CHIP and Medicaid 2005 Texas Legislative Update

Legislative advocacy

During the 79th Texas Legislature, important changes were made to the Children’s Health Insurance Program (CHIP) and Medicaid.

CHIP
Since 2003, 180,786 children dropped from enrollment because of cuts to the CHIP program. By 2007, the expected caseload is 398,630 children in Texas compared to the 507,259 children who were enrolled in September 2003.

	Texas capitol

CHIP will continue:

• Six-month continuous eligibility

• 90-day waiting period to access benefits after accepted into program

• Asset test and the elimination of income disregards

 
CHIP will change:

• Funding to provide services for vision, substance abuse, additional mental health coverage, chiropractic, skilled nursing facility and tobacco cessation services for children. These changes will begin Sept. 1, 2005.

• Enrollment fee paid at initial enrollment, and renewal, will begin Sept. 1, 2005. The fee will be based on the family’s federal poverty level (FPL).

  • EZ pay is no longer an option since enrollment or renewal fee is only collected every six months.

  • The Health and Human Services Commission (HHSC) will suspend CHIP enrollment for up to three months if the family fails to pay the renewal fee.

  • If the family pays the renewal fee within three months, a new six-month enrollment period begins and the child is not subject to the 90-day waiting period.

  • Dental benefits linked to timely payment of enrollment and renewal fee.

• Dental benefits restored are based on a three-tier system that will allow the state to offer expanded benefits and act as an incentive for timely renewal and enrollment fee payment.

  • Benefits may go into effect as early as Dec. 1, 2005, and coverage is for one year.
    
    Tier I - Preventive services up to $175; therapeutic services up to $200
    Tier II - Preventive services up to $175; therapeutic services up to $300
    Tier III - Preventive services up to $175; therapeutic services up to $400

  • New enrollees will be eligible for Tier I, for Tier II the second year of coverage, and for Tier III the third year.
     

  • The following families would be eligible to begin at Tier II:

    • Families who previously paid monthly premiums between January and October 2004.

    • Children of families who are exempt from cost-sharing (less than 133 percent FPL or Native American or Alaskan Native)

    • Children moved from Medicaid to CHIP

  • All of the above are based on timely payment of enrollment and renewal fee.

• NEW Perinate Program to cover unborn children of non-Medicaid eligible women. A federal rule changed the definition of a “child” to be an individual under the age of 19 including the period from conception to birth.

  • Unborn children will be eligible from conception and, once enrolled, perinate/child will receive 12 months of continuous eligibility.

  • Example: Woman enrolls when six months pregnate; perinate will receive coverage for three months until birth and then child will receive nine months of coverage, for a total of 12 months coverage.

  • Unborn children exempt from 90-day waiting period and CHIP asset test (above 150 percent FPL)

  • Limited benefit package with certain restrictions for inpatient hospital services associated with labor and delivery.

  • There must be a connection between the benefits provided and the health of the unborn child. Post-partum care is not an allowable service.

  • At this time, a specified set of services for the unborn child has not been provided. It is also undetermined when this program will begin.

Medicaid
Children’s Medicaid

• The six-month continuous eligibility remains.

• The 2.5 percent cut to provider rates was not restored.

• Graduate Medical Education (GME) funding provided to children’s hospitals for training future physicians was not restored.

Adult Medicaid—provisions will go into effect Oct. 1, 2005

• Provides $140 million for eyeglasses, hearing aids, chiropractic and podiatry services for adult Medicaid recipients. Also, subject to availability of funds, adult Medicaid patients may receive mental health services from a licensed psychologist, master social worker, marriage and family therapist or professional counselor.

• A Medicaid buy-in program will be implemented for working adults with disabilities.

• Expansion of the Medicaid Integrity Pilot program, if it is shown to be cost effective. The system confirms the identity of the cardholder at the point of service by matching a recipient’s finger image with an image stored on the card. The program will assist with the detection of fraudulent billing by providers.

• HHSC will seek to establish a five-year Medicaid demonstration project to expand access to preventive health and family planning services for women 18 years of age and older.