Medicaid matters
On Feb. 1, 2006, the U.S. House of Representatives approved the
budget reconciliation conference agreement, which included
several changes to Medicaid benefits for children.
As a result, states will now have the flexibility to increase
co-payments and premiums, and reduce health care services.
Under the conference agreement, states are permitted to increase
co-payments substantially and impose premiums on many
beneficiaries, including some children. These increases are
estimated to reduce Medicaid expenditures by $1.9 billion over
five years and $9.9 billion over 10 years.
The Congressional Budget Office (CBO) estimates 80 percent of
the savings that result from the increases in co-payments will
come from decreased use of medical services, rather than from
collection of increased co-payments. Research has shown that
increases in co-payments or premiums lead many low-income
beneficiaries to forgo needed health care services and
medications. Some of the savings from increased payments could
be offset partially by higher Medicaid expenditures for
emergency room visits.
States also will now have the option to reduce the health care
services that Medicaid offers. It is uncertain how many states
will opt to reduce their Medicaid benefits and to what extent.
If states choose to provide scaled-back benefit packages, they
will have to offer “wrap around” benefit packages with the same
health care services now guaranteed to children on Medicaid
under the program’s Early and Periodic Screening, Diagnostic and
Treatment (EPSDT) component.
Estimated results of bill:
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Some 80 percent of the budget cuts that would result from
Medicaid co-payment increase would come from enrollees who won’t
receive the health care they need because they can’t afford the
co-payments.
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65,000 individuals would lose Medicaid coverage entirely
because they will be unable to afford new premiums. Children
will account for 60 percent of the individuals who are unable to
pay their premiums and are therefore denied Medicaid coverage.
The bill also cuts short Katrina health care benefits for many
evacuees in Texas, as well as cuts billions of dollars from
child support enforcement, child care, foster care, Medicare,
disability assistance, student loans, and other vital services
for families to help fund $70 billion in new tax cuts.
As of October 2005, 2.7 million Texans were enrolled in
Medicaid and 1.84 million were children.
(Source: Center for Budget and Policy Priorities Jan. 29, 2006)
Children’s Health Insurance Program
(CHIP)
CHIP enrollment for December 2005 was 322,898, a slight increase
from the previous month. In 2006, CHIP will be adding two new
programs to its list of services.
A new dental benefit, managed by Delta Dental, is tentatively
scheduled to launch April 1, 2006. Families will be assigned to
a tier group (Tier I, Tier II or Tier III) based on several
criteria. New enrollees will be assigned to Tier I, enrollees
who are deemed from Medicaid will be assigned to Tier II.
Families who renew in a timely manner will enhance their
benefits up to Tier III. The maximum 12-month benefit for six
months of dental coverage under Tier I is $375, under Tier II is
$475 and under Tier III is $575. Each tier will have a dental
benefit amount of $175 for preventive care. Therapeutic benefit
amount will vary as follows: Tier I $200, Tier II $300 and Tier
III $400. Families can use all of their dental benefits in the
first six months of coverage.
Another change to the CHIP program, which came out of the 2005
Texas Legislature, is that benefits will be offered to women 18-44
years old with net family income at or below 185 percent of the
Federal Poverty Level (FPL), who are also U.S. citizens and
Texas residents. The purpose of the Women’s Health Waiver is to
expand women’s health services to low-income women, identify
women at risk of diabetes and cardiovascular disease for health
counseling and education, and to launch culturally appropriate
outreach efforts to Hispanics, a high birth-rate population.
Women enrolled in the program will receive a variety of
services, including physical exams, early prevention screenings
such as high blood pressure and cholesterol, and family planning
counseling and education. Roll-out of the program is tentatively
scheduled for Sept. 1, 2006.
Overall, the waiver is estimated to save $430 million in state
and federal funds over five years. State savings for the
2006-2007 biennium is estimated to be over $3.3 million.
(Information taken from Texas CHIP Coalition; Jan. 13, 2006,
meeting minutes)
How is Medicaid different from CHIP?
Although Medicaid and CHIP share the mission of providing health
care to low-income children, significant differences exist
between the two programs, particularly in the child populations
they cover, and the type of coverage their beneficiaries need.
Children on Medicaid are poorer than children on CHIP. Medicaid
provides health coverage to the poorest children, near or below
the federal poverty level. CHIP targets low-income children with
incomes higher than Medicaid eligibility levels. In Texas, CHIP
covers children up to 200 percent FPL.
Medicaid children have greater health needs than children on
CHIP. In addition to qualifying for Medicaid based on income,
Medicaid also considers disability status as a basis for
eligibility, and provides a comprehensive benefit package that
is better suited than private insurance for beneficiaries with
disabilities. Children cannot qualify for CHIP based on
disability status.
Medicaid exempts children from cost sharing. Medicaid generally
prohibits states from requiring children to pay premiums,
deductibles, and co-payments. States can require cost sharing
from CHIP children, up to 5 percent of family income.
Differences in cost of care between Medicaid and CHIP can be
attributed to the unique populations each program targets.
Although there is no extensive research on the differences in
cost between Medicaid and CHIP, it is widely acknowledged that
children on Medicaid are more expensive to treat than CHIP
children. The cost differences reflect the greater likelihood
that Medicaid children will have disabilities and more complex
health needs than CHIP children, and that they will require more
extensive services.
(Source: National Association of Children’s Hospitals January 2006)
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Hot
topics
Child and adult protective services
In 2005, reform of the child and adult protective services
systems in Texas was mandated. Senate Bill 6, which became
effective on Sept. 1, 2005, centers on improving CPS efforts by
reforming agency operations. The change is projected to add
2,500 additional caseworkers reducing caseloads by 40 percent
and reducing paperwork by 58 percent. These changes will add an
additional $250 million in the child protective services system
and $34 million into adult protective services.
Other modifications call for instituting an incentive program to
help protective services employees develop advanced skills,
strengthening CPS investigations, adding additional support and
resources for caseworkers, increasing private sector
involvement, and improving management and accountability within
CPS.
Childhood obesity
The United States Government Accountability Office (GAO) has
produced a
report for
Congress on key strategies most important to include in programs
to prevent and reduce childhood obesity. Increasing physical
activity was ranked as the most important strategy. Other
proposed strategies included improving diet and nutrition,
reducing TV viewing time and altering child-targeted food
marketing.
The rate of childhood obesity tripled for children between the
ages of 6 and 11 over the past 30 years. For children between
the ages of 2 and 5 and between the ages of 12 and 19, that rate
more than doubled.
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In Houston, 36.2 percent of children ages 6-17 are overweight.
Within this population, 19.2 percent are obese.
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A child who is obese by age 12 has more than a 75 percent
chance of becoming an obese adult.
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Risk factors for heart disease, high cholesterol and
high-blood pressure are higher for overweight children and
adolescents compared to children with healthy weights.
A person is considered overweight if they are 25-30 pounds, or
10-15 percent, over the recommended weight for a person’s
height. A person is considered obese if they are at least 30
pounds, or 20 percent, over the recommended weight for a
person’s height.
Doctors and other health care professionals are the best people
to determine whether your child or adolescent's weight is
healthy, and they can help rule out rare medical problems as the
cause of unhealthy weight.
Physical activity suggestions
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Be physically active. It is recommended that Americans
accumulate at least 30 minutes (adults) or 60 minutes (children)
of moderate physical activity most days of the week. Even
greater amounts of physical activity may be necessary for the
prevention of weight gain, for weight loss, or for sustaining
weight loss.
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Plan family activities that provide everyone with exercise and
enjoyment.
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Provide a safe environment for your children and their friends
to play actively; encourage swimming, biking, skating, ball
sports and other fun activities.
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Reduce the amount of time you and your family spend in
sedentary activities, such as watching TV or playing video
games. Limit TV time to less than two hours a day.
Pandemic flu
plan
There have been three pandemics (global disease outbreaks) of
influenza in the 20th century: the 1918 pandemic caused at least
500,000 deaths in the United States and up to 40 million deaths
worldwide; the 1957 pandemic caused 70,000 U.S. deaths and the
1968 pandemic caused about 34,000 U.S. deaths.
The Department of State Health Services (DSHS) was scheduled to
release its Pandemic Influenza plan in January. The state plan
establishes how Texas will deal with pandemic flu in the context
of the National Strategy for Pandemic Influenza, which was
released on Nov. 1, 2005. The goals of the national strategy are
to stop or slow the spread of a pandemic to the United States,
limit domestic spread and mitigate disease and death in the
United States, and mitigate the impact on the economy and
functioning of society.
Child Passenger Safety Week – Feb. 12-18
Texas Children’s Center for Childhood Injury Prevention and Safe
Kids Greater Houston will host special events the week of Feb.
12-18 to highlight best practice recommendations and proper use
of car seats. In particular, education will focus on parents
with children ages 4-8 who, depending on the child’s height,
should ride in a booster seat for continued safety.
Go to our
Texas
Children’s Hospital Web site
to learn more child passenger safety, the events scheduled
during Child Passenger Safety Week, and where you can go to have
your car seat checked.
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Visits to Texas Children's Hospital
Meet Texas Lieutenant Governor David Dewhurst
The lieutenant governor is required to sign all bills and
resolutions that pass in the Senate. He is designated as chair
of the Legislative Budget Board and Legislative Council. Through
his chairmanship and his power to make appointments to the
board, the lieutenant governor exerts a powerful influence on
public policy, state programs and the budget.
Committees: Has served as Commissioner of Texas General Land
Office, the Governor’s Business Council and chairman of the
Governor’s Task Force on Homeland Security.
Personal: Born Aug.11, 1945, in Houston. Earned a Bachelor of
Arts degree from the University of Arizona. He began his career in the
mid-1970s after serving as an officer in the U.S. Air Force, in
the Central Intelligence Agency, and at the U.S. State
Department.
Lt. Governor Dewhurst visited Texas Children’s Hospital Jan. 31
for a tour of the hospital and to talk at Texas Children’s
quarterly leadership forum.
Dr. Ralph Feigin, Mark Wallace and Lt. Governor David Dewhurst
discuss the Neonatal Intensive Care Unit with Dr. James Adams, medical director
for the NICU.
Chairman of Appropriations visits Texas Children's Hospital
On January 11, Representative Jim Pitts got a sneak peek into a
few of the busiest areas of the hospital; touring the Emergency
Center, the Cancer Center and the Neonatal Intensive Care Unit.
Pitts represents District 11, Ellis and Hill Counties in
Waxahachie, and has been a member of the Texas Legislature since
1992. As chairman of Appropriations, Pitts provides leadership
to the 29-member committee, which handles appropriation requests
by all agencies including criminal defense, education and health
care. Last year, $45 billion in state funding was
allocated for health care alone.
Dr. Joan Shook, chief of
Emergency Medicine services, takes Representative Pitts on a
tour of the Emergency Center. Other tour participants, pictured in the background, included Tom Kleinworth, director of state policy for Baylor College of Medicine, and Rosie Valadez McStay, director of government relations for Texas Children's Hospital.
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Congressman Kevin Brady
speaks with Dr. Ralph Feigin, Physician-in-chief, after
the pulmunary hypertension press conference |
U.S. Congressman Kevin Brady visited Texas Children’s in Nov.
2005 to discuss pulmonary hypertension. As a past Texas
legislator, Brady created the Texas Birth Defects Registry. A
strong supporter of medical research, Brady has a special
interest in finding cures for rare diseases, especially primary
pulmonary hypertension – for now an incurable disease that
strikes young women and children in growing numbers.
Brady is currently serving his fifth term in Congress,
representing the 8th district of Texas in the U.S. House of
Representatives. The 8th district includes Montgomery, Walker,
San Jacinto, Tyler, Polk, Hardin, Jasper, Newton, Orange and
parts of Trinity and Liberty counties.
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Be an educated advocate
Get out and vote
An informed voter is a smart voter! Remember to register to vote
and learn about the candidates before you head to the voting
booth. The Texas primary and general elections will be held on
March 7, 2006. Among offices that will be voted on are the U.S.
and state House of Representatives, the governor and lieutenant
governor and county judges. To learn more about voter
registration and the upcoming election, visit the
Texas
Secretary of State Web site or
VOTEXAS
Be informed!
To be an educated advocate (and voter) you have to know the
facts. Here are a few resources you can turn to:
Center for Public Policy Priorities – policy
research organization committed to improving public policies
that influence the economic and social conditions of
individuals, families and communities.
Kaiser Family Foundation – facts focused on major
health care issues and used by policymakers, media, health care
community and the public in general.
Safe Kids Worldwide – organization focused on
the prevention of accidental childhood injury, a leading killer
of children 14 and under. Offers safety advice on a variety of
topics such as water, pedestrian, fire and car seats.
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