PUBLIC BENEFITS

With nearly 6 million Texans lacking health insurance coverage and the cost of coverage growing ten times faster than incomes, Texas needs to take bold steps to confront issues with access to health coverage. Healthy Texas has the potential to put private health insurance coverage within reach of many uninsured Texans by addressing the primary barrier to coverageâ€"the high cost of premiumsâ€"using public-private partnerships. The overall goals of Healthy Texas are commendable, but the ultimate value of the program will depend upon key policy decisions, many that have yet to be made.

Senate Bill 6 in 2005 directed HHSC to create a new health care delivery model to provide foster children with comprehensive services, a “medical home,” and coordinated access to care. HHSC worked with the DFPS to develop STAR Health, a new Medicaid managed-care model for foster children, which was implemented on April 1, 2008. This report explores the initial implementation of the program and STAR Health’s potential to improve health outcomes for foster children.

A Child Alone and Without Papers, released today by the Center for Public Policy Priorities (CPPP), reveals what happens to more than 43,000 undocumented, unaccompanied children removed annually from the United States and repatriated to their home countries. Policy analysis and interviews with adults and children in the system revealed the U.S. often compromises children’s rights, safety, and well-being, contrary to international law and U.S. child welfare standards.

For more information, including a two-page summary, backgrounders and appendices, visit www.cppp.org/repatriation.

CPPP's new report provides an update on major actions on health care access in the 2007 legislative session and the important issues and challenges that remain as we approach the 2009 session.

Methodist Healthcare Ministries (MHM) Chief Executive Officer Kevin C. Moriarty is this year’s recipient of the Hobby Visionary Award. CPPP selected Moriarty for the award because of his strong record of charitable service and advocacy for good public policy, particularly for access to health care. Former Lieutenant Governor Bill Hobby, for whom the award is named, presented the award on September 19 at the 2008 William P. Hobby Policy Conference in Austin.

The Texas Health and Human Services Commission (HHSC) received approval today from the federal government to provide Emergency Food Stamps to victims of Hurricane Ike. Families must have limited income to qualify, but will only need to provide proof of identity and residence in one of the 29 counties declared a federal disaster area.

Senior Policy Analyst Celia Hagert delivered testimony in a public hearing held by the USDA in Austin on July 15, 2008. Her recommendations for reauthorization of child nutrition programs include improving access, meal quality and nutrition in school breakfast and lunch, summer nutrition, afterschool and child and adult care food programs.

Access to health care, good nutrition, and cash assistance is vital to low-income Texas families who don’t earn enough to make ends meet, particularly during economic downturns. Yet, enrolling in programs like Food Stamps and Medicaid has gotten harder over the last year due to problems with TIERSâ€"the new computer systemâ€"and a shortage in state workers that resulted from the Legislature’s failed attempt to privatize the system in 2006. Rebuilding and sustaining a viable eligibility system promises to be one of the most important challenges facing Texas in the years to come. Today, the Legislative Oversight Committee overseeing efforts to rebuild the eligibility system will hold a public hearing. The Health and Human Services Commission (HHSC) will provide a progress report and present the benchmarks that will be used in determining whether to continue implementing TIERS. In this report, CPPP outlines recommendations for HHSC to consider.

Access to health care and good nutrition is vital to low-income Texas families who don’t earn enough to make ends meet. Yet, enrolling in programs like Food Stamps and Medicaid has gotten harder over the last year due to problems with TIERSâ€"the new computer systemâ€"and a staff shortage that resulted from a legislatively-mandated attempt by the state to privatize the system in 2006, which failed. Rebuilding a viable eligibility system promises to be one of the most important challenges facing Texas in the years to come. On Monday, July 14, the Legislative Oversight Committee overseeing efforts to rebuild the eligibility system will hold a public hearing. The Texas Health and Human Service Commission (HHSC) will provide a progress report and present the benchmarks that will be used in determining whether to continue implementing TIERS.

By insurance industry standards, Texas’ commercial health insurance market is considered one of the healthiest in the United States because it has a relatively large number of insurance companies offering plans, is subject to less rate regulation than in most states, and brings in $22 billion a year in premiums. The effect of this market on Texas consumers, however, is anything but healthy. The private health insurance market in Texas leaves one in four uninsured, generates the third highest premium increases in the nation, and produces one of the lowest rates of coverage through employer-sponsored insurance in the nation. Many small-business owners in Texas want to provide coverage to their workers but cannot afford to with premium quotes as high as $23,000 a year per employee. Texans must think twice before switching jobs or starting businesses for fear that a preexisting condition will prevent them from getting health insurance. The notion that a hands-off approach to regulation promotes the best outcomes has not worked any better in the Texas health insurance market than it has in the mortgage industry. Texans deserve a truly healthy insurance market in which insurance companies vigorously compete for business and make reasonable profits while consumers are able to purchase the insurance they need at prices they can afford. This policy page focuses on sensible market reform optionsâ€"many already enacted by other statesâ€"that can help make private health insurance more affordable and accessible in Texas.

Policy Analyst Stacey Pogue submitted comments on the Texas Department of Insurance and Office of Public Insurance Council Sunset Staff Report. With one in four Texans lacking health insurance coverage and the cost of coverage increasing ten times faster than income, the staff report correctly identifies the need for the state to examine its current approach to insurance regulation.

With rising gas and food prices, families need help putting food on the table now more than ever. Nationally, the cost of groceries is up dramatically, especially staples like eggs (up 25% in the last year), milk (up 17%), cheese (up 15%), bread (up 12%), and rice (up 13%). Earlier this month, Congress passed the Farm Bill, expanding the Food Stamps, Emergency Food Assistance, School Meals, and Fresh Fruit and Vegetable programs. This bill will help low-income Americans during these harder times. Thanks to the Farm Bill, Texas will receive $674 million in new money for nutrition assistance over the next nine years, according to the national Center on Budget and Policy Priorities. Not only that, but nearly 900,000 more Texans will receive additional Food Stamp benefits in 2012.

Federal Medicaid officials are trying to impose a number of rules that, if implemented, would make program cuts that would threaten our most vulnerable citizens, limit our ability to serve more low-income children in CHIP, and shortchange taxpayers at the same time. Texas Medicaid officials estimate that these rules would cost Texas Medicaid $3.4 billion in lost federal support over five years. The cuts would force Texas to cut services for children with disabilities and frail seniors as well as support for safety net hospitals, or else raise taxes to make up the lost federal funds. Governor Rick Perry, the National Governors Association, and the National Association of State Medicaid directors all have urged Congress to stop the rules from taking effect, and Congress is now debating bills that would delay the rules for at least a year. In every case, these rules attempt to impose harsher policies than underlying federal law, and in many cases policies that have been specifically rejected by Congress. Read more about the rules and how you can help prevent these cuts (including a letter from Governor Perry urging Congress to stop the rules from taking effect).

The Texas Health and Human Services Commission has released two draft Request for Proposals related to the development and operation of an integrated eligibility system for Food Stamps, Medicaid, TANF, and CHIP. Similar to the now defunct “TAA” contract with Accenture, the RFPs ask vendors to submit their proposals for operating a system of call centers to provide “eligibility support services” for Food Stamps, Medicaid, and TANF; determine eligibility for CHIP-only cases; and provide document processing services through a centralized mail center. CPPP has prepared a contracting matrix that describes these and other major contracting opportunities with HHSC related to the delivery of health and human services, including information on the new Twogether in Texas contract award.

As one step to decrease the number of uninsured, in 2007, the Texas Legislature directed the Texas Health and Human Services Commission to request a “waiver” of federal Medicaid laws to allow Texas to use federal Medicaid dollars to fund a health care coverage program that would be allowed to operate in ways not normally allowed under federal law. In developing a waiver, HHSC must balance keeping the cost per person low against the need to provide a decent and affordable standard of care. Top concerns for the low-income uninsured Texas adults who might be served are (1) a package with “bare-bones” benefits; (2) co-payments that are too high for the poorest parents; and (3) no clear policy on whether parents whose benefits run out will be in debt for the additional care they need. Achieving “affordable” care by cutting benefits dramatically (instead of finding a way to provide an acceptable standard of care) raises serious concerns. An overarching concern for all Texans is whether the financing of the proposed program will hurt our safety net hospitals, which are the backbone of the trauma system for every Texanâ€"rich or poor. Finally, the amount of funding available for the new program is uncertain, and so the number of adults who will be able to enroll is also unknown. This policy page makes recommendations for improving the state’s waiver proposal and explains how you can voice your concern to state officials.

Associate Director Anne Dunkelberg testified on the Medicaid 1115 waiver concept before the Texas Legislature’s Medicaid Reform Oversight Committee.

This updated report illustrates the history and consequences of Texas' policies related to children's Medicaid and CHIP, using official state program data. It also summarizes national and state research on the effects of eligibility and enrollment policies, and explains how Texas policies compare to those of other states. The report was funded by the generous support of the Texas Association of Community Health Centers.

The Senate is soon to take up the economic stimulus bill. We have urged our Texas Senators to vote against the House bill to give the Senate an opportunity to produce a better bill. If the House bill is defeated, we have urged our Texas Senators to vote for the proposal from the Senate Finance Committee. If an amendment to the proposal is offered for a temporary boost in food stamp benefits, we have strongly urged our Senators to support the amendment. A temporary boost in food stamp benefits is a particularly good economic stimulus for Texas. Our letter to our Texas Senators is posted here as a Full Article. We urge you to contact each Senator with a strong message to support the Senate Finance Committee proposal and a food stamp amendment. You can contact Senator Hutchison at http://www.senate.gov/~hutchison/contact.html. You can contact Senator Cornyn at http://cornyn.senate.gov/public/index.cfm?FuseAction=Contact.Home.

An effective federal economic stimulus package must target aid to those who will be hardest hit by a recession and who will most quickly boost the economy by spending to support their families. Today, national groups are asking organizations in Texas and other states to sign on to two letters calling for timely, targeted, and temporary assistance to those most in need. The first letter calls on Congress to include (1) an increase in the Medicaid federal medical assistance percentage (FMAP), with a requirement that states must maintain eligibility to qualify for the funds; and, (2) a grant based on population. The second letter urges Congress to boost Food Stamp payments and extend unemployment benefits as part of the stimulus package. The Congressional Budget Office reports that Food Stamps and unemployment insurance would stimulate spending even more quickly than rebates. Congress is reported to have dropped these elements from the stimulus package and would instead boost business tax incentives, which are among the least effective ways to increase economic activity.