The Texas Senate and House of Representatives have passed 2018-19 budget bills that fall short of maintaining the state’s Medicaid program.
Extreme reductions are included.
Both houses should settle on a budget that continues to stabilize and improve Medicaid coverage and benefits for kids.
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About 3.5 million Texas children are enrolled in Medicaid or the Children’s Health Insurance Program. That’s about half of the children in Texas.
In Tarrant County alone, more than 208,000 children are enrolled in Medicaid.
In 2014, Cook Children’s Medical Center in Fort Worth provided inpatient care to more than 11,000 children from 142 Texas counties.
Still, children aren’t the ones driving Medicaid costs. Non-disabled children make up about 70 percent of the Medicaid caseload in Texas but account for only 30 percent of spending.
Medicaid provides a safety net for working families that have children with complex medical conditions. The program helps shoulder the financial burden not covered by commercial insurance.
Children with access to Medicaid are more likely to graduate from high school, go to college and become healthier adults who will earn more and pay more in taxes than those who do not have appropriate healthcare as children.
Thanks to the program’s efficiency, growth in per capita Medicaid expenditures in Texas falls below both commercial insurance and Medicare levels.
When adjusted for inflation, Texas is spending less per Medicaid enrollee than in 2001.
The Children’s Hospital Association of Texas advocates for a series of elements that we believe are essential for the Medicaid program to adequately protect Texas children.
To continue to be efficient and cost-effective, the Medicaid benefit design should specifically address children’s needs.
Current criteria for children’s Medicaid eligibility should remain in place.
Delaying access to health care for children, especially preventive services, through waitlists or suspended enrollment only creates higher costs for these children and the health system later.
Children must have timely access to appropriate healthcare services.
Access to high-quality care can be ensured through fair and adequate provider reimbursement.
Reimbursement rates must be sufficient so that an adequate number and the appropriate types of providers participate in Medicaid.
Similarly, network adequacy requirements should ensure children have access to high-quality services designed for them.
Children should continue to have access to preventive services at no cost.
Burdensome cost-sharing requirements will delay treatment, add to providers’ bad debt and increase costs.
Alternatively, cost-sharing should be applied on a sliding fee scale and certain children should be exempt from these requirements.
Reasonable out-of-pocket caps should be implemented to avoid penalizing patients with chronic physical or behavioral health conditions.
Medicaid should incentivize improvements in quality, safety and efficiency.
This can be achieved by sharing cost savings with providers or encouraging other alternative payment methodologies.
Medicaid should also provide bonuses or other incentive payments for quality and safety achievements by providers.
Children must not lose ground as healthcare is debated at the federal and state levels.
Any reforms must build on the achievements our state has already made to further improve children’s health coverage and care.
Stacy E. Wilson is the president of the Children’s Hospital Association of Texas. CHAT members include Cook Children’s Health Care System in Fort Worth.