89R7660 CMO-D
	By: Lalani	H.B. No. 4639

	A BILL TO BE ENTITLED
	AN ACT
	relating to the development and implementation of a veterans health
	care coverage program to assist certain veterans in obtaining
	health care coverage.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Subtitle I, Title 4, Government Code, is amended
	by adding Chapter 550A to read as follows:
	CHAPTER 550A. VETERANS HEALTH CARE COVERAGE PROGRAM
	Sec. 550A.0001.  DEFINITIONS. In this chapter:
	(1)  "Eligible individual" means a veteran who is
	eligible to participate in the program.
	(2)  "Participant" means a veteran who is enrolled in
	the program.
	(3)  "Program" means the veterans health care coverage
	program established under this chapter.
	(4)  "Veteran" has the meaning assigned by Section
	411.1951.
	Sec. 550A.0002.  FEDERAL AUTHORIZATION FOR PROGRAM. (a)
	The executive commissioner shall seek a waiver under Section 1115
	of the federal Social Security Act (42 U.S.C. Section 1315) to
	obtain any federal money available for implementing the program to
	assist eligible individuals in obtaining health care coverage.
	(b)  The terms of the waiver the executive commissioner seeks
	must:
	(1)  be designed to:
	(A)  provide financial assistance for eligible
	individuals to obtain health care coverage, including coverage for
	mental health services; and
	(B)  encourage participants to seek employment
	opportunities, including through programs operated by the Texas
	Workforce Commission; and
	(2)  allow for the operation of the program consistent
	with the requirements of this chapter, except to the extent
	deviation from the requirements is necessary to obtain federal
	authorization of the waiver.
	Sec. 550A.0003.  FUNDING. Subject to approval of the waiver
	described by Section 550A.0002, the commission shall implement the
	program using federal money obtained for that purpose.
	Sec. 550A.0004.  NOT AN ENTITLEMENT. This chapter does not
	establish an entitlement to financial assistance for obtaining
	health care coverage under the program for eligible individuals.
	Sec. 550A.0005.  PROGRAM PROMOTION AND ADMINISTRATION. The
	commission shall promote and provide information on the program to
	veterans who are potentially eligible to participate in the
	program. The commission shall ensure the program's promotion is
	designed in a manner to reach as many veterans as possible.
	Sec. 550A.0006.  ELIGIBILITY REQUIREMENTS. An individual is
	eligible to participate in the program if:
	(1)  the individual:
	(A)  is a resident of this state;
	(B)  is a veteran;
	(C)  is 19 years of age or older but younger than
	65 years of age; and
	(D)  applying the eligibility criteria in effect
	in this state on December 31, 2024, is not eligible for Medicaid;
	and
	(2)  federal money is available to provide benefits to
	the individual under the program.
	Sec. 550A.0007.  COMMISSION'S AUTHORITY RELATED TO
	ELIGIBILITY AND MEDICAID COORDINATION. The commission may:
	(1)  accept applications for program participation and
	implement program eligibility screening and enrollment procedures;
	(2)  resolve grievances related to eligibility
	determinations; and
	(3)  to the extent possible, coordinate the program
	with Medicaid.
	Sec. 550A.0008.  APPLICATION FORM AND PROCEDURES. (a) The
	executive commissioner shall adopt an application form and
	application procedures for the program. The form and procedures
	may be coordinated with Medicaid forms and procedures to ensure
	there is a single consolidated application process to seek health
	care coverage under the program or Medicaid.
	(b)  To the extent possible, the commission shall make the
	application form available in languages other than English.
	(c)  The executive commissioner may permit a veteran to apply
	by mail, over the telephone, or through the Internet.
	Sec. 550A.0009.  ELIGIBILITY SCREENING AND ENROLLMENT. (a)
	The executive commissioner shall adopt eligibility screening and
	enrollment procedures or use the Texas Integrated Enrollment
	Services eligibility determination system or a compatible system to
	screen veterans and enroll eligible individuals in the program.
	(b)  The eligibility screening and enrollment procedures
	must ensure that a veteran applying for the program who appears
	eligible for Medicaid is identified and assisted with obtaining
	Medicaid coverage. If the veteran is denied Medicaid coverage but
	is otherwise determined eligible to participate in the program, the
	commission shall enroll the veteran in the program without
	additional application or qualification.
	(c)  Not later than the 30th day after the date a veteran
	submits a complete application form, the commission shall ensure
	that the veteran's eligibility to participate in the program is
	determined and that the veteran is enrolled in the program if
	eligible.
	Sec. 550A.0010.  ELIGIBILITY REDETERMINATION AND
	DISENROLLMENT. (a) The commission shall redetermine a
	participant's eligibility to participate in the program during the
	12th month following the date the participant is initially enrolled
	in the program or was most recently redetermined eligible for the
	program. The commission shall ensure the eligibility
	redetermination process is as seamless and contains as little
	administrative burden for the participant as possible to facilitate
	the participant's successful eligibility redetermination.
	(b)  Not later than the 60th day before the expiration of a
	participant's coverage period, the commission shall take all
	reasonable steps to notify the participant regarding the
	eligibility redetermination process and request documentation
	necessary to redetermine the participant's eligibility.
	(c)  The commission shall disenroll a participant from the
	program if:
	(1)  the participant does not submit the requested
	eligibility redetermination documentation before the last day of
	the participant's coverage period; or
	(2)  the commission, based on the submitted
	documentation, determines the participant is no longer eligible to
	participate in the program.
	Sec. 550A.0011.  SLIDING SCALE SUBSIDIES. (a) The
	commission shall ensure a participant receives a sliding scale
	subsidy under the program to purchase health benefit coverage.
	(b)  A sliding scale subsidy provided to a participant must:
	(1)  be based on:
	(A)  the average health benefit coverage premium
	in the market; and
	(B)  a realistic assessment of the participant's
	ability to pay a portion of the premium; and
	(2)  include an enhancement for participants who choose
	a high deductible health plan with a health savings account.
	(c)  The commission shall ensure that counselors are made
	available to participants to advise the participants on selecting
	health benefit coverage that meets the participant's needs.
	(d)  A participant is responsible for paying:
	(1)  any difference between the premium costs
	associated with the purchase of health benefit coverage and the
	amount of the participant's subsidy under this section; and
	(2)  any copayments associated with the health benefit
	coverage, except to the extent the individual receives an
	additional subsidy under Section 550A.0012 to pay the copayments.
	(e)  If the amount of a subsidy a participant receives under
	this section exceeds the premium costs associated with the
	participant's purchase of health benefit coverage, the participant
	may deposit the excess amount in a health savings account that may
	be used only in the manner described by Section 550A.0013(b).
	Sec. 550A.0012.  ADDITIONAL COST-SHARING SUBSIDIES. In
	addition to providing a subsidy to a participant under Section
	550A.0011, the commission shall provide additional subsidies for
	coinsurance payments, copayments, deductibles, and other
	cost-sharing requirements associated with the participant's health
	benefit coverage. The commission shall provide the additional
	subsidies on a sliding scale based on income.
	Sec. 550A.0013.  DELIVERY OF SUBSIDIES; HEALTH SAVINGS
	ACCOUNTS. (a) The commission shall determine the most appropriate
	manner for delivering and administering subsidies provided under
	Sections 550A.0011 and 550A.0012. In determining the most
	appropriate manner, the commission shall consider depositing
	subsidy amounts for a participant in a health savings account
	established for that participant.
	(b)  A health savings account established under this section
	may be used only to:
	(1)  pay health benefit coverage premiums and
	cost-sharing amounts; and
	(2)  if appropriate, purchase health care-related
	goods and services.
	Sec. 550A.0014.  RULEMAKING AUTHORITY. The commission shall
	adopt rules as necessary to implement the program.
	SECTION 2.  As soon as practicable after the effective date
	of this Act, the executive commissioner of the Health and Human
	Services Commission shall apply for and actively pursue from the
	federal Centers for Medicare and Medicaid Services or another
	appropriate federal agency the waiver required by Section
	550A.0002, Government Code, as added by this Act. The commission
	may delay implementing this Act until the waiver applied for under
	this section is granted.
	SECTION 3.  This Act takes effect immediately if it receives
	a vote of two-thirds of all the members elected to each house, as
	provided by Section 39, Article III, Texas Constitution. If this
	Act does not receive the vote necessary for immediate effect, this
	Act takes effect September 1, 2025.