In a March letter to the Texas congressional delegation, Gov. Rick Perry set strict parameters for any possible expansion of the Texas Medicaid program using billions of dollars available under the federal health reform law, saying he would support a plan that includes "increased flexibility" for Texas to develop a state-specific plan.
But the governor was careful to reiterate his stance against a full expansion of the current program as prescribed by the Patient Protection and Affordable Care Act (PPACA), as Medicaid continues to consume "a ballooning portion of state budgets – already a quarter of our budget in Texas."
The reforms Governor Perry says he would like to implement include promoting the use of:
- Cost sharing to establish copays, deductibles, and premiums payments on a sliding scale;
- Asset testing to ensure care is there for those who need it most;
- Health savings accounts to improve patients' control over heath care spending; and
- Existing private coverage and employer-sponsored coverage.
"States have innovative ideas for providing accessible and affordable health care for those in need, but lack the flexibility to implement any meaningful reforms," Governor Perry wrote.
The Senate Finance Committee attached a rider to its version of the 2014-15 budget that seeks to test the waters of a Medicaid expansion but first requires the Texas Health and Human Services Commission to seek legislative approval. The rider specifically says that "no amount may be expended to modify Medicaid eligibility unless the commission develops a plan to create more efficient health care coverage options for all existing and newly eligible populations."
That plan also must pass certain muster and meet several principles spelled out in the rider that include those outlined by the governor, as well as:
- Reduced uncompensated care costs and nonemergency visits to emergency departments;
- Customized benefit plans for a defined Medicaid population;
- Pay-for-performance initiatives;
- Efficiency controls, including cost-containment and improved care coordination; and
- Elimination of the need to gain federal approval for minor program changes.
The proposals echo those made by TMA to first fix the current broken Medicaid system by increasing physician payments and reducing hassles, and then use expansion money in a way that makes care available to more Texas patients.
The April issue of Texas Medicine has more information on TMA's plan to fix the state's Medicaid system.
Action, April 1, 2013