SB 232

relating to the development and implementation of the Live Well
Texas program and the expansion of Medicaid eligibility to provide
health benefit coverage to certain individuals; imposing
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1.  Subtitle I, Title 4, Government Code, is amended
by adding Chapters 537A and 537B to read as follows:
CHAPTER 537A.  LIVE WELL TEXAS PROGRAM
SUBCHAPTER A.  GENERAL PROVISIONS
Sec. 537A.0001.  DEFINITIONS.  In this chapter:
(1)  "Basic plan" means the program health benefit plan
described by Section 537A.0202.
(2)  "Eligible individual" means an individual who is
eligible to participate in the program.
(3)  "Health Savings Account" means a personal wellness
and responsibility account the commission establishes for a
participant under Section 537A.0251.
(4)  "Participant" means an individual who is:
(A)  enrolled in a program health benefit plan; or
(B)  receiving health care financial assistance
(5)  "Plus plan" means the program health benefit plan
described by Section 537A.0203.
(6)  "Program" means the Live Well Texas program
established under this chapter.
(7)  "Program health benefit plan" includes:
(8)  "Program health benefit plan provider" means a
health benefit plan provider that contracts with the commission
under Section 537A.0107 to arrange for the provision of health care
services through a program health benefit plan.
SUBCHAPTER B.  FEDERAL WAIVER FOR LIVE WELL TEXAS PROGRAM
Sec. 537A.0051.  FEDERAL AUTHORIZATION FOR PROGRAM.  (a)
Notwithstanding any other law, the executive commissioner shall
develop and seek a waiver under Section 1115 of the Social Security
Act (42 U.S.C. Section 1315) to the state Medicaid plan to implement
the Live Well Texas program to assist individuals in obtaining
health benefit coverage through a program health benefit plan or
health care financial assistance.
(b)  The terms of a waiver the executive commissioner seeks
(A)  provide health benefit coverage options for
(B)  produce better health outcomes for
(C)  create incentives for participants to
transition from receiving public assistance benefits to achieving
(D)  promote personal responsibility and engage
participants in making decisions regarding health care based on
(E)  support participants' self-sufficiency by
requiring unemployed participants to be referred to work search and
(F)  support participants who become ineligible
to participate in a program health benefit plan in transitioning to
private health benefit coverage; and
(G)  leverage enhanced federal medical assistance
percentage funding to minimize or eliminate the need for a program
(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. 537A.0052.  FUNDING.  Subject to approval of the waiver
described by Section 537A.0051, the commission shall implement the
program using enhanced federal medical assistance percentage
funding available under the Patient Protection and Affordable Care
Act (Pub. L. No. 111-148) as amended by the Health Care and
Education Reconciliation Act of 2010 (Pub. L. No. 111-152).
Sec. 537A.0053.  NOT AN ENTITLEMENT; TERMINATION OF PROGRAM.
(a)  This chapter does not establish an entitlement to health
benefit coverage or health care financial assistance under the
program for eligible individuals.
(b)  The program terminates at the time the share of federal
funding for the program under the Patient Protection and Affordable
Care Act (Pub. L. No. 111-148) as amended by the Health Care and
Education Reconciliation Act of 2010 (Pub. L. No. 111-152) is
SUBCHAPTER C.  PROGRAM ADMINISTRATION
Sec. 537A.0101.  PROGRAM OBJECTIVE.  The program's principal
objective is to provide primary and preventative health care
through high deductible program health benefit plans to eligible
Sec. 537A.0102.  PROGRAM PROMOTION.  The commission shall
promote and provide information about the program to individuals
(1)  are potentially eligible to participate in the
(2)  live in medically underserved areas of this state.
Sec. 537A.0103.  COMMISSION'S AUTHORITY RELATED TO HEALTH
BENEFIT PLAN PROVIDER CONTRACTS.  The commission may:
(1)  enter into contracts with health benefit plan
providers under Section 537A.0107;
(2)  monitor program health benefit plan providers
through reporting requirements and other means to ensure contract
performance and quality delivery of services;
(3)  monitor the quality of services delivered to
participants through outcome measurements; and
(4)  provide payment under the contracts to program
Sec. 537A.0104.  COMMISSION'S AUTHORITY RELATED TO
ELIGIBILITY AND MEDICAID COORDINATION.  The commission may:
(1)  accept applications for health benefit coverage
under the program and implement program eligibility screening and
(2)  resolve grievances related to eligibility
(3)  to the extent possible, coordinate the program
Sec. 537A.0105.  THIRD-PARTY ADMINISTRATOR CONTRACT FOR
PROGRAM IMPLEMENTATION.  (a)  In administering the program, the
commission may contract with a third-party administrator to provide
enrollment and related services.
(b)  If the commission contracts with a third-party
administrator under this section, the commission may:
(1)  monitor the third-party administrator through
reporting requirements and other means to ensure contract
performance and quality delivery of services; and
(2)  provide payment under the contract to the
(c)  The executive commissioner shall retain all
policymaking authority over the program.
(d)  The commission shall  procure each contract with a
third-party administrator, as applicable, through a competitive
procurement process that complies with all federal and state laws.
Sec. 537A.0106.  TEXAS DEPARTMENT OF INSURANCE DUTIES.  (a)
At the commission's request, the Texas Department of Insurance
shall provide any necessary assistance with the program.  The
department shall monitor the quality of the services provided by
program health benefit plan providers and resolve grievances
(b)  The commission and the Texas Department of Insurance may
adopt a memorandum of understanding that addresses the
responsibilities of each agency with respect to the program.
(c)  The Texas Department of Insurance, in consultation with
the commission, shall adopt rules as necessary to implement this
Sec. 537A.0107.  HEALTH BENEFIT PLAN PROVIDER CONTRACTS.
The commission shall select through a competitive procurement
process that complies with all federal and state laws and contract
with health benefit plan providers to provide health care services
under the program.  To be eligible for a contract under this
(1)  be a Medicaid managed care organization;
(2)  hold a certificate of authority issued by the
Texas Department of Insurance that authorizes the entity to provide
the types of health care services offered under the program; and
(3)  satisfy, except as provided by this chapter, any
applicable requirement of the Insurance Code or another insurance
Sec. 537A.0108.  HEALTH CARE PROVIDERS.  (a)  A health care
provider who provides health care services under the program must
meet certification and licensure requirements required by
commission rules and other law.
(b)  In adopting rules governing the program, the executive
commissioner shall ensure that a health care provider who provides
health care services under the program is reimbursed at a rate that
is at least equal to the rate paid under Medicare for the provision
of the same or substantially similar services.
Sec. 537A.0109.  PROHIBITION ON CERTAIN HEALTH CARE
PROVIDERS.  The executive commissioner shall adopt rules that
prohibit a health care provider from providing program health care
services for a reasonable period, as determined by the executive
commissioner, if the health care provider:
(1)  fails to repay program overpayments; or
(2)  owns, controls, manages, or is otherwise
affiliated with and has financial, managerial, or administrative
influence over a health care provider who has been suspended or
prohibited from providing program health care services.
SUBCHAPTER D.  ELIGIBILITY FOR PROGRAM HEALTH BENEFIT COVERAGE
Sec. 537A.0151.  ELIGIBILITY REQUIREMENTS.  (a)  An
individual is eligible to enroll in a program health benefit plan
(1)  the individual is a resident of this state;
(2)  the individual is 19 years of age or older but
(3)  applying the eligibility criteria in effect in
this state on December 31, 2024, the individual is not eligible for
(4)  federal matching funds are available under the
Patient Protection and Affordable Care Act (Pub. L. No. 111-148) as
amended by the Health Care and Education Reconciliation Act of 2010
(Pub. L. No. 111-152) to provide benefits to the individual under
the federal medical assistance program established under Title XIX,
Social Security Act (42 U.S.C. Section 1396 et seq.).
(b)  An individual who is a parent or caretaker relative to
whom 42 C.F.R. Section 435.110 applies is eligible to enroll in a
(c)  In determining eligibility for the program, the
commission shall apply the same eligibility criteria regarding
residency and citizenship in effect for Medicaid in this state on
Sec. 537A.0152.  CONTINUOUS COVERAGE.  The commission shall
ensure that an individual who is initially determined or
redetermined to be eligible to participate in the program and
enroll in a program health benefit plan will remain eligible for
coverage under the plan for a period of 12 months beginning on the
first day of the month following the date eligibility was
determined or redetermined, subject to Section 537A.0252(f).
Sec. 537A.0153.  APPLICATION FORM AND PROCEDURES.  (a)  The
executive commissioner shall adopt an application form and
application procedures for the program.  The form and procedures
must be coordinated with forms and procedures under Medicaid to
ensure that there is a single consolidated application process to
seek health benefit 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 an individual to
apply by mail, over the telephone, or through the Internet.
Sec. 537A.0154.  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 individuals and enroll eligible individuals in the program.
(b)  The eligibility screening and enrollment procedures
must ensure that an individual applying for the program who appears
eligible for Medicaid is identified and assisted with obtaining
Medicaid coverage.  If the individual is denied Medicaid coverage
but is determined eligible to enroll in a program health benefit
plan, the commission shall enroll the individual in a program
health benefit plan of the individual's choosing and for which the
individual is eligible without further application or
(c)  Not later than the 30th day after the date an individual
submits a complete application form and unless the individual is
identified and assisted with obtaining Medicaid coverage under
Subsection (b), the commission shall ensure that the individual's
eligibility to participate in the program is determined and that
the individual, if eligible, is provided with information on
program health benefit plans and program health benefit plan
providers.  The commission shall enroll the individual in the
program health benefit plan and with the program health benefit
plan provider of the individual's choosing in a timely manner, as
(d)  The executive commissioner may establish enrollment
Sec. 537A.0155.  ELIGIBILITY REDETERMINATION PROCESS;
DISENROLLMENT.  (a)  Not later than the 90th day before a
participant's coverage period expires, the commission shall notify
the participant regarding the eligibility redetermination process
and request documentation necessary to redetermine the
(b)  The commission shall provide written notice of
termination of eligibility to a participant not later than the 30th
day before the date the participant's eligibility will terminate.
The commission shall disenroll the 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 for
the program, subject to Subchapter H.
(c)  An individual may submit the requested eligibility
redetermination documentation not later than the 90th day after the
date the commission disenrolls the individual from the program.  If
the commission determines that the individual continues to meet
program eligibility requirements, the commission shall reenroll
the individual in the program without any additional application
(d)  An individual who does not complete the eligibility
redetermination process in accordance with this section and who the
commission disenrolls from the program may not participate in the
program for a period of 180 days beginning on the date of
disenrollment.  This subsection does not apply to an individual:
(1)  described by Section 537A.0206 or 537A.0208; or
(B)  younger than 21 years of age.
(e)  At the time the commission disenrolls a participant from
the program, the commission shall provide to the participant:
(1)  notice that the participant may be eligible to
receive health care financial assistance under Subchapter H in
transitioning to private health benefit coverage; and
(2)  information on and the eligibility requirements
SUBCHAPTER E.  BASIC AND PLUS PLANS
Sec. 537A.0201.  BASIC AND PLUS PLAN COVERAGE GENERALLY.
(a)  The basic and plus plans offered under the program must:
(1)  comply with this subchapter and coverage
requirements prescribed by other law; and
(2)  at a minimum, provide coverage for essential
health benefits required under 42 U.S.C. Section 18022(b).
(b)  In modifying covered health benefits under the basic and
plus plans, the executive commissioner shall consider the health
care needs of healthy individuals and individuals with special
(c)  The basic and plus plans must allow a participant with a
chronic, disabling, or life-threatening illness to select an
appropriate specialist as the participant's primary care
Sec. 537A.0202.  BASIC PLAN: COVERAGE AND INCOME
ELIGIBILITY.  (a)  The program must include a basic plan that is
sufficient to meet the basic health care needs of individuals who
(b)  The covered health benefits under the basic plan must
(1)  primary care physician services;
(2)  prenatal and postpartum care;
(3)  specialty care physician visits;
(4)  home health services, not to exceed 100 visits per
(8)  intravenous infusion services;
(11)  emergency care hospital services;
(12)  emergency transportation, including ambulance
(13)  urgent care clinic services;
(14)  hospitalization, including for:
(A)  general inpatient hospital care;
(B)  inpatient physician services;
(C)  inpatient surgical services;
(D)  non-cosmetic reconstructive surgery;
(F)  treatment for a congenital abnormality;
(I)  care in a skilled nursing facility for a
period not to exceed 100 days per occurrence;
(15)  inpatient and outpatient behavioral health
(16)  inpatient, outpatient, and residential substance
(17)  prescription drugs, including tobacco cessation
(18)  inpatient and outpatient rehabilitative and
habilitative care, including physical, occupational, and speech
therapy, not to exceed 60 combined visits per year;
(19)  medical equipment, appliances, and assistive
technology, including prosthetics and hearing aids, and the repair,
technical support, and customization needed for individual use;
(20)  laboratory and pathology tests and services;
(21)  diagnostic imaging, including x-rays, magnetic
resonance imaging, computed tomography, and positron emission
(22)  preventative care services as described by
(23)  services under the early and periodic screening,
diagnostic, and treatment program for participants who are younger
(c)  To be eligible for health care benefits under the basic
plan, an individual who is eligible for the program must have an
annual household income that is equal to or less than 100 percent of
Sec. 537A.0203.  PLUS PLAN: COVERAGE AND INCOME ELIGIBILITY.
(a)  The program must include a plus plan that includes the covered
health benefits listed in Section 537A.0202 and the following
additional enhanced health benefits:
(1)  services related to the treatment of conditions
affecting the temporomandibular joint;
(4)  notwithstanding Section 537A.0202(b)(18),
inpatient and outpatient rehabilitative and habilitative care,
including physical, occupational, and speech therapy, not to exceed
(6)  other services the commission considers
(b)  An individual who is eligible for the program and whose
annual household income exceeds 100 percent of the federal poverty
level will automatically be enrolled in and receive health benefits
under the plus plan.  An individual who is eligible for the program
and whose annual household income is equal to or less than 100
percent of the federal poverty level may choose to enroll in the
(c)  A participant enrolled in the plus plan is required to
make Health Savings Account contributions in accordance with
Sec. 537A.0204.  PREVENTATIVE CARE SERVICES.  (a)  The
commission shall provide to each participant a list of health care
services that qualify as preventative care services based on the
participant's age, gender, and preexisting conditions.  In
developing the list, the commission shall consult with the federal
Centers for Disease Control and Prevention.
(b)  A program health benefit plan shall, at no cost to the
participant, provide coverage for:
(1)  preventative care services described by 42 U.S.C.
(2)  a maximum of $500 per year of preventative care
services other than those described by Subdivision (1).
(c)  A participant who receives preventative care services
not described by Subsection (b) that are covered under the
participant's program health benefit plan is subject to deductible
and copayment requirements for the services in accordance with the
Sec. 537A.0205.  COPAYMENTS.  (a)  A participant enrolled in
the basic plan shall pay a copayment for each covered health benefit
except for a preventative care or family planning service.  The
executive commissioner by rule shall adopt a copayment schedule for
basic plan services, subject to Subsection (c).
(b)  Except as provided by Subsection (c), a participant
enrolled in the plus plan may not be required to pay a copayment for
(c)  A participant enrolled in the basic or plus plan shall
pay a copayment in an amount set by commission rule not to exceed
$25 for nonemergency use of hospital emergency department services
(1)  the participant has met the cost-sharing maximum
for the calendar quarter, as prescribed by commission rule;
(2)  the participant is referred to the hospital
emergency department by a health care provider;
(3)  the visit is a true emergency, as defined by
(4)  the participant is pregnant.
Sec. 537A.0206.  CERTAIN PARTICIPANTS ELIGIBLE FOR STATE
MEDICAID PLAN BENEFITS.  (a)  A participant described by 42 C.F.R.
Section 440.315 who is enrolled in the basic or plus plan is
entitled to receive under the program all health benefits that
would be available under the state Medicaid plan.
(b)  A participant to which this section applies is subject
to the cost-sharing requirements, including copayment and Health
Savings Account contribution requirements, of the program health
benefit plan in which the participant is enrolled.
(c)  The commission shall develop screening measures to
identify participants to which this section applies.
Sec. 537A.0207.  PREGNANT PARTICIPANTS.  (a)  A participant
who becomes pregnant while enrolled in the program and who meets the
eligibility requirements for Medicaid may choose to remain in the
(b)  A pregnant participant described by Subsection (a) who
is enrolled in the basic or plus plan and who remains in the program
(1)  notwithstanding Section 537A.0205, not subject to
any cost-sharing requirements, including copayment and Health
Savings Account contribution requirements, of the program health
benefit plan in which the participant is enrolled until the
expiration of the second month following the month in which the
(2)  entitled to receive as a Medicaid wrap-around
benefit all Medicaid services a pregnant woman enrolled in Medicaid
is entitled to receive, including a pharmacy benefit, when the
participant exceeds coverage limits under the participant's
program health benefit plan or if a service is not covered by the
(3)  eligible for additional vision and dental care
Sec. 537A.0208.  PARENTS AND CARETAKER RELATIVES.  (a)  A
parent or caretaker relative to whom 42 C.F.R. Section 435.110
applies is entitled to receive as a Medicaid wrap-around benefit
all Medicaid services to which the individual would be entitled
under the state Medicaid plan that are not covered under the
individual's program health benefit plan or exceed the plan's
(b)  An individual described by Subsection (a) who chooses to
participate in the program is subject to the cost-sharing
requirements, including copayment and Health Savings Account
contribution requirements, of the program health benefit plan in
which the individual is enrolled.
SUBCHAPTER F.  HEALTH SAVINGS ACCOUNTS
Sec. 537A.0251.  ESTABLISHMENT AND OPERATION OF HEALTH
SAVINGS ACCOUNTS.  (a)  The commission shall establish a personal
wellness and responsibility account for each participant who is
enrolled in a program health benefit plan that is funded with money
contributed in accordance with this subchapter.
(b)  The commission shall enable each participant to access
and manage money in and information regarding the participant's
Health Savings Account through an electronic system.  The
commission may contract with an entity that has appropriate
experience and expertise to establish, implement, or administer the
(c)  Except as otherwise provided by Section 537A.0252, the
commission shall require each participant to contribute to the
participant's Health Savings Account in amounts described by that
Sec. 537A.0252.  HEALTH SAVINGS ACCOUNT CONTRIBUTIONS;
DEDUCTIBLE.  (a)  The executive commissioner by rule shall
establish an annual universal deductible for each participant
enrolled in the basic or plus plan.
(b)  To ensure each participant's Health Savings Account
contains a sufficient amount of money at the beginning of a coverage
period, the commission shall, before the beginning of that period,
fund each account with the following amounts:
(1)  for a participant enrolled in the basic plan, the
annual universal deductible amount; and
(2)  for a participant enrolled in the plus plan, the
difference between the annual universal deductible amount and the
participant's required annual contribution as determined by the
schedule established under Subsection (c).
(c)  The executive commissioner by rule shall establish a
graduated annual Health Savings Account contribution schedule for
participants enrolled in the plus plan that:
(1)  is based on a participant's annual household
income, with participants whose annual household incomes are less
than the federal poverty level paying progressively less and
participants whose annual household incomes are equal to or greater
than the federal poverty level paying progressively more; and
(2)  may not require a participant to contribute more
than a total of five percent of the participant's annual household
income to the participant's Health Savings Account.
(d)  A participant's employer may contribute on behalf of the
participant any amount of the participant's annual Health Savings
Account contribution.  A nonprofit organization may contribute on
behalf of a participant any amount of the participant's annual
Health Savings Account contribution.
(e)  Subject to the contribution cap described by Subsection
(c)(2) and not before the expiration of the participant's first
coverage period, the commission shall require a participant who
uses one or more tobacco products to contribute to the
participant's Health Savings Account an annual Health Savings
Account contribution amount that is one percent more than the
participant would otherwise be required to contribute under the
schedule established under Subsection (c).
(f)  An annual Health Savings Account contribution must be
paid by or on behalf of a participant monthly in installments that
are at least equal to one-twelfth of the total required
contribution.  The coverage period for a participant whose annual
household income exceeds 100 percent of the federal poverty level
may not begin until the first day of the first month following the
month in which the first monthly installment is received.
Sec. 537A.0253.  USE OF HEALTH SAVINGS ACCOUNT MONEY.  A
participant may use money in the participant's Health Savings
Account to pay copayments and deductible costs the participant's
program health benefit plan requires.  The commission shall issue
to each participant an electronic payment card that allows the
participant to use the card to pay the program health benefit plan
Sec. 537A.0254.  PROGRAM HEALTH BENEFIT PLAN PROVIDER
REWARDS PROGRAM FOR ENGAGEMENT IN CERTAIN HEALTHY BEHAVIORS;
SMOKING CESSATION INITIATIVE.  (a)  A program health benefit plan
provider shall establish a rewards program through which a
participant receiving health care through a program health benefit
plan the program health benefit plan provider offers may earn money
to be contributed to the participant's Health Savings Account.
(b)  Under a rewards program, a program health benefit plan
provider shall contribute money to a participant's Health Savings
Account if the participant engages in certain healthy behaviors.
The executive commissioner by rule shall determine:
(1)  the behaviors in which a participant must engage
to receive a contribution, which must include behaviors related to:
(A)  completion of a health risk assessment;
(C)  as applicable, chronic disease management;
(2)  the amount of money a program health benefit plan
provider shall contribute for each behavior described by
(c)  Subsection (b) does not prevent a program health benefit
plan provider from contributing money to a participant's Health
Savings Account if the participant engages in a behavior not
specified by that subsection or a rule the executive commissioner
adopts in accordance with that subsection.  If a program health
benefit plan provider chooses to contribute money under this
subsection, the program health benefit plan provider shall
determine the amount of money to be contributed for the behavior.
(d)  A participant may use contributions a program health
benefit plan provider makes under a rewards program to offset a
maximum of 50 percent of the participant's required annual Health
Savings Account contribution the executive commissioner
establishes under Section 537A.0252.
(e)  Contributions a program health benefit plan provider
makes under a rewards program that result in a participant's Health
Savings Account balance exceeding the participant's required
annual Health Savings Account contribution may be rolled over into
the next coverage period in accordance with Section 537A.0256.
(f)  During the first coverage period of a participant who
uses one or more tobacco products, a program health benefit plan
provider shall actively attempt to engage the participant in and
provide educational materials to the participant on:
(1)  smoking cessation activities for which the
participant may receive a monetary contribution under this section;
(2)  other smoking cessation programs or resources
Sec. 537A.0255.  MONTHLY STATEMENTS.  The commission shall
distribute to each participant with a Health Savings Account a
monthly statement that includes information on:
(1)  the participant's Health Savings Account activity
during the preceding month, including information on the cost of
health care services delivered to the participant during that
(2)  the balance of money available in the Health
Savings Account at the time the statement is issued; and
(3)  the amount of any contributions due from the
Sec. 537A.0256.  HEALTH SAVINGS ACCOUNT ROLL OVER.  (a)  The
executive commissioner by rule shall establish a process in
accordance with this section to roll over money in a participant's
Health Savings Account to the succeeding coverage period.  The
commission shall calculate the amount to be rolled over at the time
the participant's program eligibility is redetermined.
(b)  For a participant enrolled in the basic plan, the
commission shall calculate the amount to be rolled over to a
subsequent coverage period Health Savings Account from the
participant's current coverage period Health Savings Account based
(1)  the amount of money remaining in the participant's
Health Savings Account from the current coverage period; and
(2)  whether the participant received recommended
preventative care services during the current coverage period.
(c)  For a participant enrolled in the plus plan who, as
determined by the commission, timely makes Health Savings Account
contributions in accordance with this subchapter, the commission
shall calculate the amount to be rolled over to a subsequent
coverage period Health Savings Account from the participant's
current coverage period Health Savings Account based on:
(1)  the amount of money remaining in the participant's
Health Savings Account from the current coverage period;
(2)  the total amount of money the participant
contributed to the participant's Health Savings Account during the
(3)  whether the participant received recommended
preventative care services during the current coverage period.
(d)  Except as provided by Subsection (e), a participant may
use money rolled over into the participant's Health Savings Account
for the succeeding coverage period to offset required annual Health
Savings Account contributions, as applicable, during that coverage
(e)  A participant enrolled in the basic plan who rolls over
money into the participant's Health Savings Account for the
succeeding coverage period and who chooses to enroll in the plus
plan for that coverage period may use the money rolled over to
offset a maximum of 50 percent of the required annual Health Savings
Account contributions for that coverage period.
Sec. 537A.0257.  REFUND.  If at the end of a participant's
coverage period the participant chooses to cease participating in a
program health benefit plan or is no longer eligible to participate
in a program health benefit plan, or if the commission disenrolls a
participant from the program health benefit plan under Section
537A.0258 for failure to pay required contributions, the commission
shall refund to the participant any money the participant
contributed that remains in the participant's Health Savings
Account at the end of the coverage period or on the disenrollment
Sec. 537A.0258.  PENALTIES FOR FAILURE TO MAKE HEALTH
SAVINGS ACCOUNT CONTRIBUTIONS.  (a)  For a participant whose annual
household income exceeds 100 percent of the federal poverty level
and who fails to make a contribution in accordance with Section
537A.0252, the commission shall provide a 60-day grace period
during which the participant may make the contribution without
penalty.  If the participant fails to make the contribution during
the grace period, the commission shall disenroll the participant
from the program health benefit plan in which the participant is
enrolled and the participant may not reenroll in a program health
(1)  the 181st day after the disenrollment date; and
(2)  the participant pays any debt accrued due to the
participant's failure to make the contribution.
(b)  For a participant enrolled in the plus plan whose annual
household income is equal to or less than 100 percent of the federal
poverty level and who fails to make a contribution in accordance
with Section 537A.0252, the commission shall disenroll the
participant from the plus plan and enroll the participant in the
basic plan.  A participant enrolled in the basic plan under this
subsection may not change enrollment to the plus plan until the
participant's program eligibility is redetermined.
SUBCHAPTER G.  EMPLOYMENT INITIATIVE
Sec. 537A.0301.  GATEWAY TO WORK PROGRAM.  (a)  The
commission shall develop and implement a gateway to work program
(1)  integrate existing job training and job search
programs available in this state through the Texas Workforce
Commission or other appropriate state agencies with the Live Well
(2)  provide each participant with general information
on the job training and job search programs.
(b)  Under the gateway to work program, the commission shall
refer each participant who is unemployed or working less than 20
hours a week to available job search and job training programs.
SUBCHAPTER H.  HEALTH CARE FINANCIAL ASSISTANCE FOR CERTAIN
Sec. 537A.0351.  HEALTH CARE FINANCIAL ASSISTANCE FOR
CONTINUITY OF CARE.  (a)  The commission shall ensure continuity of
care by providing health care financial assistance in accordance
with and in the manner described by this subchapter for a
(1)  the commission disenrolls from a program health
benefit plan in accordance with Section 537A.0155 because the
participant's annual household income exceeds the income
eligibility requirements for enrollment in a program health benefit
(2)  seeks and obtains private health benefit coverage
within 12 months following the date of disenrollment.
(b)  To receive health care financial assistance under this
subchapter, a participant must provide to the commission, in the
form and manner the commission requires, documentation showing the
participant has obtained or is actively seeking private health
(c)  The commission may not impose an upper income
eligibility limit on a participant to receive health care financial
assistance under this subchapter.
Sec. 537A.0352.  DURATION AND AMOUNT OF HEALTH CARE
FINANCIAL ASSISTANCE.  (a)  A participant described by Section
537A.0351 may receive health care financial assistance under this
subchapter until the first anniversary of the date the commission
disenrolled the participant from a program health benefit plan.
(b)  Health care financial assistance the commission makes
available to a participant under this subchapter:
(1)  may not exceed the amount described by Section
(2)  may be used only to pay for eligible services
described by Section 537A.0354.
Sec. 537A.0353.  BRIDGE ACCOUNT; FUNDING.  (a)  The
commission shall establish a bridge account for each participant
eligible to receive health care financial assistance under Section
537A.0351.  The account is funded with money the commission
contributes in accordance with this section.
(b)  The commission shall enable each participant for whom
the commission establishes a bridge account to access and manage
money in and information regarding the participant's account
through an electronic system.  The commission may contract with the
same entity described by Section 537A.0251(b) or another entity
with appropriate experience and expertise to establish, implement,
or administer the electronic system.
(c)  The commission shall fund each bridge account in an
amount equal to $1,000 using money the commission retains or
(1)  during the roll over process described by Section
(2)  following the issuance of a refund as described by
(d)  The commission may not require a participant to
contribute money to the participant's bridge account.
(e)  The commission shall retain or recoup any unexpended
money in a participant's bridge account at the end of the period for
which the participant is eligible to receive health care financial
assistance under this subchapter for the purpose of funding another
participant's Health Savings Account under Subchapter F or bridge
Sec. 537A.0354.  USE OF BRIDGE ACCOUNT MONEY.  (a)  The
commission shall issue to each participant for whom the commission
establishes a bridge account an electronic payment card that allows
the participant to use the card to pay costs for eligible services
(b)  A participant may use money in the participant's bridge
(1)  premium costs incurred during the private health
benefit coverage enrollment process and coverage period; and
(2)  copayments, deductible costs, and coinsurance
associated with the private health benefit coverage the participant
obtains for health care services that would otherwise be
(c) Costs described by Subsection (b)(2) associated with
eligible services delivered to a participant may be paid by:
(1)  a participant using the electronic payment card
issued under Subsection (a); or
(2)  a health care provider directly charging and
receiving payment from the participant's bridge account.
Sec. 537A.0355.  ENROLLMENT COUNSELING.  The commission
shall provide enrollment counseling to an individual who is seeking
private health benefit coverage and who is otherwise eligible to
receive health care financial assistance under this subchapter.
CHAPTER 537B.  EXPANDED MEDICAID ELIGIBILITY FOR CERTAIN
Sec. 537B.0001.  APPLICABILITY.  This chapter applies only
to an individual who would be eligible to participate in the Live
Well Texas program under Chapter 537A based on the eligibility
requirements described by Section 537A.0151, if the commission were
Sec. 537B.0002.  EXPANDED MEDICAID ELIGIBILITY UNDER
PATIENT PROTECTION AND AFFORDABLE CARE ACT.  (a)  Except as provided
by Subsection (b) and notwithstanding any other law, the commission
shall provide Medicaid benefits to all individuals who apply for
those benefits and to whom this chapter applies.
(b)  After the waiver described by Section 537A.0051 is
approved and the commission implements the Live Well Texas program
under Chapter 537A, the commission shall:
(1)  provide health benefit coverage through that
program in accordance with Chapter 537A to individuals to whom this
(2)  cease providing Medicaid benefits to those
individuals, except as provided by Chapter 537A.
(1)  continue to provide Medicaid benefits to
individuals described by Subsection (a) if the waiver described by
Section 537A.0051 is not approved; and
(2)  resume providing Medicaid benefits to individuals
described by Subsection (a) if the Live Well Texas program
implemented under Chapter 537A terminates in accordance with
(d)  The executive commissioner shall adopt rules regarding
the provision of Medicaid benefits as required by this section,
including, as applicable, rules on transitioning individuals from
receiving Medicaid benefits under this section to receiving health
benefit coverage under the Live Well Texas program implemented
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 as required by Section
537A.0051, Government Code, as added by this Act.  The commission
may delay implementing other provisions of Chapter 537A, Government
Code, as added by this Act, until the waiver applied for under that
SECTION 3.  (a)  Chapter 537B, Government Code, as added by
this Act, applies only to an initial determination or
recertification of an individual's Medicaid eligibility under
Chapter 32, Human Resources Code, made on or after the
implementation of Chapter 537B, regardless of the date the
individual applied for Medicaid.
(b)  As soon as practicable after the effective date of this
Act, the executive commissioner of the Health and Human Services
Commission shall take all necessary actions to expand Medicaid
eligibility in accordance with Chapter 537B, Government Code, as
added by this Act, including notifying appropriate federal agencies
of that expanded eligibility.  If before implementing Chapter 537B
a state agency determines that any other waiver or authorization
from a federal agency is necessary for implementation of that
chapter, the agency affected by the chapter shall request the
waiver or authorization and may delay implementing that chapter
until the waiver or authorization is granted.
SECTION 4.  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.