STATE OF TEXAS ACCESS REFORM

1
STATE OF TEXAS ACCESS REFORM
2
How does HHSC design a managed care program?
3
(No Transcript)
4
(No Transcript)
5
(No Transcript)
6
What has HHSC built to date?
7
STAR Health
See Tab 2 in Binder
8
Percent of All Medicaid Managed Care Members
See Tab 3 in Binder
9
See Tab 4 in Binder
10
See Tab 4 in Binder
11
See Tab 5 in Binder
12
5.5 Billion Revenue (SFY 2010, excluding CHIP
Dental) See Tab 7 in Binder
13
What is HHSCs financing strategy?
14
See Tab 6 in Binder
15
See Tab 7b in Binder
16

• HHSC does not require a minimum Medical Loss
  Ratio.
• HHSC does require an Experience Rebate.

STAR Formula, Contract Period 1-3
Pre-Tax Incomes as a of Revenue HMO Share HHSC Share
lt 3 100 0
gt 3 and lt 7 75 25
gt 7 and lt 10 50 50
gt 10 and lt 15 25 75
gt 15 0 100
SFY 2010 HMO Net Income 150,135,000 Experien
ce Rebates 62,143,000
17
How does HHSC define quality?
18
See Tab 8 in Binder
19
Does HHSC think about behavioral health?
20
(No Transcript)
21
See Tab 9 in Binder
22
Where is HHSC headed next?
23
(No Transcript)
24
2010
2012
Percent of All Medicaid Managed Care Members
25
(No Transcript)
26
See Tab 3 in Binder