TMA: Expand Coverage and Reform Medicaid

Political leaders in Washington and Austin must immediately develop a bipartisan solution to reform the state's Medicaid program and expand coverage of low-income adults, the Texas Medical Association Board of Trustees says in a resolution the board adopted at its meeting Feb. 1 during the TMA Winter Conference.

"The Texas Medicaid system is broken," said TMA President-Elect Stephen Brotherton, MD. "As a result, it is morally unconscionable for national-state public policy gridlock to deny proper medical care for over 1 million of our state's low-income families and Texans with disabilities.

"We need to reform it to attract physicians back to the program," he said. "The current system offers the promise of coverage without adequate funding to ensure access to care. It is fraught with exasperating, unyielding red tape.

"Additionally, we need to make sure Medicaid payments cover the real cost of health care. If we don't address these two critical reforms, our state's Medicaid physician participation crisis (only 3 out of 10 Texas physicians now accept all new patients) will worsen."

Instead, Dr. Brotherton and TMA leaders called on state leaders and lawmakers to "look beyond the federal government expansion solution and design a solution that works for Texas and for Texans."

TMA officials emphasized that the association is seeking expansion of coverage for poor adults that is not traditional Medicaid. The state, they say, has the ability to work with the Centers for Medicare & Medicaid Services on a proposal that:

  • Has patient copays and deductibles,
  • Allows the state to develop a benefit package that makes sense for this patient population, and
  • Allows the state to drop out of the program if conditions change.

"Texas physicians share both the taxpayer concerns of our state leaders as well as the very realistic medical care concerns of our state's uninsured population," Dr. Brotherton said.

TMA calls on Texans to use their ingenuity to "devise a comprehensive solution that:

  1. Draws down all available federal dollars to expand access to health care for poor Texans;
  2. Gives Texas the flexibility to change the plan as our needs and circumstances change;
  3. Clears away Medicaid's financial, administrative, and regulatory hurdles that are driving up costs and driving Texas physicians away from the program; and
  4. Relieves local Texas taxpayers from the unfair and unnecessary burden of paying the entire cost of caring for their uninsured neighbors."

Action, Feb. 15, 2013


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    We have been waiting for TMHP to change the rules back and cover 100% Medicare fee schedule for our cancer patients and TMHP not only NOT update the J code fee schedule but also not paying a lot of codes. The incompetent employees do not know what they are doing when we called for the claim denial. If TMHP is still not going to cover the medicare patients, we definitely not able to treat them anymore or just let those patients go to hospital for treatment which will increase taxpayers' expense. If TMHP system is not going to change, no physician wants to take mediciad patients even a lot of uninsurer go to medicaid. These patients will be packed in county hospital.

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