Legislative Priority #3: Medicaid Payment Increases
By Sean Price Texas Medicine January 2023


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Goal: Help physicians enhance their Medicaid panels and improve access to care with targeted payment increases 

Impact: Broad Medicaid rate increases remain unlikely this session, as lawmakers continue to balk at additional spending on the program – one of the state’s largest budget expenditures, says Texas Medical Association lobbyist Caitlin Flanders.  

However, targeted payment increases are quite possible, says pediatric cardiologist Hanoch Patt, MD, a member of the TMA’s Committee on Medicaid, CHIP, and the Uninsured.  

Texas physicians have not seen an increase in their Medicaid payments in more than a decade, except for a brief, temporary one that took place in 2013-14 under the Affordable Care Act. Those low Medicaid rates have had a direct impact on patient care, Dr. Patt says: They drive down the number of Texas physicians who are able to accept Medicaid patients, and those physicians who do accept them may be forced for economic reasons to take fewer of them. 

“Combining that with the increase in the cost of staffing and overall increasing costs for physician practices, it makes it really difficult to care for Medicaid patients,” he said. 

There appear to be some bright spots this session to ameliorate that problem for certain patient populations. Strong support exists to improve Medicaid coverage for women who have just delivered. (See “Priority: Medicaid Coverage for Women and Children,” page 18.) Also, pediatric services hold a lot of promise for a payment increase because they have three factors going for them. 

First, the Texas House of Representatives in 2019 passed a bill that would have increased payments for the care of children aged 0-3. The Senate stopped the budgetary increase, opting instead to commission a report on the subject (tma.tips/2022PediatricReport). 

Second, Texas’ elected leaders understand that the U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, which triggered additional abortion restrictions under Texas law, will lead to an increase in pregnancies and young children over time, Dr. Patt says. 

Third, the Texas Health and Human Services Commission (HHSC) has, in fact, requested higher pediatric payments in its 2024-25 budget ask – an extremely rare occurrence, says Helen Kent Davis, TMA’s associate vice president of governmental affairs. Texas saw a 26% increase in pediatric enrollment in Medicaid under the COVID-19 public health emergency because of relaxed eligibility measures, she adds. 

HHSC’s move serves as important recognition by the state “that rates are simply too low,” Dr. Patt said. 

Achieving a pediatric payment increase would be an important first step because it would improve access to care for these young Medicaid patients and could potentially smooth the way for future rate increases for other types of medical care, he says. 

“It’s important for [physicians] to achieve what we can to start working on rate increases that will improve access to care and outcomes for these patient populations. We can go back and broaden those rate increases to other populations over time,” he said.

Last Updated On

January 09, 2023

Originally Published On

December 21, 2022