P.O. Box 12068, State Capitol
Austin, Texas 78711
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MEDICAID REFORM PASSES TEXAS HOUSE
AUSTIN -- The Texas House of Representatives today approved SB 10 by State Senator Jane Nelson, R-Lewisville, reforming Medicaid and helping to reduce the rate of Texans without health insurance. The House also today approved SB 23 by Senator Nelson, establishing TexLINK, an office tasked with connecting Texans to available health plans.
"This legislation lays the foundation for a new approach to health care for the poor, the fragile and the uninsured," Senator Nelson said. "It expands our efforts to assist with premiums for the uninsured, discourages inappropriate visits to the emergency room, and focuses heavily on preventive health, which will help contain our acute care costs over the long term and, more importantly, help Texans maintain good health."
SB 10 and SB 23 were amended and will have to return to the Senate for concurrence or to appoint a conference committee before going to the governor's desk.
SB 10 provisions relating to Medicaid patients:
- Rewards Medicaid patients who complete smoking cessation, weight loss and other preventative health programs;
- Encourages Medicaid managed care plans to enroll patients in "value-added" preventative health services;
- Creates customized benefit plans that are tailored to a patient's individual health care needs;
- Creates a pilot program for Health Savings Accounts under Medicaid, which would be completely optional;
- Expands the effort to assist with the cost of premiums for those who are Medicaid-eligible but have access to employer-based plans;
- Allows individuals to voluntarily opt out of Medicaid in exchange for the state paying the employee's portion of premiums for employer-based coverage;
SB 10 provisions relating to Medicaid costs:
- Expands efforts to stop fraud and abuse;
- Authorizes co-pays for non-emergency visits to hospital emergency rooms, providing that there are alternative health care options available;
- Standardizes the way hospitals report uncompensated care to eliminate guesswork involved in the state's cost projections;
- Evaluates possible expansion of integrated care management to areas where it is currently unavailable;
SB 10 provisions relating to the uninsured:
- Develops a "3-Share" or "Multi-Share" model in which the state can partner with employers and local governments or charitable entities to connect Texans with health coverage;
- Creates a committee to recommend incentives for more employers to offer health and long-term care insurance;
- Establishes a low income funding pool that could be used to set aside a portion of federal uncompensated care dollars to connect low-income families with private health care.
- SB 22 by Senator Nelson creates a Long Term Care Partnership, which rewards seniors who obtain long-term care insurance by protecting some of their assets in determining eligibility for Medicaid.
- SB 23 by Senator Nelson establishes TexLink, an office at the Texas Department of Insurance that will work to educate major employers, small businesses and citizens about available health insurance plans in Texas.
Fast Facts on Medicaid & the Uninsured:
- Number of Texans covered by Medicaid: 3.7 million;
- Ratio of children covered: One in three;
- Total Medicaid costs annually: $17.9 billion;
- More than half of those costs are associated with hospitals ($5.8 billion), prescription drugs ($2.4 billion), and nursing homes ($1.8 billion);
- Percentage of Texans without health insurance in 2004: 25 percent;
- Texas ranking among states on percentage of population uninsured in 2004: 1st.
SENATOR JANE NELSON represents District 12, which includes parts of Tarrant and Denton counties. She is Chairman of the Senate Health & Human Services Committee.