Medicaid

New Report Aims to Catalyze Texas Medicaid’s Shift to Value-Based Care - 03/02/2023

A new report aims to accelerate Texas Medicaid’s transition from a fee-for-service payment model to a value-based one, a shift that has been underway for 25 years.

The Unwinding: What the End of the COVID PHE Means for Continuous Medicaid Coverage - 02/24/2023

After nearly three years and 11 extensions, the federal public health emergency related to COVID-19 is poised to end this spring, and with it, continuous Medicaid coverage for more than 2.5 million Texans.

Marketplace Enrollment Could Help Blunt Potential Uninsured Surge as Public Health Emergency Ends - 11/11/2022

AA number of positive changes expanding access to and affordability of federal marketplace health plans could be coming just in time as Texas’ uninsured rate stands to worsen after the end of the public health emergency.

Commissioned With Change : An Interview With HHSC Commissioner Cecile Erwin Young - 11/11/2022

As leader of the state’s largest agency, Texas Health and Human Services Executive Commissioner Cecile Erwin Young is faced with some of the largest health care challenges among some of the most vulnerable patient populations. She visited the Texas Medical Association’s Winter Conference in late January to talk to Texas physicians about their concerns in caring for those patients, especially during a pandemic.

Address Delayed Care Pileup, TMA Tells House Panel - 10/17/2022

The COVID-19 pandemic strained an already overburdened primary health care system in Texas, making it vital that state lawmakers back measures that encourage patients to see a physician and catch up on delayed care before it gets even worse, Tyler pediatrician Valerie Smith, MD, told the Texas House of Representatives Select Committee on Health Care Reform.

“Administrative Churn” Could Cost Texas Medicaid Patients Their Coverage When PHE Ends - 09/13/2022

Nearly half of the 15 million Medicaid patients across the U.S. at risk of losing coverage when the COVID-19 public health emergency (PHE) ends may fall prey to “administrative churning.” That is, they could lose coverage despite remaining eligible because of difficulties navigating the renewal process, address changes, and other administrative challenges.

Access to Hep C Treatment in Texas Medicaid Delayed - 09/07/2022

Texas Medicaid patients with hepatitis C will have to wait a little longer to access potentially curative antiviral medications.

Texas Medicaid to Loosen Access to Hepatitis C Treatment - 08/21/2022

Texas Medicaid patients with hepatitis C have struggled for years to access potentially curative antiviral medications. But this will get much easier on Sept. 1.

Texas Children Among Most at Risk of Losing Health Coverage When PHE Ends - 08/19/2022

Texas is one of six states where children enrolled in Medicaid and in the Children’s Health Insurance Program are especially at risk of losing their health insurance when the public health emergency ends.

Medicaid Extends Reenrollment Time Frames - 08/09/2022

To help manage a backlog of revalidation applications stemming from the transition to Medicaid’s new Provider Enrollment Management System (PEMS), the state’s Medicaid claims payment contractor announced it will extend revalidation timeframes for physicians and other health care practitioners and suspend disenrollments related to that process.

The Only Alternative: Medicaid Practices May Not Be Viable Without Value-Based Care - 07/29/2022

For years, the Texas Medical Association has pushed for a significant Medicaid physician pay bump every year that the Texas Legislature meets, without success. As long as that streak continues, physicians looking to make Medicaid more worthwhile for their bottom line have to find another way. Value-based systems – and the alternative payment models that drive them – have been the path Medicaid managed care organizations and practitioners have been methodically walking in recent years.

New Texas Website Streamlines Access to Medicaid Enrollment, Family Resources - 07/26/2022

Physicians who frequently refer patients to no- and low-cost state services like health insurance and child care will find that easier now that the state has launched familyresources.texas.gov, a website that puts links to those services all in one place.

CMS Drops Opposition to Texas’ Medicaid Waiver Extension; TMA Concerns Persist - 05/26/2022

Texas’ safety net got a reprieve when the federal government agreed to drop its opposition to a 10-year extension of Texas’ Medicaid 1115 Transformation Waiver, ensuring an annual $3.8 billion to offset uncompensated care through 2030.

Maximize Medicaid Coverage Under New State Laws, TMA Tells Legislature - 05/24/2022

The Texas Medical Association recently advised state policymakers on two big upcoming events that will affect millions of Texans relying on Medicaid – and the physicians who treat them.

Self-Reporting Errors to OIG - 04/05/2022

More physicians are taking advantage of the opportunity to self-audit and self-disclose overpayments during the course of a Texas Health and Human Services Office of Inspector General (OIG) investigation. Self-reports to the OIG in fiscal year 2021 lead to the resolution of 45 cases, totaling $8.1 million; only 12 self-reports were made just three years earlier. Those using the self-report process include physicians, clinics, hospitals, home health agencies, and mental health rehabilitative services entities.

Bolster Medicaid and CHIP Enrollment With These Grants - 04/05/2022

Organizations interested in increasing access to Medicaid and Children’s Health Insurance Program (CHIP) coverage can apply for up to $1.5 million each after the Centers for Medicare & Medicaid Services (CMS)  announced on Jan. 27 that it was committing more than $49 million in federal grants to the Biden administration’s effort to “fund organizations that can connect more eligible children, parents, and pregnant individuals to health care coverage.”

Medicaid to Fix Physician Enrollment Problems With TMA's Help - 03/31/2022

A rocky start for the state’s new Medicaid Provider Enrollment and Management System frustrated a number of practices around the state – and caused some worries that care they provided might go unpaid.

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.