Dual-Eligibles Cut Partially Reversed

After months of TMA-organized rallies, lobbying, and meetings, the Legislative Budget Board directed the Texas Health and Human Services Commission (HHSC) to reverse part of the cut in payments for patients covered by both Medicare and Medicaid.

The tipping point was a meeting State Sen. Juan "Chuy" Hinojosa (D-McAllen) organized at the Capitol last week with Lt. Gov. David Dewhurst and House Speaker Joe Straus. The group included TMA Board of Trustees Vice Chair Carlos Cardenas, MD, of Edinburg, and La Joya family physician Javier Saenz, MD. Although Gov. Rick Perry did not attend the meeting, his support helped move the change over the finish line.

"It's a great first step," said TMA President Michael E. Speer, MD. "Physicians across the state and their patients have been reeling from the impact of these cuts for almost a year. We definitely needed a reprieve. Since January, it's been a true medical emergency. Physicians who care for Texas' most sick and most vulnerable patients have had to borrow money to keep their doors open, lay off staff – some dropped out of the Medicaid program, and some did close their practices."

The 2011 Texas Legislature ordered the cut in dual-eligible payments as a budget-saving move. The way HHSC implemented it covered two pieces of the complex interaction between Medicare and Medicaid payments to physicians. The change effectively:

  1. Stopped Medicaid from covering all of the dual-eligible patients' $140 annual Medicare deductible; and
  2. Prevented Medicaid from paying more than the Medicaid-allowable charge; this stopped Medicaid coverage of the Medicare copay.

The agreement reached would reinstate coverage of the Medicare deductible in 2013. Exact details of how HHSC would implement that change were still being worked out as this issue of Action was prepared. TMA will keep you informed as we learn more.

South Texas physicians praised Senator Hinojosa, state Rep. Richard Raymond (D-Laredo), state leaders, TMA, and HHSC officials for reaching agreement on the deductibles issue.

"This was indeed a team effort from the rallies we have had here on the border and in countless meetings in Austin," Hidalgo-Starr County Medical Society President Victor Gonzalez, MD, told the Rio Grande Guardian. "Chairman Raymond and Senator Hinojosa and all our elected officials were so helpful and supportive."

Reversing the cut is one of the top priorities identified by TMA's Physicians Medicaid Congress. Dr. Speer said TMA will continue to pressure lawmakers when the legislature convenes in January to restore the remainder of the cut.

"We now urge lawmakers to eliminate the rest of this cut as soon as possible," he said. "While this cut has disproportionately impacted dual-eligible patients with disabilities and seniors, when physicians are forced to close their doors or reduce services, it affects all of our patients."

Action, Dec. 17, 2012

Last Updated On

January 06, 2020

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