COD E R E D

1) Increasing Parkland Hospital’s charge structure could draw down up to $16 million inadditional federal funds through the Upper Payment Limit program.2) Using SCHIP funds to provide prenatal care to undocumented immigrants to pay forprenatal care (currently being paid entirely from local funds)—seven other statescurrently have such plan amendments approved by CMS. Health ManagementAssociates estimates this could yield an additional $7 to $9 million.3) Increasing Medicaid payments to physicians affiliated with Parkland Hospital would bringin an unspecified amount (this would require an agreement with the University of TexasSouthwestern Medical Center that this would reduce its need for funding from thehospital district).4) Increasing rates for Parkland Health and Hospital System’s HMO is estimated to bring in$5.6 million with a 5 percent increase in premiums.5) Dallas County could pay the state share of Medicaid UPL payments to private DSHhospitals in Dallas County. Health Management Associates estimates that the availableUPL capacity of these private DSH hospitals is about $412 million. 148Medicaid and SCHIP Expansion Options for TexasSections 1931 and 1902(r)(2)One of the easiest mechanisms Texas could use to expand coverage is to take advantage ofSection 1931 and/or Section 1902(r)(2) of the Social Security Act. As described previously,Section 1931 of the SSA allows states to extend Medicaid coverage to low-income families withchildren (above the TANF limits) by income and asset disregards. To expand coverage to theseparents, all that is needed is an amendment to the State Medicaid Plan, and this method allowsthe state to cap enrollment and to alter the benefits. Similarly, Section 1902(r)(2) allows a stateto use less restrictive income and resource methodologies when determining eligibility forMedicaid. This can also be done through a state plan amendment. Both of these optionsrequire additional state general revenue (GR) match dollars.Women’s Health WaiverAs mentioned previously, a women’s health waiver has been proposed and is being consideredin the 2005 Texas Legislature. This would expand women’s health and family planning servicesto millions of women at or below 185 percent FPL, and would receive a 90 percent federalMedicaid match for qualified family planning services. Appendix C contains a fiscal analysis ofthe current women’s health bill by the Legislative Budget Board that concludes that thedemonstration project as introduced in Senate Bill 747 would save the state over $135 millionthrough the biennium ending August 31, 2007.Elimination of Income Disregards/Assets Tests for SCHIPThe 78th Texas Legislature implemented a number of policy changes that led to a decline in thenumber of SCHIP-covered children in Texas. Among these changes were the elimination ofincome disregards and the implementation of asset testing. In order to expand coverage Texascould eliminate these recent changes.B-33