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As noted previously, a women’s health waiver (which would receive the 90 percent match forqualified family planning services) has been developed and considered at various times over thepast several years. Legislation is not necessarily needed for HHSC to pursue such a waiver,provided HHSC, the Governor, and the Legislative Budget Board agree to the program. In the79th Texas Legislature (2005), legislation has been introduced to educate decision-makers andto build support for the concept. Waiver proponents suggest that had the 2001 legislation beenimplemented, Texas would have saved $122 million in fiscal year 2005. 143 See Appendix C fora fiscal analysis of the current women’s health bill. This analysis by the Legislative BudgetBoard concludes that the demonstration project as introduced in Senate Bill 747 would have “apositive impact of $135,207,202 through the biennium ending August 31, 2007.”Women’s health proposals seek to take advantage of the 90 percent federal Medicaid match aswell as the “cost-beneficial nature of family planning services” to expand women’s health andfamily planning services to millions of low-income and uninsured women at or below 185percent FPL. 144 Waiver proponents point out that less than 25 percent of the over 4 millioneligible women in Texas (at or below 185 percent FPL) receive care because of the lack ofaffordable care and/or affordable insurance, because the Medicaid income eligibility level fornon-pregnant women is currently much lower. The waiver is expected to meet budget-neutralityrequirements, and to produce significant cost savings, as the costs for services would be offsetby savings from otherwise Medicaid-paid prenatal care, deliveries, and newborn care.Additional cost savings are expected due to early detection and treatment of breast and cervicalcancers.Impact of Initiatives and Strategies for TexasPossible Federal ChangesThe Bush Administration and Mike Leavitt, Secretary of the Department of Health and HumanServices, want to make major changes to Medicaid in the next year. A conversion to blockgrants has been one of the proposals in the past. As discussed in a previous section, criticsargue that block grants create inequities for low-income people who are no longer guaranteedcoverage even if they qualify due to imposed caps, and they discriminate against fast-growingstates because federal funding would be locked in to certain fixed amounts. Planned periodicincreases in the grants may not correspond to the growth in population or be responsive tohigher costs, spending levels, or economic downturns in a state. And for states with a relativelylow level of expenditure using historic allocations for the future base can be particularly unfair. Ifon the other hand federal funds were allocated based on the number of low-income persons inthe state or some similar method there might be a circumstance under which block grants wouldmake short-term sense in a state like Texas.In addition to the FMAP floor issue discussed in the federal section (the 50 percent minimum formatching being an indirect subsidy to richer states), people have argued that a state’s numberof people in poverty should be a factor in the formula for a state’s matching rate instead of thestate’s average income. 145Leveraging Local FundsThere are thousands of local governmental units in Texas and many spend money on healthcare services for the uninsured. One idea that keeps coming up is to find a way to use theselocal dollars as part of the state match for Medicaid or SCHIP in order to draw down additionalmatching federal funds. There are several federal restrictions on using local money for the statematch, but it can be done if it meets the following criteria: 1) at least 40 percent of the stateB-31