Medicaid and the Children’s Health Insurance Program (CHIP) cover more than 4 million low-income Texans. That includes half of all children in the state and about two-thirds of people in nursing homes. As TMA has long cautioned, however, a Medicaid card does not equal access to health care. Extremely poor payment rates and extraordinarily high bureaucratic burdens lead most Texas physicians either to refuse to accept all new Medicaid patients or to limit the numbers they can see.
TMA encourages the Texas Legislature to increase Medicaid and CHIP payments and reduce administrative hassles, and to search for creative new ways to provide more health insurance coverage for low-income Texans..
Medicaid’s new e-signature capability and its portal for verifying patients’ Medicaid eligibility and accessing their available health information are two ways to help cut down on the busywork in your office.
Achieving the cost-savings we mutually envision will require more than just innovative and clinically sound health care policies. It also will require bold action by the legislature to rebuild theMedicaid physician network, which has steadily eroded over the 16 years largely for one reason:unreasonably low payment rates. Medicaid physician payments average 73 percent of Medicare and 50 percent of commercial payments.
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.
If you participate in Medicaid, don't forget about the implementation of the STAR Kids managed care program on Nov. 1. The legislature directed the Texas Health and Human Services Commission (HHSC) to develop the managed care program specifically designed for children aged 20 and younger who have disabilities.
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.
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.
Got Medicaid or CHIP questions? Call or email the Knowledge Center.
STAR Kids Takes Effect Nov. 1; Training Available
TMA Asks HHSC to Request More Medicaid, Public Health Funds
Use These Medicaid Tools to Help Get Paid More Efficiently
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