Texas enrollments in children’s Medicaid and CHIP took big a drop in January.
Improving economy or re-enrollment snafus?
Hard to know.
In Tarrant County, 2,961 fewer kids were on children’s Medicaid, but 65 more were on CHIP.
Statewide, 21,109 fewer kids were on children’s Medicaid, and 1,088 fewer were on CHIP.
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Not everyone agrees with me on this — especially in Texas — but I believe all kids should have equal access to the healthcare they need.
As a nation, we are a long ways from that. The U.S. is a patchwork of coverage requirements, a fact underlined this week in a new report, Performing Under Pressure: Annual Findings of a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2011-2012.
There’s a lot to digest in this 92-page report, but the one big take-away I get is how very, very different these “United” States are in children’s coverage. For the one-third of kids that depend on Medicaid and CHIP, their access to our nation’s healthcare pie depends entirely on where they live.
Here are just a few examples:
This report lays out probably a hundred or more different variables in the eligibility, enrollment, renewal, and cost-sharing approaches that states can take for Medicaid and CHIP. And, I’ll bet no two states are alike. They’ve each developed their own synchronic concoction — a mixture that they believe will work best for kids — or if you’re cynical, what taxpayers have decided they’ll spend on kids’ health.
But there was one thing ALL 50 states had in common between 2010 and 2012. Even as our nation went through the worst recession in a quarter-century, states did not take draconian measures to cut kids from Medicaid.
Oh, many wanted to. Oh how they wailed! But, it was against the law. The Affordable Care Act, also known as Obamacare, said that if your state receives Medicaid funding, your state must maintain eligibility, enrollment, and renewal policies that were in place as of March 23, 2010 (when the law was enacted).
For that, we should be thankful. It could have been much, much worse.
Posted in Uncategorized | Tagged CHIP, Medicaid, Texas Medicaid, Texas uninsured, uninsured children Texas | Leave a Comment »
Last week, the state issued a pretty important report. It was basically a report card on how Medicaid managed care plans were performing on key child health benchmarks.
I’m really interested in this information, and you should be, too. First of all, Texas pays private health plans to manage the care of kids in Medicaid in most urban areas. The state has gone with a managed care strategy as one that contains costs, but also provides a professional coordinator that ensures that kids are getting appropriate care.
Physicians are obviously important partners in children’s care, and so are parents. But only health plans are paid to “manage” that care. Measuring how well they manage care boils down to some widely used national benchmarks. Texas, as it should, has adopted several of these. These benchmarks can be used by state officials and health plans to identify opportunities for improvement. Families also can use these to select the Medicaid health plan that’s right for them.
The report released this week analyzed data from September 2009 to August 2010. To read the entire 101-page report, click here. The report has measurements by plan as well as by county.
I’ve summarized it here.
Primary care access — % who had a visit with a primary care physician
o 12 to 24 months old — 98% in Texas and in Tarrant County.
o 25 months to 6 years old — 95% in Texas, 93% in Tarrant County.
o 7 to 11 years old — 96% in Texas, 95% in Tarrant County
o 12 to 19 years old. — 95% in Texas, 94% in Tarrant County
This looks pretty good to me. Access is slightly lower, though, in Tarrant County.
Well-child visits
o Six or more well-child visits in their first 15 months of life — 63% in Texas, 70% in Tarrant County
o One or more well-child visits in the 3rd, 4th, 5th, and 6th years of life — 80% in Texas, 75% in Tarrant County
o One or more well-care visits for 12 to 21 years old — 63% in Texas, 57% in Tarrant County
A mixed bag here on Tarrant County performance.
ED visits per 1,000 member months
o Total — Texas, 59; Tarrant County, 73.
o Less than 1 year old. — Texas, 108; Tarrant County, 116.
o 1 to 9 years old — Texas, 52; Tarrant County, 61.
o 10 to 19 years old — Texas, 39; Tarrant County, 51.
Here a low score is preferred. Research shows that at least a third of ER visits could have been handled in a lower cost setting, such as a physician office or clinic. Looks like Tarrant County has some work to do here.
Inpatient rates per 100,000 members
o Asthma — National, 124; Texas, 113; Tarrant, 79.
o Diabetes short-term complications — National, 28; Texas 25; Tarrant, 39.
o Gastroenteritis — National, 105; Texas, 50; Tarrant, 24.
o Urinary tract infection — National, 43; Texas, 34; Tarrant, 13.
o Perforated Appendix — National, 29; Texas, 39; Tarrant, 37.
Here, national benchmarks are also available, and a low score is preferred. No one wants their child to wind up in the hospital. Excellent score on asthma! Good on the others, too, except diabetes.
Appropriate testing for pharyngitis (sore throat) — National, 62%; Texas 52%; Tarrant, 59%.
Appropriate treatment for upper respiratory infection — National, 86%; Texas 83%; Tarrant, 80%
Use of Appropriate Medications for Asthma
o 5 to 9 years old — Texas, 96%; Tarrant, 94%.
o 10 to 17 years old — Texas, 94%; Tarrant, 92%.
Tarrant County plans underperformed on all of the above.
Mental health
o Had an initial follow-up visit with a provider within 30 days of beginning an ADHD medication — Texas, 47%; Tarrant, 48%.
o Remained on an ADHD medication for at least 7 months and had two or more follow-up visits with a provider within 9 months — Texas, 58%; Tarrant, 58%.
o Readmitted to the Hospital Within 30 Days After an Inpatient Stay for Mental Health — Texas and Tarrant, both 10%.
Mixed bag.
All in all, most Texas Medicaid health plans are doing a pretty good job.
My beef is it’s hard for families to find this info.
If I have a child with asthma, I’d like to know which health plan has the best track record at taking care of kids with asthma. Same with diabetes or mental health issues.
Hope you’ll let families know. Keeping kids healthy takes a collaborative effort in which everyone works towards improvement.
Posted in Children's health, Medicaid | Tagged children's Medicaid, Medicaid, Tarrant County, Texas Medicaid, Texas Medicaid managed care, Texas Medicaid performance, Texas Medicaid plans, Texas Medicaid quality | Leave a Comment »
Have your ears been burning?
You wouldn’t know it by reading or listening to the local media, but the East Coast press has had quite a discussion around how much guidance Texas’ population needs to find coverage.
First, the Washington Post broke the story of how Texas was preparing to shut down its Texas Consumer Health Assistance Program (CHAP). It had been the state’s first office dedicated to helping consumers find health insurance. CHAP was federally funded with a $2.8 million grant that was part of the Patient Protection and Affordable Care Act. The funding is running out so they’re closing it down in April.
According to the Post. CHAP had hired nine employees who handled about 6,000 phone calls. The article pointed out that meant the government has spent $466 on each call handled to date. That may not seem like a good use of tax dollars. (Obviously, the money went for more. Texas CHAP has a nice educational website; click here to view.)
Next, the New York Times weighed in with a column by Princeton University health economist Uwe E. Reinhardt further analyzing Texas’s consumer assistance budget. Reinhardt pointed out that consumers don’t need much help buying insurance in Europe, but they may in Texas. Switzerland, Germany and the Netherlands all have social health insurance in which consumers select from various private carriers — all of which sell standardized packages. But, here in the U.S., it’s a different story.
As Reinhardt so bluntly states; “Choice in the United States is expensive, because it requires prospective enrollees to do near-Talmudic studies of the fine print of each insurer’s offerings — many times multiple distinct offerings per insurer.”
Then, today, the Post published another piece about Texas’ CHAP. In this piece, the Post compares the cost-per-call with what an insurance broker charges, saying its not that much more.
Here’s my reaction to all of this:
Posted in Uncategorized | Tagged children's health insurance program, children's Medicaid, Texas uninsured, Texas' Consumer Health Assistance Program | Leave a Comment »
Last week, the federal government awarded nearly $300 million in performance bonuses to 23 states for making access to health coverage easier for eligible children and signing up more children who qualify.
To be eligible for a performance bonus, states had to adopt five of eight specified measures aimed at simplifying Medicaid/CHIP enrollment and renewal for children.
For the third year in a row, Texas didn’t qualify. Last year, 15 states got more than $200 million in bonuses. In 2009, 10 states got $75 million in bonuses.
Notice how more states got on board with each round?
Is this another Oops moment?
The “5 of 8″ test is designed to determine whether states really want to enroll more children in Medicaid/CHIP. The system actually serves to further separate the “haves” from the “have-nots” by giving more money to states that are more generous to their children. The states that are stingier get less money. Not the fairest system in the world, but it’s designed to influence behavior of the “have-nots,” like Texas
Here are the eight requirements for children’s Medicaid and CHIP:
The formula for calculating these bonuses is really complicated, but I think we can easily figure that Texas has forgone hundreds of millions of dollars so far.
Other implications:
Posted in Uncategorized | Tagged children's health, children's health insurance program, children's Medicaid, Tarrant County uninsured, Texas uninsured, uninsured children Texas | Leave a Comment »
Hope you enjoyed the holiday fun. To read last year’s The Grinch who ALMOST stole Medicaid, click here
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Posted in Uncategorized | Tagged children's health insurance program, children's Medicaid, Medicaid, Tarrant County CHIP, Texas uninsured, uninsured children Texas | Leave a Comment »
More kids found coverage this month, which is good news.
In Tarrant County:
In Texas:
Posted in Uncategorized | Tagged children's health insurance program, children's Medicaid, Medicaid, Tarrant County uninsured, uninsured children Texas | Leave a Comment »
Last week, some new numbers came out that I had been eagerly anticipating. The federal government released state-by-state estimates of health spending. This is unusual. Each year, the government releases national spending numbers, but not by state.
So, one of the things I’ve been curious about is around the Health Care Compact. Earlier this year, the Legislature passed and Gov. Perry signed a measure approving the state to move to a Health Care Compact. This would allow states to receive their share of federal money for Medicaid, Medicare and children’s health insurance to spend on healthcare as Texas government leaders sees fit. In other words, they’d be free from all federal regulations. (To read my blog about the Health Care Compact earlier this year, click here.)
I’d been curious how much money we’re talking about here.
What I found out was that in Texas, $146.7 billion was spent on healthcare in 2009. Of that, Medicare and Medicaid accounted for $55.8 billion. So, this Compact makes me think about the story of the Prodigal Son. As you recall, a son asks his father to give him his share of the estate. The, the young man goes and wastes it. At the end, he returns to has father, who welcomes him back and forgives him.
Like the son, Texas’ elected leaders are asking Uncle Sam for their share: $33 billion in Medicare and $22 million in Medicaid. Will Texas be a Prodigal son, though?
The real question is: Would Texas be better stewards of federal health funding for its residents than the federal government has been — or would be?
Medicare patients are getting a lot now without state influence. From these new numbers, I found out that nationally, Medicare spent $10,365 per enrollee. But in Texas, each resident on Medicare got 11% more. Medicare spent $11,479 on Texans’ hospital care, physician services, drugs, nursing homes and other care. By the way, Medicare has national regulations on how much physicians and hospitals are paid and what’s covered. Given that, Texans on Medicare must have received more services or more expensive services or treatments, or perhaps, they were sicker than average.
Now, let’s look at Medicaid. Medicaid is different. States have latitude on how much they pay doctors and hospitals and on what’s covered.
Nationally, Medicaid spent $6,826 per enrollee on average. In Texas, it was slightly less — $6,469. But, how it spent it — well, there was wide variation. For example, Texas physician spending per Medicaid enrollee was $673. In Oklahoma it was nearly twice as much — $1,217.18. In California, it was $533.
If Texas got its share of federal funding, is there any evidence that it would not waste it like the Prodigal Son?Well, gee, I don’t know. But, this week we found that in spite of the billions spent, Texans are not getting any healthier compared to Americans in other states. Texas ranked 44th in health status this year; it was 40th in 2010, according to the national rankings.
It will be up to Congress to decide whether the Health Care Compact goes through. But, I’d feel better for our seniors and our kids if we improved
Posted in Uncategorized | Tagged children's health, children's Medicaid, Medicaid, Medicare, uninsured children Texas | 1 Comment »
Texas does not lead the nation in percentage of uninsured children. That privilege goes to Nevada. We’re second.
That was the news this week from Georgetown University Health Policy Institute, which analyzed 2010 Census Data on uninsured children. (Click here to read the report.)
The Institute also found that some states have done a much better job than others in reducing the number of uninsured children.
Nationally, Texas was among those that have done a better job.
In 2008, the percent of uninsured children in Texas was 17%. In 2010, it was 14.5%
This means that there are 141,374 fewer uninsured children in Texas in 2010 than 2008. That’s HUGE! In fact, Texas ranked second in the nation in reducing the number of uninsured kids.
Unfortunately, we were so far behind that getting second place is a somewhat dubious distinction. It’s like when you’re really bad at something, but the coach wants to give you encouragement for making progress. You might get the “most improved” award.
Well, in this case Florida was “most improved” by reducing the number of children by 160,824.
But Texas was the Second Most Improved. And when you think about the population gains we’ve had, we got ahead of the game, and the number of uninsured kids went down by 141,374 kids. It’s a win-win.
To everyone who has helped make this possible, thank you. It takes so many people because the problem is so widespread.
So what now? Well, our coalition is lucky to be working with Cinco Media on a strategy for Hispanic outreach in DFW. Cinco has a rich history in marketing to the Hispanic population, and we’re thrilled to have their expertise. As you may know, Hispanic children are disproportionately uninsured.
Want to help with this? Our steering committe meets on Wednesday. Let me know if you’d like to attend.
Quote of the week:
“We are a nation headed for justice, for fairness and justice in access to care. We are a nation headed for much more healing and much safer care. There is a moon shot here.” – Dr. Don Berwick, who headed CMS, the federal agency that administers Medicare and Medicaid. The entire interview is worth reading here.
Posted in Children's health, Children's health insurance program, CHIP, health reform, Medicaid, uninsured | Tagged children's health insurance program, children's Medicaid, l, Medicaid, Tarrant County uninsured, Texas uninsured, uninsured children Texas | Leave a Comment »
Texas is widely hailed as a low-cost state. That’s true, but not for healthcare.
Texans paid the 12th highest health insurance premiums in 2010, according to a new study from the Commonwealth Fund.
Why is healthcare so costly here? Well, if four people went out to dinner, and one couldn’t pay, what would happen? The other three would have to kick in.
That’s what happens in Texas when one-fourth of the population is uninsured.
So, when the uninsured need care, that cost is shifted elsewhere. Part of it is paid for through property taxes to county-owned systems like JPS. But, part of it is shifted to private payers. Ask any hospital executive in Texas why hospitals charge so much, and one of the first things he or she will say is “cost shifting.”
You’ve got all these uninsured people who don’t pay, but they show up in the ER and use expensive resources. Someone’s got to pay for that ER doctor, that lab test, that CT scan. The costs shift to those who do pay. It’s kind of like a hidden tax.
Some states have taken steps to reduce this cost-shifting by making more of the uninsured eligible for Medicaid. Texas has not.
Unfortunately, we have instead created a recipe for generating more uninsured.
Here’s how it works — with stats courtesy of the new Commonwealth Fund survey.
Health insurance premiums for a Texas family cost $14,526 in 2010. Of family household income, premiums ate up 25.9% in 2010. That’s up from 19.9% in 2003.
Of those premiums, Texas families paid 31%. (Employers paid the rest.) Texans actually pay a higher share of those costs than most Americans; in fact, their share is the third highest nationally. Only families in Arizona and Mississippi pay a higher percentage of employer-sponsored health insurance premiums.
Then, think about deductibles, which have really soared in recent years. The average deductible for a Texas family in 2010 was $2,283. That was higher than the national average, but more importantly it was higher than Mississippi. So, in terms of out-of-pocket spending, Texas families ranked second behind Arizona.
Here’s where the recipe for generating uninsured comes in. A Texas family starts seeing its premiums and deductibles eat into what it spends on housing, food, utilities, transportation. Healthcare insurance becomes unaffordable. The family becomes uninsured. Fortunately, if the family doesn’t make more than 200% of the poverty level, the kids can get on Medicaid or CHIP.
But the parents often can’t get Medicaid because income eligibility in Texas is one of the lowest in the country. (26% of poverty level compared to 100%+ in Arizona, for example.)
Combine high health insurance costs with a high uninsured rate and low eligibility for Medicaid, and the result is going to be more and more uninsured. It’s a vicious circle. It’s also why Texas leads the nation in uninsured.
Until 2014. Then, everything changes then as mandates, exchanges, subsidies and Medicaid expansion kick into place.
Til then, the cycle continues.
Posted in Children's health insurance program, CHIP, Medicaid, Texas Medicaid, uninsured | Tagged children's health insurance program, Employer health insurance, Medicaid, Tarrant County uninsured, Texas uninsured, uninsured children Texas | Leave a Comment »
