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Safety-net hospitals throughout the state already provide prenatal care to some of thispopulation using local dollars, so having SCHIP cover them would allow federal matching fundsto be obtained to cover a majority of these expenses. The definition of “child” for SCHIPpurposes was revised by CMS effective November 1, 2002, to include children from conception(instead of birth) to age 19, allowing for this opportunity to extend prenatal care to morewomen. 152,153 Seven states already cover this population for prenatal care. 154Other SCHIP/Medicaid Premium Assistance ProgramsTexas could develop a new public-private partnership model in which a health plan is developedspecifically for small businesses. Such plans use either a state-designated board or a privateinsurer to administer the plan, and the state subsidizes premiums for low-income workers. Thismodel is similar to Maine’s Dirigo Health. These plans can, using a waiver, reduce the benefitpackage, and take advantage of Medicaid or SCHIP funds. 155Other OptionsSeveral states, such as Florida, are proposing a fundamental restructuring of their Medicaidprograms to control growing costs. Florida Governor Jeb Bush recently outlined a programwhere the state would pay the premiums for Medicaid beneficiaries to enroll in private healthplans offered by insurance companies and HMOs, including an employer’s plan if a beneficiaryhas access to employer-sponsored insurance. Gov. Bush said the state can predict and controlcosts better by calculating a premium for each Medicaid patient and allowing for an appropriaterate of growth. Since the state would pay the health plans instead of the providers directly, thisnew government-funded insurance program would have to be approved by the state and thefederal government, and the governor hopes to get these approvals by the end of 2005. Hesaid it is not clear yet whether federal approval will include a cap on federal funds and if so, ifthe state or patients would be required to pay more if costs increase more than expected. 156In the Florida proposal, the private plans would set limits on care and coverage, and savings isexpected to come from competition between plans for patients. Basic services coveredcurrently (mandatory and optional Medicaid services) would still be covered, and health planscould offer additional services to attract patients, giving them a choice on the best plans for theirhealth situations. Beneficiaries who take responsible health measures, like participating indisease management programs or immunizing their children, could earn credit for enhancedMedicaid services like over-the-counter drugs. There would be a cap on Medicaid benefits todecrease some of the financial risk for insurers, and patients who reached the cap would becovered by a catastrophic care fund created from a percentage of premiums. 157 A conceptpaper was published in March 2005 outlining the proposed reforms, 158 and legislation is beingconsidered by a committee of the Florida House of Representatives to allow the state to applyfor an 1115 waiver to implement some of the changes. 159More ideas for dramatic changes to Medicaid are likely to be developed by states as manystruggle with rapidly growing costs.AcknowledgmentsThe authors wish to thank the following people for their help with this project: the members ofthe Task Force on Access to Health Care in Texas, Kristine Niemeyer (LBJ School of PublicAffairs), Anne Dunkelberg (Center for Public Policy Priorities), Olga Garcia (HHSC), TracyHenderson (HHSC), Mike Hudson (The Health Policy Group), and Charles Begley (School ofPublic Health, University of Texas Health Science Center – Houston).B-35