Medicaid Reform
Health Opportunity Pool Trust Fund
Senate Bill 10, 80th Legislature, Regular Session, 2007, authorizes the Health and Human Services Commission (HHSC) to seek a federal waiver to create a Health Opportunity Pool Trust Fund to increase health coverage options for low-income Texans.
Goals of the Health Opportunity Pool Trust Fund
The Health Opportunity Pool Trust Fund would be administered by HHSC on behalf of state residents without private health insurance and health-care providers providing uncompensated care. The trust fund is intended to:
- Increase the number of Texans with health coverage.
- Protect Texas’ safety net by compensating health-care providers for a portion of their uncompensated care costs.
- Reduce the need for uncompensated care by using subsidies to help uninsured Texans obtain health care coverage.
- Protect at-risk federal funds now providing supplemental payments to Texas hospitals.
- Maintain and enhance the community public health infrastructure provided by hospitals.
The Health Opportunity Pool Trust Fund will improve Texas’s investment of health-care dollars by emphasizing primary and preventive health care for uninsured Texans rather than more costly treatments later
Trust Fund Uses
HHSC will develop an allocation methodology for allocating trust funds for:
Premium subsidies for the uninsured: HHSC and the Texas Department of Insurance will develop a premium payment assistance program to help uninsured Texans purchase health coverage . The agencies are working to identify eligibility criteria, the amount of assistance that will be provided, how assistance will be paid, and a way to measure the number of people who obtain health insurance or other coverage through the program. HHSC will implement the premium payment assistance program subject to the availability of money in thetrust fund.
- Uncompensated care funds: Hospital or political subdivisions that provide uncompensated care can receive funds to cover part of their uncompensated care costs if they use a portion of the funding to to reduce the need for uncompensated care. Strategies that may be used includefostering improved access to primary care systems or other programs that offer medical homes including:
- Regional or local programs providing primary and preventive care through a medical home (e.g. three-share or multiple-share programs).
- Programs that provide premium subsidies for health coverage.
- Programs to increase access to benefits coverage.
Infrastructure improvements and support : Up to 10 percent of the money not used for uncompensated care may be used for developing and implementing initiatives to improve local provider networks for Medicaid recipients and low-income Texans. These may include developing and implementing a system for maintaining electronic medical records.
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