Request by Texas to broaden Medicaid managed care on track

Federal health officials have given a tentative thumbs-up to a request by Texas to expand risk-based Medicaid managed care to 28 counties in rural parts of the state. But the Texas Medical Assn. is concerned that the state will not provide managed care plans enough resources to ensure that Medicaid enrollees have adequate access to care.

Final federal approval for the waiver could arrive at any time, according to a Sept. 14 letter to Texas' Medicaid agency from Cindy Mann, director of the Center for Medicaid, CHIP and Survey & Certification at the Centers for Medicare & Medicaid Services. CMS and the state still were working on a formula to reinvest any savings from managed care into delivery system reforms, among other items.

"We commit to doing whatever we can to expedite the process," Mann wrote.

Texas Medicaid covers more than 3 million people, 1.9 million of whom already are in risk-based managed care. The waiver expansion would shift nearly all of the remaining 1.1 million people into this model by March 2012, said Stephanie Goodman, a spokeswoman for the Texas Health and Human Services Commission.

The state needs to find innovative ways to manage its Medicaid population in part because the health system reform law is expected to increase Texas Medicaid enrollment by 2 million people, said Texas Medical Assn. President C. Bruce Malone, MD. However, expanding risk-based managed care to rural areas may be difficult.

"There's not much infrastructure for managed care," Dr. Malone said. "We're very concerned about that -- whether the managed care companies can really provide the coverage and the panels they need in those areas."

Texas physicians are eager to help the state care for Medicaid enrollees, he said. "We don't want the Medicaid patients of Texas to have an insurance card but no access to doctors."

The Texas waiver proposal is available online (link).