Bill Text: TX HB54 | 2021 | 87th Legislature 3rd Special Session | Introduced
Bill Title: 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.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2021-09-14 - Filed [HB54 Detail]
Download: Texas-2021-HB54-Introduced.html
By: Reynolds | H.B. No. 54 |
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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. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
ARTICLE 1. BLOCK GRANT FUNDING SYSTEM FOR STATE MEDICAID PROGRAM | ||
SECTION 1.01. 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. 540.0001. DEFINITIONS. Notwithstanding Section | ||
531.001, 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. 540.0002. 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 540.0003, administer and operate the state Medicaid program | ||
in accordance with this chapter. | ||
Sec. 540.0003. 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 540A.0002(b); and | ||
(2) a provision of federal law or any authorization | ||
described under Section 540.0002, the federal law or authorization | ||
controls. | ||
Sec. 540.0004. 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. 540.0005. RULES. The executive commissioner shall | ||
adopt rules necessary to implement this chapter. | ||
SUBCHAPTER B. ACUTE CARE | ||
Sec. 540.0051. 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 in this state on August 31, 2021. | ||
(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 540A 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. 540.0052. MEDICAID SLIDING SCALE SUBSIDIES. (a) An | ||
individual who is eligible for the state Medicaid program under | ||
Section 540.0051 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, except to the extent the individual receives an additional | ||
subsidy under Section 540.0053 to pay the copayments. | ||
(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 540.0054(b). | ||
Sec. 540.0053. ADDITIONAL COST-SHARING SUBSIDIES. In | ||
addition to providing a subsidy to an individual under Section | ||
540.0052, 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. 540.0054. DELIVERY OF SUBSIDIES; HEALTH SAVINGS | ||
ACCOUNTS. (a) The commission shall determine the most appropriate | ||
manner for delivering and administering subsidies provided under | ||
Sections 540.0052 and 540.0053. 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. 540.0055. 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. 540.0056. 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 the 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. 540.0101. 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 2. PROGRAM TO ENSURE HEALTH BENEFIT COVERAGE FOR CERTAIN | ||
INDIVIDUALS THROUGH PRIVATE MARKETPLACE | ||
SECTION 2.01. Subtitle I, Title 4, Government Code, is | ||
amended by adding Chapter 540A to read as follows: | ||
CHAPTER 540A. PROGRAM TO ENSURE HEALTH BENEFIT PLAN COVERAGE FOR | ||
CERTAIN INDIVIDUALS THROUGH PRIVATE MARKET SOLUTIONS | ||
SUBCHAPTER A. GENERAL PROVISIONS | ||
Sec. 540A.0001. DEFINITION. In this chapter, "state | ||
Medicaid program" has the meaning assigned by Section 540.0001. | ||
Sec. 540A.0002. 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 the state Medicaid program operated under Chapter 32, Human | ||
Resources Code, or under a block grant funding system under Chapter | ||
540. | ||
Sec. 540A.0003. PROGRAM FOR HEALTH BENEFIT PLAN COVERAGE | ||
THROUGH PRIVATE MARKET SOLUTIONS. Subject to the requirements of | ||
this chapter, the commission in consultation with the commissioner | ||
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. 540A.0004. NOT AN ENTITLEMENT. This chapter does not | ||
establish an entitlement to assistance in obtaining health benefit | ||
plan coverage. | ||
Sec. 540A.0005. RULES. The executive commissioner shall | ||
adopt rules necessary to implement this chapter. | ||
SUBCHAPTER B. FEDERAL AUTHORIZATION | ||
Sec. 540A.0051. FEDERAL AUTHORIZATION FOR FLEXIBILITY TO | ||
ESTABLISH PROGRAM. (a) The commission in consultation with the | ||
commissioner of insurance shall negotiate with the United States | ||
secretary of health and human services, the 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. 540A.0101. 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 state Medicaid program, including through a program | ||
operated under Chapter 32, Human Resources Code, or under Chapter | ||
540 through a block grant funding system or a waiver, other than a | ||
waiver granted under this chapter, to the program. | ||
(b) The executive commissioner may modify or further define | ||
the eligibility requirements of this section if the commission | ||
determines it necessary to reach an agreement under Subchapter B. | ||
Sec. 540A.0102. 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 manage enrollee participation; | ||
(5) allow recipients under the state Medicaid program | ||
to enroll in the program to receive premium assistance as an | ||
alternative to the state Medicaid 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 2.02. The Health and Human Services Commission in | ||
consultation with the commissioner of insurance shall actively | ||
develop a proposal for the authorization from the appropriate | ||
federal entity as required by Subchapter B, Chapter 540A, | ||
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 3. FEDERAL AUTHORIZATION AND EFFECTIVE DATE | ||
SECTION 3.01. Subject to Section 2.02 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 3.02. This Act takes effect on the 91st day after | ||
the last day of the legislative session. |