Extending Medicaid

Texas likes to bill itself as a business-friendly state. But there's one thing that a lot of businesses want that the Republican leadership has been unwilling to entertain, and that's to make Medicaid renewals an annual event instead of every six months.

Arlington hospital executive Joel Ballew, speaking for the Healthcare Legislative Task Force of the Dallas Regional Chamber, said Texas needs to boost state funding of the Medicaid and Children's Health Insurance Program to draw down the maximum amount of federal matching funds possible. The Dallas chamber and its counterparts in the state's eight biggest urban areas said annual renewals for the 1.9 children on Medicaid would put more youngsters on the rolls, by reducing gaps in coverage caused by excessive red tape and the state eligibility system's problems.

"How would y'all like to sign up for your health insurance twice a year?" Bruce LaBoon of the Greater Houston Partnership said at a news conference. "I doubt if you'd like it very much. And the paperwork of course for Medicaid is significant. The [processing] delays are significant. ... In order to retain your eligibility in a children's Medicaid program in this state, you pretty much have to start signing up as soon as your coverage is approved for the last time. It's a continuous process of applying and applying and applying again."

Hold that thought about the processing delays for a minute, I'll get back to it.

In the past, some lawmakers have opposed what's known as "12 months' continuous eligibility" because they want families' income checked more often than once a year. That way, they argued, those over the income ceilings wouldn't get free care.

However, speakers at the news conference said semiannual renewals have gummed up an overtaxed eligibility-determination system. They said Texas takes as long as three months to process Medicaid applications and renewals. Even Louisiana does a better job, they said. Early in the decade, Texas made some progress in simplifying enrollment but it has backslid with a botched privatization of signups for social services, said advocates and five House Democrats who spoke at the press conference.

Makes your heart swell with pride to know that Louisiana does a better job than we do, doesn't it? The "botched privatization effort" of course refers to the Accenture debacle, but the effect is aggravated by the TIERS implementation, whose expansion has been postponed once again because it couldn't keep up with the demands on it, and also by the fact that demand for social services has increased sharply due to the lousy economy. Lengthening the eligibility period would go a long way towards alleviating many of these problems.

Ballew, director of government affairs and advocacy for Texas Health Resources, the amalgam of Dallas' Presbyterian Healthcare Resources and Fort Worth's Harris Methodist Health System, said "if current trends continue, access to health care will decline and costs to business will increase."

The Dallas chamber wants the Legislature "to implement policies to enroll every eligible child in Medicaid or CHIP," he said. That way, not only would Texas draw down all federal funds it's entitled to, he said, but parents could be more productive workers because their youngsters would have regular checkups and receive preventive care.

Doing this would require that the state spend more money, which is a big part of the Republican reluctance to embrace this. But the added cost would bring an even larger return.

The largest chambers of commerce in Texas are pushing for 12-month Medicaid coverage, which is standard in the private sector. The Greater Houston Partnership also has thrown its "strong support" for 12-month coverage in an effort to reduce the number of uninsured children in Texas. A $500 million match by the state would generate an extra $800 million in federal funds and reduce the number of uninsured children by one-third.

"It is absolutely good social policy. It is absolutely good business policy as well," said Bruce LaBoon, past chairman of the Greater Houston Partnership.

Texas gets back $1.47 from the federal government for every $1 it invests in the children's Medicaid program.

"It is absolutely essential that we allow parents and children to sign up once a year, like we all do," LaBoon said.

Yeah, we've had this same discussion with things like CHIP and more recently unemployment insurance. For whatever the reason, the "we get back a lot more than we spend" argument just doesn't move too many members of the Lege (assuming they know what Medicaid is, of course), not to mention Rick Perry and David Dewhurst. At this point in the session, with so much to do and so little time to do it, I can't say I have much hope for a different outcome this time around. Vaqueros and Wonkeros has more.

Posted by Charles Kuffner on April 16, 2009 to Budget ballyhoo