Transcript Slide 1

80th Texas Legislature and Health Care Access:
Major Actions and Solutions
West Texas Legislative Summit
August 9, 2007 – San Angelo, Texas
Anne Dunkelberg, Associate Director
([email protected])
900 Lydia Street - Austin, Texas 78702
Phone (512) 320-0222 (X102)– fax (512) 320-0227 - www.cppp.org
Center for Public Policy Priorities
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Texans and Health Insurance
US Census Bureau Statistics (March 2006 CPS):
• Approximately 5.5 million Texans uninsured in 2005
–23.6% of Texans of all ages were uninsured (versus
15.7% U.S.)
–26.9% of Texans under age of 65 were uninsured
• Ages 0-18: 19% uninsured
• Ages 19-64: 30% uninsured
• Ages 65: 2% uninsured
–Another three million Texans covered by Medicaid or CHIP (i.e.,
generally not insured through private coverage)
–The BIG difference: Texas has far lower coverage through work
(“ESI”) than U.S. (56% Texans have ESI, vs. 64% in US)—even though
Texas has very high rates of employment. Even large firms (100-499 workers)
have 19% uninsured!
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How Does Immigration Factor In?
• Immigrants are NOT the primary cause of Texas’
last-place ranking
– Census Bureau reported 2.4 million non-citizens (includes both
legal residents and undocumented persons); 1.3 million of them
are uninsured (54.5% of non-citizens)
– BUT! If you removed non-citizens from the equation, Texas
would still have the worst uninsured rate at 20% uninsured (4.1
million), even if you left the non-citizens in the other state’s
counts.
– So, immigrants are only part of the problem, not the cause, and
only about 1/5 of Texas’ uninsured.
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Uninsured Texas Children:
We CAN Cut the Number in Half by Enrolling Kids
Who are Eligible Right Now
•Texas is home to nearly 1.4 million uninsured children.
• 2/3 of these uninsured Texas children are below 200% of the federal
poverty line, despite Medicaid and CHIP.
•More than HALF our uninsured Texas Kids Could be enrolled in
Medicaid or CHIP today! (Adjusting for ~230,000 undocumented kids; another
160,000 legal immigrant (LPR) children can participate in CHIP (Pew Hispanic Center)).
Texas Children who are Uninsured, 2004-05 – U.S. Census
All incomes, under age 19 (0-18*; 2-year
average 2004-05 Census CPS)
20.4%
1.367 million
< 200% FPL; under age 19 (0-18; 2-year
average 2004-05 Census CPS)
28% of <200%;
13.4% of all
kids
919,000
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Texas Kids’ Uninsured Rate Drops,
Thanks to CHIP and Medicaid
BEFORE CHIP and streamlined Children’s Medicaid
In 1997, When Congress created the CHIP Block Grant, U.S. Census
estimated that:
• 24%-25% of Texas children were uninsured (about 1.4 million children),
– and over three quarters (76%) of these were in families at or below 200% FPL.
•
There were about 5.95 million Texas children (under age 19).
SINCE CHIP and Streamlined Children’s Medicaid:
• 20.4% of Texas children under age 19 (1.37 million) are uninsured
– just over two-thirds (68%) are in families below 200% FPL.
•
There are about 6.6 million Texas children (under age 19).
Texas CHIP and streamlined children’s Medicaid have provided
health coverage for about 1 million more Texas children.
Uninsured Texas children below 200% FPL have dropped from 35%
to 29% (kids potentially served by children's Medicaid and CHIP) .
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Texas Medicaid: Who it Helps
February 2007, HHSC data.
Disabled,
353,390
Elderly,
367,672
Poor Parents,
55,901
TANF Parent,
24,288
Children,
1,769,244
Maternity,
93,063
Total enrolled 2/1/2007: 2.66 million
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CHIP and Medicaid: Helping Texas Kids
As of February 2007:
• 1.77 million Texas children (under age 19) were enrolled in Medicaid
•
•
•
•
about 100,700 of these children get Medicaid because of a serious disability
About 122,000 in TANF cash assistance families (7% of the kids)
About 12,700 pregnant teens (less than 1% of the children)
Other 1.53 MILLION predominantly in WORKING poor families
• 325,479 Texas children were enrolled in CHIP.
“CHIP stands on the broad shoulders of Medicaid”
That’s 2.09 million Texas children –
nearly one-third of all our kids.
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Medicaid in Texas: Who it Helps
Medicaid:
As of February, 2.7 million Texans were enrolled in
Medicaid:
895,000 were adults:
– 721,000 (80.5% of the adults) were elderly or disabled.
Adults on SSI account for 60% of the aged and disabled
recipients
– Other adults: 93,000 maternity coverage;
– 24,288 TANF cash assistance parents (less than 1.0% of
total caseload);
• NOTE: there are fewer than 81,000 total poor parents on Texas
Medicaid. 55,901 are parents who are at or below TANF income,
but not receiving TANF cash assistance
Children’s Health Insurance Program (CHIP):
• as of September 1, 2003 — 507,259 children
• as of March 1, 2007 — 325,090 (drop of 182,169, or 36%)
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Income Caps for Texas Medicaid and CHIP, 2007
250%
200%
$22,428
$31,765/yr $31,765/yr
$22,836/yr
150%
100%
$17,170
$34,3400
222%
200%
Long
Term
Care
CHIP
$7,716
185% 185%
133%
50%
100%
$2,256
$3,696
13.6% 22.3%
74%
0%
Pregnant Newborns Age 1-6 Age 6-18 TANF Working SSI (aged
Women
parent of Parent of
or
2, no
2
disabled)
income
Mandatory
Optional
Income Limit as Percentage of Federal Poverty Income
Annual Income is for a family of 3,
except Individual Incomes shown for SSI and Long Term Care
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Positive Developments &
Opportunities
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More adequate reimbursement for Medicaid
and CHIP providers
• Many physicians, dentists and other providers severely restrict
participation in Medicaid & CHIP, or choose not to serve them at all,
because of inadequate reimbursement that is well below Medicare
and commercial payment rates.
• Rate cutbacks have reduced physicians’ fees to 1993 levels for most
services. Rate cuts were the largest HHS cut made in 2003; even
larger than the CHIP cuts.
• TMA surveys of Texas doctors show that the percentage of
doctors taking new Medicaid patients dropped from 75% in
1996 to 39% in 2006.
• 2007 Session:
– Medicaid rate cuts from 2003 reversed ($122.8 million GR).
– $707 million GR rate INCREASES for services to under-21 Medicaid
kids/youth (to comply with Frew lawsuit), incl. dentists.
– $408 million GR rate INCREASES for adult care, Nursing homes,
hospitals, community care.
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CHIP - HB 109
HB 109 by Representative Sylvester Turner (D-Houston) and Senator
Kip Averitt (R-Waco) will restore an estimated 96,000-127,000 Texas
children to the CHIP rolls through the following measures:
• 12 months eligibility. Families will fill out one paper application a year.
Children above 185% of the federal poverty line ($38,203 a year for a family
of four) would have their income (not assets) reviewed after six months by the
Texas Health and Human Services Commission (HHSC).
• Deducts (some) child care expenses when calculating income.
• Waives the 90 day waiting period for uninsured children. Only children
who drop private health insurance (and do not qualify for an exception) will
have to wait 90 days to enter the CHIP program. This restores the waiting
period to the original 1999 Texas CHIP law.
• Doubles the asset test limit from $5,000 to $10,000.
• Community-based outreach program.
• Takes effect on September 1, 2007 (except for the six month electronic
check for families earning more than 185% of the federal poverty line, which
is phased in by 9/2008).
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Latest on SCHIP in Congress
• Texas CHIP rolls dropped by over 200,000 children (over 40%) from
2003 to June 2007,
• Because of this, we—more than any other state— need the federal
block grant to grow to allow us to re-enroll ALL of our eligible, but not
enrolled, children. Without a “bigger pie”, we cannot re-build CHIP
or let it grow with population, inflation.
• Due to later start, 2003 CHIP cuts, Texas had to give back (20002006): $913.4 million federal CHIP dollars.
New Funding in Washington CHIP proposals:
• House bill: $50 billion
• Senate bill: $35 billion (Sen. Hutchison supports)
• Needed to avoid CUTTING CHIP: $13.4 billion
• Funding: Tobacco tax increases. Eliminating subsidies for Medicare
Advantage plans.
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SB 10 by Nelson, “Medicaid Reform”
•
•
•
•
•
•
•
Healthy Lifestyles Pilot
Medicaid Medical Savings Account Pilot
Tailored Benefit Packages
Medicaid “Opt-Out” Pilot (HIPP)
Non-emergent ER use co-payment
Protections for Medicaid clients
Health Opportunity Pool to be created, to be used for statewide and
local/regional projects to reduce uncompensated care, uninsured, “3shares”, premium assistance, and other programs to increase access to
health coverage.
– Support for infrastructure improvements to improve systems of care for lowincome uninsured and Medicaid, NTE 10% annual spending from fund.
– Electronic Health Information Pilot
– Legislative Oversight Committee
•
•
•
Greater access to Medicaid breast and cervical cancer treatment.
Extended Medicaid coverage of former foster kids in higher ed (to age
23)
Challenge: making the most of the HOP. How can we get the most
more Texans insured with decent coverage and standards that treat all
Texans—urban and rural—equally?
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What Would the 2008-09 Budget Do for Community
Care/Other Waiting Lists?
Served in
Fiscal 2006
Added by
2009
Increase
from 2006
Community-Based Alternatives
26,733
1,607
6%
Home & Community-Based Svcs.
10,318
2,676
26
Community Living Assistance
2,044
586
29
Deaf-Blind Multiple Disabilities
131
16
12
Medically Dependent Children
960
415
43
In-Home and Family Support
3,944
1,374
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Independent Living Services (DARS)
2,301
102
4
Comprehensive Rehab.Svcs. (DARS)
380
92
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Children w/Special Health Care Needs
1,979
646
Children’s Community MH Services
9,994
288
Program
DADS Non-Medicaid Community Svcs.
Center for Public Policy Priorities
2,228
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Other Health Care Investment in 2008-09 Texas
Budget
• More than 21,000 community care clients will move to a managed care model
(STAR+PLUS) by 2009
• Repairs and renovations for State Schools (mental retardation) and State
Hospitals (mental health)
• $82 million GR in new General Revenue for community mental health crisis
services; 6 million GR and a public safety triage/detox unit in Bexar County
• 65% ($8.5 million) increase in funding for tobacco prevention and control
programs, including smokeless tobacco use by rural youth
• $17 million GR for tuberculosis and HIV services/medications
• Breast and cervical cancer: more sites to provide screenings/ diagnosis;
easier access to treatment for low-income women
• Nurse Family Partnership grants program (SB 156)
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Texas Child Medicaid Enrollment
(February 2001-August 2007)
Simplified Enrollment
begins under SB 43
Old High:
1,838,239
2,200,000
August 2007:
1,850,714
1,900,000
2006 low:
1,720,025
1,600,000
1,300,000
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1,000,000
Source: Texas Health and Human Services Commission
1/2007 to present include “perinates”
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Texas CHIP Enrollment
(May 2000-July 2007)
Highest, 5/02:
529,271
600,000
9/03:
507,259
7/07:
302,386
400,000
200,000
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ay
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pJa 00
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pJa 06
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-0
7
0
Source: All figures from Texas Health and Human Services Commission;
Compares most recent month with September 2003
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Texas Child Medicaid and CHIP Enrollment
6.5
Enrollment (millions)
5.5
Estimated child population growth
of almost 70,000 per year
2.5
4.5
Sept. ’03:
2,150,543
3.5
2.0
Combined CHIP/Child
Medicaid Enrollment
August ‘07:
2,150,976
1.5
0.5
Ja
n
A 02
pr
Ju 02
l
O 02
ct
Ja 02
n
A 03
pr
Ju 03
l
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Ja 03
n
A 04
pr
Ju 04
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A 05
pr
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Ja 05
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A 06
pr
Ju 06
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Ja 06
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A 07
pr
Ju 07
l0
7
1.5
2.5
Sources: Enrollment from Texas Health and Human Services Commission;
Texas State Demographer's 0-17 Population Estimates
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Child population (millions)
3.0
Medicaid, Food Stamp and TANF Recipients Per Eligibility
Determination FTE
0
100
200
300
400
500
600
700
800
900
1000
1995
1997
1999
2001
2003
2005
Source: Texas Health and Human Services Commission
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Eligibility System Improvements
• HHSC eligibility systems have been far below federal law standards
for prompt processing since early 2006, and also have reported very
high rates of erroneous denials, and other processing mistakes.
• CHIP’s private contractor also plagued by serious errors, delays, lost
applications.
•
The 2008-2009 budget includes requirements improve the CHIP
and children’s Medicaid eligibility process and eliminate barriers,
delays and wrongful denials.
• Budget also ensures HHSC can add eligibility workers as needed to
(1) replace contracted workers and (2) meet all federal performance
standards (accuracy, timeliness).
• HB 3575 by Patrick Rose creates a Legislative Oversight
committee for the HHSC eligibility system and sets goals to
improve customer service, reduce processing time, and meet federal
standards.
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