Texas Well and Healthy

Today’s opening of the new Health Insurance Marketplace is kind of a big deal–for health care access, for Texas, for the nation, and for CPPP.  Many of you know that the Center was founded in 1985 by the Benedictine Sisters of Boerne with a mission to improve health care access for “poor and disenfranchised Texans.”

Given that mission, and having worked here at CPPP for nearly 19 years, I am excited about the roll-out of new health coverage in 2014 under the Affordable Care Act (ACA) because, for the first time, our nation is creating a system to make comprehensive health care available to nearly all Americans, not for free, but at a “sliding-scale” price that works for your budget.  It’s not a perfect system, and I know that there will be bumps and delays as the new systems roll out.  But the fact that the U.S. is finally trying to break down the financial barriers to a decent standard of health care is of enormous significance.  And with the Census reporting Texas still has more than 6 million (one in four) uninsured, no state has more to gain than ours!

Most Texans who are already insured through work will not interact with the new Marketplace, but folks who are uninsured today or buying directly from an insurance company really owe it to themselves to go the www.healthcare.gov and check out new options.

Health plans in the Marketplace won’t leave out major parts of health care–every plan will include prescriptions, mental health, maternity, and must cover any pre-existing condition—so you won’t have hard choices about benefits.  Instead, one of the biggest choices will be whether you prefer a lower monthly premium (with the risk of paying more out of pocket later when you need care), or a higher monthly premium but less out of your pocket at the doctor’s office or pharmacy.  Another big choice is to pick a plan that includes the doctor or clinic that you want to use, and will give you access to any special medications or services you need.

As Megan Randall blogged here last week, the sneak preview of Texas Marketplace rates provided by US HHS last week showed that with the “premium credit” discounts available, some low-income Texans will have the option to get a “bronze” plan with zero monthly premium cost!  That will be tempting, no doubt, but may not really be the least expensive choice for a person who needs regular health care visits or prescriptions.  It is really important that folks facing the trade-off between low monthly premiums on the one hand, and higher costs when you need care on the other hand, take a careful look at their health care needs, and get any help they need to make a good choice.

Texans must first submit an application to get those premium and co-pay discounts, and that can be done online at www.healthcare.gov, over the phone, by mail, or in person at a local community agency.  You can look up place to get in-person help at www.healthcare.gov, with a special link to search by zip code at www.localhelp.healthcare.gov.

It is important to know that thousands of Texans working for community-based agencies across Texas have been trained and certified to help out with the new systems, and to help individuals and families sort through the choices so they can make their own decisions.  Our governor has said he opposes the ACA, and he wants to add Texas requirements for the specially trained “Navigators” helping Texas consumers under federal grants to community-based agencies.  But you should know that privacy and protection of personal information is a big focus of the federal training for Navigators, and that in-person help from Navigators and other trained and certified in-person helpers is moving on ahead, despite his actions.

Today is a big day!  Celebrate, tell your friends and families, and do your part to help folks in your community learn about their new choices for affordable health care, and where they can get the information and help they need.

Written by: Anne Dunkelberg, Center for Public Policy Priorities. Cross-posted from Better Texas Blog.

Over 66,000 uninsured Texas veterans and their spouses could gain health care coverage if the state moves forward with Medicaid expansion under the Affordable Care Act.

In Texas, over 200,000 veterans and their spouses are uninsured – the highest of any state in the nation.

Under the ACA, states have the opportunity to extend Medicaid coverage to U.S. citizen adults with incomes up to 138% of the federal poverty income level (FPL), roughly $32,000 annually for a family of four.  In Texas, this expansion would extend Medicaid coverage to many low-income parents, caretakers, and childless adults who do not currently qualify—including a substantial number of veterans and their spouses.

According to a new report published by the Urban Institute, an estimated 48,900 uninsured Texas veterans (38% of all uninsured Texas vets) will be eligible for Medicaid coverage if Texas chooses to participate in the expansion.

Moreover, three-quarters of these veterans—over 36,000—have incomes below 100% of FPL and would not be eligible for subsidies in the exchange.  The same is true for the 11,500 uninsured spouses of veterans whose incomes also fall below 100% of FPL.

These groups will only qualify for new coverage options under the ACA if Texas chooses to expand Medicaid.uninsured-veterans

Implementation of Medicaid expansion in Texas will be critical to ensuring that our lowest-income veterans and their spouses have access to affordable health care.

In total, Medicaid expansion would extend eligibility to approximately one third of all uninsured Texas veterans and spouses, over 66,000 people.

Nineteen bills supporting Medicaid expansion for low-income adults have been filed during the 2013 legislative session, and budget directions for expansion are included in both the House and Senate appropriations bills.

Texas needs to move forward with Medicaid expansion this session in order to improve the health and well-being of those men and women – and their family members – who have put their own health and lives at risk serving in the armed forces.

All calculations are derived from data provided by the Urban Institute.

For more information, please see:

Written by: Megan Randall, Center for Public Policy Priorities

Three of four people who will be eligible for coverage through the new online health insurance marketplace opening in October say they want in-person assistance to help them learn about and enroll in coverage. Navigators—in-person assistance providers who will help consumers and small employers enrolling in the marketplace—are one of the ways the Affordable Care Act addresses this demand. Navigators will also be able to tailor outreach efforts to marketplace enrollees who, compared to people who are insured today, are more likely to be lower income, less educated, more racially and ethnically diverse, and more likely to speak a language other than English.

Today, the U.S. Department of Health and Human Services released its Funding Opportunity Announcement (FOA) for ACA Navigators in federally facilitated or state partnership exchanges. U.S. HHS encourages all applicants to submit a letter of intent (optional) by May 1, 2013 to navigatorgrants@cms.hhs.gov.  Final applications are due by 1 p.m. (EDT) on June 7, 2013 through grants.gov.  Awards will cover a 12-month period of performance following the anticipated August 15, 2013 award date.

The total $54 million award will be distributed among the 34 eligible states according to a formula that directs more funding to states with larger uninsured populations, with $8,151,185 earmarked for Texas.  At least two types of eligible entities will receive awards in each state, including at least one community and consumer-focused nonprofit.

You can find the full grant announcement on www.grants.gov by searching for CFDA 93.750.

Applicants must have an Employer Identification Number/Taxpayer Identification Number (EIN/TIN) as well as a Dun and Bradstreet Data Universal Numbering System (DUNS) number, and must register for the System for Award Management (SAM) database in order to apply.  Completing these steps can take up to four weeks.  More information can be found at the grants.gov page, “Get Registered.”

U.S. HHS will host two technical assistance calls in upcoming weeks for organizations interested in applying:

First call: Thursday, April 11, 2013 from 3:30 to 5:00 p.m. EDT

Toll-free teleconference phone number: 877-267-1577; ID: 5119

Second call: Friday, April 19, 2013 from 3:30 to 5:00 p.m. EDT

Toll-free teleconference phone number: 877-267-1577; ID: 2917

U.S. HHS also released a rule last week that proposes the training, conflict of interest, and privacy/security standards that will apply to Navigators.  Comments on the rule are due by 5 p.m. on May 6, 2013.

Written by: Stacey Pogue, Center for Public Policy Priorities

Contributed by: Anne Dunkelberg, Center for Public Policy Priorities

Last week, I promised to come up with shorthand names to help us distinguish between the two different Medicaid 1115 waivers. To avoid wonky acronyms, I’ve decided to call the new waiver that the feds approved in December 2011—formally named, “Texas Healthcare Transformation and Quality Improvement Program”—the “Hospital Waiver.”

Now, the OTHER 1115 waiver:

• was authorized in article 13 of Senate Bill 7 of the 82nd special session of the Texas legislature;
• directs Texas Medicaid to seek exemption from federal minimum Medicaid eligibility, benefits, and co-pay standards;
• at present, is only a concept, but has a newly-named Legislative Oversight committee with a first public hearing set for Wednesday February 29!

I will be calling this the “SB 7 waiver.”  This avoids calling it anything that indicates either opposition (like “block grant waiver”) OR support (like “reform waiver”).  At least for now, that seems the reasonable thing to do.

Consumer Eyes on the Hospital Waiver

As I reported last week, Texas HHSC asked staff of the CPPP to act as a consumer representative in their working group of mostly hospital representatives that meets monthly. Here are some newsworthy notes from the February 2 meeting:

  • Stanley Stewart, who some people may know from his successful oversight of the TIERS roll-out and the rescue of the HHSC eligibility system after its 2006-2009 melt-down, has been designated the project implementation director for the hospital 1115. Waiver policy development leads will still be Maureen Milligan and Bill Rago, under Texas Medicaid Director & Deputy Executive Commissioner Billy Millwee.
  • Timelines: HHSC wants to send a “menu” of reform project choices for Regional Health Partnerships (RHPs) to pick from to federal Medicaid authorities at the end of August 2012, and a list of the RHPs (what counties, which hospitals) by the end of October 2012.
  • HHSC has a group of “clinical champions” advising them on SERVICE/QUALITY/SAFETY/PAYMENT reform ideas and benchmarks that may go into the menu of options.
  • An important discussion seemed to clarify that the “anchor” hospitals – the ones that have local tax dollars to contribute to the waiver funding pool – will NOT be in the role of auditing or “policing” services by and payments to the partner hospitals. It is not yet clear who WILL audit to ensure partner hospitals really meet their goals.
  • Another discussion considered whether a private-for-profit hospital could participate and ONLY do Medicaid care and free care to the uninsured; that is NOT participate in the health delivery reforms. HHSC indicated that policy was not defined, but that clearly the anchor hospitals would have to agree.
  • HHSC said they will provide an option to sign up for email alerts when there is Hospital 1115 waiver news, but as of 2/20/2012 this does not appear to have been added to the HHSC web site. You can check here for HHSC updates.
  • Read a quick CPPP analysis of the waiver and key concerns here (page 4).

The Take-Away: Communities around Texas are holding stakeholder meetings about their ideas for their local Regional Health Partnership.

On behalf of the CPPP, I will be sending a recommendation to HHSC that all local RHP planning meeting announcements be shared with HHSC and posted at the HHSC website. If you or your organization agrees, you may wish to make a similar comment.

Contributed by: Anne Dunkelberg, Center for Public Policy Priorities

In December, federal Medicaid officials approved a Texas request for a Medicaid waiver officially named “Texas Healthcare Transformation and Quality Improvement Program.”  This waiver lets Texas Medicaid expand HMO-style care to more Texans without losing large federal payments to hospitals.  In return for keeping those federal dollars, Texas will re-purpose them into a fund to help pay hospitals for care for the uninsured, and help launch health reforms that move away from paying hospitals simply for volume of care, and toward payment that depends on better outcomes and safety, and more cost-effective care.

You can find all the official state and federal documents here and here.  Read the Center for Public Policy Priorities analysis of the waiver and key concerns here (page 10).

Consumer Eyes and Ears for this Waiver.  Texas HHSC (that’s Health and Human Services Commission for all non-wonks) has a working group of mostly hospital representatives meeting monthly, and CPPP was asked to send a staff member as a sort of informal consumer representative.  We will update fellow consumers on key information and issues from these meetings through regular emails and blog posts in the months to come.  Check back for a report on the 2/2/2012 meeting in the next few days.

BUT, another 1115 Waiver May be On the Way.  The 2011 Legislature also authorized a different 1115 waiver (article 13 of SB 7, special session), directing HHSC to seek exemption from federal minimum Medicaid eligibility, benefits, and co-pay standards.

Read CPPP analysis of this second proposed waiver and key concerns here (page 12).  See also testimony on HB 13.


A legislative oversight committee required in the SB 7 was just named and a hearing has just been posted for 9:00 AM, Wednesday, February 29, 2012.  See the Agenda and the Schedule.

Joint Committee on Oversight of Medicaid Reform Waiver (C885):

Sen. Jane Nelson

Rep. Garnet Coleman
Rep. Brandon Creighton
Sen. Bob Deuell
Rep. Lois W. Kolkhorst
Sen. Dan Patrick
Sen. Royce West
Rep. John Zerwas

Texans who care about kids health and the health care safety net in general will need to stay tuned for opportunities to get involved in this committee’s work and not-yet-known process Texas HHSC will take to develop a second 1115 waiver proposal. Meanwhile, we promise to come up with shorthand names to help us keep these two different waivers apart—by next week!

Contributed by: Anne Dunkelberg, Center for Public Policy Priorities