The Texas Senate unanimously approved an overhaul of long-term and acute care Medicaid services on Monday in an effort to expand care to more disabled Texans while saving millions of state dollars.
SB 7 is expected to save $8.5 million in Medicaid costs in the 2014-15 biennium by expanding managed care services, establishing pilot programs to try to provide services at capitated costs and implementing measures to ensure more efficient monitoring of services. It also sets up an advisory committee to advise the Health and Human Services Commission on ways to efficiently redesign Medicaid acute care services and a new functional assessment tool which Nelson said would allow the state to more accurately assess patient needs.
Nelson said that under the current assessment methods, many disabled Texans receive more services than they actually need, while others receive too few services.
“I firmly believe that the new assessment tool will do a better job for us in identifying individuals who need help,” said Nelson. She estimated 12,000 additional disabled Texans would be able to receive some services through SB 7.
Disabled Texans, their families and advocacy groups raised many concerns during a committee hearing on SB 7, particularly on the effects of transitioning disabled Texans to Medicaid managed care plans. They expressed fears that Medicaid managed care plans would limit provider networks or reduce reimbursement rates, forcing disabled Texans to lose access to trusted medical practitioners or community-based services. HHSC held a stakeholder meeting on March 6 and Nelson offered an amendment, which the Senate adopted, to address those concerns.
Amy Mizcles, interim executive director of the ARC of Texas, an advocacy group for disabled Texans, wrote in a letter to Nelson on Friday that her organization supported the amended bill. “Having worked closely with your office during this process, we believe that the proposed floor amendment addresses the concerns we have identified through the committee process," she said.
Nelson’s amendment would allow disabled enrollees participating in Medicaid waiver programs to remain in those programs or voluntarily choose to join a Medicaid managed care plan. The amendment also sets up a service to help Texans with intellectual or developmental disabilities who have difficulty accessing care. It also includes language to ensure disabled Texans have access to community-based services to keep them near home and out of state institutions, among other provisions.
The Senate also adopted an amendment by Sen. Judith Zaffirini, D-Laredo, to ensure that stakeholders will be included in the system redesign advisory committee and that Medicaid managed care organizations will develop provider networks that have experience delivering services to adults with disabilities.
“This was a really complex bill and we had many advocacy groups and stakeholders that provided input,” said Nelson.