TX HB5311

Establishes the Texas Care Plan Medicaid buy-in program allowing Texas residents to purchase health benefit plan coverage through Medicaid by enrolling in managed care plans offered by Medicaid managed care organizations

Requires the executive commissioner to seek a federal Section 1115 waiver from the Centers for Medicare and Medicaid Services to implement the program

Eligibility requirements include household income limits, ineligibility for traditional Medicaid benefits, and lack of access to or inability to afford employer-sponsored health coverage

Participants must pay a portion of premiums or cost-sharing payments on a sliding scale based on household income, aligned with federal cost-sharing reduction eligibility categories under 45 C.F.R. Section 155.305(g)

Program must leverage enhanced federal medical assistance percentage funding available under the Affordable Care Act and will be substantively identical to existing Medicaid buy-in programs under Section 532.0353, except nonemergency transportation services are not required