H.B. No. 4282 aims to amend the Government Code by adding Section 546.0303, which outlines the provisions for residential services under the Medicaid home and community-based services (HCS) waiver program. The bill defines a "Medicaid residential facility" as a group home or similar setting that provides residential services to recipients of the HCS waiver program. It allows these facilities to refuse admission to recipients under specific circumstances, such as reaching service capacity, the recipient's history of severe emotional behavior or physical aggression, and the facility's ability to provide necessary care for medically fragile individuals.

Additionally, the bill mandates that before placing a medically fragile recipient in a Medicaid residential facility, the commission must assess the facility's capacity and capability to provide the required care. The commission is prohibited from requiring facilities to make modifications to accommodate the recipient. The bill also includes a provision that allows state agencies to delay implementation of any part of the act until necessary federal waivers or authorizations are obtained. The act is set to take effect on September 1, 2025.