More Pay for Medicaid Doctors Lost in Budget Deal

As final details of the state's next budget for health and human services emerged Wednesday, Republicans hailed a fiscally conservative approach to serving the state’s neediest populations, while doctors’ groups and advocates for the poor saw little to celebrate.

A House-Senate budget conference committee reconciling differences between spending plans approved by the two chambers voted for a compromise health and human services budget 9-1. State Rep. Sylvester Turner, D-Houston, was the lone no vote. 

Turner questioned the committee’s decision not to boost payments to primary care doctors who see patients on Medicaid, the joint federal-state insurer of last resort for the poor and disabled. In Texas, physician groups say Medicaid pays significantly below the cost of treating patients, making it unappealing for doctors to treat people in the program.

Turner noted that the number of primary care doctors seeing new Medicaid patients is low — about 34 percent, according to the Texas Medical Association. The House version of the budget would have raised Medicaid payments to the same level as payments from Medicare, the federal insurance program for the elderly. Texas Medicaid currently pays physicians about 65 percent of what Medicare does, according to the Kaiser Family Foundation.

“One of the reasons we funded it on the house side was to try and stop the decline” in participating doctors, Turner said.

But state Sen. Charles Schwertner, a Republican of Georgetown and chairman of the upper chamber’s Health and Human Services Committee, said boosting Medicaid reimbursements to doctors “does not significantly increase [the] provider network.”

“I don’t believe the provider network is going to be any more strained,” he said.

The reconciled budget also includes:

• An additional $8 million for the Alternatives to Abortion program, which provides pregnancy and parenting information to low-income women, to serve about 16,000 additional women each year. Democrats this year made the program a target of criticism.
• Preserved funding for the state’s HIV and STD prevention program. That program was the subject of a tense debate earlier this session, when state Rep. Stuart Spitzer, R-Kaufman, sought to move $3 million from it to pay for abstinence education. The adopted budget will not include Spitzer’s provision.
• A modest increase to the wages for attendants who care for people with disabilities, to about $7.97 an hour. Republicans, including Gov. Greg Abbott, championed a wage increase for community attendants, but it fell short of the $10 an hour rate advocates for people with disabilities had pushed for this session.

“Both sides had to make determinations on what were going to be priorities,” said state Rep. John Otto, R-Dayton, the House’s chief budget writer.

Aman Batheja contributed reporting.

Disclosure: The Texas Medical Association is a corporate sponsor of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.