89R1026 JG-D     By: Garcia Hernandez H.B. No. 2627       A BILL TO BE ENTITLED   AN ACT   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   penalties.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subtitle I, Title 4, Government Code, is amended   by adding Chapters 532A and 532B to read as follows:   CHAPTER 532A. LIVE WELL TEXAS PROGRAM   SUBCHAPTER A. GENERAL PROVISIONS          Sec. 532A.0001.  DEFINITIONS. In this chapter:                (1)  "Basic plan" means the program health benefit plan   described by Section 532A.0202.                (2)  "Eligible individual" means an individual who is   eligible to participate in the program.                (3)  "Participant" means an individual who is:                      (A)  enrolled in a program health benefit plan; or                      (B)  receiving health care financial assistance   under Subchapter H.                (4)  "Plus plan" means the program health benefit plan   described by Section 532A.0203.                (5)  "POWER account" means a personal wellness and   responsibility account the commission establishes for a   participant under Section 532A.0251.                (6)  "Program" means the Live Well Texas program   established under this chapter.                (7)  "Program health benefit plan" includes:                      (A)  the basic plan; and                      (B)  the plus plan.                (8)  "Program health benefit plan provider" means a   health benefit plan provider that contracts with the commission   under Section 532A.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. 532A.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   under this section must:                (1)  be designed to:                      (A)  provide health benefit coverage options for   eligible individuals;                      (B)  produce better health outcomes for   participants;                      (C)  create incentives for participants to   transition from receiving public assistance benefits to achieving   stable employment;                      (D)  promote personal responsibility and engage   participants in making decisions regarding health care based on   cost and quality;                      (E)  support participants' self-sufficiency by   requiring unemployed participants to be referred to work search and   job training programs;                      (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   enrollment cap; 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. 532A.0052.  FUNDING. Subject to approval of the waiver   described by Section 532A.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. 532A.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   reduced below 90 percent.   SUBCHAPTER C. PROGRAM ADMINISTRATION          Sec. 532A.0101.  PROGRAM OBJECTIVE. The program's principal   objective is to provide primary and preventive health care through   high deductible program health benefit plans to eligible   individuals.          Sec. 532A.0102.  PROGRAM PROMOTION. The commission shall   promote and provide information about the program to individuals   who:                (1)  are potentially eligible to participate in the   program; and                (2)  live in medically underserved areas of this state.          Sec. 532A.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 532A.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   health benefit plan providers.          Sec. 532A.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   enrollment procedures;                (2)  resolve grievances related to eligibility   determinations; and                (3)  to the extent possible, coordinate the program   with Medicaid.          Sec. 532A.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   third-party administrator.          (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. 532A.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   related to those providers.          (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   section.          Sec. 532A.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 section,   an entity must:                (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   law of this state.          Sec. 532A.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. 532A.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. 532A.0151.  ELIGIBILITY REQUIREMENTS. (a) An   individual is eligible to enroll in a program health benefit plan   if:                (1)  the individual is a resident of this state;                (2)  the individual is 19 years of age or older but   younger than 65 years of age;                (3)  applying the eligibility criteria in effect in   this state on December 31, 2024, the individual is not eligible for   Medicaid; and                (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   program health benefit plan.          (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   December 31, 2024.          Sec. 532A.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 532A.0252(f).          Sec. 532A.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. 532A.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   qualification.          (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   determined by the commission.          (d)  The executive commissioner may establish enrollment   periods for the program.          Sec. 532A.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   participant's eligibility.          (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   requirements.          (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 532A.0206 or 532A.0208; or                (2)  who is:                      (A)  pregnant; 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   for that financial assistance.   SUBCHAPTER E. BASIC AND PLUS PLANS          Sec. 532A.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   health care needs.          (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   physician.          Sec. 532A.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   enroll in the plan.          (b)  The covered health benefits under the basic plan must   include:                (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   year;                (5)  outpatient surgery;                (6)  allergy testing;                (7)  chemotherapy;                (8)  intravenous infusion services;                (9)  radiation therapy;                (10)  dialysis;                (11)  emergency care hospital services;                (12)  emergency transportation, including ambulance   and air 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;                      (E)  a transplant;                      (F)  treatment for a congenital abnormality;                      (G)  anesthesia;                      (H)  hospice care; and                      (I)  care in a skilled nursing facility for a   period not to exceed 100 days per occurrence;                (15)  inpatient and outpatient behavioral health   services;                (16)  inpatient, outpatient, and residential substance   use treatment;                (17)  prescription drugs, including tobacco cessation   drugs;                (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   tomography;                (22)  preventive care services as described by Section   532A.0204; and                (23)  services under the early and periodic screening,   diagnostic, and treatment program for participants who are younger   than 21 years of age.          (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   the federal poverty level.          Sec. 532A.0203.  PLUS PLAN: COVERAGE AND INCOME ELIGIBILITY.   (a) The program must include a plus plan that includes the covered   health benefits listed in Section 532A.0202 and the following   additional enhanced health benefits:                (1)  services related to the treatment of conditions   affecting the temporomandibular joint;                (2)  dental care;                (3)  vision care;                (4)  notwithstanding Section 532A.0202(b)(18),   inpatient and outpatient rehabilitative and habilitative care,   including physical, occupational, and speech therapy, not to exceed   75 combined visits per year;                (5)  bariatric surgery; and                (6)  other services the commission considers   appropriate.          (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   plus plan.          (c)  A participant enrolled in the plus plan is required to   make POWER account contributions in accordance with Section   532A.0252.          Sec. 532A.0204.  PREVENTIVE CARE SERVICES. (a) The   commission shall provide to each participant a list of health care   services that qualify as preventive care services based on the   participant's age, gender, and preexisting conditions. In   developing the list, the commission shall consult with the Centers   for Disease Control and Prevention.          (b)  A program health benefit plan shall, at no cost to the   participant, provide coverage for:                (1)  preventive care services described by 42 U.S.C.   Section 300gg-13; and                (2)  a maximum of $500 per year of preventive care   services other than those described by Subdivision (1).          (c)  A participant who receives preventive 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   terms of the plan.          Sec. 532A.0205.  COPAYMENTS. (a) A participant enrolled in   the basic plan shall pay a copayment for each covered health benefit   except for a preventive 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   a covered service.          (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   unless:                (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   commission rule; or                (4)  the participant is pregnant.          Sec. 532A.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 whom this section applies is subject to   the cost-sharing requirements, including copayment and POWER   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. 532A.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   program or enroll in Medicaid.          (b)  A pregnant participant described by Subsection (a) who   is enrolled in the basic or plus plan and who remains in the program   is:                (1)  notwithstanding Section 532A.0205, not subject to   any cost-sharing requirements, including copayment and POWER   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 pregnancy ends;                (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   plan; and                (3)  eligible for additional vision and dental care   benefits.          Sec. 532A.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   coverage limits.          (b)  An individual described by Subsection (a) who chooses to   participate in the program is subject to the cost-sharing   requirements, including copayment and POWER account contribution   requirements, of the program health benefit plan in which the   individual is enrolled.   SUBCHAPTER F. PERSONAL WELLNESS AND RESPONSIBILITY (POWER)   ACCOUNTS          Sec. 532A.0251.  ESTABLISHMENT AND OPERATION OF POWER   ACCOUNTS. (a) The commission shall establish a personal wellness   and responsibility (POWER) 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   POWER account through an electronic system. The commission may   contract with an entity that has appropriate experience and   expertise to establish, implement, or administer the electronic   system.          (c)  Except as otherwise provided by Section 532A.0252, the   commission shall require each participant to contribute to the   participant's POWER account in amounts described by that section.          Sec. 532A.0252.  POWER 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 POWER 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 POWER 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 POWER account.          (d)  A participant's employer may contribute on behalf of the   participant any amount of the participant's annual POWER account   contribution. A nonprofit organization may contribute on behalf of   a participant any amount of the participant's annual POWER 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 POWER account an annual POWER 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 POWER 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. 532A.0253.  USE OF POWER ACCOUNT MONEY. A participant   may use money in the participant's POWER 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 costs.          Sec. 532A.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 POWER account.          (b)  Under a rewards program, a program health benefit plan   provider shall contribute money to a participant's POWER 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;                      (B)  smoking cessation; and                      (C)  as applicable, chronic disease management;   and                (2)  the amount of money a program health benefit plan   provider shall contribute for each behavior described by   Subdivision (1).          (c)  Subsection (b) does not prevent a program health benefit   plan provider from contributing money to a participant's POWER   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 POWER   account contribution the executive commissioner establishes under   Section 532A.0252.          (e)  Contributions a program health benefit plan provider   makes under a rewards program that result in a participant's POWER   account balance exceeding the participant's required annual POWER   account contribution may be rolled over into the next coverage   period in accordance with Section 532A.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;   and                (2)  other smoking cessation programs or resources   available to the participant.          Sec. 532A.0255.  MONTHLY STATEMENTS. The commission shall   distribute to each participant with a POWER account a monthly   statement that includes information on:                (1)  the participant's POWER account activity during   the preceding month, including information on the cost of health   care services delivered to the participant during that month;                (2)  the balance of money available in the POWER   account at the time the statement is issued; and                (3)  the amount of any contributions due from the   participant.          Sec. 532A.0256.  POWER 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 POWER 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 POWER account from the participant's   current coverage period POWER account based on:                (1)  the amount of money remaining in the participant's   POWER account from the current coverage period; and                (2)  whether the participant received recommended   preventive care services during the current coverage period.          (c)  For a participant enrolled in the plus plan who, as   determined by the commission, timely makes POWER account   contributions in accordance with this subchapter, the commission   shall calculate the amount to be rolled over to a subsequent   coverage period POWER account from the participant's current   coverage period POWER account based on:                (1)  the amount of money remaining in the participant's   POWER account from the current coverage period;                (2)  the total amount of money the participant   contributed to the participant's POWER account during the current   coverage period; and                (3)  whether the participant received recommended   preventive 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 POWER account for the   succeeding coverage period to offset required annual POWER account   contributions, as applicable, during that coverage period.          (e)  A participant enrolled in the basic plan who rolls over   money into the participant's POWER 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 POWER account contributions for   that coverage period.          Sec. 532A.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   532A.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 POWER account at the   end of the coverage period or on the disenrollment date.          Sec. 532A.0258.  PENALTIES FOR FAILURE TO MAKE POWER 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 532A.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 benefit plan   until:                (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 532A.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. 532A.0301.  GATEWAY TO WORK PROGRAM. (a) The   commission shall develop and implement a gateway to work program   to:                (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   Texas program; and                (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   PARTICIPANTS          Sec. 532A.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   participant who:                (1)  the commission disenrolls from a program health   benefit plan in accordance with Section 532A.0155 because the   participant's annual household income exceeds the income   eligibility requirements for enrollment in a program health benefit   plan; and                (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   benefit coverage.          (c)  The commission may not impose an upper income   eligibility limit on a participant to receive health care financial   assistance under this subchapter.          Sec. 532A.0352.  DURATION AND AMOUNT OF HEALTH CARE   FINANCIAL ASSISTANCE.  (a)  A participant described by Section   532A.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   532A.0353; and                (2)  may be used only to pay for eligible services   described by Section 532A.0354.          Sec. 532A.0353.  BRIDGE ACCOUNT; FUNDING.  (a)  The   commission shall establish a bridge account for each participant   eligible to receive health care financial assistance under Section   532A.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 532A.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   recoups:                (1)  during the roll over process described by Section   532A.0256;                (2)  following the issuance of a refund as described by   Section 532A.0257; or                (3)  under Subsection (e).          (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 POWER account under Subchapter F or bridge account   under this subchapter.          Sec. 532A.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   described by Subsection (b).          (b)  A participant may use money in the participant's bridge   account to pay:                (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   reimbursable under Medicaid.          (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. 532A.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 532B. EXPANDED MEDICAID ELIGIBILITY FOR CERTAIN   INDIVIDUALS          Sec. 532B.0001.  APPLICABILITY. This chapter applies only   to an individual who would be eligible to participate in the Live   Well Texas program under Chapter 532A based on the eligibility   requirements described by Section 532A.0151, if the commission were   to establish the program.          Sec. 532B.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 532A.0051 is   approved and the commission implements the Live Well Texas program   under Chapter 532A, the commission shall:                (1)  provide health benefit coverage through that   program in accordance with Chapter 532A to individuals to whom this   chapter applies; and                (2)  cease providing Medicaid benefits to those   individuals, except as provided by Chapter 532A.          (c)  The commission shall:                (1)  continue to provide Medicaid benefits to   individuals described by Subsection (a) if the waiver described by   Section 532A.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 532A terminates in accordance with   Section 532A.0053(b).          (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   under Chapter 532A.          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   Centers for Medicare and Medicaid Services or another appropriate   federal agency the waiver as required by Section 532A.0051,   Government Code, as added by this Act. The commission may delay   implementing other provisions of Chapter 532A, Government Code, as   added by this Act, until the waiver applied for under that section   is granted.          SECTION 3.  (a)  Chapter 532B, 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 532B, 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 532B, Government Code, as   added by this Act, including notifying appropriate federal agencies   of that expanded eligibility.  If before implementing Chapter 532B   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.