(a) In this section, "program" means the Texas Care Plan Medicaid |
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buy-in program implemented under this section. |
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(b) The executive commissioner shall seek a waiver under |
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Section 1115 of the Social Security Act (42 U.S.C. Section 1315) to |
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implement the Texas Care Plan Medicaid buy-in program in accordance |
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with this section. |
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(c) The commission in consultation with the commissioner of |
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insurance shall develop the program to allow residents of this |
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state to purchase health benefit plan coverage through Medicaid by |
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enrolling in a managed care plan offered by a Medicaid managed care |
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organization. |
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(d) The executive commissioner shall adopt rules for the |
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program that: |
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(1) establish eligibility requirements for |
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participation, including: |
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(A) household income limits; |
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(B) a requirement that a program participant be |
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ineligible for benefits under Medicaid, other than through the |
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program; and |
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(C) a requirement that a program participant not |
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have health benefit coverage under another health benefit plan |
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because the participant does not have access to or cannot afford |
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coverage through an employer-sponsored health benefit plan; and |
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(2) require financial participation by a program |
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participant, including a requirement that a program participant |
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pay, according to a sliding scale based on household income |
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determined in accordance with commission rules that are consistent |
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with the cost-sharing reduction eligibility categories provided by |
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45 C.F.R. Section 155.305(g), a portion of premiums imposed or |
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cost-sharing payments required under the program. |
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(e) The program must be designed to leverage enhanced |
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federal medical assistance percentage funding available under the |
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Patient Protection and Affordable Care Act (Pub. L. No. 111-148) as |
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amended by the Health Care and Education Reconciliation Act of 2010 |
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(Pub. L. No. 111-152). |
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(f) The program, including benefits offered under the |
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program, must be substantively identical to the Medicaid buy-in |
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programs established under Section 532.0353, except: |
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(1) to the extent that programmatic differences are |
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appropriate because of the populations served by the programs; and |
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(2) that a health benefit plan under the program is not |
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required to include nonemergency transportation services as |
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defined by Section 526.0351. |
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SECTION 2. As soon as practicable after the effective date |
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of this Act, the executive commissioner of the Health and Human |
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Services Commission shall apply for and actively pursue the waiver |
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from the Centers for Medicare and Medicaid Services or any other |
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federal agency required by Section 532.0354(b), Government Code, as |
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added by this Act. The commission may delay implementing Section |
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532.0354, Government Code, as added by this Act, until the waiver |
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applied for under this section is granted. |
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SECTION 3. 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, 2025. |