By DIANE XAVIER
The Dallas Examiner
When it comes to health care, the state of Texas lags behind many other states in the U.S.
In fact, Texas has the nation’s highest rate of residents without health insurance, according to statistics gathered from the Texas Comptroller’s office.
Furthermore, the number of Texans with no health insurance sits at 18.4%, which is twice the national average of 9.2%, recent data released by the U.S. Census in 2019 revealed.
In order to take a proactive role in addressing these issues, the Texas Health and Human Services Commission held a public hearing online and in person at U.T. Southwestern June 2 on the state’s proposed Medicaid funding request to the federal government, known as the 1115 Texas Healthcare Transformation Quality Improvement Program Waiver Extension Application.
The public hearings came after President Joe Biden’s administration reversed the Donald Trump Administration’ extension of Texas Medicaid funding in April that was pushed through at the last minute without public input. As part of the extension application, federal law requires that the state of Texas must collect public comments on the issue and submit them in their application. The meeting in Dallas was one of three statewide meetings being held.
Brittani Bilse, facilitator and director of the 1115 Waiver Strategy for the Texas Health and Human Services Commission, hosted the presentation.
The state hearings, in response to the 1115 Waiver Texas Healthcare Transformation and Quality Improvement Program, summarized that Texans are in support of Medicaid expansion. The application requests funding to reimburse hospitals for emergency care provided to uninsured Texans, and to offset uninsured services provided by local health departments and mental health authorities. However, the state’s proposal does not include funding for actual health care coverage for uninsured Texans.
“This is about Texas Medicaid announcing our intent to file an extension application with the Centers for Medicare and Medicaid Services regarding the 1115 Transformation Waiver,” Bilse said. “Since 2011, the 1115 Transformation Waiver has provided the authority under which Texas Medicaid has sought to improve our delivery system in Medicaid managed care which includes programs such as STAR, STAR PLUS, STAR Kids and the Children’s Dental Program. We have over 4 million people who have Medicaid in Texas. Over 95% are in Medicaid Managed Care. This is a significant program that impacts a significant number of beneficiaries.”
Bilse said that in the last 10 years, Texas Medicaid has sought to increase and enhance accountability with the state’s Medicaid Managed Care partners.
“Texas has implemented initiatives to improve managed care organization’s accountability for quality of care such as the Medical Pay-for-Quality program, Dental Pay-for-Quality program, Performance Indicator Dashboards, and with sources such as the MCO Report Cards and ‘Secret shopper’ monitoring of provider access and availability,” she said. “Texas is taking the necessary steps and taking the necessary steps through district transition and our work there to secure a sustainable program through the transition while also responding to COVID-19 without the terms previously negotiated a fiscal cliff of nearly $3 billion has reemerged.”
Bilse then talked about the great work that the waiver has provided from December 2011 through September 2016 according to research conducted by the Texas Health and Human Services.
The waiver has provided an increase in access to care for the STAR, STAR+PLUS program, increased utilization of STAR, STAR+PLUS and increased care coordination for STAR+PLUS. It also reduced hospitalizations for STAR, STAR+PLUS recipients and reduced potentially preventable hospitalizations, according to the data provided.
“For the renewal evaluation from January 2018 through September 2022, we saw increased access to care for areas in adoption assistance, Children’s Medicaid Dental Services, Medicaid for Breast and Cervical Cancer, Nursing Facility, STAR Kids and also increased care coordination for the Former Foster Care Children and STAR Kids,” she said. “It also increased quality of care for Nursing Facilities, STAR Kids and provided improved health outcomes for Children’s Medicaid Dental Services, Medicaid for Breast and Cervical Cancer, and Nursing Facilities, and STAR Kids. Finally, it increased client satisfaction for the STAR Kid program.”
Bilse said that Texas Medicaid is now seeking an extension of the waiver.
“HHSC will continue to advance the goals of the waiver under this extension and align new programs with overall Medicaid,” she said. “The terms of 2020 finalized the end of the delivery system for performance and payment programs. It ends on Sept. 30, of 2021. In preparation for this, Texas Medicaid has launched six directive payment programs and requested approval of these through the Centers for Medicaid and Medicare Services.”
Those requested programs include the Comprehensive Hospital Increased Reimbursement Program that seeks $5,020,000,000; the Quality Incentive Payment Program that seeks $1,100,000,000, the Texas Incentives for Physicians and Professional Services that requests $600,000,000; the Rural Access Primary and Preventive Services, of which $18,700,000 is needed; the Ambulance Average Commercial Reimbursement Program that seeks $150,000,000 in funding; and DPP for Behavioral Health Services that seeks $165,575,152.
“So the terms that were agreed to in January of 2021 included a district transition program related to public health providers,” Bilse said.
The district transition program is called the Public Health Provider Charity Care Program
“The Public Health Providers Extension creates the Public Health Provider Charity Care Program and this begins on Oct. 1, 2021 which looks to offset costs associated with care; including behavioral health, immunizations, chronic disease prevention and other preventive services for the uninsured,” she said. “This is only for public providers only and is financed by certified public expenditures. In year one and two, there will be up to $500 million in funding.”
Bilse said there are many benefits to having the waiver extended.
“This includes a potential of $11.4 billion per year on average and includes $3.9 billion per year for payments for uncompensated care,” she said. “It saves an estimated $10 billion in taxpayer funds over the life of the waiver.”
Many attendees of the meeting both virtually and online were in support of the initiative.
Steve Love, president and CEO of Dallas-Fort Worth Hospital Council, which represents about 90 hospitals in the area, said his organization is in full support of the Texas HHSC efforts to expand Medicaid coverage.
“We are certainly in favor of this extension waiver,” Love said. “One in five Texans has no health insurance. So when you walk down the street, every fifth person has no health insurance. We need comprehensive coverage. We need a robust uncompensated care program. This waiver extension will certainly help and we need Medicaid expansion as well. Why is this? So you can have a healthy workforce.”
Ruth Torres, a community activist, spoke about the lives lost due to those Texans that were uninsured.
“I also support this because of 51,689 reasons, that’s the number of deaths in the state of Texas,” Torres said. “We know that people of color are disproportionately represented in these numbers. And a great deal of these numbers were their vulnerability to death increased because of preexisting conditions. Again, 51,689, that’s the number of reasons why to pass and improve the access to medical care for all Texans. Also, I want to address the vision issue. Due to COVID-19, kids are on the computer more due to online classes and it has increased the need for glasses. It is a problem and so are the mental health issues that COVID brought. We need to be prepared for the long term. Also, with the recent passage in the Texas legislature that limits abortions with the HeartBeat bill, that means more women are going to get pregnant which then means more women need access to health care or medical care that they would otherwise not have had.”
The other public hearings regarding the state’s request for Medicaid funding expansion take place June 10 online only at 9 a.m., June 15 in-person in Austin and virtually at 10 a.m. Anyone interested in participating can visit https://www.hhs.texas.gov.