Texas Delays Program To Expand Coverage To Low-Income Adults

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Texas Health and Human Services Executive Commissioner AlbertHawkins has announced that a plan to provide health coverage to about 482,000uninsured parents whose children are enrolled in Medicaid or SCHIP will notbegin this fall as planned, the Austin American-Statesman reports. The program, which ismandated by the state Legislature, is intended to reduce the number ofuninsured residents with incomes too high to qualify for Medicaid but below200% of the federal poverty level. Commission spokesperson Stephanie Goodmansaid the uninsured probably will not have access to the program until 2010 or2011.

In a letter last week to state Sen. Jane Nelson (R) and state Rep. Dianne WhiteDelisi (R), both of whom chair health committees, Hawkins wrote, "We havenow determined that limitations to this model outweigh the benefits." Headded that the parents "would not have the level of consumer choice webelieve is important for the Texasreform effort." Hawkins noted that the plan would not offer sufficientoptions to hypothetical applicants seeking either catastrophic care or morecomprehensive coverage to care for a chronic disease.

The insurance program is part of a larger plan in Texas to shift health care spending awayfrom emergency care and toward preventive care. According to the American-Statesman,the program has been criticized by hospitals, physicians and advocates forpeople with low incomes (MacLaggan, Austin American-Statesman,4/8).

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Enrollment Problems

In related news, the DallasMorning Newson Sunday examined problems with the state's effort to switch to a partiallyprivatized system for determining eligibility for public programs. In 2003,Gov. Rick Perry (R) decreased the payroll of the state's welfare offices andordered a shift of many screening duties to four privately operated callcenters. However, expected cost savings from the move have not materialized,and the new call centers have not made it easier for state residents to obtaininformation about and apply to programs such as Medicaid and SCHIP. In somecases, paperwork has been lost, and some eligible applicants are denied healthcare and other benefits because of system errors.

State officials "acknowledge the failures but say there's no turningback," according to the Morning News. Goodman said the newsystem is a "much more flexible system. It's modern, it's Web-based, andit allows us to provide Texans with a great deal of choice in how they apply forbenefits." She said the promised savings and efficiency have not beenachieved because the program authorized in 2003 has not been fully implemented.Hawkins has announced several new initiatives this year to improve recruitmentand retention of state eligibility workers and to train more of them on the newcomputer system, which many fault for the problems.

According to the Morning News, the system "could be headedfor more severe problems, as a jittery economy means more Texans may soon applyfor public assistance." In addition, the problems could distract stateofficials who are separately working to overhaul Medicaid. The MorningNews reports that some advocates are concerned that if the state HHS"remains preoccupied with fixing the eligibility system, it will bedistracted just as it needs to focus on huge changes designed to cover moreadults" and improve preventive and dental care for low-income children.

Nelson said, "These problems need to be resolved now -- not in the next(legislative) session -- because people's health is at stake." The MorningNews lists several potential solutions to the enrollment problems, aswell as pros and cons of the suggestions (Garrett, Dallas Morning News,4/6).

Reprintedwith permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign upfor email delivery at kaisernetwork.org/email . The Kaiser Daily Health PolicyReport is published for kaisernetwork.org, a free service of The Henry J.Kaiser Family Foundation.

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