Medicaid and the Children’s Health Insurance Program (CHIP) cover more than 4 million low-income Texans. That includes half of all children in the state and about two-thirds of people in nursing homes. As the Texas Medical Association has long cautioned, however, a Medicaid card does not equal access to health care. Extremely poor payment rates and extraordinarily high bureaucratic burdens lead most Texas physicians either to refuse to accept all new Medicaid patients or to limit the numbers they can see.
TMA encourages the Texas Legislature to increase Medicaid and CHIP payments and reduce administrative hassles, and to search for creative new ways to provide more health insurance coverage for low-income Texans.
Enact Competitive Payments
Historically, Medicaid and CHIP have been the lowest-paying health insurers in the state, paying far less than what it costs physicians to provide the services to covered patients. In the past 20 years, Medicaid physician payments have mostly stagnated or declined, save rate increases enacted in 2007 for children’s preventive and office-based services. Physician participation rate has consequently plummeted.
A natural “experiment” documents the direct correlation between physician participation and Medicaid payment rates. In 2012, 21 percent of primary care physicians told TMA they accept all new Medicaid patients. In 2014, that figure jumped to 30 percent, an increase directly attributable to the temporary, two-year primary care physician rate increase paid for with federal funds. The increase brought Medicaid payment rates for certain primary care services equal to what Medicare pays. After that increase expired, the share of primary care physicians who accept all new Texas Medicaid patients fell to 26 percent in TMA’s 2016 Physician Survey.
TMA recommends exempting physician Medicaid and CHIP payments from proposed 4-percent budgetary cuts for the 2018-19 biennium. Instead, TMA believes Texas should set physicians’ Medicaid rates equal to Medicare for all services and all specialties and restore full Medicaid cost-sharing for patients dually eligible for Medicaid and Medicare. Expanding covered patients’ access to physician care would keep them healthier (and in school and at work), and help them manage chronic illnesses, avoid costly hospitalizations, and stay out of expensive and crowded emergency departments.
Reduce Medicaid Managed Care Red Tape
The conversion from Medicaid fee-for-service to managed care has concomitantly increased Medicaid’s complexity, amplifying bureaucratic hassles and onerous paperwork that interfere with Texas physicians’ ability to care for their patients. Over the past 18 months, however, Texas Medicaid has set about to reduce Medicaid managed care red tape, including streamlining Medicaid enrollment and credentialing, reducing excessive prior authorization requirements, and seamlessly transitioning women losing pregnancy-related Medicaid into the Healthy Texas women’s program, thus eliminating gaps in coverage. In TMA’s 2016 Physician Survey, 41 percent of respondents said they do not treat Medicaid managed care patients because of the administrative burden, and 54 percent said they would be likely to accept more Medicaid managed care patients if red tape is reduced.
Even becoming a “Medicaid provider” is a time-consuming hassle for Texas physicians, requiring six months or more to obtain a state Medicaid number and then earn credentials from one or more of the Medicaid HMOs in the state.
TMA recommends the legislature direct the Health and Human Services Commission to continue its efforts to streamline Medicaid managed care processes and eliminate unnecessary administrative hassles that keep good doctors out of the program or force them to limit the number of Medicaid patients they can see. New reforms should include improving Medicaid coordination of benefits with other payers, scrutinizing prior authorization requirements, and modernizing the Medicaid Vendor Drug Program.
Improve Coverage
Texas continues to be the “Uninsured Capital of the United States.” About 4.6 million Texans - including 623,000 children - lack health insurance. Texas' uninsurance rates are almost twice the national average. Dallas and Houston, are the least insured major metropolitan areas in the country. Among adults, the majority of the uninsured work, but either cannot afford employer-sponsored insurance or find it unavailable. Purchasing private health insurance is prohibitively expensive for low-income families. Providing health care coverage to more low-income Texans does not have to mean expanding traditional Medicaid. In fact, given the current political climate in Texas, it very likely will not mean expanding Medicaid.
Health insurance coverage matters – to patients and their families, to their communities, to taxpayers, and to the economy. For patients, insurance coverage can mean better health and faster and more affordable and appropriate care. Better coverage also will be essential to further improving Texans’ timely access to behavioral health interventions and reducing Texas’ distressingly high rate of maternal mortality and morbidity. Expanded coverage can mean savings for state and local taxpayers in Texas. And creating a healthier workforce can help Texas attract the kinds of jobs that will grow our economy into the future.
TMA recommends that lawmakers use federal money to develop a plan, tailored to Texas’ unique circumstances, to cover more than 1 million uninsured individuals. Instead of expanding Medicaid, this plan would provide low-wage, working Texans with private insurance that includes copays, tailored benefits and even health savings accounts to encourage appropriate service utilization. Several other politically conservative states – notably Indiana and Arkansas – have successfully adopted a similar model.
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Texas Legislature
Medicaid and CHIP