The bill, H.B. No. 5311, proposes the establishment of the Texas Care Plan Medicaid buy-in program, which aims to provide health benefit plan coverage to certain residents of Texas. It introduces a new section, 532.0354, to the Government Code, detailing the program's implementation. The executive commissioner is tasked with seeking a waiver under Section 1115 of the Social Security Act to facilitate the program, which will allow eligible residents to purchase health coverage through Medicaid by enrolling in managed care plans. The bill outlines specific eligibility requirements, including household income limits and conditions regarding existing health coverage.

Additionally, the bill mandates that the program must be designed to utilize enhanced federal funding available under the Affordable Care Act. It stipulates that the benefits offered must be substantially identical to those in existing Medicaid buy-in programs, with some exceptions, such as the exclusion of nonemergency transportation services. The executive commissioner is also required to apply for the necessary federal waiver as soon as practicable, with the option to delay implementation until the waiver is granted. The bill is set to take effect immediately upon receiving a two-thirds vote from both houses or on September 1, 2025, if that threshold is not met.