payment was the single overriding reason physicians cited for why they or their colleagues limit or no longer participate in Medicaid.” He also decried the legislature’s decision to autho- rize Medicaid managed care plans to charge higher premiums, saying “any new money [should] be dedicated to improving patient care and the availability of that care.” Senator Nelson said she “would have liked to improve re- imbursement rates for our health care providers, but that un- fortunately did not have the necessary support to make it into the budget.” As for the raise in Medicaid managed care premiums, Rep-
resentative Zerwas said the legislature underfunded some of the managed care plans when it rolled them out into the Rio Grande Valley and some rural areas last year, “and that was merely due to the fact we didn’t have the experience in those places in order to adequately compensate them for the care they were taking on.”
He added that he and other lawmakers are working on ac- countability measures to make sure access and quality of care aren’t compromised as Medicaid managed care continues to roll out.
A better budget Lawmakers really have only one required task each session, and that’s to pass a state budget. Coming off of a grueling 2011 legislative session that started with a $26 billion defi- cit and ended in deep reductions in health care funding, it seemed there was only room for improvement. Overall, the legislature answered TMA’s call to reverse those cuts and avert access-to-care losses, leaders say. With an estimated surplus of $8.8 billion and a healthy $11.8 billion Rainy Day Fund, lawmakers did not have as tight a budget to deal with as in the previous session and got down to business drafting a spending plan earlier than usual. Even though legislators still took every remaining day of the session to finalize it, medicine emerged with reparations to many of last session’s harsh cuts amid competing interests to increase funding for education, water, and infrastructure needs. The governor and state comptroller signed off on Senate Bill 1 by Sen. Tommy Williams (R-The Woodlands) and Rep. Jim Pitts (R-Waxahachie), which spends roughly $197 billion in state and federal funding for the 2014–15 biennium, a $25 billion increase over 2012–13 funding levels. The bill adds $2 billion over last session for health and human services, includes increased spending for mental health and women’s health services, and takes steps to restore some of the GME funding lost last session. Senator Nelson, who served on the House-Senate confer- ence committee that finalized the budget, hailed this session as “very successful” in terms of meeting the state’s health care needs.
The higher revenue enabled lawmakers “to not only meet
our responsibilities to the most vulnerable among us, but also invest in prevention and other efforts to ensure the health of our citizens.” To maintain those goals, Senator Nelson said she also “focused on finding ways to deliver services more
efficiently and in a way that achieves healthy outcomes for patients” through improvements to Medicaid managed care and fraud mitigation efforts, for example. Representative Zerwas, who also served on the budget con-
ference committee, called the 2011 and 2013 legislative ses- sions as different as night and day. “When you go through a budget-cutting session like last time, you really go after those things that don’t require you to sacrifice a federal match, and women’s health and men- tal health are two areas where we don’t always have federal matching dollars available. But we really were able to put more money back into those places this time,” he said. Law- makers also intentionally shortchanged the Medicaid program by about $4.5 billion last session, “so that was one clear, ur- gent health care need that had to be met,” and the new budget funds Medicaid “at a much more appropriate level.” (Legisla- tors did make up the $4.5 billion shortfall with an emergency appropriations bill passed early in the session.) As part of the Texas Women’s Healthcare Coalition, TMA ad- vocated for improvements to women’s health services. The pro- gram saw important gains that made up for drastic cuts during last session’s budget crunch and a loss of more than $30 mil- lion in annual federal funding after the 2011 legislature voted to exclude Planned Parenthood from the former state-federal Women’s Health Program. Texas has since replaced it with the state-only Texas Women’s Health Program (TWHP). Women’s health funding came together through several funding streams. In addition to restoring and increasing by $32 million state federal family planning funding that the De- partment of State Health Services lost in 2011, SB 1 allocates $100 million more for preventive care under the Community Primary Care Services Program and for women’s health and family planning services. Lawmakers also fully funded TWHP with $71 million in state funding. Mental health services funding saw one of the largest in-
creases in recent history with more than $225 million in new money targeting a wide array of initiatives to address Texas’ mental health needs, including prevention, early identification, community-based services, and inpatient hospital care. That includes $25 million to promote private-public partnerships to improve mental health care delivery. Dr. Secrest, a psychiatrist in Dallas, testified that for every $1 spent on mental health services, the state would see $23 returned, and as Texas’ population continues to grow, the per- centage of people with mental illness stays constant. “Even in the previous legislative session, lawmakers had the sense that [mental health funding] was something they can’t cut,” he said. Now, the additional money, along with other mental health legislation passed this session “will help build out more robust services to address a population with mental illnesses they didn’t sign up for.”
Senator Nelson said the shootings in Connecticut last De- cember shined a light on mental health, and lawmakers real- ized that “if left unaddressed, mental health problems present themselves in our jails, hospitals, or as we have seen recently, in tragedy.”
August 2013 TEXAS MEDICINE 31
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