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needs, however, there is a shortage of such facilities. While federal law excludesundocumented children from Medicaid and SCHIP enrollment, states may use SCHIP funds toprovide “health services initiatives” that do not screen for immigration status, including programsaimed at migrant farm worker communities, low-income immigrant communities, newbornscreening, lead testing, health education, and school health programs. 24Additionally, the Maternal and Child Health Block Grant (Title V), which provides health carefunds for pregnant women, mothers, infants, and children who do not have access to adequatehealth care, is a significant source of health care for undocumented women in Texas. Theprogram only requires beneficiaries to be Texas residents, not necessarily citizens, to receiveprenatal care. 25Undocumented “Responsibility?”Due to the limited access to primary and preventive care for over a quarter of all Texans,growing numbers of individuals, including large numbers of immigrants, must rely on hospitalemergency departments for all of their care. A recent estimate put the national figure foremergency room admissions which did not involve an actual emergency at 50 percent. 26 Inrecent years, emergency departments have consequently been increasingly unable to meetcare demands.In July 2001, then-Texas Attorney General John Cornyn ruled on an inquiry from Harris Countyregarding the legality of using local public funds to provide nonemergency health care forundocumented immigrants. Cornyn ruled that it was illegal. * The attorney general’s opinionwas not legally binding, and the majority of Texas hospital districts continued their policy ofserving residents without regard to immigration status. In the 2003 legislative session, state andlocal entities were granted permission to provide services to undocumented immigrants.In January 2004, the Tarrant County District Attorney ruled that this legislation “required” itscounty hospital district to provide nonemergency care to undocumented immigrants, which ithad not done since 1997. In February 2004, the Montgomery County Hospital District, alsoconsidering discontinuing nonemergency services to undocumented immigrants, sought a newopinion from Attorney General Greg Abbott. Abbott ruled that while undocumented workers areeligible for public health services, they are not entitled to receive services from state funds, butmay be entitled to receive services from local funds if the given hospital district permits it. 27Tarrant County hospital district again discontinued preventive care services to undocumentedimmigrants following the attorney general’s ruling. 28Medicare Prescription Drug, Improvement, and Modernization ActThe Emergency Medical Treatment and Labor Act (EMTALA) of 1985 requires hospitalsparticipating in Medicare to medically screen all persons seeking care in hospital emergencydepartments, and to provide the treatment necessary to stabilize those determined to have anemergency condition, regardless of income, insurance, or immigration status. 29Currently, hospitals and other providers must absorb the costs associated with this care.Section 1011 (Federal Reimbursement of Emergency Health Services Furnished to* The opinion stems from a provision in the PRWORA that required state legislatures to actively affirm theirintention to provide public benefits to undocumented and other “not qualified” immigrants. Those who took issuewith the Cornyn opinion claimed that the Texas Legislature had complied with PRWORA in 1997 by amending astatute requiring hospital districts to provide medical care for all indigent residents.B-52
Undocumented Aliens) of the Medicare Prescription Drug Act is intended to help offset some ofthe cost to these providers for caring for undocumented immigrants and other specified aliens.The amount allotted for this relief is $1 billion, or $250 million per year for fiscal years 2005-2008, to be allocated to hospitals and other health care providers of emergency health servicesfor emergency care. 30Two-thirds of the funds will be divided among all 50 states and the District of Columbia basedon their relative percentages of undocumented aliens. One-third will be divided among the sixstates with the largest number of undocumented alien apprehensions. 31Appendix Endnotes1 State of Texas, Task Force on Indigent Care Final Report, December 1984.2 Ibid.3 Caton Fenz, Providing Health Care to the Uninsured in Texas: A Guide for County Officials (Boston, Mass.: TheAccess Project, August 9, 2000).4 Email interview by Kristie Kimbell with Jan Maberry, Program Manager, County Indigent Health Care Program,Texas Department of Health, November 18, 2004.5 Department of State Health Services, County Indigent Health Care Program, available athttp://www.tdh.state.tx.us/cihcp/default.htm, accessed March 24, 2005.6 Caton Fenz, Providing Health Care to the Uninsured in Texas: A Guide for County Officials (Boston, Mass.: TheAccess Project, August 9, 2000).7 Department of State Health Services, County Indigent Health Care Program, available athttp://www.tdh.state.tx.us/cihcp/default.htm, accessed March 24, 2005.8 Caton Fenz, Providing Health Care to the Uninsured in Texas: A Guide for County Officials (Boston, Mass.: TheAccess Project, August 9, 2000).9 Ibid.10 Texas Association of Counties, “State Budget Reductions Will Impact Counties that Receive Indigent Health CareAssistance,” County Issues, vol. 13, issue 9, June 6, 2003, available at http://www.county.org/resources/library/cissue/v13_09/12.html, accessed March 24, 2005.11 House Research Organization, Interim News (78-7), July 22, 2004, available at http://www.capitol.state.tx.us/hrofr/interim/int78-7.pdf, accessed March 24, 2005.12 Texas Department of Health, County Indigent Health Care Program Summary for FY 2004, available athttp://www.tdh.state.tx.us/cihcp/Spending_Data/Summary%20FY04.doc, accessed March 24, 2005.13 House Research Organization, Interim News (78-7), July 22, 2004, available at http://www.capitol.state.tx.us/hrofr/interim/int78-7.pdf, accessed March 24, 2005.14 Texas Department of Health, Office of Policy and Planning, Agreement Regarding the Disposition of TobaccoSettlement Proceeds (June 8, 1999), available at http://www.tdh.state.tx.us/dpa/tobsett.htm, accessed January 31,2002.B-53
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Appendix ATask Force Members and St
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Hector Balcazar, Ph.D.Regional Dean
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Charles Haley, M.D., M.S.Medical Di
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Michael McKinney, M.D.Senior Execut
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M. Roy Wilson, M.D.PresidentTexas T
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Appendix BMedicaid and the State Ch
Page 16 and 17: services. There are two broad types
Page 18 and 19: Mandatory and Optional Covered Popu
Page 20 and 21: • Nurse-midwife services;• Fede
Page 22 and 23: Disproportionate Share Hospital Pro
Page 24 and 25: March 13, 2001, that limited the am
Page 26 and 27: year from FFY 2002-2004, $4.05 bill
Page 28 and 29: Medicaid beneficiaries. Section 191
Page 30 and 31: started in 2001 and 2002 to curb in
Page 32 and 33: urban and with fewer than 250,000 p
Page 34 and 35: Protection Act of 2000 and the Medi
Page 36 and 37: orientation). Recipients of Supplem
Page 38 and 39: enrollee is assigned a primary care
Page 40 and 41: Table 7. Texas Medicaid Policy Chan
Page 42 and 43: Table 8. Texas SCHIP Policy Changes
Page 44 and 45: families (through the employer’s
Page 46 and 47: share of the match must come from t
Page 48 and 49: Reinstating the Medically Needy Spe
Page 50 and 51: Endnotes1 Texas Health and Human Se
Page 52 and 53: 35 Powers, Pyles, Sutter, and Vervi
Page 54 and 55: 73 Office of Management and Budget,
Page 56 and 57: 113 TexCare, Children’s Health In
Page 58 and 59: 150 Lyndon B. Johnson School of Pub
Page 60 and 61: States by Groupings with Current El
Page 62 and 63: Medicaid and the State Children’s
Page 64 and 65: Graduate Medical Education ProgramA
Page 68 and 69: 15 Texas Association of Counties,
Page 70 and 71: ecording and evaluation; physical e
Page 72 and 73: Medicaid and the State Children’s
Page 74 and 75: ReferencesAmerican Academy of Pedia
Page 76 and 77: downloads/bipa.pdf#search='Medicare
Page 78 and 79: Texas Health and Human Services Com
Page 80 and 81: Appendix CAn Analysis of Reform Opt
Page 82 and 83: Encouraged by these low rates, Cong
Page 84 and 85: Establishing state-only tax incenti
Page 86 and 87: New York passed the Health Care Ref
Page 88 and 89: Hospital Cost Containment — Maryl
Page 90 and 91: dollar spent. 237 Texas spent almos
Page 92 and 93: Another option for small businesses
Page 94 and 95: • Medical equipment and supplies,
Page 96 and 97: pay the premiums for Medicaid benef
Page 98 and 99: Medicaid to children born after Sep
Page 100 and 101: Bill of Rights or “TABOR”; and
Page 102 and 103: The federal share for CHP+ is 65 pe
Page 104 and 105: SCHIP: increased eligibility in CHP
Page 106 and 107: • Medical equipment and supplies
Page 108 and 109: 6. Funds obtained through the recov
Page 110 and 111: Status ReportMaineCare Program Expa
Page 112 and 113: the federal poverty level. 404 Sinc
Page 114 and 115: need their jobs as a source of empl
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Endnotes191 Deborah Chollet, Issue
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225 Ibid.226 Maryland Health Care C
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259 Kaiser Family Foundation, State
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SCHIP&subcategory=Medicaid+Spending
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325 Kaiser Family Foundation, State
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361 State Coverage Initiatives, Sta
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SCHIP&subcategory=SCHIP&topic=Feder
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An Analysis of Reform Options Devel
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ReferencesAdvantage Insurance and F
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Donnell-Kay Foundation. “Amendmen
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Kaiser Family Foundation. Demograph
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State Coverage Initiatives. Profile
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Appendix DLocal Initiatives to Expa
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with more coordinated services that
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FinancingSources of revenue include
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AdministrationThe Health and Hospit
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Until 1993, Denver Health (DH) was
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different benefit plans are offered
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Cost SharingPatient cost-sharing is
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management programs. I-Care promote
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the county indigent care plan. Bene
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Firstplan xxvi,12Moore County, Mich
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Benefits and ServicesEnrollees can
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EligibilityAs of 2005, enrollment i
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etween $23 and $120 per month. Ther
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Healthcare Accountability Act xxxvi
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Coordination - When health care age
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subsidized initiatives offer exposu
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arriers, two health plans attempted
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xxi Simmons, Sandy Coe, Gionfriddo,
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Table 1 (Continued). Local Care Ini
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Table 2 (Continued). Local Coverage
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Appendix EEducation and Health:A Re
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The human capital approach suggests
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etween standardized test scores (St
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INTRODUCTIONEducation plays a wide
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of children with chronic health con
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Implications. Given the current pre
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DiabetesPrevalence. Diabetes in chi
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Limitations. The cross-sectional de
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chronic lung disease, cystic fibros
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significant differences between tho
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Table 1. Prevalence of Selected Chr
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findings of lower test scores are b
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al (McKewen et al., 1998) report a
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Section 3. School-Based Interventio
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mathematics, science and oral expre
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Table 4. Summary of Research Findin
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etween SES and health is a dose-res
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Self-Rated Health. Evidence accumul
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economic hardship. One of the skill
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Education also improves the stabili
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sex in the expectation of a more pr
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TABLE 6. SUMMARY OF EXPLANATIONS FO
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According to the Census 2000 data,
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Policy Reports Recommendations (Tot
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Section 2. Recommendations on Schoo
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Childhood ConditionsSchool-based Pr
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Childhood ConditionsDiabetes (n=11)
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eduction in reading test scores com
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Table 10. Estimates of the Cost of
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National Asthma Education and Preve
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REFERENCESAck, M., Miller, I., & We
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Elo, I. T., & Preston, S. H. (1996)
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Kaemingk, K. L., Pasvogel, A. E., G
Page 246 and 247:
Miller, D. S., & Miller, T. Q. (199
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Ross, C. E., & Wu, C. L. (1996). Ed
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Williams, D. R. (1990). Socioeconom
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SAMPLE, DESIGN, & INTERVENTIONACHIE
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SAMPLE, DESIGN, & INTERVENTIONStudy
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Page 258 and 259:
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Page 262 and 263:
Page 264 and 265:
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SICKLE CELL ANEMIAArmstrong(1996)SA
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SAMPLE, DESIGN, & INTERVENTIONSickl
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SAMPLE, DESIGN, & INTERVENTIONhemog
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SAMPLE, DESIGN, & INTERVENTIONStudy
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Curriculum Content: Statute §28.00
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• HEALTH PROMOTING ENVIRONMENTSch
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• COORDINATION/IMPLEMENTATIONCoor
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Education and Health: A Review and
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Appendix FState Regulation of Healt
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coverage they offer. 14 By 2004 onl
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poor health may make coverage more
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account for most, or even much, of
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More active state intervention in t
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Table 3 (GAO Appendix IV) shows whi
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Appendix GEmergency and Trauma Care
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The treatment of shock prior to sur
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the EMS needs in rural areas of the
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Level IV trauma centers should be a
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Table 2. Trends in Trauma Severity,
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the hospitals were on diversion or
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Representative Delisi was successfu
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Mental Health Access ChallengesCare
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fhttp://www.techproservices.net/his
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oohttp://www.saveourers.org/reports
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Appendix HBrief: Consulate ClinicDe
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In addition, the roundtable discuss
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clinic(s) affiliated with medical s
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Appendix ICommon Abbreviations
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HMOHRQOLHRSAICF/MRIHCTAIOMISSLBBLIU
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Appendix JPresentersDate/Location:
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Appendix KProvider Taxes: A Differe
Page 334:
were previously categorized as char
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