By: Coleman	H.B. No. 3845

	A BILL TO BE ENTITLED
	AN ACT
	relating to a "Texas Way" to reforming and addressing issues
	related to the Medicaid program, including the creation of an
	alternative program designed to ensure health benefit plan coverage
	to certain low-income individuals through the private marketplace;
	authorizing a fee.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	ARTICLE 1. LEGISLATIVE INTENT
	SECTION 1.01.  (a) The legislature finds that:
	(1)  over a million citizens of this state fall into a
	health care coverage gap because they cannot qualify for Medicaid
	in this state but do not earn enough to qualify for federal tax
	credits that are available to assist those citizens with purchasing
	health benefit plan coverage through the private marketplace;
	(2)  it is imperative that this state act to ensure that
	these citizens no longer fall through the health care coverage gap;
	and
	(3)  this state should seek to address the unique
	health care needs of our citizens in the same way other states,
	including Indiana and Arkansas, have addressed the health care
	needs of their citizens.
	(b)  The legislative intent of this Act is to propose a
	"Texas Way" to closing the health care coverage gap that allows this
	state flexibility in addressing the needs of its citizens in a way
	that will make the private marketplace accessible to uninsured
	citizens of this state, promote personal responsibility,
	effectively utilize this state's health care resources, reduce
	expensive emergency room care, and protect citizens of this state
	currently insured through the private marketplace from potentially
	losing their federal tax credits.
	ARTICLE 2.  BLOCK GRANT FUNDING SYSTEM FOR STATE MEDICAID PROGRAM
	SECTION 2.01.  Subtitle I, Title 4, Government Code, is
	amended by adding Chapter 540 to read as follows:
	CHAPTER 540.  BLOCK GRANT FUNDING SYSTEM FOR STATE MEDICAID PROGRAM
	SUBCHAPTER A. GENERAL PROVISIONS
	Sec. 540.001.  DEFINITIONS. In this chapter:
	(1)  "Health benefit exchange" means an American Health
	Benefit Exchange administered by the federal government or an
	exchange created under Section 1311(b) of the Patient Protection
	and Affordable Care Act (42 U.S.C. Section 18031(b)).
	(2)  "Medicaid program" means the medical assistance
	program established and operated under Title XIX, Social Security
	Act (42 U.S.C. Section 1396 et seq.).
	(3)  "State Medicaid program" means the medical
	assistance program provided by this state under the Medicaid
	program.
	Sec. 540.002.  FEDERAL AUTHORIZATION TO REFORM MEDICAID
	REQUIRED. If the federal government establishes, through
	conversion or otherwise, a block grant funding system for the
	Medicaid program or otherwise authorizes the state Medicaid program
	to operate under a block grant funding system, including under a
	Medicaid program waiver, the commission, in cooperation with
	applicable health and human services agencies, shall, subject to
	Section 540.003, administer and operate the state Medicaid program
	in accordance with this chapter.
	Sec. 540.003.  CONFLICT WITH OTHER LAW. To the extent of a
	conflict between a provision of this chapter and:
	(1)  another provision of state law, the provision of
	this chapter controls, subject to Section 541.002(b); and
	(2)  a provision of federal law or any authorization
	described under Section 540.002, the federal law or authorization
	controls.
	Sec. 540.004.  ESTABLISHMENT OF REFORMED STATE MEDICAID
	PROGRAM. The commission shall establish a state Medicaid program
	that provides benefits under a risk-based Medicaid managed care
	model.
	Sec. 540.005.  RULES. The executive commissioner shall
	adopt rules necessary to implement this chapter.
	SUBCHAPTER B.  ACUTE CARE
	Sec. 540.051.  ELIGIBILITY FOR MEDICAID ACUTE CARE. (a)  An
	individual is eligible to receive acute care benefits under the
	state Medicaid program if the individual:
	(1)  has a household income at or below 100 percent of
	the federal poverty level;
	(2)  is under 19 years of age and:
	(A)  is receiving Supplemental Security Income
	(SSI) under 42 U.S.C. Section 1381 et seq.; or
	(B)  is in foster care or resides in another
	residential care setting under the conservatorship of the
	Department of Family and Protective Services; or
	(3)  meets the eligibility requirements that were in
	effect on September 1, 2013.
	(b)  The commission shall provide acute care benefits under
	the state Medicaid program to each individual eligible under this
	section through the most cost-effective means, as determined by the
	commission.
	(c)  If an individual is not eligible for the state Medicaid
	program under Subsection (a), the commission shall refer the
	individual to the program established under Chapter 541 that helps
	connect eligible residents with health benefit plan coverage
	through private market solutions, a health benefit exchange, or any
	other resource the commission determines appropriate.
	Sec. 540.052.  MEDICAID SLIDING SCALE SUBSIDIES. (a)  An
	individual who is eligible for the state Medicaid program under
	Section 540.051 may receive a Medicaid sliding scale subsidy to
	purchase a health benefit plan from an authorized health benefit
	plan issuer.
	(b)  A sliding scale subsidy provided to an individual under
	this section must:
	(1)  be based on:
	(A)  the average premium in the market; and
	(B)  a realistic assessment of the individual's
	ability to pay a portion of the premium; and
	(2)  include an enhancement for individuals who choose
	a high deductible health plan with a health savings account.
	(c)  The commission shall ensure that counselors are made
	available to individuals receiving a subsidy to advise the
	individuals on selecting a health benefit plan that meets the
	individuals' needs.
	(d)  An individual receiving a subsidy under this section is
	responsible for paying:
	(1)  any difference between the premium costs
	associated with the purchase of a health benefit plan and the amount
	of the individual's subsidy under this section; and
	(2)  any copayments associated with the health benefit
	plan.
	(e)  If the amount of a subsidy received by an individual
	under this section exceeds the premium costs associated with the
	individual's purchase of a health benefit plan, the individual may
	deposit the excess amount in a health savings account that may be
	used only in the manner described by Section 540.054(b).
	Sec. 540.053.  ADDITIONAL COST-SHARING SUBSIDIES. In
	addition to providing a subsidy to an individual under Section
	540.052, the commission shall provide additional subsidies for
	coinsurance payments, copayments, deductibles, and other
	cost-sharing requirements associated with the individual's health
	benefit plan.  The commission shall provide the additional
	subsidies on a sliding scale based on income.
	Sec. 540.054.  DELIVERY OF SUBSIDIES; HEALTH SAVINGS
	ACCOUNTS.  (a)  The commission shall determine the most appropriate
	manner for delivering and administering subsidies provided under
	Sections 540.052 and 540.053. In determining the most appropriate
	manner, the commission shall consider depositing subsidy amounts
	for an individual in a health savings account established for that
	individual.
	(b)  A health savings account established under this section
	may be used only to:
	(1)  pay health benefit plan premiums and cost-sharing
	amounts; and
	(2)  if appropriate, purchase health care-related
	goods and services.
	Sec. 540.055.  MEDICAID HEALTH BENEFIT PLAN ISSUERS AND
	MINIMUM COVERAGE. The commission shall allow any health benefit
	plan issuer authorized to write health benefit plans in this state
	to participate in the state Medicaid program.  The commission in
	consultation with the commissioner of insurance shall establish
	minimum coverage requirements for a health benefit plan to be
	eligible for purchase under the state Medicaid program, subject to
	the requirements specified by this chapter.
	Sec. 540.056.  REINSURANCE FOR PARTICIPATING HEALTH BENEFIT
	PLAN ISSUERS.  (a)  The commission in consultation with the
	commissioner of insurance shall study a reinsurance program to
	reinsure participating health benefit plan issuers.
	(b)  In examining options for a reinsurance program, the
	commission and commissioner of insurance shall consider a plan
	design under which:
	(1)  a participating health benefit plan is not charged
	a premium for the reinsurance; and
	(2)  the health benefit plan issuer retains risk on a
	sliding scale.
	SUBCHAPTER C. LONG-TERM SERVICES AND SUPPORTS
	Sec. 540.101.  PLAN TO REFORM DELIVERY OF LONG-TERM SERVICES
	AND SUPPORTS.  The commission shall develop a comprehensive plan to
	reform the delivery of long-term services and supports that is
	designed to achieve the following objectives under the state
	Medicaid program or any other program created as an alternative to
	the state Medicaid program:
	(1)  encourage consumer direction;
	(2)  simplify and streamline the provision of services;
	(3)  provide flexibility to design benefits packages
	that meet the needs of individuals receiving long-term services and
	supports under the program;
	(4)  improve the cost-effectiveness and sustainability
	of the provision of long-term services and supports;
	(5)  reduce reliance on institutional settings; and
	(6)  encourage cost sharing by family members when
	appropriate.
	ARTICLE 3.  IMMEDIATE REFORM: PROGRAM TO ENSURE HEALTH BENEFIT
	COVERAGE FOR CERTAIN INDIVIDUALS THROUGH PRIVATE MARKETPLACE
	SECTION 3.01.  Subtitle I, Title 4, Government Code, is
	amended by adding Chapter 541 to read as follows:
	CHAPTER 541.  PROGRAM TO ENSURE HEALTH BENEFIT PLAN COVERAGE FOR
	CERTAIN INDIVIDUALS THROUGH PRIVATE MARKET SOLUTIONS
	SUBCHAPTER A. GENERAL PROVISIONS
	Sec. 541.001.  DEFINITION. In this chapter, "medical
	assistance program" means the program established under Chapter 32,
	Human Resources Code.
	Sec. 541.002.  CONFLICT WITH OTHER LAW. (a)  Except as
	provided by Subsection (b), to the extent of a conflict between a
	provision of this chapter and:
	(1)  another provision of state law, the provision of
	this chapter controls; and
	(2)  a provision of federal law or any authorization
	described under Subchapter B, the federal law or authorization
	controls.
	(b)  The program operated under this chapter is in addition
	to any medical assistance program operated under a block grant
	funding system under Chapter 540.
	Sec. 541.003.  PROGRAM FOR HEALTH BENEFIT PLAN COVERAGE
	THROUGH PRIVATE MARKET SOLUTIONS. Subject to the requirements of
	this chapter, the commission in consultation with the Texas
	Department of Insurance shall develop and implement a program that
	helps connect certain low-income residents of this state with
	health benefit plan coverage through private market solutions.
	Sec. 541.004.  NOT AN ENTITLEMENT. This chapter does not
	establish an entitlement to assistance in obtaining health benefit
	plan coverage.
	Sec. 541.005.  RULES. The executive commissioner shall
	adopt rules necessary to implement this chapter.
	SUBCHAPTER B.  FEDERAL AUTHORIZATION
	Sec. 541.051.  FEDERAL AUTHORIZATION FOR FLEXIBILITY TO
	ESTABLISH PROGRAM. (a)  The commission in consultation with the
	Texas Department of Insurance shall negotiate with the United
	States secretary of health and human services, the federal Centers
	for Medicare and Medicaid Services, and other appropriate persons
	for purposes of seeking a waiver or other authorization necessary
	to obtain the flexibility to use federal matching funds to help
	provide, in accordance with Subchapter C, health benefit plan
	coverage to certain low-income individuals through private market
	solutions.
	(b)  Any agreement reached under this section must:
	(1)  create a program that is made cost neutral to this
	state by:
	(A)  leveraging premium tax revenues; and
	(B)  achieving cost savings through offsets to
	general revenue health care costs or the implementation of other
	cost savings mechanisms;
	(2)  create more efficient health benefit plan coverage
	options for eligible individuals through:
	(A)  program changes that may be made without the
	need for additional federal approval; and
	(B)  program changes that require additional
	federal approval;
	(3)  require the commission to achieve efficiency and
	reduce unnecessary utilization, including duplication, of health
	care services;
	(4)  be designed with the goals of:
	(A)  relieving local tax burdens;
	(B)  reducing general revenue reliance so as to
	make general revenue available for other state priorities; and
	(C)  minimizing the impact of any federal health
	care laws on Texas-based businesses; and
	(5)  afford this state the opportunity to develop a
	state-specific way with benefits that specifically meet the unique
	needs of this state's population.
	(c)  An agreement reached under this section may be:
	(1)  limited in duration; and
	(2)  contingent on continued funding by the federal
	government.
	SUBCHAPTER C.  PROGRAM REQUIREMENTS
	Sec. 541.101.  ENROLLMENT ELIGIBILITY. (a)  Subject to
	Subsection (b), an individual may be eligible to enroll in a program
	designed and established under this chapter if the person:
	(1)  is younger than 65;
	(2)  has a household income at or below 133 percent of
	the federal poverty level; and
	(3)  is not otherwise eligible to receive benefits
	under the medical assistance program, including through a program
	operated under Chapter 540 through a block grant funding system or a
	waiver, other than one granted under this chapter, to the program.
	(b)  The executive commissioner may amend or further define
	the eligibility requirements of this section if the commission
	determines it necessary to reach an agreement under Subchapter B.
	Sec. 541.102.  MINIMUM PROGRAM REQUIREMENTS. A program
	designed and established under this chapter must:
	(1)  if cost-effective for this state, provide premium
	assistance to purchase health benefit plan coverage in the private
	market, including health benefit plan coverage offered through a
	managed care delivery model;
	(2)  provide enrollees with access to health benefits,
	including benefits provided through a managed care delivery model,
	that:
	(A)  are tailored to the enrollees;
	(B)  provide levels of coverage that are
	customized to meet health care needs of individuals within defined
	categories of the enrolled population; and
	(C)  emphasize personal responsibility and
	accountability through flexible and meaningful cost-sharing
	requirements and wellness initiatives, including through
	incentives for compliance with health, wellness, and treatment
	strategies and disincentives for noncompliance;
	(3)  include pay-for-performance initiatives for
	private health benefit plan issuers that participate in the
	program;
	(4)  use technology to maximize the efficiency with
	which the commission and any health benefit plan issuer, health
	care provider, or managed care organization participating in the
	program manages enrollee participation;
	(5)  allow recipients under the medical assistance
	program to enroll in the program to receive premium assistance as an
	alternative to the medical assistance program;
	(6)  encourage eligible individuals to enroll in other
	private or employer-sponsored health benefit plan coverage, if
	available and appropriate;
	(7)  encourage the utilization of health care services
	in the most appropriate low-cost settings; and
	(8)  establish health savings accounts for enrollees,
	as appropriate.
	SECTION 3.02.  The Health and Human Services Commission in
	consultation with the Texas Department of Insurance and the
	Medicaid Reform Task Force shall actively develop a proposal for
	the authorization from the appropriate federal entity as required
	by Subchapter B, Chapter 541, Government Code, as added by this
	article. As soon as possible after the effective date of this Act,
	the Health and Human Services Commission shall request and actively
	pursue obtaining the authorization from the appropriate federal
	entity.
	ARTICLE 4.  FEDERAL AUTHORIZATION AND EFFECTIVE DATE
	SECTION 6.01.  Subject to Section 3.02 of this Act, 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 6.02.  This Act takes effect September 1, 2015.