Reforming Medicaid: A program that impacts one in every nine Texans

About one in every nine Texans relies on Medicaid for health insurance or long-term care support.

The jointly funded federal-state health care program primarily serves low-income families non-disabled children related caretakers of dependent children pregnant women elderly and certain people with disabilities.  In Texas the federal government funds approximately 61 percent of the cost of the Medicaid program which annually costs Texas taxpayers $17.9 billion.

Although Medicaid is a program for uninsured Texans those who have health insurance are impacted by those who don’t.  With health care costs continuing to increase Texas legislators knew that something had to be done to contain Medicaid costs while still providing needed health care to eligible Texans.

This year during the 80th Legislative Session we passed Senate Bill 10 a Medicaid Reform Bill that changes the face of Medicaid in Texas by focusing on prevention and individual choice.  The bill also contains provisions for better planning modernizing services and reducing the state’s number of uninsured Texans.

I am happy to report that a major provision of Senate Bill 10 requires the Health and Human Services Commission to develop and implement a pilot program under which Medicaid recipients are provided positive incentives to lead healthy lifestyles.  In the pilot program the commission may for example expand health care benefits to Medicaid recipients who quit smoking or lose weight.

Preventive health care should help cut down on visits to the emergency room which is the most expensive type of healthcare delivery.  Inappropriate emergency room visits significantly increase acute care costs.

Senate Bill 10 creates customized benefit plans that are tailored to an individual’s health care needs.  For example women beyond childbearing age do not need a plan that includes obstetrics; however it does expand access to breast and cervical cancer screenings and treatment for women who are Medicaid recipients.

The bill also expands the effort to stop fraud and abuse and standardizes how hospitals report uncompensated care.  This provision is especially important.  In 2005 the Health and Human Services Committee announced that more than $441 million had been recovered as a result of fraud investigations.

As you may guess any bill that addresses a combined federal and state program is lengthy and filled with legalese.  The bottom line of the bill is basically threefold.

It begins a step-by-step process to reduce the cost of Medicaid.  It requires the state to deliver services more cost-effectively while ferreting out those who would abuse the system and it will encourage Medicaid-eligible Texans to make personal lifestyle choices that will both reduce their reliance on taxpayer-funded programs and help them live longer healthier lives.