State May Raise Payments to Medicaid HMOs

Texas Medical Association President Michael E. Speer, MD, says that any new money going to Medicaid HMOs should go to patient care.

MarketWatch and the Texas Tribune report that the Texas Health and Human Services Commission (HHSC) is considering increasing the premiums it pays to Medicaid HMOs. HHSC is requesting a 2.6-percent increase to managed care premiums, a 0.8-percent increase to long-term and acute care service premiums, and a 1.8-percent rise in children's health plan premiums. The premium increases would cost an additional $59.2 million, which includes $23.7 million in state general revenue, for the last three months of fiscal year 2013.

In response, Dr. Speer said that for years, "the HMOs have promised the Texas Legislature and the citizens of Texas that Medicaid managed care would save the state money, provide 'budget certainty,' and better coordinate health care for Medicaid recipients. A number of the HMOs have failed to keep these promises."

Noting that physicians "are forced to leave the Medicaid program in droves," he said it is critical "that any new money be dedicated to improving patient care and the availability of that care. Any new money needs to be used to ensure Medicaid recipients have a medical home and that they can obtain needed care from specialists."

Dr. Speer added that the "physicians of the Texas Medical Association have worked hard to make sure our state leaders understand where and how our Medicaid system is broken." He said the TMA action plan calls for:

  • Equalizing Medicaid payments for patient care to those of Medicare;
  • Significantly reducing the reams of paperwork and exasperating, irreconcilable red tape that plague physicians who want to care for patients enrolled in the Medicaid program; and
  • Requiring Medicaid auditors to focus on actual financial fraud instead of second-guessing real-life medical treatment decisions.

"The 2013 Texas Legislature is making significant progress on the paperwork and fraud investigation issues. Requiring Medicaid HMOs to spend any new money on patient care would further our prescription to mend our broken system," Dr. Speer said. 


Action, April 15, 2013


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