GOVERNMENT CODE

TITLE 4. EXECUTIVE BRANCH

SUBTITLE I. HEALTH AND HUMAN SERVICES

CHAPTER 537.  MEDICAID REFORM WAIVER


Text of section effective until April 01, 2025

Sec. 537.002.  FEDERAL AUTHORIZATION FOR MEDICAID REFORM.  (a)  The executive commissioner shall seek a waiver under Section 1115 of the federal Social Security Act (42 U.S.C. Section 1315) to the state Medicaid plan.
(b)  The waiver under this section must be designed to achieve the following objectives regarding Medicaid and alternatives to Medicaid:
(1)  provide flexibility to determine Medicaid eligibility categories and income levels;
(2)  provide flexibility to design Medicaid benefits that meet the demographic, public health, clinical, and cultural needs of this state or regions within this state;
(3)  encourage use of the private health benefits coverage market rather than public benefits systems;
(4)  encourage people who have access to private employer-based health benefits to obtain or maintain those benefits;
(5)  create a culture of shared financial responsibility, accountability, and participation in Medicaid by:
(A)  establishing and enforcing copayment requirements similar to private sector principles for all eligibility groups;
(B)  promoting the use of health savings accounts to influence a culture of individual responsibility; and
(C)  promoting the use of vouchers for consumer-directed services in which consumers manage and pay for health-related services provided to them using program vouchers;
(6)  consolidate federal funding streams, including funds from the disproportionate share hospitals and upper payment limit supplemental payment programs and other federal Medicaid funds, to ensure the most effective and efficient use of those funding streams;
(7)  allow flexibility in the use of state funds used to obtain federal matching funds, including allowing the use of intergovernmental transfers, certified public expenditures, costs not otherwise matchable, or other funds and funding mechanisms to obtain federal matching funds;
(8)  empower individuals who are uninsured to acquire health benefits coverage through the promotion of cost-effective coverage models that provide access to affordable primary, preventive, and other health care on a sliding scale, with fees paid at the point of service; and
(9)  allow for the redesign of long-term care services and supports to increase access to patient-centered care in the most cost-effective manner.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 13.01, eff. September 28, 2011.
Amended by: 
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.270, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.