May 15, 1990 

Mr. Ron Lindsey 

Commissioner 

Texas Department of Human 

Services 

P. 0. Box 149030 

Austin, Texas 78714-9030 

Opinion No. ~~-1174 

Re: Authority of the Texas 

Department of Human Services 

to extend medicaid coverage 

to children under age six 

meeting certain income criteria (RQ-1989) 

Dear Mr. Lindsey: 

You advise that the U.S. Congress in 1989 adopted 

amendments to the provisions of section 1396a of title 42 of 

the United States Code mandating coverage under state 

medicaid programs receiving federal matching funds of 

children under age six meeting certain income criteria. 

Omnibus Budget Reconciliation Act of 1989, Pub. L. No. 

101-239, 5 6401, 1989 U.S. Code Cong. & Admin. News (103 

Stat.) 2106, 2258. Prior thereto, federal law required 

coverage of children under age one. 42 U.S.C. 5 1396aW , 

amended bv Pub. L. NO. 101-239, 5 6401(a) (approved Dec. 

19, 1989). Section 1396a provides inter alia minimum 

coverage requirements that the "state plans" of participating states must comply with in order for such states to 

receive federal medicaid matching funds. See also 42 U.S.C. 

55 1396, 1396b(a) (authorizing the U.S. Secretary of Health 

and Human Services to provide federal matching funds to 

states having submitted approved state medicaid plans). 

Subsection (c) of section 6401 of Public Law 101-239 

provides that the amendments made in section 6401 with 

regard to required medicaid coverage shall apply to payments 

made by the Secretary of Health and Human Services under the 

medicaid program on or after April 1, 1990. 

You point out that the Texas Legislature in 1989, prior 

to the adoption of Public Law 101-239, amended section 

32.024 of the Human Resources Code by adding a subsection 

p. 6191 
Mr. Ron Lindsey - Page 2 (JM-1174) 

(g)l directing the Texas Department of 

state agency designated to administer 

program, to 

Human Services, the 

the state medicaid 

set the income eligibility cap for medical 

assistance for children up to age four at not 

less than 100 percent of the federal poverty 

guidelines for state fiscal year 1990 and for 

children up to age six for state fiscal year 

1991.2 

Acts 1989, 71st Leg., ch. 1219, § 1, at 4939: see aenerallv 

Hum. .Res. Code s§ 11.001 (defining "department" as used in 

the code to mean the Department of Human Services), 32.021 

(naming the department as the state agency designated to 

administer the medicaid program under chapter 32). 

The focus of your concern is the discrepancy between 

the provisions of section 6401 of Public Law 101-239 and the 

new subsection (g) of section 32.024 of the Human Resources 

Code. The federal provision requires in effect that 

children under age six meeting certain income criteria be 

covered by a state medicaid plan as of April 1, 1990. The 

state provision directs the Department of Human Services to 

extend coverage to children up to age six beginning in 

fiscal year 1991. You ask whether additional state legislation is necessary in order for the department now to extend 

coverage under the state plan to children under age six. It 

is our opinion that no further state legislative action is 

required in order for the department to thus extend coverage 

under the state medicaid plan to comport with the new 

federal requirement. 

1. The 7Ist Legislature also added in 1989 two other 

provisions denominated as subsections (g) of Human Resources 

Code section 32.024. Acts 1989, 71st Leg., ch. 1085, 0 3, 

at 4439: & ch. 1107, § 1, at 4595. 

2. The amendments made by section 6401 require that 

the income eligibility cap be set at not less than 133 

percent of the income amounts set under federal poverty 

guidelines. The 100 percent figure provided for in the new 

subsection (g) of section 32.024 is a limitation on the 

minimum rather than the maximum amount and does not, we 

think, restrict the department from increasing that amount 

to 133 percent in order to comport with the federal 

requirement. 

p. 6192 
Mr. Ron Lindsey - Page 3 (JM-1174) 

P 

When subsection (g) was added to section 32.024, 

directing the department to‘cover under the medicaid program 

children up to four years of age in fiscal year 1990 and up 

to six years of age in 1991, federal law did not yet require 

such coverage. * 42 U.S.C. 5 1396a(a)(lO), (1) (as 

amended in 1988) (Supp. 1989 at 525, 541, 547, 552). We 

think that the purpose of the addition of subsection (g) was 

to require the department to extend coverage beyond that 

required by federal law but not to limit the department's 

authority to later increase such coverage as necessary to 

comport with subsequently added federal requirements. 

The stated purpose of chapter 32 of the code, which 

provides for the department's administration of the state's 

medicaid program, is "to provide medical assistance on 

behalf of needy individuals and to enable the state to 

obtain all benefits for those persons" authorized under 

federal law. Hum. Res. Code 3 32.001. Significantly, 

section 32.002(a) provides: 

This chapter shall be liberallv construed 

and aoolied in relation to.applicable federal 

laws and regulations so that adequate and 

high quality health care may be made 

available to all children and adults who need 

the care and are not financially able to pay 

for it. (Emphasis added.) 

Subsections (a), (b), and (c), of section 32.024, give the 

Department of Human Services broad authority: (1) to provide medical assistance to persons if the provision of such 

services is required by federal law as a condition of the 

state's receiving federal matching funds or if the persons 

are unable to meet the cost of the services and federal 

matching funds are available for such purpose, and (2) to 

establish standards (not lower than the minimum standards 

required by federal law) governing the scope of coverage 

under the medicaid program. 

It is our opinion that no additional state legislation 

is needed in order for the department to now extend coverage 

under the state medicaid plan to children under six years of 

age so as to comport with federal requirements.3 

P 

P 

3. Your question concerning the need for additional 

state legislation may relate to a provision of subsection 

(c)(2) of section 6401 of Public Law 101-239. Subsection 

(Footnote Continued) 

p. 6193 
Mr. Ron Lindsey - Page 4 (JM-1174) 

SUMMARY 

Additional state legislation is not required in order for the Department of Human 

Services to extend coverage under the state 

medicaid plan to children under age six who 

meet certain income criteria. 

/ v-y/z* 

JIM MATTOX 

Attorney General of Texas 

MARY KELLER 

First Assistant Attorney General 

JUDGE ZOLLIE STEAKLEY 

Special Assistant Attorney General 

RENEA HICKS 

Special Assistant Attorney-General 

RICK GILPIN 

Chairman, Opinion Committee 

Prepared by William Walker 

Assistant Attorney General 

(Footnote Continued) 

(c) providing in subpart (1) that the section's requirements 

apply on and after April 1, 1990, provides in subpart (2) 

that if the U.S. Secretary of Health and Human Services 

determines legislation, other than that appropriating funds, 

is necessary to enable the state plan to be brought into 

conformity with the section's new requirements, the state 

has until after the next legislative session to bring its 

plan into conformity. We do not think that the extension 

provision in subpart (2) will be triggered in the instant 

situation because we do not think additional state 

legislation is required in order to permit the Department of 

Human Services to bring the state plan into conformity with 

the new federal requirement. 

p. 6194