Background

The Texas Association of Community Health Plans (TACHP) represents the 12 managed care organizations (MCOs) established by public and non-profit health systems in Texas. We are Texas companies, not publicly traded or beholden to shareholders. TACHP MCOs employ Texans and keep our taxpayer dollars in Texas. Our health plans cover over two million Texans and collectively serve all 254 Texas counties. We are committed to supporting and improving the health of Texans living at low and moderate incomes.

Recommendations

1. Guarantee 12-months of continuous eligibility for children in Medicaid. Texas has the highest uninsured rate for children, in part because of the onerous processes that are in place for Medicaid families to regularly verify their income. Most children in the higher income CHIP program already have 12-months of guaranteed eligibility. We ask for you to correct this inequity. When enrollment for our Medicaid children lapses because of procedural red tape placed on our families, it limits the ability of the health plans to influence the quality of healthcare for Texas children.
2. Extend Medicaid coverage for women of child-bearing age. We know that access to health coverage after pregnancies is a key strategy in tackling maternal mortality and morbidity in Texas. It is also important from a fiscal perspective to ensure women have access to healthcare resources to better plan and/or delay pregnancies. The Healthy Texas Women’s Program is available for family planning services, but we know Texas women would have better access to comprehensive healthcare services if they were allowed to remain or enroll in Medicaid.
3. Maintain a fully integrated approach within managed care for services and populations. Carve-outs and opt-outs would fragment care, make the Medicaid system less efficient, and cost the state. We would be particularly concerned if there were any carve-out of pharmacy services or sub-populations of children in the STAR Kids program. Complex medical issues like chronic lung disease need coordinated care from medications to providers to therapies. We believe we must stay focused on improving integration of services within the existing managed care service delivery system.
4. Direct HHSC to more accurately develop capitation rates for STAR Kids. Community MCOs take care of the sickest and highest cost children in Texas. HHSC’s rate-setting methodology for STAR Kids needs to be modified to take account for high-cost services such as Private Duty Nursing. HHSC must also establish a risk pool to partially compensate STAR Kids MCOs for children with very high costs. Proposed risk adjustment and risk pool changes would be cost neutral.

Please view our Legislative priorities for 2018

• Texas Association of Community Health Plans – House Human Services Committee
  in support of committee substitute for HB 25
• Texas Association of Community Health Plans – House Appropriations Article II Subcommittee
• Texas Association of Community Health Plans – Senate Finance Committee
• Texas Association of Community Health Plans and Texas Association of Health Plans –  Letter to the Honorable Richard Raymond 
• Texas Association of Community Health Plans, Texas Hospital Association, Texas Medical Association, and Texas Association of Health Plans – Letter to Courtney N. Phillips, PhD, Executive Commissioner
• Texas Association of Community Health Plans, Children’s Health Coverage Coalition, and Texas Association of Health Plans – Keeping Children Connected to Care Reduces Costs and Improves Outcomes