• Medicaid and CHIP

    • Provide Appropriate Funding for Physician Services

      Medicaid is a state- and federally funded health care program that provides low-income patients access to essential health care services. Without Medicaid, millions more Texans would be uninsured: As of March 2012, Medicaid covered 3.3 million Texans. To qualify, patients must be low-income, though being poor does not mean a patient will qualify. For example, low-income childless adults are not now eligible even if their income meets the state’s Medicaid income requirements
  • Key Issues

    • Medicaid Roadblocks: HMOs Save Money But Create Problems
      The 2012 rollout of Medicaid managed care into rural areas and South Texas has been a rough ride for many physicians. And their patients, too.
    • Higher Medicaid Primary Care Payments Coming Next Year
      Eligible primary care physicians in the Medicaid program should begin receiving higher payments by March 1, 2014, the program's director says in a letter to physicians. The Affordable Care Act authorizes the fees.
    • Medicaid Congress Recommends Reform, Expansion
      Finding a way for Texas to expand Medicaid coverage is among more than 100 different recommendations the Medicaid Congress researched and developed with input from diverse physician specialties and geographic regions across Texas.
    • Medicaid Makeover: 1115 Waiver Has Its Flaws
      Transformation. Accountability. Coordination. Local solutions. These are just a few terms used to describe the lofty goals of the Medicaid 1115 waiver the state is undertaking to reform health care delivery for Medicaid patients and the uninsured.
    • State Now Paying Dual-Eligibles' Medicare Deductible
      The Texas Health and Human Services Commission restored the Medicare Part B deductible payment on Jan. 25 for patients eligible for both Medicare and Medicaid, also known as "dual eligibles."
    • State Delays Medicaid Fee Increase
      The Texas Health and Human Services Commission postponed the Medicaid primary care physician payment increase authorized under the Patient Protection and Affordable Care Act.
    • HHSC Adopts Disputed Medicaid Fraud Rules
      Despite the Texas Medical Association's objections, the Texas Health and Human Services Commission (HHSC) adopted new "program integrity rules" that TMA believes give the agency's Office of Inspector General (OIG) too much power and presume that physicians are crooks. The rules took effect Oct. 14.
    • Medicaid Physician Payments
      Texas primary care physicians would receive a temporary fee increase in 2013-2014 for treating Medicaid patients if the Centers for Medicare & Medicaid Services (CMS) adopts a rule it proposed May 9.
    • Medicaid Managed Care
      The state's Medicaid managed care program pays health plans a monthly fee to cover treatment of patients on Medicaid. Texas Legislature enacted numerous reforms to reduce Medicaid expenditures by nearly $3 billion, including authorizing the expansion of Medicaid HMOs, decreasing physician and provider payments, and reducing benefits and services.
    • Medicaid Expansion
      The Supreme Court's decision upholding the Patient Protection and Affordable Care Act may not help the uninsured in Texas as much as many people think, even if the state does expand the Medicaid system. There simply may not be enough physicians to care for the thousands of patients who would be added to the rolls.
  • TMA Advocacy and Communications

    • Reform Medicaid First, Then Create Tx-Specific Expansion
      Texas physicians have a clear message for our federal and state policymakers on the issue of Medicaid expansion: “Reform first, then expand only with a state-specific plan that targets the unique health care needs of our state’s population and that Texas taxpayers can afford.”
    • TMA Physicians Medicaid Congress Action Center
      Help us improve Medicaid. TMA Physicians Medicaid Congress needs your ideas to fix the program for you.
    • Drop in Physician Acceptance of Medicaid, Medicare Patients
      Texas Medical Association (TMA) physician leaders have long predicted government regulatory burdens, red tape, payment hassles, and low pay would erode the physician foundation of both Medicaid and Medicare.
    • Dual-Eligibles Action Center
      Until January 2012, the federal government (Medicare) paid 80 percent of a "dual-eligible" patients visit to a doctor. The other 20 percent of the cost was paid by Texas Medicaid. The state Medicaid program also paid the Medicare deductible for these patients. Under the new guidelines, which went into effect Jan. 1, 2012, Texas Medicaid no longer pays the physician the patient's 20-percent coinsurance. Nor does Medicaid pay the full $140 annual deductible if Medicare's payment for a service exceeds Medicaid's allowable. Follow updates on the Dual-Eligibles Resource page.
    • Medicaid Perception vs. Reality
      As state lawmakers look to balance the budget with steep cuts to the program, TMA debunks seven persistent myths about Texas Medicaid. Use this flyer to educate your friends, colleagues, patients (and legislators).
    • 2013 TMA Physician Testimonies and Comments
      Read testimony, letters, and comments by TMA physician leaders at the state capitol during the 2013 legislative session.
  • Resources