• 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 June 2014, Medicaid covered nearly 3.8 million Texans. To qualify, patients must have a low income, but being poor doesn’t always mean a patient will qualify for the program. For example, low-income childless adults are not eligible in Texas even if their income meets the state’s Medicaid income requirements. Most Medicaid recipients in Texas are children, pregnant women, or disabled.
  • Improve Access to Care

    • TMA Asks Legislature to Increase Medicaid, CHIP Payments for Physicians
      TMA and 17 state specialty societies called on the Legislative Budget Board (LBB) asking for action to increase "utterly inadequate physician payment rates" in Texas Medicaid and CHIP.
    • TMA Urges Congress to Extend CHIP Funding Beyond 2015
      TMA signed onto a March of Dimes and Texas Pediatric Society letter asking Gov. Rick Perry to urge the Texas congressional delegation to support continued Children's Health Insurance Program (CHIP) funding beyond 2015. Though the program will run through 2019, federal funding for CHIP expires Oct. 1, 2015, unless Congress extends it.
    • Dual Dilemma State Pilot to Streamline Medicare-Medicaid Patient Care
      When San Antonio pulmonologist John Holcomb, MD, treats patients enrolled in both Medicare and Medicaid, he knows he's dealing with a particularly fragile population that has little to no income and is elderly or has a disability. Neither these so-called "dual-eligible" patients nor the physicians treating them have it easy. 
    • 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.
  • Reduce Medicaid Red Tape

    • TMA-Backed Law Prompts Medicaid Red-Tape Relief
      Apparently, the state got the message loud and clear: Physicians and patients are overly frustrated with the myriad administrative roadblocks that came along with the expansion of Medicaid managed care in Texas. Thanks to TMA's advocacy during the 2013 legislative session and the successful passage of Senate Bill 1150, relief from Medicaid red tape may finally be in sight.
    • 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.
    • 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 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.
  • TMA Advocacy and Communications

    • TMA-Backed Law Prompts Medicaid Red-Tape Relief
      Apparently, the state got the message loud and clear: Physicians and patients are overly frustrated with the myriad administrative roadblocks that came along with the expansion of Medicaid managed care in Texas. Thanks to TMA's advocacy during the 2013 legislative session and the successful passage of Senate Bill 1150, relief from Medicaid red tape may finally be in sight.
    • TMA: CHIP Managed Care Plans Responsible for Out-of-Network Payments
      Because federal law prohibits patients covered by the Children's Health Insurance Program (CHIP) from paying anything other than a copay, the state of Texas should require managed care organizations in CHIP to cover the costs for out-of-network physicians. That's the position TMA takes in a formal letter to the Texas Health and Human Services Commission.
    • TMA Urges Congress to Extend CHIP Funding Beyond 2015
      TMA signed onto a March of Dimes and Texas Pediatric Society letter asking Gov. Rick Perry to urge the Texas congressional delegation to support continued Children's Health Insurance Program (CHIP) funding beyond 2015. Though the program will run through 2019, federal funding for CHIP expires Oct. 1, 2015, unless Congress extends it.
    • Improve Health Care Coverage for Low-Income Texans
      The Affordable Care Act (ACA) created two coverage options for uninsured patients with incomes up to 400 percent of the federal poverty level (FPL). One choice, which the U.S. Supreme Court made optional for states, was expanding Medicaid eligibility to 138 percent of FPL ($16,104 for an individual or $32,913 for a family of four in 2014). The other was the new health insurance marketplaces, where patients go to buy private insurance. Texas is one of 21 states that chose not to expand Medicaid eligibility in 2014.
    • 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.
    • 2013 TMA Physician Testimonies and Comments
      Read testimony, letters, and comments by TMA physician leaders at the state capitol during the 2013 legislative session.