Texas Delays Program To Expand Coverage to Low-Income Adults
Texas Health and Human Services Executive Commissioner Albert Hawkins has announced that a plan to provide health coverage to about 482,000 uninsured parents whose children are enrolled in Medicaid or SCHIP will not begin this fall as planned, the Austin American-Statesman reports. The program, which is mandated by the state Legislature, is intended to reduce the number of uninsured residents with incomes too high to qualify for Medicaid but below 200% of the federal poverty level. Commission spokesperson Stephanie Goodman said the uninsured probably will not have access to the program until 2010 or 2011.In a letter last week to state Sen. Jane Nelson (R) and state Rep. Dianne White Delisi (R), both of whom chair health committees, Hawkins wrote, "We have now determined that limitations to this model outweigh the benefits." He added that the parents "would not have the level of consumer choice we believe is important for the Texas reform effort." Hawkins noted that the plan would not offer sufficient options to hypothetical applicants seeking either catastrophic care or more comprehensive coverage to care for a chronic disease.
The insurance program is part of a larger plan in Texas to shift health care spending away from emergency care and toward preventive care. According to the American-Statesman, the program has been criticized by hospitals, physicians and advocates for people with low incomes (MacLaggan, Austin American-Statesman, 4/8).
Enrollment Problems
In related news, the Dallas Morning News on Sunday examined problems with the state's effort to switch to a partially privatized system for determining eligibility for public programs. In 2003, Gov. Rick Perry (R) decreased the payroll of the state's welfare offices and ordered a shift of many screening duties to four privately operated call centers. However, expected cost savings from the move have not materialized, and the new call centers have not made it easier for state residents to obtain information about and apply to programs such as Medicaid and SCHIP. In some cases, paperwork has been lost, and some eligible applicants are denied health care and other benefits because of system errors.
State officials "acknowledge the failures but say there's no turning back," according to the Morning News. Goodman said the new system is a "much more flexible system. It's modern, it's Web-based, and it allows us to provide Texans with a great deal of choice in how they apply for benefits." She said the promised savings and efficiency have not been achieved because the program authorized in 2003 has not been fully implemented. Hawkins has announced several new initiatives this year to improve recruitment and retention of state eligibility workers and to train more of them on the new computer system, which many fault for the problems.
According to the Morning News, the system "could be headed for more severe problems, as a jittery economy means more Texans may soon apply for public assistance." In addition, the problems could distract state officials who are separately working to overhaul Medicaid. The Morning News reports that some advocates are concerned that if the state HHS "remains preoccupied with fixing the eligibility system, it will be distracted just as it needs to focus on huge changes designed to cover more adults" and improve preventive and dental care for low-income children.
Nelson said, "These problems need to be resolved now -- not in the next (legislative) session -- because people's health is at stake." The Morning News lists several potential solutions to the enrollment problems, as well as pros and cons of the suggestions (Garrett, Dallas Morning News, 4/6).
