Access to Healthcare and Health Insurance
MEDICAID BUY-IN
House Bill 1135 (Delisi) and Senate Bill 566 (Deuell) (Companion bills)
Position: FOR
Outcome: PASSED AND SIGNED BY THE GOVERNOR
Background and Purpose: The Texas Medicaid Buy-In will allow certain persons with disabilities who are working to purchase their health insurance from the state Medicaid program at an affordable price. This change in public policy will encourage and reward meaningful work for people with disabilities. The program will become available in the fall of 2006.
People with disabilities who would like to return to work, or in some cases wish to remain employed, face significant challenges. One of the biggest barriers to working for people who currently have Medicare or Medicaid is the loss of health benefits if their income level exceeds Medicaid or Medicare eligibility standards. The amount earned by people returning to work may be enough to disqualify them for public assistance, but not enough to purchase private health insurance. People who are currently working but do not have health coverage, or are at risk of losing their coverage, may be forced to leave employment in favor of public assistance simply to ensure their health needs are met.
A study by the Lewin Group in 2004 found that Texans with disabilities interested in working, or working more, face major barriers to health coverage. They found that, “In fact, obtaining and retaining health care coverage for this population is more difficult in Texas than in other states that Lewin has studied because of an array of health care policies and practices driving a high rate of uninsured regardless of health or disability status.”
National MS Society Action:
1. Vice President of Public Policy was appointed to the workgroup that developed models and recommendations for the Medicaid Buy-In
2. Staff worked with bill sponsors on bill language
3. Advocates made personal visits to legislators
4. Staff made personal visits to all key committee members
5. Staff gave testimony at the following committee hearings: House Appropriations; House Public Health; Senate Finance; Senate Health and Human Services
6. Calls to action were initiated for all committee votes and floor votes in the House and Senate
Partners: Texas Association of Goodwills; Advocacy Inc.
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RESTORE FUNDING FOR ADULTS IN THE MEDICALLY NEEDY PROGRAM
House Bill 1/Senate Bill 1 (Appropriations issue)
Position: FOR
Outcome: PARTIAL RESTORATION
Background and Purpose: The Medically Needy “spend down” program was created to assist certain families who earn too much money to qualify for Medicaid, but do not have enough money to cover their medical expenses. This assistance is temporary, and the families’ medical bills, when subtracted from earnings, must reduce their income to 22 to 31 percent of poverty level ($375 a month for a working parent of two children) in a given month.
The budget passed in 2003 eliminated this coverage for adults with dependent children, resulting in no coverage by 2005 for a monthly average of 9,328 “medically needy” adults. Since Medically Needy is a temporary, month to month program, the number of people affected by the program cut in a year will be much larger than the monthly average. This cut will likely create more uncompensated care for health care providers, and leaves working families in Texas who are experiencing serious medical difficulties without a safety net.
The chapter supported full restoration of this program, and also a policy change that could potentially draw down more federal dollars, allowing the state to raise the income cap.
Legislators settled on partial restoration of funding for adults with dependent children in the Medically Needy program. This is a positive step toward strengthening the health care safety net. Limited information has been made public about how this partial restoration will work. The restoration appears to cover inpatient hospital care, and will likely require a significant contribution from local governments. We will be monitoring implementation of this program.
NATIONAL MS SOCIETY Action:
1. Staff visited key Finance and Appropriations committee members to advocate for restoration
2. Staff provided written testimony to all Finance and Appropriations committee members
3. A call to action was initiated for advocates in budget conference committee member districts
Partners: Center for Public Policy Priorities
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TEXAS HEALTH INSURANCE RISK POOL
House Bill 2813 (Hochberg)
Position: FOR
Outcome: DID NOT PASS
Background and Purpose: When a person leaves their job or loses employment, they become eligible for COBRA health coverage. This coverage allows the person to continue their health insurance coverage for up to 18 months by paying a monthly premium. The monthly premium is often quite high. House Bill 2813 proposed allowing individuals who are eligible for COBRA to purchase their insurance through the Texas Health Insurance Risk Pool (THIRP) if the premium for Pool coverage is lower than the COBRA premium. Currently individuals who are COBRA eligible cannot participate in the Pool, even if they are not purchasing the COBRA coverage. Though THIRP premiums can also be quite high, there are several plans to choose from, and there are cases when the THIRP premium would be less expensive than COBRA. This change in public policy would help people with MS who are experiencing a period of unemployment to continue their health insurance coverage.
This bill was strongly opposed by insurance industry lobbyists. Insurance companies are required to pay the balance of costs for the Risk Pool that are not covered by premiums paid by enrollees, and thus do not want to increase enrollment in the Pool.
The chapter will be working over the next few months to develop proposals for alternatives for funding Risk Pool expansions, and to get an accurate estimate of the cost of proposed expansions.
NATIONAL MS SOCIETY Action:
1. Testified in favor at House Insurance Committee hearing
2. Worked with bill sponsor on language and strategy
3. Initiated call to action for House Insurance Committee vote
Partners: Disability Policy Consortium