Medicaid Reform

1
Medicaid Reform

• Health Human Services Commission Council
• Maureen Milligan, Deputy Chief of Staff
• April 10, 2008

2
Status Texas Proposal

• Waiver submission this month.
• HHSC has determined that a phased approach would
  not provide sufficient level of consumer choice
  and could impede the ability to implement more
  comprehensive reforms for all low-income Texans.
• State will lay out an alternative implementation
  approach, offering subsidies to all uninsured
  adults to purchase market-based insurance and
  coverage options.
• Reform goals remain the same
• Improve the efficiency of Texas health care
  investment, reducing the number of uninsured,
  focus on keeping Texans healthy, and establishing
  an infrastructure to accomplish reform goals.
• Provide subsidies to uninsured adults once an
  independent administrative capability is
  procured estimated in 2011
• Subsidies would be used for Employer Sponsored
  Insurance (ESI), or a choice of market-based
  insurance and coverage options.

3
Key Elements for Reform

• Provisions to allow greater flexibility in the
  use of federal funds to support prevention,
  individual choice and the broader range of state
  and federal health policy goals.
• Premium subsidy program funded through the Health
  Opportunity Pool (HOP) that allows low-income
  Texans to access qualifying ESI, or when not
  available, to use towards the purchase of an
  affordable insurance.
• Programs will include blending funding options,
  from Medicaid, CHIP and HOP to help low-income
  Texans buy into employer sponsored coverage.

4
Key Elements for Reform

• Grants to support innovative local programs to
  expand access to health coverage, reduce
  uncompensated care costs, and develop the
  infrastructure to support other health care
  reforms.
• Establishment of new requirements to enable
  data-driven state health, uncompensated care,
  public health, and insurance policy development
  through
• Hospital uncompensated care cost and financing
  reporting requirements and
• Creation of new uncompensated care claims
  submission requirements.

5
Summary of Health Care Reform in Texas

• Using funds and funding flexibility sought for
  the Texas Health Opportunity Pool (HOP) will
  begin transforming health care for the uninsured
  by
• Reducing the heavy reliance on fragmented and
  costly hospital-based uncompensated care services
• Supporting a coordinated, locally-integrated care
  approach
• Providing new subsidies to provide access to
  affordable market-based insurance and other
  coverage options with an emphasis on primary and
  preventive care
• Texas will pursue parallel initiatives designed
  to
• Better understand and analyze uncompensated care
  in Texas
• Create and leverage existing program approaches
  to reduce uncompensated care
• Improve health system coordination and
  integration

6
Next Steps and Information

• HHSC will submit federal waiver request to CMS
  later this month
• HHSC will continue to provide regular updates
  throughout the waiver process
• For more information
• Sign up for updates and notification at
  www.hhs.state.tx.us.
• Visit our website at http//www.hhs.state.tx.us/me
  dicaid/reform.shtml
• For questions Email medreform_at_hhsc.state.tx.us