This edition of “5 Things We’re Watching” in Texas includes coverage of HHSC’s work to prepare for Medicaid redeterminations, an update on the Texas Medical Association’s ongoing litigation against the federal government over how to resolve disputed medical claims, and a conversation with Texas Association of Health Plans’ Jamie Dudensing about the top-of-mind priorities for her and her organization this year.
I also want to note that we’re less than a month away from the 2023 Texas State of Reform Health Policy Conference! We can’t wait for you to hear from the terrific speakers our team has curated about some of the most pressing topics in state health policy. If you haven’t already, you can register here to join us in Austin on March 9th!
Thanks for your support!
State of Reform
1. HHSC working to minimize impact of Medicaid redeterminations
HHSC is preparing to begin the process of Medicaid eligibility redeterminations once the PHE’s continuous coverage provision ends on April 1st. In a recent report from Georgetown University, experts warned that there’s a high likelihood of Medicaid-eligible individuals still losing coverage due to “bureaucratic snafus,” which include low staffing levels and overwhelmed call centers.
During a recent Senate committee hearing, HHSC officials told lawmakers the agency is experiencing a workforce shortage that’s causing its eligibility staff to work overtime. Despite these challenges, HHSC Commissioner Cecile Young affirmed during the meeting that HHSC is working hard to minimize losses of coverage. “This is a massive undertaking that requires agency-wide focus and attention and we are working on several fronts to make the transition as seamless as possible,” she said. The agency has requested funding to hire 600 temporary eligibility staff.
2. Q&A: Jamie Dudensing talks lowering costs, decreasing regulation, and improving coverage
In a recent conversation with State of Reform, Jamie Dudensing, CEO of the Texas Association of Health Plans, said reducing the overall cost of care should be a priority for the state’s healthcare sector. She discussed how market consolidation and surprise billing in the form of facility fees are primary contributors to rising healthcare costs.
She is critical of Texas’s growing regulation of healthcare, which she notes is contradictory to the state’s firm opposition to the Affordable Care Act. “It’s almost as if we’re embracing it and going 100 miles past it,” she said regarding the ACA. She also underscored the importance of raising awareness about coverage options, referencing a recent study showing that most of the 42% of Texans who are eligible for health insurance marketplace subsidies aren’t even aware of it.
3. Texas Medical Association continues judicial battle over independent dispute resolution
TMA first filed suit in Oct. 2021 against the federal government’s interim final rule over the independent dispute resolution process for disputed medical claims, alleging bias toward insurers over providers. TMA won the lawsuit, but again litigated against HHS’s final rules when they were published in August of last year, contending they were still biased. A federal judge ruled in favor of TMA earlier this month that the final rule unfairly favors insurers. The ruling nullified HHS’s IDR rules, with IDR decisions to now be made solely based on “the statute as written.”
Separately, TMA filed its 4th lawsuit concerning IDR last month in protest of the HHS’s decision to raise the administrative fee for IDR from $50 to $350 starting this year. “Why would doctors and providers pay the $350 nonrefundable administrative fee to arbitrate a $200 or so payment dispute with a health insurer?” TMA President Dr. Gary Floyd said. “The fees deny physicians the ability to formally seek fair payment for taking care of our patients, and that’s just wrong.”
4. Lawmakers developing health funding for FY 2024-2025 budget
House and Senate leaders released their respective chambers’ preliminary budgets for fiscal year 2024-2025 last month, with both proposing nearly $289 billion in total spending and $130.1 billion in general funds. Notable funding recommendations from the legislature include a total of $547.2 million for women’s health and increased funding to support and grow the nurse workforce.
Lawmakers have been hearing testimony from state leadership about their departments’ funding needs to further inform the state budget before it’s finalized this summer. With the legislature proposing $97.36 billion in general funding for health and human services, HHSC is requesting $88.6 billion of this for its budget. Commissioner Young explained that this includes increased pay for employees due and general workforce support efforts.
5. Texans’ support for healthcare spending, expansion increased in 2022
An Episcopal Health Foundation survey, conducted last year and released last week, shows that 63% of Texans support increased spending on healthcare (compared to 54% in 2018) and 72% of Texans want the state to expand Medicaid (compared to 64% in 2018). Texas had the 10th highest growth in enrollment (an increase of 870,000) for children in Medicaid and CHIP during the pandemic, and concerns about coverage losses are emerging in light of upcoming redeterminations.
Texas Democrats are again hoping to expand Medicaid this session—in alignment with the views of the majority of the state’s residents—but it’s unlikely to gain traction while Republicans maintain leadership. According to the survey, Texans’ top three healthcare priorities are lowering healthcare costs and increasing insurance access (67% of Texans), addressing maternal mortality (60% of Texans), and increasing funding for mental health programs (52% of Texans).