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Medicaid, SCHIP, & Federal Authority

  • Section 115 Waiver – In March 2007, the Centers for Medicare and Medicaid Services (CMS) approved the state of Texas for a State Children’s Health Insurance Program (SCHIP) section 1115 demonstration, Texas SCHIP Cost Share 1115. This new program moves from a monthly premium to a semi-annual enrollment fee of $25 for those with incomes between 133 percent and 150 percent of the federal poverty level (FPL). The purpose of this waiver program is to promote continuous SCHIP coverage and to reduce the likelihood of disenrollment due to non-payment of monthly cost-sharing requirements. Unborn children will be exempt from this cost-sharing requirement.   


High-Risk Pools

  • The Texas Health Insurance Risk Pool became operational in 1998. The pool is financed by premiums paid by enrollees and assessments on insurers. The premium cap is 200 percent of the average standard rate for commercial health insurance. The board of directors sets the rates annually; currently they are at the maximum of 200 percent.  At the end of February 2008, over 27,500 people were enrolled in the pool.

Limited-Benefit Plans

  • Beginning in 2004, Texas required all small employer insurance carriers to offer at least one plan offering all the mandated benefits by law, and at least one Consumer Choice Plan that may exclude or limit coverage of certain mandated benefits. Insurers are required to disseminate written disclosures listing the mandated benefits absent from the health plan.  Some of the benefits which may be excluded or reduced include treatment for acquired brain injury; coverage for AIDS, HIV or related illnesses; chemical dependency treatment, or telemedicine/telehealth services. In addition, carriers may also charge higher deductible and coinsurance requirements than are allowed under traditional plans.  In 2006, approximately 130,000 Texans were covered under the new Consumer Choice plans, including 14,429 people who were previously uninsured.


Dependent Coverage

  • Dependents remain eligible for insurance up to their 25th birthday. Passed in 2003, House Bill 1446 extends eligibility for health insurance to students 25 and over as long as they are full-time.

Group Purchasing Arrangements

  • Since the mid-1990s, Texas has had legislation allowing for the formation of group purchasing arrangements.  Both small and large employers may join a cooperative; however small employers may only pool with other small employers and large employers may only pool with other large employers.  As of March 2008, 57 cooperatives and coalitions were registered with the state.