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Medicaid and the State Children’s Health Insurance Program in Texas:Appendix D. Alternative HIFA ProposalsThis proposal for expansion of coverage to parents and childless adults is a three-stepapproach:1) Consider a hypothetical section 1931 expansion to parents. The 1931 expansion wouldrequire a state plan amendment (not a waiver) and would expand Medicaid to all parentsof children under 19 up to a certain agreed-upon income. It is called “hypothetical”because the state would not actually implement the 1931 expansion in this plan unlessthe next two steps were going to be implemented, but by saying that the state isconsidering it, the state can use this expenditure projection as the “without the waiver”projection in a test for budget neutrality for the 1115 HIFA waiver (1115 waivers have tobe budget-neutral but 1931 expansions do not, so 1931 would raise the expenditurelevel that the HIFA waiver would have to keep within).2) Propose a HIFA waiver reducing benefits and applying cost-sharing to this newpopulation. The HIFA waiver could propose to waive the requirement that optionalpopulations must receive the same benefits as mandatory populations. HIFA guidelinesalso say that states can require a higher level of cost-sharing on optional and expansionpopulations.3) Propose that the HIFA waiver expand a reduced benefits package and cost-sharing touninsured childless adults. This would use the savings from the reduced benefitspackage and cost-sharing implemented to extend Medicaid to childless adults under acertain income. These benefits would be the reduced package offered to the 1931expansion population, and enrollment could be capped if needed to control costs.This model does not provide as many benefits as the traditional Medicaid benefits package tothe new enrollees, however, it does not take away any benefits from current Medicaid eligibilitygroups, and it extends coverage to additional adults without health insurance.The cost estimates in the following table were created in 2002 and used the followingassumptions: 1) Texas Medicaid matching rate of $.5999 for 2002, 2) used March CurrentPopulation Survey number of uninsured parents and childless adults averaged over last threeyears, 3) decreasing participation rates as premiums increase as reported in an article inInquiry, 4) a specific phase-in period, 5) specified average costs per participant, and 6) a 6percent inflation factor. (See Kegler pp. 100-112 for more details.) Note that costs, number ofpotentially eligible people, and other factors may have changed in the past three years andthese numbers are for illustration onlyB-58
FPL ofParents/FPL ofChildlessAdults: CostsharingEstimates for Selected HIFA Expansion Models in Texas, 2002Percent BenefitsPackage ofMandated TANFAdultsPremium perMember perMonthAmount of StateRevenue Neededover Five YearsAmount of StateRevenue Neededfor the NextBienniumNumber ofUninsuredTexansCovered100/50: 0% 54.04% $136.75 $985,482,000 $360,197,000 290,419150/50: 0% 65.87% $166.64 $1,572,433,000 $590,920,000 390,966200/50: 0% 71.90% $181.90 $2,084,811,000 $783,472,000 474,879200/100: 0% 60.83% $153.89 $$2,084,811,000 $783,472,000 561,325100/50: 2% 54.05% $136.75 $643,756,000 $241,924,000 195,058150/50: 2% 65.87% $166.64 $1,056,112,000 $369,887,000 262,589200/50: 2% 71.90% $181.90 $1,400,246,000 $526,212,000 318,948200/100: 2% 60.83% $153.89 $1,400,246,000 $526,212,000 377,010100/50: 5% 54.05% $136.75 $243,197,000 $91,393,000 73,688150/50: 5% 65.87% $166.64 $398,976,000 $149,935,000 99,200200/50: 5% 71.90% $181.90 $528,982,000 $198,792,000 120,492200/100: 5% 60.83% $153.89 $528,982,000 $198,792,000 142,426Source: Elizabeth Raye Kegler, “Utilizing Federal Waiver Flexibility to Expand Medicaid to Adults in Texas”(Professional Report, Lyndon B. Johnson School of Public Affairs, The University of Texas at Austin, May2002), p. 117.Sources for Appendix: Elizabeth Raye Kegler, “Utilizing Federal Waiver Flexibility to Expand Medicaidto Adults in Texas” (Professional Report, Lyndon B. Johnson School of Public Affairs, The University ofTexas at Austin, May 2002), pp. 100-119; and Charles Milligan, Section 1115 Waivers and BudgetNeutrality: Using Medicaid Funds to Expand Coverage (State Coverage Initiatives Issue Brief, May 2001,p. 4), available at http://statecoverage.net/pdf/issuebrief501.pdf, accessed February 28, 2005.B-59
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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
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services. There are two broad types
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Mandatory and Optional Covered Popu
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• 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 66 and 67: needs, however, there is a shortage
Page 68 and 69: 15 Texas Association of Counties,
Page 70 and 71: ecording and evaluation; physical e
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
Page 116 and 117: Endnotes191 Deborah Chollet, Issue
Page 118 and 119: 225 Ibid.226 Maryland Health Care C
Page 120 and 121: 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
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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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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
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were previously categorized as char
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