COD E R E D

Reinstating the Medically Needy Spend-Down Eligibility for ParentsAs noted previously, funding for the Medically Needy spend-down program for parents withdependent children was discontinued in 2003, leaving a spend-down option only for pregnantwomen and children. The spend-down part of the Medically needy program allows temporaryMedicaid coverage for pregnant women and children (and before 2003 also included non-aged,non-disabled parents or caregivers with dependent children) with high medical bills who maketoo much to qualify for Medicaid but whose earnings after medical bills are subtracted would bereduced to qualifying levels. A bill has been introduced in the 2005 Texas Legislature to restorethe Medically Needy program to pre-2003 levels in order to offer coverage to families withserious medical problems who need it most. The fiscal note to House Bill 710 states therestoring these benefits is estimated to cost $241.3 million in All Funds ($94.9 million GR) in2006 and $276.4 million in All Funds ($109.2 million GR) in 2007, with increases in subsequentyears, and that the people served (in average monthly recipient months) would be 10,118 in2006, 10,918 in 2007, 11,796 in 2008, 12,745 in 2009, and 13,769 in 2010. 149Hypothetical 1931/HIFAAnother expansion option for Texas takes advantage of the flexibility afforded in HIFA waiversto expand to both the 1931 (optional) population and to an additional (expansion) population ofnon-disabled, childless adults. Basing the HIFA cost savings on a hypothetical 1931 expansionto the full Medicaid package of benefits (that would be more costly to the federal government forless coverage), the state could offer a reduced benefit package to the 1931 population and withthe “savings” cover additional childless adults. 150 See Appendix D for more details andestimated costs and impacts of possible alternatives. Also, note that if this waiver option wereimplemented, the Medically Needy spend-down eligibility could be extended to adults not livingwith dependent children, which could help reduce uncompensated care in hospital emergencyrooms and help fund trauma care.Ticket to WorkThe Ticket to Work Program, established in 1999 through the Ticket to Work and WorkIncentives Improvement Act, was designed to support individuals with disabilities in theiremployment and help with employment retention efforts using infrastructure and demonstrationgrants to provide Medicaid and other services to eligible individuals. Texas was approved byCMS in 2001 for a demonstration grant to initiate a Ticket to Work project in two urban areas,Harris and Tarrant counties. The project would have provided Medicaid services (a somewhatreduced benefit package) to working individuals with schizophrenia, bipolar disorder or majordepression, ages 18 to 64, who were not yet able to meet the SSI disability test. 151 However,the 78th Legislature did not appropriate the state matching funds for the expansion project.Covering Legal Permanent ResidentsThe Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA)required states to implement a five-year wait period for legal permanent residents arriving afterAugust 1996 to receive Medicaid or SCHIP. The act left it to the states’ discretion to allowcoverage after the five years. To date, Texas has not taken advantage of this coverageexpansion option. This option requires only a state plan amendment.Prenatal Care under SCHIPTexas could submit an amendment to the SCHIP State Plan that would allow the state toexpand SCHIP eligibility to unborn children who meet certain criteria, regardless of the eligibilitystatus of the mother, including unborn children of low-income undocumented pregnant women.These women and unborn children could receive prenatal care and other related services.B-34