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 income limits and conditions regarding existing health coverage, as well as financial participation from program participants based on a sliding scale.

Additionally, the program is designed to leverage enhanced federal funding available under the Affordable Care Act and must offer benefits that are substantially identical to existing Medicaid buy-in programs, with certain exceptions. The executive commissioner is required to apply for the necessary federal waiver as soon as practicable, and the implementation of the program may be delayed 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 vote is not achieved.