Transcript Slide 1

Health Care Briefing
University of Texas at San Antonio
November 17, 2006
Eva DeLuna Castro, Senior Budget Analyst
Outline
• Health insurance coverage data
• Highlights of CPPP/MHM June 2006
report, Texas Health Care
• Prospects for the 80th Legislative Session
Millions
Texans by Age and Insurance Status, 2005
15
31% uninsured
4.2 million
10
20% uninsured
1.3 million
5
44,000 (<2%
uninsured)
-
Under 19
19 to 64
65 and over
Job-based Medicaid/CHIP Medicare Uninsured
All age groups combined:
25% uninsured, the worst rate in the nation
How Does Immigration Factor In?
Citizenship Status of Uninsured
Texans in 2005 (Total: 5.5 million)
Not a U.S.
Citizen
24%
U.S.-born
Citizen
72%
Naturalized
5%
•Immigrants NOT the main
cause of our last-place
ranking
–Texas is home to 2.4 million
non-citizens (legal residents
& undocumented persons);
1.3 million are uninsured
(55% of non-citizens)
–BUT! Removing non-citizens
from the equation, Texas
would still be tied with New
Mexico for last place at 20.6%
uninsured (4.2 million
Texans), even if you left the
non-citizens in NM’s rate.
(Without immigrants, New
Mexico’s rate drops to 18.9%)
Of 1.367 million uninsured kids (TX 04-05 average), about 919,000 are
below 200% of poverty. Excluding undocumented kids (230,000), this
means 689,000 more children could be reached by Medicaid or CHIP.
Bexar County’s Economic Indicators
(from American Community Survey)
Child Poverty Rate:
24.1% in 2005
Rate (percent)
30
20
Poverty rate, all ages:
17% in 2005
10
Unemployment Rate:
6.6% in 2005
0
2000
2001
2002
2003
2004
2005
No significant improvements in poverty; low-paying
jobs are unlikely to provide health insurance.
Texas Health Care:
What Has Happened and What Work Remains
Full Report: http://www.cppp.org/research.php?aid=535
2005 Session Gains for Medicaid:
• Restoration of coverage of podiatry services, eyeglasses, hearing
aids, and mental health services for adults;
• New Buy-In program for working adults with disabilities
• New health “waiver” to provide basic preventive check-ups (such as
diabetes, breast/cervical cancer) and family planning services to lowincome women (up to 185% of poverty, ages 18 to 44)
Medicaid Cuts Still in Effect:
• Medically Needy Spend Down Program for Parents;
• Rate cuts for many Medicaid and CHIP health care providers (about
$740 million over two years)
Other Medicaid Challenges:
Covering working-poor parents up to the poverty line ($16,600 for
family of 3); for women’s health waiver, outreach is needed, as well as
a way to provide follow-up care for illnesses not covered by Medicaid
Texas Physicians Less Likely To Accept New
Medicaid Patients
Accept no new
Medicaid patients
Limit new Medicaid
patients
Percent of physicians surveyed
16
28
36
17
27
Accept all new
Medicaid patients
26
67
45
2000
2004
38
2006
Source: Texas Medical Association Survey, Reported by Dallas Morning News.
Income Caps for Texas Medicaid & CHIP, 2006
Percent of federal poverty line
250
Federal Mandate
State Option
200
150
185
185
200
100
133
50
222
133
100
13.6
22.3
74
Working
Parent of
2
SSI (aged
or
disabled)
0
New borns Ages 1 to Ages 6 to
5
18
CHIP
Pregnant
Wom en
TANF
Parent of
2, No
Incom e
LongTerm
Care
Texas Medicaid Enrollees and Expenditures, 2004
100%
21%
Elderly/Disabled
80%
9%
59%
Other Adults
60%
40%
11%
70%
20%
Children
30%
0%
Enrollees: 2.6 million
Expenditures: $14.7 billion
2005 Session Gains for CHIP:
• Restoration of dental, vision (eyeglasses and exams), hospice, and
mental health benefits that were cut in 2003
• Instead of monthly premiums instituted in 2003 session, families will
pay an enrollment fee ($25 to $50) once every six months. Families
below 133% of poverty exempt from fees.
• New prenatal care and health coverage for newborns
CHIP Cuts Still in Effect:
• 2003 policy changes requiring more frequent re-enrollment; asset test
(savings, vehicles, etc.) for families above 150% of poverty; 90-day
waiting period; income deductions for child care and child support
expenses are no longer allowed; rate cuts
Other CHIP Challenges:
Outreach (especially for new prenatal program); future federal funding
2005 Session Gains for Public Health, Safety,
Mental Health, and Prevention Programs:
• Funding and caseloads increased for immunizations, HIV drug
program, newborn screening, and County Indigent Health Care (state
grants to counties that fund health care for the impoverished)
• Increased funding for Children with Special Health Care Needs
(seriously ill/medically fragile); 1,463 clients receiving medical services
in 2003 versus 2,897 by 2007
• More funding for substance abuse services and staffing levels/facilities
repairs at state mental hospitals
Cuts Still in Effect:
• County Indigent Health Care, along with other programs such as
Kidney Health, Primary Health Care, and Community Mental Health
services for adults & children, are still below pre-2003 funding levels
Other Challenges:
Potential impact of “10% Cut in General Revenue” budget instructions
for 2008-09; future federal funding
In million $
State Matching Funds for County Indigent
Health Care Programs
$10.0
$7.5
$5.0
If 10% cuts are
enacted by 80th
Legislature
$2.5
$1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2005 Session and Privatization/Outsourcing of
Eligibility Determination for Safety Net Programs:
•HHSC was directed to change the way Texans apply for public
benefits, including Medicaid, CHIP, Food Stamps, and cash aid
(Temporary Assistance for Needy Families)
•June 2005: 5-year, $899 million contract signed by Accenture (Texas Access
Alliance, or TAA), to operate & revamp eligibility and enrollment systems.
Instead of 310 local offices, there would be 167 full-service offices and 44
“satellite” offices open on certain days only; 99 offices would close. Four call
centers to provide assistance from 8 AM to 8 PM and receive and process
applications; consumers could track applications through an automated phone
system. Primary number for assistance would be 2-1-1; calls for eligibility
services routed to TAA (not the 2-1-1 call centers).
Major Problems/Declines in Enrollment Lead to a Delay
in Further Implementation of New System
CHIP enrollment taken over by Accenture in Dec. 2005; in Jan. 2006,
new system for TANF/Food Stamps/Medicaid launched in Travis &
Hays counties
Texas CHIP Enrollment
600,000
Sep. ’03*:
507,259
High: May ’02:
529,271
Nov. ’06:
321,341
400,000
200,000
0
May
'00
Nov
'00
May
'01
Nov
'01
May
'02
Nov
'02
May
'03
Nov
'03
May
'04
Nov
'04
May
'05
Nov
'05
Source: Texas Health and Human Services Commission
*Sept. ’03 is the beginning of the state fiscal year in which
CHIP cuts/policy changes started taking effect.
May
'06
Nov
'06
Recent Declines in Texas CHIP Enrollment
December
2005
October
2006
Decline, December to
October
322,898
300,685
-22,213
-6.9%
20,915
19,202
-1,713
-8.2%
7,814
8,125
311
4.0%
Dallas
33,325
31,848
-1,477
-4.4%
El Paso
13,628
12,009
-1,619
-11.9%
Harris
65,465
58,711
-6,754
-10.3%
HAYS
1,489
1,371
-118
-7.9%
Tarrant
19,754
19,231
-523
-2.6%
TRAVIS
8,550
8,540
-10
-0.1%
Webb
5,279
5,385
106
2.0%
State total
Bexar
Cameron
Source: Texas Health and Human Services Commission
Texas Child Medicaid and CHIP Enrollment
6.5
Estimated child population growth
of almost 70,000 per year
2.5
Sept. ’03:
2,150,543
2.5
Combined CHIP/Child
Medicaid Enrollment
Oct. ’06:
2,020,710
1.5
A
pr
0
Ju 2
l0
O 2
ct
0
Ja 2
n
0
A 3
pr
0
Ju 3
l0
O 3
ct
0
Ja 3
n
0
A 4
pr
0
Ju 4
l0
O 4
ct
0
Ja 4
n
0
A 5
pr
0
Ju 5
l0
O 5
ct
0
Ja 5
n
0
A 6
pr
0
Ju 6
l0
O 6
ct
06
0.5
02
1.5
n
4.5
3.5
2.0
Ja
Enrollment (millions)
5.5
Sources: Enrollment from Texas Health and Human Services Commission;
Texas State Demographer's 0-17 Population Estimates
Child population (millions)
3.0
Declines in Texas Children’s Medicaid Enrollment
December
2005
1,720,025
-118,214
-6.4%
139,682
133,204
-6,478
-4.6%
64,339
62,992
-1,347
-2.1%
182,954
170,054
-12,900
-7.1%
98,319
89,265
-9,054
-9.2%
Harris
316,896
291,991
-24,905
-7.9%
HAYS
4,953
5,108
155
3.1%
Tarrant
97,908
89,483
-8,425
-8.6%
TRAVIS
52,667
49,267
-3,400
-6.5%
Webb
36,473
32,746
-3,727
-10.2%
State total
Bexar
Cameron
Dallas
El Paso
1,838,239
October 2006
Decline, December to
October
Source: Texas Health and Human Services Commission. November preliminary
enrollment has increased.
Want more
information on
privatization of
eligibility
determination?
See CPPP
report released
earlier this week
http://www.cppp.org/files/3/
CPPP_PrivReport_(FS).pdf
Improving/Protecting Health Care
Access in 2008-2009
•Cover Texas children
•Expand access to Medicaid for poor parents
•Improve Medicaid access and quality by adequately
paying health care providers
•Ensure that revamped/privatized eligibility system
doesn’t impede access to Medicaid and CHIP
All of the above require adequate state tax revenue
(currently 50th per capita) to draw down federal funds
WHAT TEXAS SPENDS
And How Much More It Would Cost to be “Average”
State “Own Source” Budget, 2006-07: $94 Billion
Higher
Education,
K-12
Education,
$17.7 B, 19%
$32.5 B, 35%
Medicaid,
All Other,
$14.1 B, 15%
$7.0 B, 7%
Business/
Econ Dev,
$9.2 B, 10%
Criminal
Justice,
$8.3 B, 9%
Other Health &
Human
Services,
$5.1 B, 5%
If state spending per Texan equaled the U.S. average,
this budget would increase to $142 billion
‘CURRENT SERVICES’ FOR 2008-2009?
“Own Source” Budget: at least $108 Billion
$7.9 B more
Higher
Education
K-12
Education
$1.7 B more
Health &
Human
Services
$0.5 B more
Other
Business/
Eco Dev
Criminal
Justice
$0.3 B more
$3.7 B more
INCLUDED IN ‘CURRENT SERVICES’
FOR 2008-2009
Don’t Make the 10% Cuts [Almost half a billion dollars in General
Revenue for HHS agencies Combined]: HHSC $72 million/550
workers; Aging & Disability, $112 million/298 workers; Family &
Protective Services, $40 million/Major cuts to prevention services; State
Health Services, $236 million/693 workers; Assistive & Rehabilitative
Services, $13 million/168 workers
HHSC needs $783 million General Revenue base increase, plus $1.8
billion GR “above the base” (“exceptional items”) to address
inflation/cost increases in Medicaid and CHIP. (Baseline holds costs at
fiscal 2006 level.)
Medicaid: base allows for modest caseload growth, from 2.791
million in fiscal 2007 to 2.995 million by 2009
CHIP: Enrollment assumed to cap at 339,000 in 2009
BEYOND ‘CURRENT SERVICES’
(additional General Revenue needed)
Restoring health care provider rates to 2003 Levels: $237 million for
Medicaid and CHIP rate restoration; $11 million for long-term care and
other providers of Aging & Disability Services; $3 million for State Health
Services health care providers
HHS program expansions/improvements: almost $1.1 billion in GR
•$255 million to reduce community care waiting/interest lists
•$54 million for private urban hospital upper payment limit (UPL)
program; $117 million to replace nonrecurring intergovt transfers; $53
million for hospital financing; $81 million for Graduate Medical Education
•$82 million to provide mental health community crisis services for
children and adults
•$32 million to address nursing/other health care professional shortages
•$23 million to reduce spread of HIV and tuberculosis
See: TX Health & Human Services Consolidated Budget 2008-2009,
http://www.hhsc.state.tx.us/about_hhsc/finance/0809_Budget/MASTER_CONSOLIDATED_BUDGET_FY0809_101106.pdf
KEY STAGES IN JANUARY 2007
• Legislative Budget Board will release “starting point”
for budget
• Governor’s Budget Office may also release a
detailed budget, mentioning his program initiatives
• New Comptroller of Public Accounts will issue a
revenue estimate for the 2008-2009 budget cycle;
may also issue a new economic forecast (latest one
is from Spring 2006) that changes the revenue
estimate for fiscal 2007
• House and Senate committee assignments will be
made
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