Highlights of the 76th Texas Legislature - Senate

_ HEALTH & HUMAN SERVICES/HEALTH CARE
Requires a managed care organization or other entity to seek participation by significant
traditional providers, if that organization or entity contracts with HHSC or with another
agency or entity to operate a part of the child health plan, and uses a provider network to
provide or arrange for health care services under the child health plan.
ELIGIBILITY AND ENROLLMENT
Requires the Texas Department of Human Services (TDHS), under the direction of
HHSC, to accept applications for coverage and implement the child health plan program
eligibility, screening, and enrollment procedures. Requires the Texas Department of
Insurance (TDI) to provide necessary assistance with developing the child health plan, at
the request of HHSC.
Requires eligibility screening and enrollment procedures to meet federal law and to
ensure that Medicaid-eligible children are identified and referred to the Medicaid
program. Allows the Texas Integrated Enrollment Services eligibility determination
system or a compatible system to be used.
Outlines criteria for the child health plan, including compliance with federal law,
consideration of health care needs of healthy children and children with special health
care needs, and allowing a child with a chronic, disabling, or life-threatening illness to
select an appropriate specialist as a primary care physician.
Requires a child who applies for enrollment in the child health plan, who is denied
Medicaid coverage after completion of a Medicaid application but who is eligible for
enrollment in the child health plan, to be enrolled in the child health plan without further
application or qualification.
Provides for open enrollment in the first year of implementation.
Requires HHSC to:
◊ provide coverage under Medicaid program and under the child health plan to a child
who is a qualified alien, as defined by specific federal law, if the federal government
authorizes the state to provide the coverage; and
◊ require enrollees to share the cost of the child health plan.
Requires the plan to include waiting periods, and allows the plan to include copayments
and other provisions intended to discourage employers and others from electing to
discontinue offering coverage for children under employee or other group health benefit
plans.
Outlines circumstances under which a child is not subject to a waiting period and
provides that these children may enroll in the plan at any time, without regard to an open
enrollment period.
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Senate Research Center 131 76 th Legislature