Commissioned With Change : An Interview With HHSC Commissioner Cecile Erwin Young
By Amy Lynn Sorrel

April_22_TM_Profile_HHSC

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
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Last Updated On

May 01, 2022

Originally Published On

March 31, 2022

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