COD E R E D

Table 7. Texas Medicaid Policy Changes, 2003-2004Legislation in 2003 Changes in 2004Continued coverage for all children currently eligible for MedicaidMaintained the continuous eligibility period for children at six monthsAllowed more thorough procedures to verify assets to be implemented(e.g., information from consumer reporting agencies, appraisal districts,or vehicle registration records)Required a personal interview for initial eligibility determination ifrequested by the applicant; otherwise allowed a personal interview forinitial eligibility determination only if eligibility cannot be determinedthrough mail correspondenceRequired a personal interview for recertification of eligibility ifrequested by the recipient; otherwise allowed a personal interview torenew coverage if eligibility cannot be determined through a telephoneinterview or mail correspondenceAllowed establishment of cost-sharing (i.e., co-pays and monthlypremiums) based on federal maximum levelsRequired that adult cash assistance recipients comply with the personalresponsibility agreement to continue to receive Medicaid coverageDiscontinued coverage for adult pregnant women above 158% of thefederal poverty levelDiscontinued coverage for non-pregnant adult clients with incomesabove 17% of the federal poverty level (medically needy spend-down)Allowed establishment of prior authorization requirements for highcostmedical servicesDirected the implementation of “disease management” effortsRequired that medical assistance be delivered through the most costeffectivemethod of managed care throughout the state and thatguidelines for appropriate usage of out-of-network providers beestablishedDirected that a Preferred Drug List (PDL) be implemented, with priorauthorization required for prescribed drugs not on PDLAllowed establishment of four brand-name and 34-day brand-namesupply limits for clients previously eligible for unlimited prescriptions(does not affect current three-prescription limits for certain clients)Discontinued coverage for certain optional Medicaid services for adultsover age 21: eyeglasses, hearing aids, podiatric, chiropractic,psychological services (from psychologists, therapists, counselors, andsocial workers)Established a statutory basis for estate recovery of Medicaidexpenditures pursuant to federal requirementsDiscontinued reimbursement of Graduate Medical Education (GME)Coverage up to 185% FPL was restoredHHSC determined that the HMO model should beused in urban areas and PCCMs in all remainingareas not served by HMOs, and dual-modelarrangements be eliminated.GME Medicaid funds were restored to teachinghospitalsDecreased reimbursement rates by 5% for Medicaid acute care Did not reverse cuts but prevented deeper cutsproviders such as physicians, hospitals, and HMOs; Decreases from taking place: doctor’s rates were cut byreimbursement rates by 2.2% to 3.5% for non-acute care providers such 2.5%, nursing homes by 1.75%, and communityas nursing homes, community care providers and ICF-MR providers care providers by 1.1% in 2004, and these wereset to double in 2005 (hospital cuts remain at 5%)Sources: Texas Health and Human Services Commission, Medicaid Policy Changes, 78th Legislature, RegularSession, 2003 (August 2003), available at http://www.hhsc.state.tx.us/news/post78/Medicaid_Policy_Changes.html, accessed January 2, 2004; Center for Public Policy Priorities, Update on Medicaid and CHIPCuts: What Was Restored in Recent Actions? (September 2004), available at http://www.cppp.org/products/PP217.html, accessed January 2, 2005; and Texas Senate Health and Human Services Committee,Interim Report to the 79th Legislature (December 2004, p. 17), available at http://www.senate.state.tx.us/75r/senate/commit/c610/downloads/rpt_c610_dec2004.pdf, accessed January 12, 2005.B-26