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. The effects of the COVID-19
public health emergency (PHE) coupled with new legislation on telehealth,
maternal and child coverage, and evolving care delivery and payment models mean
“lots of changes are underway with new policies being implemented,” she said. Texas
Medicine followed up on that conversation with Commissioner Young. Here are
excerpts from the email interview.
How are you planning for
the end of the PHE?
HHSC’s goal is to
redetermine eligibility quickly for those whose coverage has been sustained due
to the PHE. When the federal government allows states to end continuous
Medicaid coverage, HHSC will conduct a new eligibility determination for people
whose Medicaid benefits have been maintained during the PHE. It’s important to
note that a person’s Medicaid coverage will be maintained until HHSC has
redetermined their eligibility, even after the PHE has ended. This
redetermination will include reviewing all available data, ensuring recipients
have the opportunity to provide any necessary additional information to verify
eligibility, and evaluating eligibility for other HHSC programs. Once a final
determination is made, [patients] will receive an official notice providing
information about their Medicaid eligibility and instructions on how to appeal
the eligibility decision if they think the decision is wrong.
Physicians can assist by reminding [patients] to
provide HHSC with their most up-to-date information. This includes providing us
with their current address, income or resources, or any household changes. It’s
also very important physicians continue to remind patients and their families
to complete and return any requests from HHSC during the coming weeks and
months and submit their Medicaid renewal packets in a timely manner.
An estimated 350,000
Texas children are eligible for but not enrolled in Medicaid. How can Texas
increase enrollment?
Applicants can submit
applications in person at any of the 240 eligibility offices across the state
or they can apply by mail, fax, or online at YourTexasBenefits.com.
Additionally, HHSC works with locally based community organizations such as
food pantries, food banks, health clinics, community centers, schools,
churches, and other similar groups through the Community Partner Program to
help Texans apply for and manage their food, cash, and health care benefits.
Local Community Support Specialists collaborate with community partners through
support visits and provide information about HHSC benefits programs at
community events. The Community Partner Program is involved in initiatives such
as the Texas Education Agency Community Partnership Grant, which provides funds
to schools [that are] in underserved neighborhoods and have high percentages of
underperforming students. The program also partners with grantees of the
Children’s Health Insurance Program Reauthorization Act that provide outreach
and application assistance for Medicaid.
What is the status of
House Bill 133 (six months’ Medicaid postpartum coverage) and implementation of
the six months’ continuous eligibility provision within House Bill 2658?
The Centers for
Medicare and Medicaid Services (CMS) requires a waiver to implement HB 133
because the length of the certification period for Medicaid for Pregnant Women
required by state statute is different from the amount required by federal law.
HHSC is currently developing the [waiver amendment] to implement this change
and plans to submit it to the CMS for approval this spring.
As required by HB 2658, HHSC is working to reduce
periodic income checks for Children’s Medicaid and to allow households 30 days
to provide requested verification. We are working on IT system changes to comply
with this law, and we anticipate [patients] will receive the new form (H1020)
with the new 30-day due date by this summer. [Meanwhile] periodic income
checks are suspended during the COVID-19 public health emergency. The timing
for the new process may change if periodic income checks remain suspended due
to the COVID-19 public health emergency.
Can you highlight some
of HHSC’s initiatives aimed at improving maternal and child health?
HHSC continues to
strengthen the services and coordination between Medicaid for Pregnant Women
and the Healthy Texas Women (HTW) program.
HB 133 also
requires HHSC to include HTW and Case Management for Children and Pregnant
Women in managed care. This September, managed care organizations (MCOs) will
start reimbursing Case Management for Children and Pregnant Women providers.
Providing HTW through managed care will help improve continuity of care for
women transitioning between Medicaid programs. To promote this goal, MCO
provider directories for pregnant women will also be updated by this summer to
identify providers who are also enrolled in HTW. This will help women choose
providers while they are pregnant and beyond. We are also strengthening MCO
service coordination requirements for women with high-risk pregnancies.
HHSC continues to
recruit providers for HTW Plus postpartum services, targeting cardiologists,
social workers, counselors, psychologists, psychiatrists, and substance use
disorder treatment providers. We continue to await CMS approval for the HTW
Plus waiver amendment that was submitted in December 2020. We appreciate the
input we received from TMA and other stakeholders to inform these changes.
As part of the
Texas HHS Maternal Depression Strategic Plan (tma.tips/maternaldepression), we
are working to ensure maternal mental health professionals in our Medicaid and
HTW provider directories are clearly identified. We’re also developing
standardized referral processes for women who screen positive for postpartum
depression, including identifying ways Medicaid health plans can support
connecting women with treatment.
HHSC is also participating in two affinity groups
sponsored by the Center for Medicaid and CHIP Services at CMS, Improving
Postpartum Care and Infant Well-Child Care. The Postpartum Care affinity group
seeks to improve the postpartum care visit rate and quality of care for
Medicaid and CHIP beneficiaries. And the Infant Well-Child affinity group aims
to improve the use and quality of well-child visits for Medicaid and CHIP
beneficiaries ages 0 to 12 months. By participating in the group, we can share
knowledge with other states and MCOs to promote best practices in postpartum
and infant well-child care over the next year.
What steps is HHSC
taking to help patients obtain behavioral health services, a heightened need
during the pandemic?
There are
flexibilities in place to allow some [Medicaid and CHIP] services via
telehealth including mental and behavioral health services. In response to
House Bill 4 passed last session, HHSC is currently assessing many services in
Texas Medicaid, including behavioral health services, to determine the cost and
clinical effectiveness of permanently allowing telehealth. Any changes to
applicable policies and rules are scheduled to be implemented by Sept. 1, 2022.
Interim guidance will be provided on the Medicaid and CHIP Teleservices webpage
(tma.tips/Medicaidteleservices) in early 2022.
HHSC staff has drafted a new Medicaid medical
policy for the Collaborative Care Model, in response to Senate Bill 672. The
Collaborative Care Model is a systematic approach to the treatment of
behavioral health conditions in primary care settings. These services are
benefits of Texas Medicaid clients of all ages who have a mental health and/or
substance use condition, including a pre-existing or suspected mental health or
substance use condition. With this approach, we anticipate enhanced access to
services, improved quality of care, and improved health outcomes. The Medicaid
policy will be implemented early this summer.
Shortly after the pandemic began, Texas HHSC
quickly launched the first-of-its-kind statewide COVID-19 Mental Health Support
Line and text chat helping Texans experiencing anxiety, stress, or emotional
challenges due to the pandemic. More than 20,000 calls have been made to HHSC’s
[hotline] since its inception in March 2020.
TMA has supported the
Medicaid 1115 Transformation Waiver but has concerns it doesn’t address
meaningful coverage for uninsured Texans, and focuses on hospitals and large
health systems versus community physicians. Your response?
Changes to eligibility
and coverage would require legislative approval. Our focus is on securing
stability for the current Texans in Medicaid and preserving Texas’ health care
delivery system through the continuation of the 1115 waiver and securing
approval of the [new] proposed directed payment programs.
As a part of the
goal for a sustainable and stable Medicaid program, our team worked with
stakeholders to design the Texas Incentives for Physicians and Professional
Services and Rural Access to Primary and Preventive Services [directed payment]
programs in ways that would be more inclusive of community physicians and rural
health clinics. These programs represent a meaningful move in the right
direction. While we don’t have approval of these programs yet, we have just
concluded public hearings regarding quality measures for our next fiscal year.
Physicians have not
received an enduring Medicaid payment increase in more than a decade, on top of
financial strains during the pandemic. How is this being addressed?
HHSC scheduled a webinar for Feb. 7 to get
feedback from providers on the Budget Rider 29 study design and plans to use
that input to guide the research that will be conducted for the report that is
due at the end of the year. (Budget Rider 29 directs HHSC to conduct a study on
the impact of increasing physician Medicaid payments for services provided to
children ages 0-3.) There will be two follow-up webinars (likely late
spring/early summer) – one to present preliminary findings and receive
feedback, as well as one to present the final report and findings. HHSC plans
to make available to the legislature, consistent with our practice each
biennium, rate tables that identify the fiscal impact of a 1 percent rate
increase for various provider types as well as the fiscal impact to reimburse
rates at the methodologically supported rate.
Tex Med. 2022;118(3):44-45
April 2022 Texas Medicine Contents
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