Health Care and the 2005 Legislative Session: An Advocate

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Health Care and the 2005 Legislative SessionAn
Advocates Perspective
900 Lydia Street - Austin, Texas 78702 Phone
[phone] fax [phone] - www.cppp.org

• IAF Conference on Education and Health Issues,
• Austin, Texas
• February 6, 2005
• Anne Dunkelberg, Assistant Director
  (dunkelberg_at_cppp.org)

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Context for Funding Texas Health Care System

• Latest US Census Bureau statistics show
• 24.6 of ALL Texans, and 26.9 of Texans under
  age 65, were uninsured in 2003
• Thats about 5.5 million Texans
• Another 3 million covered by Medicaid or CHIP
• Culprit Texas has one of the lowest of
  employer-sponsored insurance (along with
  Arkansas, Louisiana, Montana, New Mexico) - 9
  below national average for under-65, at 52.4,
  and 11.8 below national average for under-18.

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Health Care for Poor Low-Income Texans

• Medicaid
• As of January 2005, 2.7 million Texans were
  enrolled in Medicaid
• 1.8 million were children
• about 78,000 of these children, or 4, were
  receiving disability-related Medicaid (97 of
  these on SSI),
• about 13,700 were pregnant teens
• 165,300 in TANF families (6.2 of total caseload)
• 862,500 were adults
• 667,600 (77 of the adults) were elderly or
  disabled. Adults on SSI account for 60 of the
  aged and disabled recipients (76 of
  blind/disabled are on SSI).
• Other adults 87,700 maternity coverage 45,100
  TANF parents (1.7 of total caseload) 61,000
  either TMA (Transitional Medicaid Assistance) or
  parents who are at or below TANF income, but not
  receiving TANF cash assistance
• Childrens Health Insurance Program (CHIP)
• as of September 1, 2003 507,259 children
• as of January 1, 2005 332,055 (drop of 175,204,
  or 35)

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Race/Ethnicity of Texas Medicaid Clients as of 9/2004      
Total (Female, Male, and Unknowns) Medicaid Enrollment (All Ages) As Of September 2004 Percent of Total Enrollees (All Ages) by Race/Ethnicity As Of September 2004 Medicaid Enrollment (Ages 0-18) As Of September 2004 Percent of Total Enrollees (Ages 0-18) by Race/Ethnicity As Of September 2004
Anglo 682,034 26.0 349,338 19.8
African American 495,542 18.9 319,704 18.1
Hispanic 1,354,332 51.6 1,054,177 59.7
American Indian 8,911 0.3 5,819 0.3
Asian 40,032 1.5 20,765 1.2
Not Known 45,618 1.7 16,349 0.9
Overall Total 2,626,469 100 1,766,152 100
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Texas Medicaid Cuts, 2004-05 Budget

• Restored
• Medicaid Maternity Coverage For Low-Income Women
  cut coverage from 185 of the federal poverty
  level to 158 of poverty.
• HHSC proposed, and LBB approved restoring to 185
  FPL for FY 2005 (20.3 million), eff. 9/04.
• Medicaid Community Care Hours of Service for
  100,000 Elderly Texans and Disabled Adults were
  cut by 15 in the state budget, but HHSC added
  money last summer for 2004, and again in August
  2005 (141 million) to prevent cutting care in
  2005.
• Cuts that Remain- Eligibility and Benefits
• Medically Needy Spend-Down Program for Parents
  (Temporary Coverage for Families with High
  Medical Bills).
• TANF Parents Now Lose Medicaid due to Work
  Sanctions (total TANF enrollment down 122,000
  from a year ago, but Medicaid parent coverage
  down about 37,000 since July 2003).
• Other Community and Long-Term Care Other
  programs for aged and disabled have had to reduce
  the numbers of people they serve or reduce the
  services they give.
• Cut the personal needs allowance of Medicaid
  nursing home residents (the monthly amount that
  Medicaid nursing home residents may keep from the
  SSI, Social Security or other pension income, the
  rest goes to the nursing home) from 60 to 45.

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Medicaid Cuts, 2004-05 Budget

• Cuts that Remain- Eligibility and Benefits
• Eliminated these services for ALL ADULTS on
  Medicaid
• (Aged, Disabled, Adult TANF recipients, Pregnant
  Women)
• mental health services by social workers,
  psychologists, licensed professional counselors,
  and licensed marriage and family therapists,
• podiatrists,
• chiropractors,
• eyeglasses and hearing aids
• Medicaid provider rate cuts
• Most Medicaid and CHIP providers had rates cut.
  The budget would have cut them even more, but in
  August 2003 state leaders added funds to reduce
  the size of the cuts for 2004, so that hospitals
  and doctors have still had a rate cut of 2.5
  instead of 5 nursing homes 1.75 instead of
  3.5, and community care providers by 1.1
  instead of 2.2.
• In August 2004, HHSC proposed and LBB approved
  keeping the cuts at the same level for 2005
  (i.e., not making deeper cuts) 53.2 million
  allocated for this. Exception hospitals ARE
  taking a deeper 5 cut.

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CHIP Cuts, 2004-05 Budget

• Summary of CHIP changes
• Benefits eliminated dental vision (eyeglasses
  and exams) hospice skilled nursing facilities
  tobacco cessation chiropractic services. Mental
  health coverage reduced to about half of the
  coverage provided in 2003.
• Coverage period reduced from 12 months to six.
• Premiums and co-payments increased.
• New coverage delayed for 90 days.
• Income deductions eliminated (gross income
  determines eligibility).
• Asset test (limit) added for those above 150 of
  the Poverty Line (took effect August 2004).

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Medicaid and CHIP the Budget (So Far)

• The LBB Budget (SB 1)
• does not fully fund Medicaid Current Services at
  HHSC, and also
• does NOT restore ANY of the 78th Legislatures
  Medicaid cuts. Still Needed at HHSC
• 1.23 BILLION GR for Medicaid inflation/cost
  increases
• 56.7 million to Restore Medicaid Adult Services
  for mental health, podiatry, hearing aids and
  eyeglasses. (5.8 million more for a managed
  care adjustment, and chiropractic 40 million
  for GME payments.)
• 177 million to Restore Medicaid Rate cuts
• 35 million for Partial Medically Needy
  Restoration (per HHSC, this amount would
  reinstate payments at about 20 of normal
  Medicaid rates.)

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Medicaid and CHIP the Budget (So Far)

• Medicaid at DADS For Nursing Homes, Community
  Care, and Programs for Texans with Mental
  retardation. Still Needed
• 29.3 million for Staffing LBB budget does not
  include enough money for staffing levels to grow
  along with the programs (and actually would
  require some staffing cuts)
• 53.8 million to restore rate cuts from 78th
  Legislature
• 13 million (/-) to restore Nursing Home
  Personal Needs Allowance

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Medicaid and CHIP the Budget (So Far)

• CHIP at HHSC The LBB Budget (SB 1)
• does not fully fund CHIP Current Services at
  HHSC, and also
• of the 78th Legislatures CHIP cuts, restores
  ONLY dental and vision benefits. Still Needed at
  HHSC
• 29.8 million for CHIP caseload growth (at current
  6-month coverage) and cost/inflation growth
• Approx. 140 million to restore back to 2003
  policies
• Coverage period reduced from 12 months to six.
• Premiums and co-payments increased.
• New coverage delayed for 90 days.
• Income deductions eliminated (gross income
  determines eligibility).
• Asset test (limit) added for those above 150 of
  the Poverty Line (took effect August 2004).
• (No official estimate yet from HHSC of cost of
  full restoration for 2006-07.)

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Medicaid and CHIP the Budget (So Far)

• Summary
• At LEAST 1.3 BILLION more needed for Medicaid
  and CHIP Current Services that is, without
  this, MORE CUTS NEEDED.
• At LEAST 520 million more needed to RESTORE
  Medicaid and CHIP cuts.
• PRS in LBB budget got only 30 million GR above
  04-05 PRS had requested nearly 200 million in
  E.I.s, and HHSC report recommended 253 million
  MORE than that.
• DONT FORGET Medicaid! Medicaid needs 1.3
  BILLION for Current Services and at least 380
  million to restore cuts. CHIP restoration is NOT
  the only priority. MANY MORE Texans lose out if
  Medicaid is not adequately funded.

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Other Major Medicaid Issues on the Agenda for
the 2005 Session?

• Medicaid Biometric Finger Imaging Statewide
  mandate? Universal Smart Card?
• Medicaid Prescription Drug benefits (PA/PDL)
• Medicaid Managed Care Statewide Expansion
• Increased Standards and Oversight for Contracting
  Privatization
• Womens Health and Family Planning Medicaid
  Waiver
• Regional Trauma Care system (funding), Increased
  county obligation to pay for care to uninsured
  residents provided by OTHER (i.e. urban)
  counties.
• MediCARE drug benefit in 2006 means elderly
  disabled on Medicaid will no longer get Rx from
  Medicaid. 465.3 million state dollars assumed by
  HHSC to be paid to Feds in Texas 2006-07 budget.

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Other HHS Cuts from 2003 Session

• MH - Reductions in Community Services (LBB funds
  at 04-05 level 400K, slight increase in fed
  projected) Adults dropped from 52,500 in 03 to
  46,100 in 05 LBB would increase by about 1,400
  by 07-stil about 5,000 below 03. Children
  served/month 11,400 in 03, dropped to 10,000 in
  05 LBB would allow to grow by 369 children/month
  in 07, still 1,100 below 03 levels.
• MR Reductions in Community Services
  clients/month in 05 were 3,200 BELOW 03 levels
  LBB freezes at that level.
• Reduction of Community Mental Health Priority
  Population to Three Disorders
• Privatization of MHMR services and institutions
• Substance Abuse treatment for adults and
  children LBB includes for increased caseloads,
  but DECREASES for dual-Diagnosis treatment
• LBB budget assumes FEWER beds in state mental
  hospitals
• Department of Health (TDH) Programs funded below
  current services levels
• Kidney Health program serving 21,247 in 2005.
  LBB recommends cutting clients by 3,949 from 05
  to 06, then growth by 1,629 to bring 07 clients
  to 18,927 (2,320 below 05).
• County Indigent Health Care grant program 04-05
  projected funding 15.8 million LBB recc is
  10.2 million for 06-07
• HIV Medication Program (LBB includes 600K above
  04-05, allows for increase of 20 clients in 2007)
• Children with Special Health Care Needs (LBB
  includes to add 200 children by 2007)
• Primary Health Care 04-05 served 11,000 fewer
  than 03 LBB funds cutting clients by another
  1,500.

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Texas Child Medicaid and CHIP Combined
EnrollmentJanuary 2002-January 2005
Source All figures from Texas Health and Human
Services Commission
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Other Price-tags
Biennial GR
State Budget, 2004-05 58.9 billion

Replacing Robin Hood At least 2.3 billion 4
Buying down local school property taxes by 10 cents per 100 taxable value 2 billion 3.4

Reaching the national average in state/local spending from taxes 16 billion 27
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50-State Ranking 13th 46th 26th 39th 15th 13th 35
th 41st 23rd 36th 33rd 43rd
Source U.S. Bureau of the Census, State Local
Government Finances, Fiscal 2002.
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Revenue Reform Must Address the WHOLE Budget, Not
Just Public Education

• Long-term structural inadequacies of state/local
  tax system are putting too much pressure on
  property taxes
• Heavy reliance on sales taxes also makes Texas
  tax system very regressive (taking more from
  families with the lowest incomes)
• A 1 per pack increase in cigarette and tobacco
  taxes could raise 1.5 billion per biennium,
  which could be used to help restore Medicaid and
  CHIP cuts and support caseload growth.
• Proposed changes to the tax system MIGHT ONLY
  reduce property taxes and replace them with new
  taxes. This would mean
• No new money for public education
• Not enough money for Medicaid and CHIP CURRENT
  SERVICES, much less for restoring cuts, and
• Not enough money for higher ed, parks, prisons,
  etc.

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Biggest Threat to Health care may be in
WASHINGTON this Year

• Bush Admin. Budget proposal expected by Feb. 7,
  and likely to include steps toward block
  granting, ending entitlement structure of
  Medicaid.
• National Governors Assoc. (dominated by
  Republican Govenors) has sent letter (with
  unanimous support of all states) opposing
  including Medicaid reform in 2006 budget,
  especially if it does nothing more than shift
  additional costs to states. benefits for the
  dual eligible population should be 100 financed
  by Medicare

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Medicaid is the Largest Single Source of Federal
Support to States, 2003
Total Federal Fund Expenditures 326 billion
National Association of State Budget Officers,
2003 State Expenditure Report, November 2004.
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Ways to Be Informed and Involved

• Go to www.cppp.org and subscribe to CPPPs e-mail
  publication, the Policy Page.
• Go to www.texaschip.org to get on Texas CHIP
  Coalition listserve
• for National information about Congress, the
  President, Medicaid and CHIP www.familiesusa.org
  
• for more technical and detailed information about
  Congress, the President, Medicaid CHIP
  www.cbpp.org