• Dual Eligibles

    • Dual-Eligibles Cut Partially Reversed

      After months of TMA-organized rallies, lobbying, and meetings, the Legislative Budget Board directed the Texas Health and Human Services Commission (HHSC) to reverse part of the cut in payments for patients covered by both Medicare and Medicaid.

      The tipping point was a meeting State Sen. Juan "Chuy" Hinojosa (D-McAllen) organized at the Capitol last week with Lt. Gov. David Dewhurst and House Speaker Joe Straus. The group included TMA Board of Trustees Vice Chair Carlos Cardenas, MD, of Edinburg, and La Joya family physician Javier Saenz, MD. Although Gov. Rick Perry did not attend the meeting, his support helped move the change over the finish line.

  • Crowd Rallies State Lawmakers to Preserve Patient Access to Care

    Hundreds of patients and their doctors joined forces Tuesday in McAllen, Texas, urging state legislators to rescind budget cuts that are harming access to care for thousands of dual-eligible patients — those who qualify for both Medicare and Medicaid.

    Texas’ new payment policy on services doctors provide to these patients has created a medical emergency across the state. The problem has been particularly acute in the Rio Grande Valley, where severe poverty makes many Medicare patients eligible for Medicaid as well.

  • Medical Emergency Action Center

    • 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."
    • Huge Drop in Physician Acceptance of Medicaid, Medicare Patients
      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. That day has come, according to TMA’s new biennial survey of Texas physicians. More physicians are forced to reduce the number of patients they see who depend on government insurance for their health care.  
    • Dual-Eligible Dilemma
      La Joya family physician Javier Saenz, MD, is going broke. As of early April, Medicaid had not paid the four-physician practice he manages in the Rio Grande Valley for treating patients who are both poor and elderly. membersonlyred(2) 
    • VIDEO: Budget Cuts, Bureaucratic Bungles Creating Medical Emergency for Dual-Eligible Patients, Doctors
      Javier Saenz, MD, is a Rio Grande Valley family physician who cares for many these patients. They make up about half of his practice. Since January he's treated them as always, but has received no Medicare payments and very little in payments from Texas through Medicaid. As a result, he is exhausting personal savings and turning to bank loans to make payroll and keep his medical practice open to serve his patients. He doesn't know how long he can hold out. "If all I see are my most needy patients, I can't stay in business," Dr. Saenz told the Texas Medical Association. "If I can't stay in business, then I can't help anybody." Dr. Saenz is not alone. Physicians who care for dual-eligible patients in poor communities from rural Texas to inner cities are caught in this vise.
    • VIDEO: Dual-Eligible Medical Emergency Hits Houston
      Primary care physician Ana M. Torres, MD, and heart surgeon Emilio Hisse, MD, say the state budget cuts are making it harder and harder for them to see the "dual-eligibles," mostly elderly patients who often battle multiple chronic diseases like diabetes and high blood pressure. TMA is calling on state leaders to reverse the cuts and spare these patients.
    • Add Your Name to "Medical Emergency" Petition
      Share it with your colleagues, friends, and family. Caution: Asking patients to sign the petition in your waiting rooms using your patient contact information to solicit petition signatures is not advised. HIPAA restricts such use without first obtaining HIPAA-compliant patient authorization. Print out a copy of the petition to share with your colleagues.
    • Medical Emergency Fact Sheet
      Until January of this year, 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 sate Medicaid program also paid the Medicare deductible for these patients. This year the Medicare deductible is $140. 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.
    • 5010 Deadline Extended: Dual Eligible Problem Not Fixed
      Acknowledging that many physicians and billing entities still aren't ready, federal officials are giving physicians three more months before it begins enforcing the use of Health Insurance Portability and Accountability (HIPAA) 5010 transaction standards. The new deadline is June 30.
    • Medicaid to Clean Up Dual Eligible Mess
      State Medicaid officials say they will fix the mistakes and reprocess the claims of physicians incorrectly paid $0 for treating patients eligible for both Medicaid and Medicare, known as "dual eligibles." The Texas Medical Association brought the problem to their attention on behalf of physicians and their patients who were threatened with losing their health care because many physicians across the state faced financial ruin.
  • TMA Advocacy

    • Dual-Eligibles Cut Partially Reversed
      After months of TMA-organized rallies, lobbying, and meetings, the Legislative Budget Board directed the Texas Health and Human Services Commission (HHSC) to reverse part of the cut in payments for patients covered by both Medicare and Medicaid.
    • BHC Ask Senate Finance Committee to Restore Dual Eligible Cuts
      Just a few days ago, the state did restore payment of the deductible payment, a tremendous relief to those practices financially struggling since enactment of the cut. Many of you on the committee fought hard to restore the deductible and I sincerely thank you for your help. However, the continued coinsurance reduction means every time I see a dual eligible patient there is a 20-percent payment cut, an unsustainable and devastating financial blow.
    • Medicaid Payment Cuts Devastating Physicians' Practices and Their Patients
      Vice Chair, TMA Board of Trustees and TMA’s Border Health Caucus, Carlos Cardenas, MD, testified yesterday before the House Human Services Committee on the devastating cut in payments for dual-eligible patients. "Texas physicians want to take care of our patients. We want to see all Medicaid, Medicare patients, and those who are covered by both payers, but … we cannot do it without your help," Dr. Cardenas said. "We need your help and action to mitigate the cut so physicians can continue to care for Texas’ elderly — and often sickest — patients. Relief for these physicians and patients cannot happen too soon."
    • HOD Urges End to Dual-Eligible Crisis
      Recommendations to help end the "dual-eligible" crisis many Texas physicians face, to set priorities for next year's legislative session, and to improve medical education were among the issues debated and voted on at the TMA House of Delegates meeting May 19 at TexMed 2012 in Dallas.
    • TMA Testifies Dual Eligible Cuts
      Eliminating payments for Medicare Part B coinsurance and deductibles to those eligible for both Medicaid and Medicare will save the state millions but it will "come at the expense of the health and well-being of some of the state's most vulnerable citizens," TMA President C. Bruce Malone, MD, told the Texas Health and Human Services Commission (HHSC) earlier this month. Read the entire testimony presented by Dr. Malone.
    • HHSC to Cut Dual Eligible Payments
      The Texas Health and Human Services Commission (HHSC) plans to eliminate coinsurance and deductible payments for Medicare Part B services for patients eligible for both Medicare and Medicaid, known as dual eligibles.
    • Nelson Seeks to Restore Medicaid Cuts
      In mid-March, Sen. Jane Nelson (R-Lewisville), chair of the Senate Finance Subcommittee for Medicaid, asked Tom Suehs, HHSC executive commissioner, to develop a list of top funding priorities. Leading Commissioner Suehs' recommendations was a proposal to restore 7 percent of the proposed 10-percent cut in physician payments for both Medicaid and the Children's Health Insurance Program.
  • Payment Information

    • Payments for Patients Dually-Eligible for Medicare and Medicaid
      To help close a $27 billion budget deficit, the 82nd Texas legislature directed the Health and Human Services Commission to implement a multitude of new initiatives aimed at trimming Medicaid expenditures by nearly $3 billion over the next two years, including reducing benefits and services for patients and applying payment reductions for physicians and providers.