(St@teside Published June 22, 2007)

Texas:

Enrollment in the Texas SCHIP program has continued to decline recently. Five thousand children were lost from the program in June, the fourth consecutive month with a decrease in enrollment. While the program currently reaches 300,800 children, roughly 25,000 children have lost coverage since December 2006. Some attribute June's loss in enrollment to an agency decision to end an amnesty program for families with incomplete applications.

Lawmakers imposed restrictions on SCHIP enrollment in 2003 by shortening the enrollment period from one year to six months and including a stricter asset test. However, Governor Rick Perry (R) recently signed House Bill 109, which would allow families below 185 percent of the federal poverty level (FPL) to enroll once a year instead of twice, would revise the 90-day waiting period requirement so that it would only apply to children who had health insurance during the 90 days prior to applying for SCHIP, and would change restrictions on a family's assets. Through these changes, an additional 100,000 children could be added to Texas ' SCHIP program.

Governor Perry also signed Senate Bill 10, Texas ' Medicaid reform bill, in June. SB 10 could expand healthcare coverage to an estimated 200,000 individuals, a portion of the five million uninsured Texans.

The legislation:

• Creates a tailored benefit package for children with special health care needs, as well as the option for creating tailored benefit packages for other categories of Medicaid recipients. The bill requires that the tailored benefit packages would increase the state's flexibility in Medicaid funding without reducing the scope of benefits, not to be implemented before September 2009.
• Creates a pilot program for voluntary health savings accounts (HSA) under Medicaid. The pilot program is designed to promote appropriate utilization of Medicaid services. However, recipients have the option of discontinuing the HSA program and resume receiving services under the traditional Medicaid model.
• Creates the Healthy Lives pilot program, which will reward Medicaid patients who complete smoking cessation, weight loss, and other preventive health programs in one region of the state. The pilot program could provide expanded health benefits, value-added benefits, or establish reward accounts for Medicaid recipients in disease management programs that could be exchanged for health-related items not covered by Medicaid.
• Authorizes the Health and Human Services Commission to seek a Medicaid waiver to implement the Texas Health Opportunity Pool (THOP), which would utilize federal Disproportionate Share Hospital and Hospital Upper Payment Limit funds, as well as other federal and state funds, to create a trust fund. These funds would be used to reduce the number of Texans who do not have health insurance coverage, reduce the need for uncompensated care provided by Texas hospitals, and other purposes specified by the waiver. The waiver could provide up to $1 billion to help low-income workers obtain health insurance.
• Authorizes counties to establish and participate in a local or regional health care program, which would provide healthcare services or benefits to employees of small employers. Regional health care programs could receive THOP funds if they comply with waiver requirements.
• Establishes a second tier of eligibility for the Health Insurance Premium Payment (HIPP) program. Those in the second tier (individuals for whom enrolling in a group health plan is not cost effective) who would prefer to enroll in the group plan versus receiving Medicaid benefits may do so. The Health and Human Services Commission would pay the employee's share of the required premiums, except when the employee's share of required premiums exceeds the total estimated Medicaid costs for the individual. Then, the employee would be required to pay the difference. The individual would also be responsible for paying all deductibles, copayments, coinsurance, and other cost-sharing obligations.