By Stacy E. Wilson, J.D.

Medicaid is an efficient and effective health coverage program for Texas children, and federal and state governments should continue to stabilize and improve the program’s coverage and benefits for children.

About 3.5 million children in Texas are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). That’s about half of the children living in Texas, yet children don’t drive Medicaid costs. Non-disabled children make up about 70 percent of the Medicaid caseload in Texas but account for only 30 percent of the spending.

Medicaid provides a safety net for working families that have children with complex medical conditions. The program helps shoulder the financial burden not covered by commercial insurance, ensuring that these families are not devastated financially.

Children with access to Medicaid are more likely to attend school, graduate from high school, and go to college, becoming healthier adults who will earn more and pay more in taxes than those who do not have appropriate health care as children. Dramatic changes or across-the-board cuts to Medicaid would negatively impact coverage for children.

Thanks to the efficiency of the program, growth in per capita Medicaid expenditures in Texas falls below both commercial insurance and Medicare levels. When adjusted for inflation, Texas is spending less per Medicaid enrollee than the state did in 2001.

The Children’s Hospital Association of Texas (CHAT) advocates for a series of elements that we believe are essential for the Medicaid program to adequately protect Texas children.

• To continue to be efficient and cost-effective, the Medicaid benefit design should specifically address children’s needs. National standards emphasize early intervention, and those standards should continue as the baseline benefit for children.
• Current criteria for children’s Medicaid eligibility should remain in place. Delaying access to health care for children, especially preventive services, through waitlists or suspended enrollment only creates higher costs for these children and the health system later.
• Children must have timely access to appropriate health care services. This access to high-quality, appropriate care can be ensured through fair and adequate provider reimbursement. Reimbursement rates must be sufficient so that an adequate number and the appropriate types of providers participate in Medicaid. Similarly, network adequacy requirements should ensure that children and their families have access to high-quality services designed for them.
• Burdensome cost-sharing requirements will delay treatment, add to providers’ bad debt, and ultimately increase costs. Children should continue to have access to preventive services at no cost. Alternatively, cost-sharing should be applied on a sliding fee scale, and certain children should be exempt from these requirements. Reasonable out-of-pocket caps should be implemented to avoid penalizing patients with chronic physical or behavioral health conditions.

•· Medicaid should incentivize improvements in quality, safety, and efficiency. This can be achieved by sharing cost savings with providers or encouraging other alternative payment methodologies. Medicaid should also provide bonuses or other incentive payments for quality and safety achievements by providers.

Children must not lose ground as health care is debated at the federal and state levels. Any reforms must build on the achievements our state and others have already made to further improve children’s health coverage and care for children. CHAT members are committed to the health care and health of children across the state, serving all children who walk through their doors. We should work towards solutions to ensure that Texas children thrive, with better health and stronger futures.

Stacy E. Wilson, J.D. is the president of the Children’s Hospital Association of Texas. CHAT members are Dell Children’s Medical Center of Central Texas (Austin), Driscoll Children’s Hospital (Corpus Christi), Children’s Health (Dallas), El Paso Children’s Hospital, Cook Children’s Health Care System (Fort Worth), Texas Children’s Hospital (Houston), Covenant Children’s Hospital (Lubbock), and Children’s Hospital of San Antonio.