Maintain Medicaid Children’s Continuity of Care

Testimony by Ryan Van Ramshorst, MD, FAAP

House Human Services Committee
House Bill 1408 (Cortez) – Medicaid Eligibility Efficiency

March 13, 2017

Submitted on behalf of:

  • Texas Pediatric Society
  • Texas Medical Association
  • Texas Academy of Family Physicians

Chairman Raymond, Vice Chair Frank and Committee Members,

Thank you for the opportunity to provide testimony today. My name is Ryan Van Ramshorst, MD, and I am a San Antonio pediatrician testifying on behalf of the Texas Pediatric Society, the Texas Medical Association and the Texas Academy of Family Physicians. We testify in firm support of House Bill 1408 as it will reduce costs and improve quality of care within the state’s Medicaid program for children.

Maintaining continuity of care and improving quality outcomes should be the primary goal of Texas Medicaid

Currently, children in Texas Medicaid only have continuous periods of eligible coverage for six months at a time unlike most plans offered in the Children’s Health Insurance Program and the commercial insurance setting. As a pediatrician who cares for children in Medicaid every day, I know the value this coverage brings them. In fact, the value of Medicaid grows exponentially the longer a child has continuous coverage. As their primary care physician, I am able to maintain a relationship with the family providing needed anticipatory guidance to prevent unnecessary injuries. I can manage a child’s complex condition — physical or mental — to ensure they remain productive in school and healthy into adulthood. Continuity of care can be jeopardized if the child churns on and off Medicaid for any reason. If this happens, a patient can go without their asthma controller for an extended period of time and end up in the emergency room suffering from an unnecessary attack. A child who I have managed to counsel and get stable on ADHD medication may go without and their grades and behavior would suffer as a result. The ripple effects of a loss of coverage are innumerous. As a family’s trusted pediatrician I do everything I can to not cause any disruptions in their care, but all that is for naught if arbitrary administrative barriers cause a child to drop off of coverage. The Legislature was well aware of this when we instituted the Children’s Health Insurance Program with 12 months continuous eligibility. It’s time to bring children’s Medicaid up to par.

Implementing 12 months continuous eligibility reduces physician practice burden

Increased physician office burden is the result of Medicaid’s overly complicated eligibility system. When children ultimately regain coverage this must be verified by a physician’s office and matched with any previous records on file for the child. The process is even more burdensome if the child has been out of coverage for more than six months because then they will not automatically be placed with their previous health plan in Medicaid. For children with basic levels of medical need this may throw off quality tracking measures imposed on the physician by the health plan, and require records to be submitted to the new plan or else a physician could lose pay-for-quality payments. For children with special health care needs such as a physical or developmental disability, the child’s health could be at risk. Many families rely on the care coordination services of a Medicaid managed care health plan, and forcing them to reacquaint themselves with another case manager is unnecessary and harmful to their health and wellbeing.

It’s time to ensure Texas children have the continuity of care they deserve, and that physicians are absolved of unnecessary administrative burden. Thank you for the opportunity to testify in support of House Bill 1408. 

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Last Updated On

March 14, 2017