Some Coverage Reinstated for Poor, Ill Texans

Dec. 18, 2012  

Some Coverage Reinstated for Poor, Ill Texans 

Texas’ “medical emergency” has been partially averted. The Texas Legislative Budget Board has directed the Health and Human Services Commission (HHSC) to restore part of a cut in payments for patients covered by both Medicare and Medicaid. Because they qualify for both government health insurance programs, these patients are sometimes called “dual-eligible” patients. They are often the poorest and sickest Texans.
For nearly a year, physicians of the Texas Medical Association (TMA) have organized rallies, met with state leaders, and lobbied to stop the cuts. Many of the doctors advocating on behalf of their patients for coverage see large percentages of dual-eligible patients. 
 “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.”
The news comes not a moment too soon, as physicians face a possible 27.5-percent cut in Medicare/TRICARE payments Jan. 1 for senior citizens, people with disabilities, and military families.
Dr. Speer added that because of the dual-eligible cut, physicians who care for these patients have had to borrow money to keep their doors open, lay off staff, drop out of Medicaid, or even close their medical practices.
 The problem started last legislative session. 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 dual-eligible patients’ $140 annual Medicare deductible, and

2. Prevented Medicaid from paying more than the Medicaid-allowable charge for a service, which stopped Medicaid from paying the Medicare copay.

Now Texas will reinstate coverage of the Medicare deductible in 2013. Exact details of how HHSC will implement that change are being finalized.

The dual-eligible cut was devastating for doctors who care for these patients, particularly since Medicaid already is the lowest-paying insurer. Physicians hardest hit are those who see large percentages of dual-eligible patients – doctors like Javier A. Saenz, MD, a family physician in La Joya, on the Texas-Mexico border. “This is such a relief. It’s truly a Godsend and a step in the right direction so we can continue to help these patients we know and love. I had to go through my personal money to keep my office open. If I had no savings whatsoever, this office would have closed.” Now he says he can keep his doors open and continue to see his 5,000 dual-eligible patients, though he hopes funding is restored completely. “We are not out of the woods yet.”

The tipping point to reverse the cut 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 Dr. Saenz. Although Gov. Rick Perry did not attend the meeting, he had met with TMA physicians on the issue previously, and his support helped prompt the change.
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.
Reversing the cut was 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,” Dr. Speer 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.”

TMA is the largest state medical society in the nation, representing more than 46,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.

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Contact: Pam Udall
phone: (512) 370-1382
cell: (512) 413-6807

Brent Annear
phone: (512) 370-1381
cell: (512) 656-7320

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Last Updated On

May 06, 2016

Originally Published On

December 18, 2012