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Medicaid Reform

Tailored Benefit Packages


Senate Bill 10, 80th Legislature, Regular Session, 2007, allows the Health and Human Services Commission (HHSC) to seek a federal waiver to provide Medicaid benefits that designed to meet the needs of certain Medicaid populations and other non-Medicaid populations as appropriate.

Section 4 of Senate Bill 10 directs HHSC to develop a tailored benefit package for children with special health care needsin Medicaid. It also allows the agency to develop tailored benefit packages for other categories of Medicaid recipients, such as:

  • People with disabilities or special health needs.
  • People who are elderly.
  • Children without special health care needs.
  • Working-age parents and caretaker relatives.

For these additional categories, HHSC must submit a report to the legislature explaining the population to be served and the details of the benefit packages. These tailored benefit packages may not be implemented before September 1, 2009.

Tailored benefit packages are customized to meet the unique health care needs of recipients in specifically designated categories and are designed to:

  • Improve health outcomes.
  • Improve access to services.
  • Achieve cost containment and efficiency.
  • Reduce administrative complexity

Tailored benefit packages:

  • May not reduce the benefits available to all Medicaid recipients under the Medicaid state plan.
  • Must provide federally required Early Periodic Screening, Diagnosis, and Treatment services to children.
  • Must provide a basic set of benefits that are provided under all benefit packages.
  • Should include a set of customized benefits to meet the needs of recipients in the designated category.
  • Should integrate the management of recipients’ acute and long-term care needs, as feasible.
  • Must increase the state’s flexibility related to funding.

Texas has already implemented health care models tailored to meet the needs of certain categories of Medicaid enrollees. An example is the STAR+PLUS program, which provides integrated acute and long-term care services for people who are elderly or have disabilities in the Harris, Bexar, Travis and Nueces service areas. Texas is also in the process of implementing an Integrated Care Management (ICM) model for people who are elderly or have disabilities in the Dallas and Tarrant service areas, as well as a statewide managed care model for children in foster care, which will provide health care and care management services specifically designed to meet the needs of children in foster care.

For more information on tailored benefits, see the Medicaid reform issue paper on benchmark plans.