HB 4639

relating to the development and implementation of a veterans health
care coverage program to assist certain veterans in obtaining
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
(3)  "Program" means the veterans health care coverage
program established under this chapter.
(4)  "Veteran" has the meaning assigned by Section
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
(A)  provide financial assistance for eligible
individuals to obtain health care coverage, including coverage for
(B)  encourage participants to seek employment
opportunities, including through programs operated by the Texas
(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
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:
(A)  is a resident of this state;
(C)  is 19 years of age or older but younger than
(D)  applying the eligibility criteria in effect
in this state on December 31, 2024, is not eligible for Medicaid;
(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
(3)  to the extent possible, coordinate the program
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
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
(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
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:
(A)  the average health benefit coverage premium
(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
(1)  pay health benefit coverage premiums and
(2)  if appropriate, purchase health care-related
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
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.