Bill Text: TX HB69 | 2021 | 87th Legislature 1st 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) 2021-07-07 - Filed [HB69 Detail]
Download: Texas-2021-HB69-Introduced.html
| 87S10166 KFF-F | ||
| By: Reynolds | H.B. No. 69 | |
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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. | ||
