Initial Medicaid Implementation: Texas first implemented their Medicaid program in September of 1967. When the state started the Medicaid program, the state did not include a medically indigent category. In 1968 the federal department in charge of Medicaid released a report that found that Texas engaged in practices that cost the federal government nearly $50,000 a month in lost interest income. The federal expansions of Medicaid eligibility in the 1980s and 1990s led to a tripling of enrollment in the Medicaid program. Between 1990 and 1995 an additional one million people became eligible for Medicaid.
Key Medicaid Political Issues: Texas has a high rate of uninsurance, rural populations, and a high rate of immigrants. All of these issues are key political issues for the state. In 1991 the state expanded coverage to more children under the age of 18. In 2002 the state made the Medicaid eligibility system more simple which led to an increase in enrollment. The bill also changed the eligibility system so that all beneficiaries had six months of continuous eligibility. These reforms were in part a result of criticism and legal action that the state of Texas faced for the difficulty that the state imposed with their Medicaid enrollment applications. At one point, Texas required Medicaid applicants to submit a 50 page application that required original copies of many documents. This burdensome application requirement was made fewer people sign up for coverage that were eligible for Medicaid benefits. In total, the state has seen a growth in Medicaid caseloads of 80 percent following the 2002 reforms although some of that growth is attributed changing economic conditions. The state has recently focused on cuts to certain eligibility categories focused on children with disabilities and problems with the state’s managed care contracts.
Medicaid Expansion Implementation: Texas has not expanded Medicaid as part of the Affordable Care Act. The state has made several attempts to pass Medicaid expansion. The first attempt included copays and deductibles for beneficiaries as well as proposed work requirements and asset tests for the existing Medicaid program. In 2014 the Governor appointed a medical board to make health care recommendations and the group found that the state should expand Medicaid. The Texas legislature meets every other year. Bills were introduced in 2015 but no bills were introduced in the 2017 session. A bill has been introduced in the 2019 session and local Texas groups have organized to encourage the legislature to consider the plan. Organizers are also considering expanding coverage using the state’s initiative process. One poll found that 60% of Texans support Medicaid expansion. Texas became a center piece in the battle between the Obama Administration’s CMS and the state when the state requested an extension of their 1115 waiver without the inclusion of a Medicaid expansion. Ultimately, the waiver was agreed to without CMS requiring the state to expand in order to consider to receive waived federal funds.
General facts about Texas Medicaid:
Medicaid program name: Medicaid
CHIP Program name: CHIP
Separate or combined CHIP: Separate CHIP
Medicaid Enrollment: 4.3 million (2018 estimate)
Total Medicaid Spending: $36.3 billion (2017 estimate)
Share of total population covered by Medicaid: 16%
Share of Children covered by Medicaid: 37.5% (estimate)
Share of Medicaid that is Children and Adults: 77%
Share of Spending on Elderly and people with disabilities: 63%
Share of Nursing Facility Residents covered by Medicaid: 62.5% (estimate)
Expansion state: No
Number of people in expansion: N/A
Work Requirement: None