Medicaid and CHIP New and Upcoming Developments

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Medicaid and CHIPNew and Upcoming Developments

Kay Ghahremani Deputy Director for Policy
Development November 2, 2009
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Medicaid Enrollment

• 13 percent (1 in 8) of Texans receive Medicaid.
• 3 million individuals receive Medicaid.
• 519,000 children receive CHIP and CHIP Perinate.
• Medicaid and CHIP enrollment is projected to
  continue to increase.

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Medicaid Enrollment
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Medicaid Spending

• Total Medicaid spending in 2008
• Estimated 22.0 billion (all funds)
• Includes Disproportionate Share Hospital (DSH),
  Upper Payment Limit payments, and administration.
• Medicaid spending increasing in both federal and
  Texas budgets.
• In 2009, Medicaid was approximately 26.2 percent
  of the total state budget (excludes DSH).
• Like Medicaid enrollment, Medicaid spending is
  projected to continue to increase.

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Legislation Impacting Clients

• Medicaid Buy-In Program for Disabled Children
  SB 187
• Allows families whose income does not exceed 300
  of FPL to buy-in to the Medicaid Program for
  their child with a disability
• Appropriation for Medicaid Services for Legal
  Permanent Resident Children
• CHIPRA allows states to cover Legal Permanent
  Residents in Medicaid and CHIP

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Legislation Impacting Clients

• Obesity prevention pilot for Medicaid and CHIP
  enrollees SB 870
• Creates a pilot in at least one area of the state
• Pilot is jointly conducted by HHSC and DSHS
• Electronic health information exchange HB 1218
• Will expand the use of the health passport from
  foster children to include all Medicaid
  recipients
• Includes an option to expand to CHIP clients at a
  later date
• Diabetes Self-Management Training Program HB
  1990
• Establishes a diabetes self-management training
  pilot program for certain Medicaid recipients
  with diabetes
• Participation is voluntary

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Riders Impacting Clients

• Rider 54 Requires HHSC to implement substance
  abuse services for adults.
• Rider 50 Requires HHSC to improve transparency
  and accountability of behavioral health service
  delivery in managed care programs.
• Rider 59 Requires HHSC to consider implementing
  managed care for children with disabilities

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Other Initiatives

• HHSC will provide grants totaling almost 25
  million to primary care providers in Texas to
  establish medical homes. Applications will be
  available in early 2010.
• Future of the CHIP Perinate program is uncertain
  because of federal requirements to change the
  financing of the program.

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Federal Changes

• CHIP Reauthorization Act of 2009
• PPS for FQHCs and RHCs
• Mental Health Parity
• Dental Services
• Coverage of Legal Permanent Resident children
• American Recovery and Reinvestment Act (ARRA)
• Will provide incentive payments for meaningful
  use of electronic health (medical) records by
  qualifying Medicaid providers.
• Establishes grant and loan programs for states
  and health entities.