TITLE: Relating to allowing Medicaid managed care organizations to engage in marketing about the availability of certain private health benefit plan coverage.

SUMMARY: Relating to allowing Medicaid managed care organizations to engage in marketing about the availability of certain private health benefit plan coverage.

FULL TEXT:
AN ACT relating to allowing Medicaid managed care organizations to engage in marketing about the availability of certain private health benefit plan coverage. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: SECTION 1. Section 540.0055, Government Code, as effective April 1, 2025, is amended by adding Subsections (c) and (d) to read as follows: (c) The marketing guidelines the commission establishes under this section may not prohibit a Medicaid managed care organization from: (1) informing an individual, including a current or former recipient, about the availability of qualified health plans offered through an exchange, as the terms "exchange" and "qualified health plan" are defined by 45 C.F.R. Section 155.20; or (2) advertising a Medicare Advantage plan or related benefit offered under Part Cof Title XVIII of the Social Security Act (42 U.S.C. Section 1395w-21 et seq.) at a community enrollment or other event. (d) The marketing guidelines the commission establishes under this section must require that a Medicaid managed care organization that informs an individual about the availability of qualified health plans offered through an exchange, as the terms "exchange" and "qualified health plan" are defined by 45 C.F.R. Section 155.20, also inform the individual about the potential deductibles, copayments, and other cost-sharing requirements under a qualified health plan. A Medicaid managed care organization informing an individual about the availability of qualified health plans offered through the exchange or an affiliate of the organization may not offer the individual material or financial gain as an actual or implied incentive for enrolling in a qualified health plan. SECTION 2. If before implementing any provision of this Act a state agency determines that a waiver or authorization from a federal agency is necessary for implementation of that provision, the agency affected by the provision shall request the waiver or authorization and may delay implementing that provision until the waiver or authorization is granted. SECTION 3. This Act takes effect September 1, 2025.