Final Draft 1/7/2013

Texas CHIP Coalition

2013 Legislative Principles & Agenda
Preserve Comprehensive Coverage under Medicaid and CHIP
Some conLemporary sLaLe and federal proposals could re-sLrucLure Medlcald and CPl ln ways LhaL could
reduce access Lo quallLy care for Lhe over 3 mllllon 1exas chlldren who rely on Lhe programs Loday Lo sLay
healLhy.
!"#$%&'()*)&+$!"##$%&!$#,-&#./$*&$&"#$0"1()%$2,'(*2$)+/"#'+%,$0#&3#'./$*2'*4$
reduce Lhe raLe of healLh care spendlng growLh whlle ralslng sLandards for quallLy of care, promoLlng
evldence-based cosL-effecLlve care, and lmprovlng ouLcomes, and
re-dlrecL flnanclal lncenLlves away from rewardlng elLher Lhe over-or under-provlslon of care.
5,$$##$!'$#,6/*#"%*"#)+3$'+7$7,-)%)*$#,7"%*)&+$.,*2&7/$*2'*4$
prehenslve medlcally necessary care,

-sharlng obllgaLlons LhaL are excesslve relaLlve
Lo famlly lncome,
ellmlnaLe Lhe currenL federal fundlng parLnershlp LhaL guaranLees LhaL 1exas can depend on
lncreased federal fundlng Lo reflecL boLh populaLlon and lnflaLlon growLh, and ln response Lo hlgher
needs ln Llmes of economlc downLurns and ma[or dlsasLers.
Reverse Damaging Cuts to Texas' Critical Public Health Safety Net and Infrastructure
1he 82
nd
-2013 cuL PealLh and Puman Servlces spendlng by $10 bllllon, from
$63.3 bllllon ln 2010-2011 Lo $33.4 bllllon for 2012-2013. Medlcald for 2012-2013 was budgeLed aL 21
below 2010-2011, wlLh roughly $2 bllllon ln LoLal spendlng reducLlons, plus nearly $3 bllllon more ln a
lCu 1 encompasses a wlde range of servlce and beneflL reducLlons, cuLs Lo
Medlcald and CPl provlder paymenLs, and managed care-relaLed spendlng reducLlons. 1hese reducLlons
Louch all Medlcald enrollees: chlldren, expecLanL moLhers, 1exans wlLh dlsablllLles, and senlors ln nurslng
homes and ln Lhe communlLy. 1he Medlcald fundlng lCu PPSC 2013 supplemenLal
approprlaLlons esLlmaLe for Medlcald of $4.7 bllllon: $3.7 bllllon C8 aL PPSC and anoLher near $1 bllllon aL
uAuS. SLaLe leaders have lCu when Lhey reLurn ln !anuary 2013.
!"#$8&'()*)&+$'79&%'*,/$*2'*$*2,$:,3)/('*"#,4$
Ponor lLs pledge Lo fully fund and cover Lhe Medlcald shorLfall lCu ln 2013.
Carefully conslder all beneflL, pollcy changes, and provlder raLe cuLs enacLed ln 2011 and/or adopLed
Lhrough rules, and reverse Lhose LhaL have reduced access Lo medlcally necessary care from healLh care
2

provlders, medlcal, denLal and vlslon servlces, servlces and supporLs needed Lo sLay ln Lhe communlLy,
dlagnosLlc LesLlng, and key medlcal supplles.
lully veL and evaluaLe proposed reforms and cosL savlng measures for Lhelr Lrue lmpacL, boLh flscal and
human. lf cosL savlngs assumed for pollcy changes ln Lhe 2012-2013 budgeL cycle are noL fully reallzed,
Lhey should noL be converLed Lo even deeper cuLs Lo safeLy neL programs, decreaslng Lhe overall healLh
of chlldren and famllles, and ulLlmaLely cosLlng more for 1exas.
8educlng fundlng for safeLy neL programs decreases Lhe overall healLh of chlldren and famllles and ls
ulLlmaLely more cosLly Lo Lhe sLaLe. ueeper cuLs ln 2013 would furLher crlpple an already devasLaLed publlc
healLh safeLy neL. 8educed access Lo healLhcare provlders wlll only resulL ln less prevenLlve LreaLmenL and
hlgher medlcal bllls pald for by 1exas Lax payers aL Lhe local level.
Bolster the Texas Health Care Workforce
1exas has a large and growlng populaLlon, buL Lhere are Loo few physlclans, nurses, and healLh care
1 1
1exas excepL llcensed vocaLlonal nurses. 1exas Loday has Lhe second-worsL prlmary care provlder supply ln
Lhe u.S., and our menLal healLh provlder shorLage ls Lhe deepesL of any caLegory of care.
LxacerbaLlng Lhe problem, fewer physlclans are now accepLlng Medlcald. lnadequaLe Medlcald paymenL
raLes, aggravaLed by growlng program complexlLy are key reasons Medlcald physlclan parLlclpaLlon ls
dropplng. A 1MA of physlclans accepL new Medlcald paLlenLs,
an 11 polnL drop from 2010 and 36 polnLs below Lhe 67 accepLlng new Medlcald ln 2000. 1he survey shows
LhaL beyond [usL llmlLlng Lhelr Medlcald parLlclpaLlon, more physlclans are decllnlng Lo accepL any Medlcald
aL all, a very worrlsome Lrend.
AddlLlonally, 1exas Medlcald has noL made regular lnflaLlon updaLes Lo physlclan and oLher healLh
professlonal fees for 20 years, and ln LhaL Llme raLes have been cuL more ofLen Lhan lncreased. 1exas
Medlcald fees for physlclans average abouL 73 of Medlcare raLes, whlch ln Lurn are below commerclal
paymenL raLes. 1hese raLes are seL enLlrely by Lhe 1exas LeglslaLure, federal Medlcald law does noL seL any
mlnlmum sLandards for sLaLe Medlcald program raLes excepL ln a very few cases.
lorLunaLely, as a resulL of Lhe Affordable Care AcL, Medlcald paymenL raLes for prlmary care physlclan
servlces wlll lncrease Lo Medlcare parlLy for Lwo years (2013 and 2014) wlLh full federal fundlng. Powever,
Lhe ACA does noL exLend Lhe more compeLlLlve paymenL raLes Lo oLher Medlcald servlces, or Lo oLher
Medlcald and CPl physlclan and healLh professlonal Lypes. WheLher Lhe enhanced federal fundlng for
prlmary care wlll exLend beyond 2014 cannoL be predlcLed.
Access Lo provlders ls a serlous problem Loday, and as more 1exans galn coverage from prlvaLe or publlc
lnsurance, even more cllnlclans and Lechnlclans wlll be needed. 1exas musL relnvesL and expand resources Lo
bulld provlder capaclLy so LhaL boLh exlsLlng and fuLure Medlcald and CPl enrollees and prlvaLely-lnsured
1exans allke wlll be able Lo obLaln Lhe healLh care servlces Lhey need. 1he coallLlon supporLs lnvesLmenLs Lo
1 C
pharmaclsLs, menLal healLh professlonals, and oLhers ln Lhe healLh care workforce, 1exas musL Lake
meanlngful sLeps Lo expand lLs efforLs Lo Lraln and recrulL more healLh care professlonals durlng Lhe 83rd
leglslaLlve sesslon.
!"#$8&'()*)&+$'79&%'*,/$*2'*4$
1exas lncrease Lo parlLy wlLh Medlcare all Medlcald and CPl professlonal and provlder paymenLs, ln
addlLlon Lo Lhe seL of prlmary care provlder servlces LhaL wlll be ralsed ln 2013 and 2014 under Lhe
federal healLh sysLem reform law.
3

1he leglslaLure reverse cuLs Lo all healLh care provlder educaLlon and Lralnlng programs enacLed ln
2011, and lnvesL ln expanded Lralnlng and resldency capaclLy Lo puL our sLaLe on Lrack for lmproved
access Lo care for all 1exans. Speclflcally resLore fundlng for:
! Lhe physlclan loan repaymenL program Lo encourage more physlclans Lo pracLlce ln medlcally
underserved areas,
! Lhe 1exas denLal loan repaymenL program, and
! C M
prlmary and speclalLy care physlclans and denLlsLs accepLlng Medlcald.
1exas lnvesL ln research Lo ldenLlfy and promoLe lnnovaLlons ln Lralnlng prlmary care resldenLs Lo
encourage more medlcal sLudenLs Lo choose prlmary care.
1he LeglslaLure esLabllsh and lmplemenL a plan Lo lncrease resldency sloLs Lo maLch Lhe number of
lncomlng medlcal sLudenLs, as Lhe 1exas Plgher LducaLlon CoordlnaLlng 8oard has recommended, so
LhaL we may reLaln here ln 1exas more of Lhe docLors we have lnvesLed ln and Lralned.
rogram plannlng and lnvesLmenL Lo Lraln and keep an adequaLe healLh workforce covers Lhe full
specLrum of cllnlclans, Lechnlclans, and para-professlonals needed Lo provlde access Lo care.
1exas sLreamllne Lhe Medlcald admlnlsLraLlve processes Lo enLlce more provlders Lo sLay ln Medlcald,
for example, adopLlng a slmpllfled PMC credenLlallng process and lmplemenLlng sLandardlzed prlor
auLhorlzaLlon mechanlsms.
Medlcald-CPl program lnLegrlLy pollcles and pracLlces be carefully analyzed Lo ensure a proper
balance beLween due dlllgence and admlnlsLraLlve burdens, for boLh provlders and cllenLs.
Reduce Health Care Costs by Supporting Practices that Improve the Quality of Care for
Children, Mothers and Newborns
1he CoallLlon supporLs pollcles and programs Lo lncrease quallLy of care for chlldren, moLhers and newborns.
1hese lnclude pollcles Lo reduce pre-Lerm blrLhs, Lo supporL healLhy blrLh spaclng, Lo lmprove maLernal
access Lo smoklng cessaLlon and subsLance abuse servlces, Lo broaden adopLlon of lnnovaLlve programs and
pracLlces LhaL lmprove Lhe effecLlveness of prenaLal care, and Lo supporL breasL feedlng, all of whlch wlll
lmprove healLh ouLcomes and reduce fuLure Laxpayer cosLs.
!"#$8&'()*)&+$/"00&#*/4$
Access Lo affordable baslc and prevenLlve healLh care for low-lncome unlnsured 1exas women.
ollcles LhaL promoLe early enLry lnLo prenaLal care.
ollcles LhaL promoLe on-golng prevenLlve care for women and chlldren, llke chronlc dlsease
managemenL and annual screenlngs.
uevelopmenL of a MaLernal MorLallLy 8evlew rogram and ongolng supporL for leLal, lnfanL and
Chlld MorLallLy 8evlew rograms.
ollcles LhaL ensure conLlnued access Lo crlLlcal neonaLal servlces.
nlCu pollcles and procedures LhaL promoLe AA levels of care.
MaLernlLy servlces LhaL reflecL besL pracLlces ldenLlfled ln currenL, peer-revlewed obsLeLrlcal
llLeraLure.
Continue to Improve and Modernize the Medicaid and CHIP Eligibility System
Slnce 2010, PPSC has made lmpresslve sLrldes ln processlng Medlcald and CPl appllcaLlons prompLly and
correcLly. AfLer several years of sub-sLandard performance, accuracy, speed, and
4

cusLomer servlce have all lmproved and 1exas now meeLs or exceeds federal sLandards. PPSC has made
Lhese sysLem lmprovemenLs whlle rolllng ouL Lhe new 1lL8S ellglblllLy compuLer sysLem across Lhe sLaLe and
developlng new onllne Lools lncludlng a self-servlce porLal.
Medlcald and CPl rolls conLlnue Lo grow ln 1exas. 1he economlc downLurn conLlnues Lo lead more
famlllesmany for Lhe flrsL LlmeLo seek coverage for Lhelr chlldren ln Medlcald and CPl. ln 2014, healLh
reform offers 1exas Lhe opporLunlLy Lo open Lhe Medlcald rolls Lo more Lhan a mllllon currenLly-unlnsured
u.S. clLlzen adulLs, and our sLaLe sysLems musL be fully lnLeroperable wlLh Lhe new healLh lnsurance
Lxchange. 1exas musL be prepared wlLh a fully modernlzed and sLreamllned ellglblllLy sysLem LhaL provldes
good, speedy, and accuraLe cusLomer servlce for more 1exans, whlle mlnlmlzlng Lhe number of publlc
employees needed Lo geL Lhe [ob done.
;&$-"#*2,#$).0#&9,$d*2,$8&'()*)&+$/"00&#*/())
Clvlng Lop prlorlLy Lo ldenLlfylng and ellmlnaLlng all sysLem barrlers LhaL delay access Lo newborn care
or prenaLal care. 1he PPSC should ensure LhaL ellglble newborns are enrolled ln Medlcald no laLer
Lhan 13 days afLer proper documenLaLlon of dellvery ls recelved. 1he agency should also prlorlLlze
sLreamllnlng processes for submlLLlng documenLaLlon, Lo reduce burdens on boLh famllles and
provlders,
lull lmplemenLaLlon of onllne self-servlce appllcaLlons and renewals for Medlcald and CPl, onllne
access Lo case lnformaLlon, ablllLy for famllles Lo updaLe and requesL lnformaLlon and submlL
documenLs onllne, and Lhe ablllLy Lo conLacL famllles vla emall or LexL when Lhey need Lo Lake
acLlons,
ConLlnulng Lo ldenLlfy and remove unnecessary or redundanL pollcles and procedures, and adopL new
processes LhaL lmprove producLlvlLy and/or accounLablllLy Lo faclllLaLe sLreamllned sysLems,
Lnsurlng LhaL Lhe PPSC ellglblllLy sysLem ls fully lnLeroperable wlLh Lhe PealLh lnsurance Lxchange
n W u 1
Clvlng PPSC Lhe resources and supporL needed Lo ensure a robusL and dlverse neLwork of
communlLy parLners Lo maxlmlze Lhe beneflL of Lhe new web porLal and lncrease efflclency and
access ln Lhe publlc beneflLs enrollmenL process.
Seek New Revenue Sources to Fill Budget Gaps instead of Slashing Health Care
Programs for Children and other Vulnerable Texans.
1he CoallLlon supporLs addresslng Lhe revenue deflclL pro[ecLed by sLaLe offlclals Lo resulL ln a recurrlng
shorLfall of aL leasL $10 bllllon every leglslaLlve sesslon. 1he CoallLlon also supporLs uslng exlsLlng and new
sources of revenue Lo ensure all ellglble 1exas chlldren recelve Lhe quallLy healLh care Lhey need.
ln order Lo resLore and proLecL healLh coverage for 1exas chlldren and famllles Lhrough Medlcald and CPl,
provlder paymenL raLes, and oLher vlLal publlc healLh and prevenLlve healLh servlces, Lhe sLaLe musL uLlllze
exlsLlng sLaLe resources, lncludlng Lhe 8alny uay lund, and look Lo lncreaslng our resources, parLlcularly by
dlscouraglng unhealLhy behavlors relaLed Lo Lhe use of Lobacco, alcohol, and sugary beverages.
Improve the Health and Well-Being of Texas Children by Maximizing Opportunities to
Connect Entire Families with Affordable Health Care.
L 1 1.2 mllllon unlnsured chlldren
-belng. When prlvaLe coverage becomes avallable Lhrough
Lhe healLh lnsurance Lxchange, famllles wlLh lncomes [usL over Lhe CPl llmlLs wlll have guaranLeed access Lo
comprehenslve coverage aL affordable prlces noL affecLed by Lhelr healLh sLaLus or hlsLory, LhaL wlll lnclude
5

slldlng-scale help wlLh premlums and ouL-of- C
beneflLs.
1oday, whlle 2.6 mllllon 1exas chlldren beneflL from Medlcald, only abouL 223,000 of Lhelr parenLs quallfy for
care. SLudles suggesL LhaL lf 1exas accepLs Lhe opporLunlLy Lo cover adulL uS clLlzens Lo 133 of Lhe lL ln
Medlcald, Lhe chlldren already enrolled ln Medlcald wlll be more llkely Lo geL care, and a hlgher percenLage
of Lhe unlnsured chlldren ellglble for Medlcald wlll be slgned up. 8oughly half of 1exas unlnsured chlldren
and LeensabouL 600,000are esLlmaLed Lo be ellglble for Medlcald or CPl buL noL enrolled Loday
accordlng Lo u.S. Census daLa.
8esearch has shown Lhese lmporLanL beneflLs for chlldren when low-lncome parenLs also geL coverage
1
:
*+',)#-%',&!)-%').$/'%'01)2$%')'345463').+430%',)',%$337 Low-lncome famllles wlLh unlnsured
parenLs are Lhree Llmes as llkely Lo have ellglble buL unlnsured chlldren as famllles wlLh parenLs
covered by prlvaLe lnsurance or Medlcald.
8+430%',)9+$!')#-%',&!)-%')',%$33'0)-%')2$%')34:'3;)&$)!&-;)',%$33'07 SLudles have found LhaL
chlldren are less llkely Lo experlence breaks ln Lhelr own Medlcald and CPl coverage and remaln
lnsured when Lhelr parenLs are also enrolled.
8+430%',)9+$!')#-%',&!)-%').$/'%'0)5'&)2$%')#%'/',&4/').-%')-,0)$&+'%)+'-3&+).-%')!'%/4.'!7))
SLudles have found LhaL lnsured chlldren whose parenLs are also lnsured are more llkely Lo recelve
check-ups and oLher care, compared Lo lnsured chlldren whose parenLs are unlnsured.
W<6'4,57 1he lnsLlLuLe of Medlclne reporLs LhaL a
unLreaLed poor physlcal or menLal healLh can conLrlbuLe Lo a sLressful famlly envlronmenL
LhaL may lmpalr Lhe healLh or well-belng of a chlld. 8eyond LhaL, unlnsured parenLs
rouLlne and ongolng care may be unable Lo work, or may end up wlLh blg medlcal bllls even when
Lhey do geL care. ln elLher case, Lhe flnanclal consequences have a blg lmpacL on chlldreneven
when Lhe chlldren Lhemselves have coverage.
Cur sLaLe should Lake maxlmum advanLage of Lhe opLlons offered under Lhe ACA Lo lmprove coverage,
access Lo prevenLlve care, and chlld and famlly well-belng.
!"#$8&'()*)&+$'79&%'*,/$-&#4$
A Lhorough and LhoughLful analysls and sLaLewlde dlalogue on Lhe cosLs and beneflLs of accepLlng Lhe
ACA M opporLunlLy.
Careful conslderaLlon of Lhe poslLlve lmpacL on chlld and famlly well-belng lf Lhe low-lncome parenLs
of chlldren ln 1exas Medlcald could also access care.
AssessmenL of Lhe economlc lmpacLs for sLaLe and local governmenL budgeLs, lncludlng offseLs Lo
currenL local and sLaLe healLh, menLal healLh, and crlmlnal [usLlce cosLs.
Analysls of new opporLunlLles Lo allow famllles Lo enroll ln Lhe same prlvaLe healLh plan Lhrough Lhe
healLh lnsurance Lxchange ln 2014, such as conslderaLlon of Lhe 8aslc PealLh lan opLlon Lo creaLe
CPl 1 n ls avallable only Lo sLaLes LhaL accepL Lhe Medlcald
expanslon).




1. Georgetown University Health Policy Institute Center for Children and Families, Expanding Coverage for Parents Helps Children:
&KLOGUHQV*URXSV+DYHD.H\5ROHLQ8UJLQJ6WDWHVWRMove Forward and Expand Medicaid; July 2012, http://ccf.georgetown.edu/wp-
content/uploads/2012/07/Expanding-Coverage-for-Parents.pdf

6

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713-41-8422 {c)

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|eg|s|ot|ve sess|ons, we must rece|ve th|s new |orm |n order to ||st
your orgon|zot|on |or the upcom|ng sess|on.