Review
Expanding Medicaid Managed Care: The Right Choice for Texas?
Abstract
We set out to determine whether expanding Medicaid managed care in Texas is the solution to the challenges faced by the state of meeting the healthcare needs of a rapidly growing Medicaid population while addressing its own fiscal limitations. We reviewed the Texas Medicaid program, the potential effects of federal healthcare reform, and the state political climate through the perspectives (advantages and disadvantages) of the primary stakeholders: patients, practitioners, hospitals, and insurers. Research was performed through online, federal and state regulatory, and legislative review. In addition, we reviewed government and peer-reviewed reports and articles pertaining to issues related to Medicaid populations, healthcare practitioners, and hospitals that serve them. Each primary stakeholder had potential advantages and disadvantages associated with the expansion of Medicaid managed care. We conclude that expanding Medicaid managed care, if done in a manner responsive to the needs of recipients, can meet enrollees’ healthcare needs while controlling the state’s costs.This content is limited to qualifying members.
Existing members, please login first
If you have an existing account please login now to access this article or view purchase options.
Purchase only this article ($25)
Create a free account, then purchase this article to download or access it online for 24 hours.
Purchase an SMJ online subscription ($75)
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
Purchase a membership plan (fees vary)
Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.
References
1. Texas Comptroller of Public Accounts. Biennial Revenue Estimate. 2012–2013 Biennium. http://www.window.state.tx.us/taxbud/bre2012/96-402_BRE_2012-13.pdf. Published January 2011. Accessed February 3, 2011.
2. US Census Bureau. Current population survey. 2010 annual social and economic supplement. POV46: poverty status by state: 2009. http://www.census.gov/hhes/www/cpstables/032010/pov/new46_100125_01.htm. Accessed February 6, 2011.
3. US Census Bureau. 2009 American community survey, table S2701 (health insurance coverage status). http://www.census.gov/hhes/www/hlthins/data/acs/aff.html. Accessed February 18, 2011.
4. Texas Health and Human Services Commission. Medicaid Program. Monthly Point-in-Time Enrollment File (Med-ID File). May 2008.
5. Pub L. No. 111-5. American Recovery and Reinvestment Act (2009).
6. Smith VK, Gifford K, Ellis E, et al. Hoping for economic recovery, preparing for health reform: a look at Medicaid spending, coverage and policy trends. Results from a 50-state Medicaid budget survey for state fiscal years 2010 and 2011. http://www.kff.org/medicaid/upload/8105_ES.pdf. Published September 2010. Accessed February 2010;4:2011.
7. Pub L No. 111-148. Patient Protection and Affordable Care Act. 2010.
8. Centers for Medicaid and Medicare Services, 2010 Poverty Guidelines. aspe.hhs.gov/poverty. Accessed February 12, 2011.
9. Holahan J, Headen I. Medicaid coverage and spending in health reform: national and state-by-state results for adults at or below 133% FPL. http://www.kff.org/healthreform/upload/Medicaid-Coverage-and-Spending-in-Health-Reform-National-and-State-By-State-Results-for-Adults-at-or-Below-133-FPL.pdf. Published May 2010. Accessed February 4, 2011.
10. Angeles J, Broaddus M. Federal government will pick up nearly all costs of health reform’s Medicaid expansion. http://www.cbpp.org/files/4-20-10health2.pdf. Published June 2010. Accessed February 12, 2011.
11. Supra at 10.
12. Eaton T. Medicaid diagnosis: we’re billions short. http://www.statesman.com/news/texas-politics/medicaid-diagnosis-were-billions-short-1223240.html. Published January 31, 2011. Accessed February 10, 2011.
13. Texas Comptroller of Public Accounts. Window on state government. HHS 14. Achieve greater savings in Medicaid managed care. http://www.window.state.tx.us/specialrpt/etxaddnl/hhs14.html. Published April 2003. Accessed February 8, 2011.
14. Texas Health and Human Services Commission. Current Medicaid HMO service areas: counties that serve and surround Houston, Dallas, Ft. Worth, San Antonio, Austin, Lubbock, El Paso, and Corpus Christi. http://www.hhsc.state.tx.us/medicaid/mc/about/faq.html#5. Accessed February19, 2012.
15. Medicaid and managed care: key data, trends, and issues. http://www.kff.org/medicaid/upload/8046.pdf. Accessed February 8, 2011.
16. Texas Association of Community Health Centers, Texas update—March 2011. http://www.tachc.org/content/Legislative_Update-March_2011.pdf. Accessed February 11, 2011.
17. Supra at 16.
18. Communicating with patients who have limited literacy skills: report of the National Work Group on Literacy and Health. J Fam Pract 1998; 46: 168–176.
19. Zuckerman S, Brennan N, Yemane A. Has Medicaid managed care affected beneficiary access and use? Inquiry 2002; 39: 221–242.
20. Garrett B, Davidoff AJ, Yemane A. Effects of Medicaid managed care programs on health services access and use. Health Serv Res 2003; 38: 575–594.
21. Shi L, Stevens GD, Wulu JT Jr, et al. America’s health centers: reducing racial and ethnic disparities in perinatal care and birth outcomes. Health Serv Res 2004; 39 (6 Pt 1): 1881–1901.
22. American College of Emergency Physicians. Costs of emergency care fact sheet. http://www.acep.org/content.aspx?id=25902. Accessed February 9, 2011.
23. Center for Studying Health System Change. A snapshot of U.S. physicians: key findings from the 2008 Health Tracking Household Survey. http://www.rwjf.org/qualityequality/product.jsp?id=47988. Published September 2009. Accessed June 26, 2012.
24. Trapp D. Medicaid panel to study access to care, quality. Am Med News 2010.
25. Zuckerman S, Williams AF, Stockley KE. Trends in Medicaid physician fees, 2003-2008. Health Aff (Millwood) 2009; 28: w510–w519.
26. Department of Justice, Federal Trade Commission. Improving health care: a dose of competition. http://www.ftc.gov/reports/healthcare/040723healthcarerpt.pdf. Published July 2004. Accessed February 7, 2011.
27. US Department of Health and Human Services, Agency for Healthcare Research and Quality. Medical Expenditure Panel Survey (MEPS), 1996–2003.
28. Peppe EM, Mays JW, Chang HC, et al. Characteristics of frequent emergency department users. http://www.kff.org/insurance/upload/7696.pdf. Published October 2007. Accessed February 12, 2011.
29. New York State Department of Health. Managed care.http://www.health.ny.gov/health_care/managed_care. Accessed February 11, 2011.
30. Health care and the underserved: America’s poor and managed care. http://www.msa.org/AMSA/Libraries/Committee_Docs/hlthcareunderserved.sflb.ashx. Accessed February15, 2011.
31. Havighurst CC. Making health plans accountable for the quality of care. Georgia Law Rev 1996; 31: 587–647.
32. Falik M, Needleman J, Herbert R, et al. Comparative effectiveness of health centers as regular source of care. J Ambul Care Manage 2006; 29: 24–35.
33. Field D, Leshen E, Patel K. Driving quality gains and cost savings through adoption of medical homes. Health Aff (Millwood) 2010; 29: 819–826.
34. Newton D, Grayson M. Trends in career choice by US medical school graduates. JAMA 2003; 290: 1179–1182.
35. Dorsey ER, Jarjoura D, Rutecki GW. Influence of controllable lifestyle on recent trends in specialty choice by US medical students. JAMA 2003; 290: 1173–1178.
36. Primary care reform in the USA: a perfect opportunity? Lancet 2010; 375: 1579.
37. Kaiser Commission on Medicaid and the Uninsured. Medicaid as a platform for broader health reform: supporting high-need and low-income populations.http://www.kff.org/medicaid/upload/7898_ES.pdf. Published May 2009. Accessed February 9, 2011.
38. Medicare Program: Clarifying Policies Related to the Responsibilities of Medicare-Participating Hospitals in Treating Individuals With Emergency Medical Conditions. 42 CFR §§413, 482 and 489 (2003).
39. Supra at 32.
40. Department of Health and Human Services. Testimony on Medicaid upper payment limits by Timothy Westmoreland, Director, Center for Medicaid and State Operations, Health Care Financing Administration, US Department of Health and Human Services, September 6, 2000. www.hhs.gov/asl/testify/t000906a.html . Accessed June 26, 2012.
41. McKethan A, Menges J. Medicaid Upper Payment Limits: Barriers to Medicaid Managed Care Expansion. Washington, DC: Medicaid Health Plans of America; 2006.
42. McCue MJ, Bailit MH. Assessing the financial health of Medicaid managed care plans and the quality of patient care they provide. http://www.commonwealthfund.org/Publications/Issue-Briefs/2011/Jun/Financial-Health-Medicaid-Managed-Care.aspx. Published June 2011. Accessed June 26, 2012.
43. Relating to efficiency, cost-saving, fraud prevention, and funding measures for certain health and human services and health benefits programs, including the medical assistance and child health plan programs. TX S. 23, 82nd TX Leg. (2011).
44. Becker H. Health plans see growth in Medicaid. http://www.markfarrah.com. Published March 25, 2010. Accessed February 9, 2011.
45. Texas Health and Human Services Commission. Uniform managed care terms & conditions. Volume 2.2. http://www.hhsc.state.tx.us/medicaid/uniformmanagedcarecontract.pdf. Accessed June 26, 2012.
46. Berry E. Mining for Medicaid gold: health plans’ latest profit strategy. Am Med News 2010.
47. Texas Health and Human Services Commission Report. The Medicaid numbers. http://www.hhsc.state.tx.us/medicaid/reports/PB8/PDF/TheMedicaidNumbers.pdf. Accessed February 1, 2011.
