Texas Medicaid Reform
Senate Bill 10, Texas' Medicaid reform bill creates:
- A tailored benefit package for children with special health care needs, as well as the option for creating tailored benefit packages for other categories of Medicaid recipients. The bill requires that the tailored benefit packages would increase the state's flexibility in Medicaid funding without reducing the scope of benefits, not to be implemented before September 2009.
- Voluntary health savings accounts (HSA) under Medicaid.
- The Healthy Lives pilot program, which will reward Medicaid patients who complete smoking cessation, weight loss, and other preventive health programs in one region of the state.
- Authorizes the Health and Human Services Commission to seek a Medicaid waiver to implement the Texas Health Opportunity Pool (THOP), which would utilize federal Disproportionate Share Hospital and Hospital Upper Payment Limit funds, as well as other federal and state funds, to create a trust fund. The waiver could provide up to $1 billion to help low-income workers obtain health insurance.
- Establishes a second tier of eligibility for the Health Insurance Premium Payment (HIPP) program. Those in the second tier (individuals for whom enrolling in a group health plan is not cost effective) who would prefer to enroll in the group plan versus receiving Medicaid benefits may do so. The Health and Human Services Commission would pay the employee's share of the required premiums, except when the employee's share of required premiums exceeds the total estimated Medicaid costs for the individual. Then, the employee would be required to pay the difference. The individual would also be responsible for paying all deductibles, copayments, coinsurance, and other cost-sharing obligations.
 Link to 1115 Waivers and Amendments page
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