89R2653 AND-D
	By: Manuel	H.B. No. 5220

	A BILL TO BE ENTITLED
	AN ACT
	relating to provision of and access to services for children with
	certain health care needs, including access to certain Medicaid
	waiver programs.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Subchapter B, Chapter 526, Government Code, as
	effective April 1, 2025, is amended by adding Section 526.0061 to
	read as follows:
	Sec. 526.0061.  TEXAS PREGNANCY AND PARENT SUPPORT NETWORK
	FOR CERTAIN EXPECTANT PARENTS. (a)  In this section, "support
	network" means the Texas pregnancy and parent support network
	established under Subsection (b).
	(b)  The commission shall establish a statewide network of
	service providers, including third-party patient navigators, for
	expectant parents who receive a prenatal diagnosis for their unborn
	child of a significant fetal anomaly, rare disorder, or other
	chronic, medically complex condition or life-altering disability.
	(c)  A third-party patient navigator who provides services
	under the support network shall:
	(1)  connect expectant and new parents with support and
	advocacy groups and services, including support groups specific to
	the diagnosis for their child and relevant to their child's
	condition or disability; and
	(2)  assist expectant and new parents in navigating the
	process of accessing and applying for home and community-based
	supports and services for their child, including medically
	dependent children (MDCP) waiver program diversion slots under
	Section 546.0506.
	SECTION 2.  Section 532.0353, Government Code, as effective
	April 1, 2025, is amended by amending Subsection (a) and adding
	Subsection (a-1) to read as follows:
	(a)  The executive commissioner shall develop and implement:
	(1)  a Medicaid buy-in program for individuals with
	disabilities as authorized by the Ticket to Work and Work
	Incentives Improvement Act of 1999 (Pub. L. No. 106-170) or the
	Balanced Budget Act of 1997 (Pub. L. No. 105-33); and
	(2)  subject to Subsection (a-1), a Medicaid buy-in
	program for children with disabilities described by 42 U.S.C.
	Section 1396a(cc)(1) whose family incomes do not exceed 300 percent
	of the applicable federal poverty level, as authorized by the
	Deficit Reduction Act of 2005 (Pub. L. No. 109-171).
	(a-1)  Notwithstanding any other law, the executive
	commissioner by rule shall increase the maximum family income
	prescribed by Subsection (a)(2) for determining eligibility for the
	buy-in program to the maximum family income amount allowable,
	considering available appropriations for that purpose.
	SECTION 3.  Subchapter K, Chapter 546, Government Code, as
	effective April 1, 2025, is amended by adding Sections 546.05031
	and 546.0506 to read as follows:
	Sec. 546.05031.  ASSESSMENT OF CERTAIN CHILDREN.  To the
	extent possible, the commission shall enroll a child in the
	medically dependent children (MDCP) waiver program if the child:
	(1)  is on the interest list for the program;
	(2)  receives Supplemental Security Income (SSI) (42
	U.S.C. Section 1381 et seq.); and
	(3)  meets the program's level of care criteria for
	medical necessity for nursing facility care.
	Sec. 546.0506.  ALLOCATION AND RESERVATION OF DIVERSION
	SLOTS.  (a)  To the extent possible, the commission shall allocate
	and reserve a portion of medically dependent children (MDCP) waiver
	program slots as diversion slots for children who:
	(1)  meet the program's level of care criteria for
	medical necessity for nursing facility care; and
	(2)  are at high risk of being placed in an
	institutional setting.
	(b)  A parent may apply for a nursing facility diversion slot
	described by Subsection (a) after the child's birth if the newborn
	child is determined to be at imminent risk of being placed in an
	institutional setting.
	SECTION 4.  Subchapter B, Chapter 32, Human Resources Code,
	is amended by adding Section 32.0521 to read as follows:
	Sec. 32.0521.  ELIGIBILITY FOR TEXAS HOME LIVING (TxHmL)
	WAIVER PROGRAM. (a) In this section, "Section 1915(c) waiver
	program" has the meaning assigned by Section 521.0001, Government
	Code.
	(b)  To the extent permitted by federal law, an individual is
	financially eligible to participate in the Texas home living
	(TxHmL) waiver program if the individual's income is not more than
	the special income limit established by the commission for other
	Section 1915(c) waiver programs, including the home and
	community-based services (HCS) waiver program.
	(c)  The commission may not require that an individual who
	has an approved primary diagnosis of a related condition meet
	intelligence quotient criteria to be eligible for the Texas home
	living (TxHmL) waiver program.
	SECTION 5.  As soon as practicable after the effective date
	of this Act, the executive commissioner of the Health and Human
	Services Commission shall adopt rules necessary to implement the
	changes in law made by this Act.
	SECTION 6.  Notwithstanding any other section of this Act,
	in a state fiscal year, the Health and Human Services Commission is
	not required to implement a provision in another section of this Act
	imposing a duty on the commission to take an action, including a
	provision that the commission determines would require adding
	additional slots under the medically dependent children (MDCP)
	waiver program or the Texas home living (TxHmL) waiver program,
	unless money is specifically appropriated to the commission for
	that fiscal year to carry out that duty.  The commission may
	implement the provision in that fiscal year to the extent other
	funding is available to the commission for the implementation.
	SECTION 7.  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 8.  This Act takes effect September 1, 2025.