Medicaid

Include Physicians on Long-Term Care Facilities Council - 04/09/2019

TMA strongly supports SB 1519 as it will address Texas’ growing need for best practices in dispute resolution and Medicaid quality-based payment systems in long-term care. However, we urge the chair and this committee to consider two additions to the long-term care council that will strengthen its ability to address medical and infectious disease concerns


Strengthen Medicaid MCO Oversight and Improve Access to Care - 04/02/2019

Over the past six months, leaders from TMA, the Texas Hospital Association, Texas Association of Health Plans, and Texas Association of Community Health Plans have met monthly to identify opportunities to reform Medicaid. While we do not always sing Kumbaya, we have developed a better understanding of the root causes of many of problems facing the program. And many problems are much more complex than we first realized, such as simplifying Medicaid prior authorizations.


Beyond the Slogan “Medicare for All” - 03/11/2019

Medicare For All is becoming popular among Democratic lawmakers and the public. But, as popular as the concept is, the details are lost in the simple slogan of “Medicare for All.”


Children Eligible for Medicaid Need Continuous Coverage - 03/11/2019

Texas is a state that values fairness. In 2007, lawmakers adopted 12 months’ continuous coverage as a best practice for children in CHIP. It is time to provide working parents of children enrolled in Medicaid the same treatment.


Urgent: Action Needed Today To Secure $500 Million For Medicaid - 03/08/2019

On Monday, the House Appropriations Committee will consider amendments, known as “riders,” to its draft state budget for 2020-21. Your state representative serves on the Appropriations Committee. Please contact your representative today and ask him or her to vote to adopt “the Sheffield rider in Article 11” to increase Medicaid rates.


TMA Pushes Back Against Planned Vaccine Payment Cuts - 02/12/2019

As the influenza virus continues to spread statewide, the Texas Medical Association and other specialty societies have taken a stand against a plan to cut by almost 36 percent payments to physicians who administer a flu vaccine in their offices.


Physicians Tell Feds: Rework Network Adequacy Plan - 02/08/2019

The Texas Medical Association and the Texas Pediatric Society are urging the Centers for Medicare & Medicaid Services to reconsider several parts of its proposal to redefine adequate networks for Medicaid.


Improve Access to Care for Working Texans - 02/07/2019

Healthy Texans underpin Texas’ economic health. To ensure Texas can sustain its economic momentum over the long haul, it must invest in its greatest asset – its people. Our organizations call upon lawmakers to adopt a patient-centered legislative agenda to boldly address Texas’ access to health care challenges.


Panel: Value-Based Care Bearing Fruit - 01/30/2019

Although some of the numbers documenting access to care in Texas are less than encouraging, the shift to value-based care in Medicaid is showing positive signs, a panel collectively told the Texas Medical Association’s Winter Conference on Saturday at the Hyatt Regency Austin.


Pediatrician Named HHSC Medicaid Chief Medical Officer - 01/15/2019

San Antonio pediatrician Ryan Van Ramshorst, MD, has been appointed chief medical officer for Medicaid and the Children's Health Insurance Program within the Texas Health and Human Services Commission.


Medicaid Eligibility Verification Website to Be Shuttered Friday - 12/13/2018

The Texas Health and Human Services Commission (HHSC) will decommission the YourTexasBenefitsCard.com website and the Medicaid eligibility verification Interactive Voice Response system at 7 pm (Central) on Friday.


TMA Offers to Help New HHSC Chief Reform Medicaid - 11/30/2018

The Texas Medical Association knows the state’s Medicaid managed care system needs to get better, and physicians are ready to help the Texas Health and Human Services Commission’s new leader make it happen. That’s what TMA and three other organizations told new HHSC Executive Commissioner Courtney Phillips, PhD, in a letter this week welcoming her to her new post and highlighting steps to cut Medicaid red tape and enhance access to care.


Doctors, Insurers, Hospitals Meet to Set Priorities for Strengthening Medicaid Managed Care - 10/24/2018

As the future of Texas Medicaid promises to be a central topic of discussion in the 86th Texas Legislature, leaders from three pillars of the Texas health care system gathered in Austin on Oct. 12 for a first-ever summit to identify and commit to working on shared priorities for strengthening the program.


Key Date on the Way: Medicaid Telemedicine Benefit Updates - 09/27/2018

Along with patients presenting via remote video, doctors using telemedicine for Medicaid encounters should have Oct. 1 on their radar screens. That’s when Texas Medicaid’s updated benefit policy language on telemedicine and telehealth for managed care organizations takes effect.


Financial Squeeze: Low Medicaid pay has Dallas clinics turning to midlevels to cut costs - 09/14/2018

Low Medicaid pay forces some Children's Health Pediatric Group clinics in Dallas to close, others turn to midlevels to cut costs, raising quality concerns.


RSV Season is Coming — Make Sure You Prescribe Properly - 09/12/2018

Human respiratory syncytial virus season is about to start. For Medicaid patients, Synagis (palivizumab) is available via prescription for high-risk patients. Each commercial health plan has its own policy and requirements for prescribing Synagis. All plans require prior authorization but may differ on their buy-and-bill guidelines.


TMA Calls On Feds to Protect Medicaid Patients’ Access to Tests - 08/03/2018

The Texas Medical Association continues to push back against the rollout of the Protecting Access to Medicare Act, which could cause Medicaid patients in Texas and elsewhere to lose access to needed clinical tests.


A Voice for the Voiceless - 08/01/2018

Lee Ann Pearse, MD, is a tireless advocate for Medicaid patients.


Avoid Prescription Denials: Enroll in Medicaid Soon - 07/19/2018

Enroll in Medicaid by July 27 of this year to ensure your Medicaid pharmacy prescriptions get filled.


Postpartum Depression Screening Now Covered by Texas Medicaid - 07/10/2018

As part of health officials’ continuing effort to improve women’s health, postpartum depression screening is now a Texas Medicaid benefit.


TMA Applauds 15-month Medicaid Waiver Extension - 06/19/2018

Statement of John Holcomb, MD, Chair of the Texas Medical Association Select Committee on Medicaid, CHIP & Uninsured, on today's Centers for Medicare & Medicaid Services announcement confirming a 15-month extension of the Medicaid 1115 Waiver for the state of Texas.


Good Planning Can Contain Costs for Long-Term Care Facilities, Help Seniors - 05/17/2018

Texas physicians urge the state to focus on ensuring high-quality care for Texas senior patients by protecting them from infectious diseases, managing their complex conditions, and implementing new models of care that support collaboration between long-term care facilities and local and state health departments.


TMA: Medicaid Patients Could Lose Access to Clinical Tests - 05/09/2018

Medicaid patients in several states, including Texas, might not receive needed clinical tests because of new payment rates mandated by a federal law named, ironically, the Protecting Access to Medicare Act.


Zika Virus Testing — New Medicaid Instructions for Laboratories and Ordering Physicians - 05/03/2018

Laboratories must use a U4 modifier when submitting Medicaid claims for Zika virus testing, the Texas Medicaid and Healthcare Partnership announced on May 5.


Maintain Medicaid Eligibility for Pregnant Women - 04/20/2018

We are highly cognizant that Texas’ current budget environment will mean the legislature must make painful budget decisions. But those decisions, as you well know, have real short- and long-term impacts on real people. Short-term cuts also may increase Texas’ costs later. With that in mind, it is important to remember that Medicaid and CHIP together serve more than 4 million Texans, people we all know or encounter every day, including hard working, low-income parents and their children as well as people with disabilities and seniors. Without the programs, the vast majority of Medicaid and CHIP patients would be uninsured, thereby depriving them of access to affordable preventive, primary and specialty care.