The Medicaid Program - Essay Example

Texas Medicaid: 1998-2008 The Medicaid program is the largest and fastest growing public en ment program in Texas as well as the other s. What began in 1965 as a program that targeted a small percentage of elderly citizens, has grown into a massive program whose costs exceed $300 billion nationally. Medicaid is a program that is administered by a federal-state partnership, jointly financed and regulated by the states under federal guidelines. This has placed many states in a budget crisis as an ever increasing portion of new tax dollars are spent to finance the program. While some states spend as much as 75 percent of every new tax dollar on Medicaid, in Texas the amount is just over 25 percent, still a substantial amount (Recap of 80th Texas Legislature). Budgetary concerns and federal mandates have forced the Texas legislature to successfully implement significant Medicaid reform in the last ten years. The overriding problem for Texas, and Medicaid's biggest impact, has been the escalating costs during the last ten years. Since 1998, the total Medicaid budget in Texas has nearly doubled, and the 80th legislature session in 2007 budgeted almost $20 billion dollars for the program for 2008 of which over $8 billion was from Texas state taxes (State & Federal Medicaid Spending in Texas; Recap of 80th Texas Legislature). Texas's biennial process, and their low level of per capita state taxes has presented Texas with significant financial challenges as they are forced to budget well in advance during uncertain economic times (Kaiser Commission 1). Affected by this uncertainty are the citizens in Texas where Medicaid, "provides health coverage for one out of every three children in Texas, pays for more than half of all births and covers two-thirds of all nursing home care" (State & Federal Medicaid Spending in Texas). The once simple program has expanded to become a complex institution with complicated eligibility requirements and federal guidelines. No single program or event has been individually responsible for this expansion, but has come as the result of small changes over a period of years (Stout 33). To deal with these inherent problems, Texas has instituted several reforms since 1998 that have been designed to contain costs while expanding the program's coverage. In an effort to bring more children under the Medicaid umbrella, the federal government enacted the State Children's Health Insurance Program (SCHIP) in 1997 to cover children who lived in families that earned too much money to qualify for Medicaid assistance. By 2005, 72 percent of the non-elderly participants in Medicaid were children who were eligible for "a full range of health services including regular checkups, immunizations, prescription drugs, lab tests, X-rays, hospital visits and more" (State & Federal Medicaid Spending in Texas). In 2001, the 77th legislature further expanded access to the children's program by eliminating the "face-to-face interview requirements for application and recertification of children's Medicaid benefits in an effort to ensure that Texas Medicaid eligibility verification procedures will be no more difficult than those of the Children Health Insurance Program" (Stout 31). Today, children comprise the largest portion of aid recipients, but the majority of the costs are incurred by the elderly and nursing home care. This has prompted Texas to fully implement the SCHIP program and fundamentally change the way Texas finances their health care. Medicaid, and the SCHIP program, have helped move Texas from a system of public hospitals and county health support systems to a system of expanded public coverage (Kaiser Commission). In Texas more than 25 percent of the population is uninsured and their reliance on emergency room care and safety net providers has led to poorer health, higher cost of care, and an increase in insurance premiums in an effort to shift the cost of health care to insurance premium holders (Texas Health and Human Services Commission (1) 3). To alleviate these pressures, Texas has reformed the eligibility requirements to include greater numbers of people in the program. Income eligibility requirements for Medicaid are based on the Federal Poverty Level (FPL). By adjusting the percentage of FPL that is required for eligibility, Texas has been able to include larger numbers of children, post foster care adults, and pregnant women since 1998 (Stout, 37,38). As an example, in 2001 the Texas 77th legislature gave eligibility to children aged 18-20 that had recently left foster care and made less than 400 percent of the FPL (Stout 31). In 2002, Senate Bill 532 included "coverage for breast and cervical cancer screening through the Breast and Cervical Cancer Control Program" without regards to income (Stout 31). The liberalized eligibility requirements, and ambitious related programs, faced significant cutbacks in the face of the economic turndown during 2004 and 2005. New participants were required to wait a 90 day period before coverage, an asset test was implemented, and premiums and co-payments were raised across the board (Kaiser Commission 8). Benefits such as dental and eyeglasses, were cutback and it is estimated that 171,000 children lost SCHIP coverage during 2004, 30 percent of the total eligible (Kaiser Foundation 8). An improved economic picture in 2004 restored some of the cutbacks such as the 185 percent of FPL for pregnant women (it had been reduced to 158 percent), and increased the spending for community care for the elderly and disabled (Kaiser Commission 9,10). To deal with the rising costs of health care, Texas implemented a pilot program to establish managed care in 1991. In the 76th legislature in 1999, the government placed a moratorium on the expansion of managed care pending an extensive evaluation of the program. The subsequent report found that while providers found the system to be more complex, it provided "improved access to providers; produced program savings; and resulted in program accountability and quality improvement standards and measurement not found in the traditional fee-for-service Medicaid program" (Texas Health and Human Services Commission (2) 6-4). In light of this report, and over the objections of the providers, the moratorium was lifted in 2001 and has continued to receive support as a cost effective program. It is projected that here will be 72 percent of the Medicaid participants enrolled in managed care in 2008 as compared with 40 percent in 2003 (Texas Health and Human Services Commission (3) 10). Additional programs have been implemented since 1998 to serve specific groups and target particular needs. Beginning in 2007, the Women's Health Program (WHP) and the CHIP Perinatal provided 200,000 women with family planning service, emergency contraception, and pre-natal care for unborn children (Texas Health and Human Services Commission (3) 13). In 2004, the Texas Health and Human Services Commission (HHSC) developed a Preferred Drug List (PDL) that reduced the cost of prescription drugs and saved the program almost half a billion dollars during the first two years of its enactment (Texas Health and Human Services Commission (3) 10). Dental care, mental disorders, and private nursing care have also been added to the program for citizens under 21 years of age (Texas Health and Human Services Commission (2) 4-14). In conclusion, the uncertain economic climate of the 21st century and Texas's biennial budget process have presented Texas lawmakers with significant challenges in the past decade. A low state tax base and the conflicting goals of expanding coverage and reducing costs have resulted in several innovative reforms that do both. Covering more citizens in poverty has reduced the costly emergency room expenses and helped to curtail the level of expensive chronic illness once incurred by state and local hospitals. The SCHIP program has provided coverage for several hundreds of thousands of children, which has the long term effect of producing a healthier adult population. Pregnant women and unborn children have also received special attention under Medicaid in recent years. Specialized programs that cover things ranging from breast and cervical cancer screening to dental care have actually reduced costs while being implemented through an expanding managed care system. While budgetary concerns and federal mandates have necessitated change over the years, the innovative programs initiated by the Texas legislature have been successful at managing the problems presented by the Medicaid program. . Works Cited Kaiser Commission. Medicaid and the 2003-05 Budget Crisis - How Texas Responded. Ed. Ian Hill. Washington , DC: The Urban Institute, 2005. "Recap of 80th Texas Legislature." Texas Health and Human Services. 2007. Texas Health and Human Services. 20 Apr. 2008 . "State & Federal Medicaid Spending in Texas." Texas Health Care Spending. 2006. Texas Impact. 20 Apr. 2008 . Stout, Mary K. Medicaid: Yesterday, Today, and Tomorrow: A Short History of Medicaid Policy and Its Impact on Texas. Austin, TX: Texas Public Policy Foundation, 2006. Texas Health and Human Services Commission (1). Texas Health Care Reform [Draft Concept Paper]. Ed. Albert Hawkins. Austin, TX: Texas Health and Human Services Commission, 2007. Texas Health and Human Services Commission (2). Texas Medicaid in Perspective. Ed. Albert Hawkins. 6th ed. Austin, TX: Texas Health and Human Services Commission, 2007. Texas Health and Human Services Commission (3) . Texas Medicaid: Where We Are and Where We're Going. Austin, AL: Texas Health and Human Services Commission , 2006. Read More