OVERARCHING GOAL

Optimize investment in health care to ensure more efficient use of available funding and best health outcomes for Texans.

1
Protect and Optimize Medicaid Funding

• Protect and preserve at-risk federal Upper Payment Limit (UPL) funding.
• Optimize federal funding for currently unmatched state and local dollars.
• Restructure current Medicaid financing to gain flexibility and ensure that financing supports, rather than conflicts with, public policy goals.
• Provide continued support for Texas’ critical safety net providers.
• Ensure quality for dollars spent better management and performance incentives.

2
Reduce the Number of Uninsured Texans

• Develop a more efficient and cost-effective system to provide care for the uninsured.
• Promote access, affordability and choice in extending health insurance and coverage to more uninsured Texans.
• Encourage and build upon existing and proposed public-private partnerships, such as multi-share programs, employer-sponsored insurance programs, premium assistance programs.

3
Focus on Keeping Texans Healthy

• Increase focus on primary and preventive health care to keep Texans healthy and reduce the need for more expensive health care services.
• Ensure timely access to appropriate level of high quality health care services through efficient care management.
• Enhance care management models.
• Increase focus on consumer choice and personal responsibility.

4
Establish Infrastructure to Facilitate Accomplishment of Reform Goals

• Establish a Health Opportunity Pool to fund health coverage for uninsured Texans.
• Consider options to facilitate the availability of affordable insurance benefits and coverage, portability for all Texans, and administrative simplicity for employers.
• Build public-private partnerships, including premium assistance for employer-sponsored insurance, individual and small group market insurance and other coverage, such as multi-share programs.
• Optimize and improve current Medicaid operations to ensure efficient integration of reform.
• Seek to provide incremental steps to help individuals transition from being uninsured or receiving public assistance to becoming insured in the private market.

General Reform Assumptions

• Federal approval for Medicaid reform will be primarily sought through waivers.
• Reform initiatives will be implemented using an incremental approach.
• Major components of reform will not be implemented until 2009.
• Medicaid reform will begin with the 80th Legislature, but further reform may occur in future legislative sessions.
• HHSC will develop partnerships with and will seek ongoing input from key stakeholders and will continue to plan for ongoing and future reforms to the health care system in Texas.