Archived Story
Aug/27 opi. Efficiency is aim of Medicaid system
#The number one criterion of the Texas Legislature in restructuring the
Medicaid pro-
gram is to improve and maintain the health of all Texans. The tool to
accomplish this reformation is a series of bills we passed this past session.
Texas is seeking waivers of certain federal regulations through legislation to
conduct a five-year demonstration project. We are submitting the Medicaid 1115
waiver to implement the State of Texas Access Reform or STAR program, a
statewide health care reform program that will replace much of Medicaid. The
deadline for the waiver is Aug. 31, 1995, and it must be approved by the
governor.
STAR clients will have access to Managed Care Organizations (MCOs),
which will be similar to Health Maintenance Organizations (HMOs), and
Intergovernmental Initiatives (IGIs), which are cooperative arrangements
between local government entities in which local dollars are matched with
federal Medicaid dollars. IGIs are responsible for management of the delivery
system.
Although Medicaid in our state has grown to a multi-billion dollar
program, with costs for fiscal years 1996-1997 expected to rise to $17
billion, our state and local public health care delivery systems are
fragmented and inefficient. Texas has the third largest percentage of
residents with no health insurance coverage in the country. In the Rio Grande
Valley, more than 50 percent of our residents live in poverty, and 60 percent
live at 150 percent of the Federal Poverty Level (FPL). A single person with
an income of $11,205 or below is considered living at 150 percent of the FPL,
while a family of four with an income of $22,725 or below is also at this
level.
Currently, many of our poor rely on county indigent health programs to
obtain health services through costly hospital emergency rooms. Eligibility
for Medicaid is based on the Aid to Families with Dependent Children (AFDC)
income guidelines, which exclude all but the very poorest Texas residents. And
even Texans eligible to receive Medicaid services often experience difficulty
in finding a physician to see them. Since doctors are often reluctant to care
for Medicaid clients, many are left with little or no preventive and primary
care.
Through the Medicaid waiver, we plan to increase our county dollars by
combining them with state and federal funds to ensure early, more appropriate
care and improve health care coverage. For example, local funds spent on
emergency room care could be used for health care prevention, which promotes
overall better health and much less expense. This restructured Medicaid system
would provide better access to services and a continuum of care, and it should
reduce the rate of increase in state and local expenditures.
The waiver will retain the Medicaid eligibility for pregnant women and
infants. This means that pregnant women or children can receive Medicaid if
they live at 185 percent of the FPL. Children from the ages of 1 to 18 living
at 133 percent of the FPL could qualify for Medicaid.
One debate right now, which must be resolved before the deadline for filing
the waivers, is whether to provide Medicaid to adults living below 45 percent
of the FPL or those below 75 percent of the FPL. Currently only adults who are
pregnant or are aged, blind, or disabled and are on Supplemental Security
Income (SSI), which is less than $478 a month, can receive Medicaid. Extending
the benefits to adults living at 45 percent of the FPL would mean health care
for 800,000 people, and at 75 percent of the FPL 1 million adults would become
eligible. Members of the Health and Human Services Committees of both
Legislative Chambers have requested that the adult rating be changed to 75
percent.
In addition to the debate over the 45 percent and 75 percent rating is the
decision on whether to expand benefits at all. Texas is making an effort to
reform its Medicaid system so that it becomes more efficient and saves more
people; however, we must await the outcome of the federal debate over
Medicaid.
#/(Eddie Lucio Jr. of Brownsville serves in the Texas Senate.)/
