Medicaid

Revalidate Your Medicaid Enrollment Soon - 11/16/2021

If you’re a physician participating in the Texas Medicaid program and saw your required revalidation period for the program extended due to the COVID-19 pandemic, take note: The end of that extension is coming on Feb. 28, 2022.


So Much Uncertainty: Struggle to Renew Medicaid 1115 Waiver Endangers Behavioral Health Care for Low-Income - 10/31/2021

Uncertainty over the waiver’s future has thrown confusion into many of the state’s biggest behavioral health efforts.


Federal Bill Includes Longer Medicaid Coverage for New Mothers and Children - 10/27/2021

A federal budget bill under negotiation in Congress would expand Medicaid coverage for both new mothers and children, and the Texas Medical Association has signed onto a letter urging preservation of those provisions.


Congress May Extend Postpartum Medicaid Coverage to 12 Months - 10/19/2021

Federal legislation could move Texas toward one of the Texas Medical Association’s long-time goals for improving maternal health – extending Medicaid postpartum coverage from two months to a full year.


How to Avoid Coding Mistakes in Texas Medicaid - 10/15/2021

Ensuring Texas Medicaid dollars are spent for their intended purpose requires the Texas Health and Human Services (HHS) Office of Inspector General (OIG) to work with health care professionals to prevent waste. Accurate medical coding is part of that work. Incorrect codes result in overpayments – which impact taxpayers – and underpayments, which can impact your practice.


How to Reverify Patients’ Medicaid Eligibility When the Public Health Emergency Ends - 10/06/2021

With the federal public health emergency (PHE) slated to expire at the end of 2021, millions of Medicaid patients across the U.S. are at risk of losing their coverage. Texas physicians should prepare by scheduling services as soon as possible for such patients and evaluating the financial impact of potential increases in uncompensated care. They also should expect to reverify patients’ Medicaid eligibility when the PHE expires.


Texas Safety-Net Programs Tied to 1115 Waiver Get New Life – for One Year - 09/10/2021

A key component of Texas’ safety net for low-income people remains intact – for at least another year – thanks to an agreement between the Texas Health and Human Services Commission (HHSC) and the Centers for Medicare & Medicaid Services (CMS) to extend three federally funded programs that were set to expire.


Medicaid Relaxes Prior Authorization for Hep C Antiviral Drugs - 09/06/2021

For years, Texas Medicaid patients with hepatitis C haven’t had access to overwhelmingly effective, often-curative antiviral therapy unless they had advanced liver disease. In many cases, getting the antiviral drugs at that point was too little, too late.


Billing for Telemedicine During COVID-19 - 09/06/2021

COVID-19 prompted an increased need for telemedicine services to connect physicians with their patients. To quickly meet that need, Texas Medicaid adopted waivers and changed policies to ease technology restrictions and expand the number of Medicaid services available virtually. Reimbursement for telemedicine and telehealth averaged less than $800,000 per month in 2019. By April 2020, Medicaid payment for virtual services jumped to $43 million, and averaged more than $37 million monthly throughout 2020.


Data Driven: Medicaid’s Inspector General Focuses on Fraud Prevention, Not Just Prosecution - 09/06/2021

Since her appointment in 2018, Texas Health and Human Services Inspector General Sylvia Hernandez Kauffman has homed in on using data analytics not only to prosecute fraud, waste, and abuse within the Medicaid program, but also to prevent it from happening in the first place. Texas Medicine spoke to Ms. Kauffman about what appears to be a shift in tone from this department as it also focuses on using the data it collects to educate physicians and other health care professionals on common billing mistakes.


Help Louisiana Medicaid Patients Affected by Hurricane Ida - 09/02/2021

If you’d like to lend medical services to people from Louisiana affected by Hurricane Ida, the Texas Health and Human Services Commission (HHSC) has released information on how Texas physicians can help Louisiana Medicaid recipients.


Keeping the Safety Net Open: Restoring the 1115 Medicaid Waiver - 08/02/2021

After CMS revokes extension of 1115 waiver, TMA lobbies for a broader, better version.


Medicaid EHR Incentive Program Deadline Coming Up - 07/28/2021

Participants in the Medicaid Electronic Health Record (EHR) Incentive/Promoting Interoperability (PI) program have one month from today to attest to meeting the program requirements – but don’t wait until the last minute.


Medicaid Relaxes Prior Authorization for Hep C Antiviral Drugs - 07/14/2021

For years, Texas Medicaid patients with hepatitis C haven’t had access to overwhelmingly effective, often-curative antiviral therapy unless they had advanced liver disease. In many cases, getting the antiviral drugs at that point was too little, too late.


TMA Shooting for Reinstatement of 1115 Waiver Extension - 07/08/2021

Facing a major setback for uncompensated care, the Texas Medical Association is taking the opportunity to think bigger and better.


Physician-Led Results: Big Steps Forward in Medicaid, Maternal Health - 06/23/2021

One of the Texas Medical Association’s biggest wins this session came in the partial realization of medicine’s longtime advocacy to extend Medicaid coverage for postpartum maternal care.


Longer Coverage, Longer Lives: COVID-19 Relief Bill Could Help With Medicaid Postpartum Coverage - 05/24/2021

TMA urges Texas to keep pregnant women on Medicaid 12 months postpartum following federal enticement in COVID-19 relief bill.


Feds’ Withdrawal of Texas’ Medicaid Waiver Extension Raises Concerns Over Future Safety-Net Funding - 04/19/2021

The Centers for Medicare & Medicaid Services (CMS) on Friday announced the withdrawal of its Jan. 15, 2021, approval to extend Texas Medicaid’s 1115 Transformation Waiver for 10 years.


Legislative Hotline: Medicaid Continuous Coverage Measures Advance - 04/06/2021

The House Human Services Committee this morning OK’d legislation supporting TMA’s longstanding goals to extend Medicaid coverage for both pregnant women and children.  


Medicaid to Increase Payment Per COVID-19 Vaccine Dose - 04/05/2021

Starting April 1, Medicaid began paying physicians and practices that administer COVID-19 vaccines $40 per dose to align with Medicare’s payment policy announced last month, the Texas Health and Human Services Commission (HHSC) announced.


New Rules Could Make It Harder to Enroll in Healthy Texas Women - 04/01/2021

Healthy Texas Women (HTW) has changed how it determines eligibility for low-income women who use the program, which could put a greater burden on physicians and other health care professionals who help patients get and stay with these services, TMA says.  


Another Poll Shows Texans Overwhelmingly Support Medicaid Expansion - 03/18/2021

Almost 70% of Texans say the state should expand Medicaid to provide health insurance to low-income people who are uninsured, according to a recently released state survey, up from 64% in a similar 2019 poll.


CMS Open Payments Registration Under Way - 02/04/2021

Registration is now open for the Centers for Medicare & Medicaid Services’ (CMS) Open Payments Program, which requires CMS to publicly report data on items of value given annually to physicians and teaching hospitals.


A Case for More Coverage: Studies Suggest Medicaid Expansion Would Fiscally Benefit Texas - 11/12/2020

Two recent studies suggest expanding Medicaid will not only save Texas money, but add to the Lone Star State’s coffers.


Expanded State Services for Some New Mothers Now Available - 10/22/2020

Certain new mothers in Texas are now eligible for expanded care through Healthy Texas Women (HTW) after the first 60 days of giving birth, including treatment for postpartum depression and substance use disorder.