HBA-MPM C.S.H.B. 2807 77(R) BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 2807 By: Kitchen Public Health 5/15/2001 Committee Report (Substituted) BACKGROUND AND PURPOSE Texas has enacted many laws that address the provision of health coverage for its uninsured children. However, low-income adults are often unable to obtain affordable, quality health care. Workers in families that fall below 200 percent of the federal poverty level are less likely to receive health insurance through their employer. More than two-thirds of uninsured, non-retired adults age 18 and older, have a job. A January 1999 poll conducted by the W.K. Kellogg Foundation indicated that 86 percent of Americans believe that working poor families should have access to health care coverage. Currently, there are a number of local initiatives that address the health needs of low-income, uninsured adults who do not qualify for Medicaid. Through a demonstration project, these initiatives could receive federal matching funds to expand health coverage for low-income adults. C.S.H.B. 2807 requires the Health and Human Services Commission to establish such a demonstration project. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that this bill does not expressly delegate any additional rulemaking authority to a state officer, department, agency, or institution. ANALYSIS C.S.H.B. 2807 amends the Human Resources Code to require the Health and Human Services Commission (HHSC) to establish a demonstration project (project) to provide medical assistance to an adult who meets the income eligibility criteria set by HHSC, is not otherwise eligible for medical assistance, and is not covered by a health benefits plan offering adequate coverage. HHSC is required to establish a family income eligibility limit in conjunction with local governmental agencies that make funds available to HHSC for the project so that only an individual whose family income is at or below 200 percent of the federal poverty level is eligible for participation and to design the components of the project including the adoption of procedures for reporting and monitoring. In establishing the project, HHSC is required to ensure that the project is financed using funds made available by certain local governmental entities to HHSC for matching purposes to maximize federal funds for the medical assistance program and that a participant in the project is not subject to a limitation of prescription drug benefits under the medical assistance program. The bill specifies that the manner in which a governmental entity makes funds available for matching purposes must include an option for the entity to be able to certify the amount of funds considered available instead of sending the funds to the state. The bill requires the Texas Department of Health (TDH) to administer the project at the direction of HHSC and to select one or more municipalities or counties in which to implement the project. One selected county must have a population of more than 725,000 or at least one municipality must have a population of more than 600,000. The bill provides that the project may be implemented in a multi-county region in which at least one county has a population of more than 725,000. TDH is required to implement the project no later than January 1, 2002. The bill requires TDH to evaluate and report to the legislature on the operation and cost-effectiveness of the project no later than December 1 of each even-numbered year. EFFECTIVE DATE On passage, of if the Act does not receive the necessary vote, the Act takes effect September 1, 2001. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 2807 differs from the original by requiring the Health and Human Services Commission (HHSC), in conjunction with local governmental entities that make funds available for the project, to establish the eligibility limit of the demonstration project, which cannot be higher than or at 200 percent of the federal poverty level. The original set the income eligibility limit at 100 percent of the federal poverty level. The substitute requires HHSC in conjunction with local governmental entities that make funds available to HHSC to design the components of the demonstration project. The bill requires HHSC to ensure that a project participant is not subject to the prescription drug benefit limitation under the medical assistance program. The substitute specifies that the manner in which a governmental entity makes funds available for the project for matching purposes must include an option for the entity to make the funds available by certification rather than sending the funds to the state. The substitute permits the Texas Department of Health (TDH) to select municipalities with a population of more than 600,000 for purposes of participating in the project, in addition to counties with populations of more than 725,000 as set forth in the original. The substitute also authorizes the participation of a multicounty region in the project.