TribBlog: Steady Medi(caid)

Despite state budget and recession woes, Medicaid programs across the country maintained eligibility practices and increased enrollment in 2010, according to a report released today by the Kaiser Family Foundation and the Georgetown University Health Policy Institute.

Thirteen states expanded Medicaid or CHIP eligibility last year, and 14 states made improvements in enrollment and renewal procedures. Texas didn't fall into either of these categories. But the state held steady in 2010, while making improvements in technology to prepare for the rollout of federal health care reform.

Texas is now one of 32 states to accept electronic submissions of Medicaid applications, one of 29 to accept electronic signatures, and will join 29 other states later this year in verifying citizenship status quickly by electronically matching data with the Social Security Administration.

“Technology is proving to be a very important tool in the toolbox for trying to improve access to care, and especially access to coverage under Medicaid and CHIP,” said Diane Rowland, executive vice president of the Kaiser Family Foundation.

The report attributes the stability of Medicaid nationally to the American Recovery and Reinvestment Act, otherwise known as the stimulus plan, which gave states significant increases in federal matching funds for maintaining their current Medicaid and CHIP eligibility and enrollment procedures. But many of these matching funds will soon dry up. And with states facing giant budget shortfalls, some elected officials — several in Texas — have suggested dropping out of Medicaid.

Not a good plan, said Cindy Mann, director of the Center for Medicaid, CHIP and Survey & Certification (CMS): “It’s just a very significant source of federal support to the state, to the hospitals, to the nursing homes, to the physicians and to the healthcare system at large," she said. 

According to a report released by Texas' Health and Human Services Commission in December, Texas doesn’t have the revenue to support the growth of Medicaid, but opting out of federal Medicaid is not a viable solution either. Federal legislation prohibits Texas and other states from tightening eligibility requirements to ease their budgets, but Mann says the details of health care reform leave room for flexibility. So far, state officials say, they haven't seen this flexibility from the feds. 

“States may cut optional services and provider reimbursement rates, but it would be virtually impossible to fund caseload growth that way,” said HHSC Spokeswoman Stephanie Goodman. “Our Legislature — along with those in other states — is going to be challenged to find enough state funding for Medicaid.”

Trisha Brooks of the Georgetown University Health Policy Institute says it's important to remember that Medicaid "is not the cause of state budget problems — it’s the economy."

“And while dropping out of Medicaid might sound like a good sound byte," she said, "it’s not as easy a solution as governors suggest that it is.”