Medicaid Reform
Senate Bill 10 Sets Stage for Health Care 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.
The Texas Medicaid program has a two-year budget of $39.5 billion and accounts for 26 percent of the state’s total budget. The program provides health coverage for one out of every three children in Texas, pays for more than half of all births and covers two-thirds of all nursing facility care. Yet Texas still has a high rate of uninsured citizens and few coverage options for low-income, able-bodied adults. Senate Bill 10 aims to change that by creating a Texas Health Opportunity Pool Trust Fund to provide premium subsidies to eligible Texans and improving the effectiveness of the state’s Medicaid program.
Senate Bill 10 Highlights
Senate Bill 10 directs improvements to the Texas Medicaid program by focusing on prevention, better planning, and helping Texans to live longer, healthier lives. Highlights of the bill include:
- Establishing the Texas Health Opportunity Pool Trust Fund to provide premium subsidies to eligible Texans and help offset uncompensated care costs for providers who implement innovative measures to provide primary and preventive care.
- Improving health outcomes and increasing consumer choice and responsibility through pilot programs such as positive incentives for healthy lifestyles, health savings accounts, and an incentive program to encourage regular health care visits.
- Increasing employer-based insurance options through the Medicaid Health Insurance Premium Payment reimbursement program and allowing individuals to opt out of Medicaid and use employer-sponsored insurance in some cases.
- Encouraging the development and use of electronic health information standards and electronic health records to improve patient care.
- Extending Medicaid coverage for former foster care children to age 23, if they are attending college.
- Using tailored benefits packages for children with special health care needs to better meet the complex needs of this population, reduce costs and simplify program administration.
- Allowing cost sharing for non-emergency use of emergency rooms to support appropriate emergency room utilization.
- Using outcome-based performance measures and incentives in health maintenance organization contracts to increase access to appropriate health care services.
Next Steps
The Texas Health and Human Services Commission is in the process of developing a Texas reform plan with the input of state leaders and stakeholders. HHSC will submit a Medicaid waiver request in late 2007 to the U.S. Department of Health and Human Services.
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