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Health Care and Medicaid Reform

Senate Bill 10, passed by the Texas Legislature and signed by Gov. Rick Perry, sets the stage for a comprehensive package of Medicaid reforms designed to increase the percentage of Texans with health care coverage, focus on prevention and emphasize individual choice. The reforms will transform Texas’ health care infrastructure, optimize health investments and provide affordable coverage options for uninsured Texans.

Texas Health Care Reform Goals
Senate Bill 10 Highlights
Next Steps and Timelines
Medicaid Reform Legislative Oversight Committee
Presentations
Research Papers
Reports and Related Documents
Medicaid Reform Contact Information

Waiver Request

HHSC submitted a waiver request to the Centers for Medicare & Medicaid Services on April 16, 2008. The waiver request outlines the state’s plan to expand health coverage options in the state, reduce reliance on expensive emergency room visits for basic care, and make it easier for the working poor to buy into employer-sponsored coverage.

Waiver request status: In September 2008, HHSC began meeting with federal officials to discuss high level principles and key components of the Texas waiver request for health care reforms.  During the negotiations, HHSC has committed to implementing comprehensive reform sooner – including making subsidies available by the end of the first year of the waiver. [Update on waiver status]

Senate Bill 10 Highlights

• Senate Bill 10 Sets Stage for Health Care Reform
• Health Opportunity Pool Trust Fund
• Uncompensated Care Hospital Reporting and Analysis
• Tailored Benefit Packages
• Multi-Share Coverage Options for Texas Communities

Next Steps and Timelines

HHSC submitted a waiver request to the Center for Medicare & Medicaid Services on April 16, 2008. [Timeline]

Medicaid Reform Legislative Oversight Committee

A Medicaid Reform Legislative Oversight Committee is established in Senate Bill 10 to facilitate the reform efforts.  The Committee is composed of four members of the Senate and four members of the House of Representatives.  Information about the Committee’s meetings will be included on this website.

Presentations

• Presentation to the HHSC Public Stakeholder Forum (May 12, 2008)
• Presentation to the HHSC Council (April 10, 2008)
• Presentation to the HHSC Public Stakeholder Forum (March 10, 2008)
• Presentation to the Senate State Affairs Committee (March 26, 2008)
• Medicaid Reform Legislative Oversight Committee Meeting (February 20, 2008)
• Texas Medicaid Reform Informational Meeting (February 8, 2008)
• Presentation to the HHSC Council Subcommittee on Medicaid Reform (February 4, 2008)
• Presentation to the Medicaid Reform Legislative Oversight Committee (December 6, 2007)
• Meeting of the Council Subcommittee on Medicaid Reform (Oct. 30, 2007)
• Presentation to HHSC Public Stakeholder Forum (Sept. 10, 2007)
• Texas Medicaid Reform Informational Meeting
  [PowerPoint Presentation] (Aug. 30, 2007) [conference call] (Aug. 31, 2007)
• Presentation to the HHSC Public Stakeholder Forum (July 9, 2007)
• Presentation to the HHSC Public Stakeholder Forum (May 14, 2007)
• Presentation to the House Appropriations Committee (April 2007)
• Presentation to the House Public Health Committee (February 2007)
• Texas Medicaid Policy Summit: Where We Are and Where We’re Going (November 2006)
• Presentation to the Senate Finance Committee: Uncompensated Care and Medicaid Hospital Reimbursement (October 2006)
• HHSC Presentation to the Senate Committee on Health and Human Services: Medicaid Reform in Texas (September 2006)

Research Papers

Before the 80th Legislative Session, HHSC prepared preliminary research and background papers on key Medicaid reform topics.  Efforts were made to verify the accuracy of the information contained in these research papers, although it is possible that some information may be outdated. Many of the states initiating Medicaid reforms are still developing their programs. Because of this, available information about their progress is sometimes limited, and programmatic changes may have occurred which are not reflected within these documents. 

Public-Private Initiatives

• Health Insurance Market Exchange (Connector)
• Children's Health Insurance Program Premium Assistance
• Three-Share/Multi-Share Programs
• Long-Term Care Partnerships
• Low-Income Pools
• Medicaid Opt-Out

Benefits and Consumer Choice and Responsibility

• Premiums and Cost Sharing
• Benchmark Plans (i.e., Tailored Benefits)
• Enhanced Benefit Accounts
• Health Savings Accounts and Health Opportunity Accounts
• Pay for Performance

Long-Term Services and Supports

• Medicare and Medicaid Integration
• Global Budgeting Approaches: The Vermont Approach
• Money Follows the Person for Intermediate Care Facilities for Persons with Mental Retardation

Reports and Related Documents

• HHSC has received a five-year, $50 million grant to provide cost sharing accounts to help low-income working Texans purchase health insurance. Grant proposal
• Senate Bill 10, A Study of Health Insurance Premium Assistance Options for Uninsured Texans - November 2008
• Senate Bill 10 required HHSC to determine if a Medicaid Health Savings Account program would be cost effective and feasible. The report concludes that due to state and federal requirements and associated administrative costs, such a pilot program would not be cost effective. Read the report
• HHSC submitted a draft concept paper that outlines the Texas reform plan to the Centers for Medicare & Medicaid Services (CMS) on Dec. 5. The cornerstone of the Texas plan is a Health Opportunity Pool trust fund that will provide premium subsidies to low-income adults. Read the draft concept paper.
• HHSC provided an update on the Texas waiver request to the Medicaid Reform Legislative Oversight Committee in an April 3, 2008, letter.
• Key decision areas for the concept paper (Summary of Public Comments)
• A Vision for Texas Health Care Reform: HHSC procured the services of outside experts to help research Medicaid and health care reform options for Texas. The report explores reform initiatives being undertaken by other states and describes the challenges and options for health care reform in Texas.
• Rider 60 Report: Medicaid Provider Reimbursement
• Rider 61 Report: Texas Hospital's Uncompensated Care
• The Texas Health and Human Services Commission issued a request for quote on Dec. 28, 2006, for consultant services to help the agency develop, analyze and produce materials related to the Medicaid Reform Project.

Medicaid Reform Contact Information

If you or your organization would like to provide input on Medicaid reform topics and updates, please e-mail medreform@hhsc.state.tx.us.