HEALTH CARE POLICY

Medicaid Reform and Expansion

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Perhaps one of the most noteworthy events of this session was the legislature’s refusal to expand Medicaid to 1.3 million Texans under the Affordable Care Act with an amendment attached to SB 7 (R-Nelson). As expected, Governor Perry and grassroots conservative groups advocated strongly against Medicaid expansion while health care advocates pushed for action in order to avoid a potential loss of $100 billion in federal dollars.

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The intended bipartisan compromise to this debate, HB 3791 (R-Zerwas), proposed the development of a ‘Texas solution’ to Medicaid expansion. This solution offered alternatives such as federally subsidized private-market coverage for low-income workers without employer health insurance, managed care delivery models for private markets, and cost-sharing initiatives for individuals. As with transportation funding, however, HB 3791 failed to garner support among more conservative members.

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The Texas legislature was more successful in its efforts to overhaul the Medicaid system by passing several key reform bills this session. Collectively, these bills will reduce Medicaid fraud and waste, redesign the long-term care delivery for the elderly and disabled, and authorize a number of pilot programs aimed at changing the way care is delivered to Medicaid recipients.

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• SB 7 (R-Nelson) redesigns the Medicaid delivery system for those individuals with intellectual and developmental disabilities through an expanded Medicaid STAR+Plus managed care program. The bill also adds several other provisions such as stricter quality control measures, greater HHSC control over provider reimbursement rates, and authorizes a number of pilot programs, such as a preventative wellness screening pilot, through Medicaid waiver programs and community Intermediate Care Facilities.

• SB 8 (R-Nelson) enhances the state’s ability to detect and prevent Medicaid fraud and abuse while reducing unnecessary or wasteful services. The bill also restricts fraudulent providers from reentering the system and cuts down on aggressive marketing practices by companies to current and future enrollees. One area specifically targeted by the bill was the state’s medical transportation system, which has often been a breeding ground for system abuse. Under the new law, HHSC is given the authority to develop and oversee a managed transportation delivery model using regionally based managed transportation organizations operating under a capitated rate system.

• SB 1542 (D-Van de Putte) aims to cut through some of the red tape within the Medicaid system by requiring HHSC to develop an evaluation and implementation process for new clinical initiatives that includes a prescreening process. In doing so, HHSC will be able to stay on pace with new technological advancements that often deliver services at a higher quality and lower cost to patients.

• SB 348 (R-Schwertner) increases system oversight of participating Medicaid STAR+PLUS managed care organizations by requiring annual reviews by HHSC. In doing so, HHSC increases accountability and ensure patients are receiving adequate care.

Mental Health

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Mental health advocates in the legislature were able to secure an additional $259 million in new funding for behavioral health programs as well as change how the state manages those affected by mental health issues in a number of different areas.

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Schools

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Several key bills passed this session that make huge strides in shifting the way behavioral health issues are identified and addressed in our public school system.

With the passage of SB 460 (R-Deuell), mental health training is now embedded in educator preparation programs and training for current teachers and administrators. This bill also requires local school advisory committees to create prevention and identification strategies. HB 3793 (D-Coleman) strengthens these initiatives by providing state funding for local mental health authorities and educators to deliver mental health first aid with no cost to school districts.

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Family Assistance

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Lawmakers also passed legislation to develop stronger support systems for parents, caregivers and guardians of those with mental health problems. Both SB 7 (R-Nelson) and HB 3793 (D-Coleman) expanded the list of diagnoses to include a wide range of known behavioral health disorders to allow authorities to administer ongoing and preventative care instead of crisis-driven care.

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SB 44 (D-Zaffirini) strengthens the Department of Family and Protective Services reporting mechanisms for the number of children committed to the state for mental health issues by parents while requiring DFPS to make recommendations to reduce this practice. Similarly, SB 421 (D-Zaffirini) creates a new system to implement strategies for minors receiving inpatient or at-home care to help prevent them from needing more restrictive care.

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Jail Diversion Programs

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SB 1185 (R – Huffman) authorized funding for a Mental Health Diversion Program in Harris County to provide inmates suffering from mental health disorders, including substance abuse, with additional resources immediately after their release. This program will provide social, clinical, housing, and welfare services based on a targeted treatment plan and strive to reduce recidivism.

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Women’s Health Programs

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Like education, women’s health funding was significantly reduced during the 2011 session, which caused 167 clinics to be defunded and 53 to close. While portions of these programs were able to secure federal support, these funds were merely meant to be a one-time cash infusion. With this in mind, a bipartisan coalition of House and Senate members made restoring last sessions cuts and replacing federal dollars a top priority during the appropriations process.

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The 2014-2015 budget highlights relating to funding for women’s health programs include:

• A rider in SB1 by Representative Donna Howard (D-Austin) secured $32.1 million in state funding to replace federal dollars awarded to the Women’s Health and Family Planning Association of Texas. This increase will provide access to preventive care for an additional 48,000 low-income women.

• Representative Sarah Davis (R-Houston) led a behind the scenes effort to procure $100 million in additional funding for a state-run primary care program to serve women of all ages.

• $71.3 million in state funding for the Texas Women’s Health Program, most of which replaces federal funds lost by 2011’s ‘Affiliate Ban Rule’. These dollars will provide family planning services for upwards of 150,000 women.

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