Related Stories

Coming Unwound: Mass Disenrollments Hurt Patients and Physicians Alike - 11/02/2023

The end of continuous Medicaid eligibility has led to mass disenrollments, hurting patients and physicians alike.

TMA Asks AMA to Stay Out of Affordable Care Act Suit - 05/02/2023

Leaders of the Texas Medical Association on Tuesday publicly objected to the American Medical Association’s plans to get involved in a high-profile federal lawsuit — filed in Texas — challenging the constitutionality of the Affordable Care Act.

Surprise Billing Rules Garner More Legal Action - 02/10/2023

Pressure is mounting on federal authorities with several legal actions now aiming to stop what physicians and hospitals say is an unfair arbitration process outlined in rules implementing the No Surprises Act, legislation passed in 2020 to address surprise medical bills.

Medicaid Extends Reenrollment Time Frames - 08/09/2022

To help manage a backlog of revalidation applications stemming from the transition to Medicaid’s new Provider Enrollment Management System (PEMS), the state’s Medicaid claims payment contractor announced it will extend revalidation timeframes for physicians and other health care practitioners and suspend disenrollments related to that process.

Private Health Plans Must Cover Women’s Obesity Counseling, Other Preventive Services - 04/05/2022

Starting next year, private health plan policies that began after the Affordable Care Act (ACA) went into effect now will have to cover multiple types of prevention counseling for women, as well as contraceptive care, double electric breast pumps, and more.

Tell Your Uninsured Patients About HealthCare.gov Marketplace Enrollment - 11/19/2021

Enrollment in the federal health insurance marketplace on HealthCare.gov is now open, so it’s a good idea to let your uninsured patients know the option is there. And if they sign up by Dec. 15, their coverage will begin at the start of 2022.

Enrollment for Marketplace Plans Extended by One Month - 09/24/2021

The Biden-Harris administration has announced a 30-day extension of the upcoming open enrollment period for federal marketplace health plans available through HealthCare.gov, as well as a new monthly special enrollment period targeting people with low incomes.

Remind Uninsured Patients: ACA Enrollment Ends Aug. 15 - 07/21/2021

The Texas Medical Association encourages physicians to remind uninsured patients to take advantage of the Affordable Care Act’s (ACA) Special Enrollment Period , which has been extended to Aug. 15 in response to the COVID-19 pandemic.

CMS Finalizes Lower-Than-Proposed Cost-Sharing for Marketplace Plans; Enrollment Closes Aug. 15 - 06/17/2021

The Centers for Medicare & Medicaid Services (CMS) has settled on a lower maximum for consumers’ out-of-pocket costs for federal health insurance marketplace plans in 2022 than what the agency proposed last November.

CMS Working to Improve Enrollment in ACA Marketplace Health Plans - 04/26/2021

More federal resources will be available next year to help uninsured Texans gain access to health coverage through the Affordable Care Act (ACA), the Centers for Medicare & Medicaid Services said last week.

Far-Reaching Implications: The Ripple Effects of Texas' Uninsured Rate - 12/04/2019

Data compiled by the Texas Medical Association and other organizations, as well as physicians’ own anecdotal experiences, show how 5 million uninsured patients in Texas become 5 million dominoes. As they fall, so do countless others representing the health of Texas: The economy and well-being of entire communities. The classmates and friends of uninsured children. And yes, the physicians who deal with the burdens of treating uninsured patients in emergency rooms and providing uncompensated care.

Open Enrollment 2020: Be Prepared for Coverage Changes - 11/13/2019

You’re probably already aware that open enrollment for commercial health insurance plans, including those on the Affordable Care Act Exchanges, opened Nov. 1 and will run through Dec. 15. While some patients won’t make any changes to their coverage, others will make significant changes, including enrolling with a completely different health plan.

Big Noises Big Issues: Health Care Takes Center Stage One Year Out From 2020 Election - 11/11/2019

One year from now, Texas voters will hit the polls. They’ll be voting for president, for Congress, and for seats in the Texas Legislature. At the state and national levels, health coverage, Medicaid access, and prescription drug costs have gotten plenty of attention already, and they’ll get plenty more between now and the closing of the polls on Nov. 3, 2020. Here’s a look at some of the major health care debates taking center stage during the 2020 election cycle, what voters are and will be hearing about, and what Texas Medical Association policy says on those particular issues.

ACA Ruling An Opportunity to Improve Health Care Access - 12/19/2018

The Texas Medical Association believes a Texas federal judge’s recent ruling that the Affordable Care Act (ACA) is unconstitutional provides a bipartisan pathway to strengthen access to health care and provide coverage for the 4.5 million Texans without health care coverage.

Guidelines for Medicaid Radiology Prior Authorization - 05/03/2018

Texas Medicaid requires prior authorization for outpatient diagnostic radiology services. Follow these guidelines to help you sail through the process.

When Patients Don’t Pay Their Premiums in the ACA Marketplace - 04/17/2018

Will physicians have to refund payments to an insurer if a patient who bought coverage from that insurer in the Affordable Care Act marketplace doesn’t pay his or her premiums?

Analysts: Ending ACA Cost-Sharing Payments to Affect Middle Class - 12/05/2017

The Trump administration made a splash in October by announcing an end to government subsidies that help insurers provide discounts to low-income enrollees in the Affordable Health Care (ACA) marketplace. However, analysts say it won't be low-income people who will feel a financial hit from President Donald Trump's decision on the cost-sharing reduction (CSR) payments. Instead, people with higher incomes pick up the tab, analysts said.

Purchasing Insurance Across State Lines - 05/25/2017

The Affordable Care Act, signed by the President in 2010, actually provides for the sale of health insurance across state lines. States may form interstate compacts that would allow states in those compacts to sell qualified health plans to purchasers in other states in the compact.

Can I Pay My Patient’s ACA Premium to Ensure Coverage? - 03/30/2017

If I receive notice that patients who are covered by a health plan in the Affordable Care Act exchange are within the three-month grace period for paying their premiums, may I just pay their premiums to make sure they have coverage while I provide services?

Health Care Coverage for Low-Income Texans - 02/03/2017

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.