To read the newly released Centers for Medicare and Medicaid Services (CMS) “Dear State Medicaid Director” letter re: New Option for Coverage of Individuals, click here.
“We just passed a law that doesn’t do much for rich people, but really helps poor people.” –Leonardo Cuello, National Health Law Program
Now that the Health Care Reform bill has been signed into law, it’s time for us to get busy advocating for state reform allowing for aspects of the federal bill to be implemented in Texas before 2014.
The federal bill includes Medicaid expansion, which will create coverage for 16 million people by 2019. This expansion signifies a radical conceptual shift from the current Medicaid system. In the current system, it’s not enough to be flat broke to receive Medicaid healthcare coverage. You have to be “broke plus” (i.e. broke plus pregnant, broke plus disabled, etc). This current system is based on the idea that only the “worthy poor” deserve health insurance. But beginning in 2014, there will be a mandatory “catch-all” category for everyone* who earns up to 133% of Federal Poverty Limits.
However, states have the option to implement a State Plan Amendment (SPA) that allows states to start buying these low income people into Medicaid earlier than 2014. Texas could potentially phase this plan in using a “lower income first” model. For example, depending on our budget, we could start with coverage for people who are at 75% or 100% of Federal Poverty Limits. In doing so, Texas would receive federal match money to cover people who wouldn’t ordinarily be covered.
Similarly, while the Health Care Reform ensures that pre-existing condition exclusions will be prohibited starting in 2014 (2010 for children) states may create a temporary high-risk pool for adults that will remain in effect until 2014.
Interested in putting together a coalition to help bring about these reforms here in the Lone Star state during the 82nd Legislative Session?
The National Health Law Program (NHeLP) suggests that organizations and individuals in Texas interested in pushing these state healthcare reforms come together, organize ourselves, and then contact NHeLP for more information and support on how to proceed.
*Does not include undocumented immigrants, as well as other groups who already have coverage such as Medicare enrollees, people over age 65, and mandatory coverage groups like pregnant women.