have already left the area,” Hidalgo-Starr County Medical Society President Victor Gonzalez, MD, said at a McAllen rally on March 27 to raise awareness of the prob- lem. While physicians statewide face the impact of the cuts, the Valley was particularly hard hit because of its large number of dual-eligible patients. TMA President C. Bruce Malone, MD, an orthopedic surgeon from Austin, says the impact on access to care for these dual-eligible patients likely will be trau- matic if state officials do not solve the problem.
“The people who are affected are our most fragile, our elderly, the ones who are poor, the ones who are unable to fend for themselves,” he said. Dr. Gonzalez added, “The future health of our elderly, the future health of our uninsured, and our Medicaid popu- lation in this region is seriously at stake.”
A patient signs a petition asking Texas legislators and the Legislative Budget Board to reverse the cap on Medicaid-allowable payments for dual-eligible patients and make sure physicians can continue to see those patients.
feeling the pinch of a decision Texas law- makers made last year to drastically cut what the state will pay for “dual-eligible” patients — those who are old enough to qualify for Medicare and whose income qualifies them for Medicaid.
Carlos Cárdenas, MD C. Bruce Malone, MD 38 TEXAS MEDICINE June 2012
On top of those cuts, a glitch in the computer systems that are supposed to communicate claims data between Medicare and the state Medicaid pro- gram meant that thousands of claims for which Medicaid should have paid at least a portion of the bill were returned with zero payment. While Texas Health and Human Ser- vices Commission (HHSC) officials say the computer glitch is resolved and phy- sicians should have begun seeing pay- ments hitting their mailboxes as of mid- April, Texas Medical Association officials and physicians in the Rio Grande Valley say the damage may already be done. “Unfortunately, some of our colleagues
No more 80-20 The problems Dr. Saenz and countless other physicians across the state face stem from a rider the legislature placed into last year’s state budget bill that eliminates a portion of the Medicaid payment for dual eligibles. Under Medicare, patients have both a deductible and a copayment. This year the deductible is $140. The copayment is 20 percent of the Medicare allowable rate for a medical service. For example, if Medicare’s allowable rate for a service is $100, Medicare will pay $80 of the bill and the patient is responsible for the re- maining $20. Until Jan. 1, the Texas Medicaid
program paid both the deductible and copayment for dual-eligible patients. That’s when the budget rider eliminating the payment of the Medicare copayment took effect.
Also part of that rider was a provi- sion that Medicaid would no longer pay the full deductible but cover only the amount up to Medicaid’s allowable rate for a particular service. So, as in the pre- vious example, if a physician submitted a claim to Medicare for a service costing $100 and the patient had not yet met his or her $140 deductible, Medicare would pay nothing but would credit $100 against the patient’s deductible.
STEVE LEVINE
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