Fraud, expansion highlight debate over Medicaid future in Texas


by MARK WIGGINS / KVUE News and photojournalist ROBERT MCMURREY

Bio | Email | Follow: @MarkW_KVUE

Posted on January 16, 2013 at 7:17 PM

Updated Wednesday, Jan 16 at 7:21 PM

AUSTIN -- Even though the 83rd Texas Legislature is officially out for the week, business continues under the dome.

Texas Lt. Gov. David Dewhurst and State Sen. Jane Nelson met with media Wednesday to announce two bills aimed to save money on Medicaid, the cost of which Dewhurst said has doubled over the last ten years.

"In Texas, the [Health and Human Services Commission's] Office of Inspector General has identified more than $6 billion in fraud and waste between 2004 and 2011," said Nelson. "We cannot afford to be losing a single dollar, let alone that amount. When you defraud the system you are stealing from the taxpayers, from children, from the poor, the elderly and Texans with disabilities."

Filed Wednesday, SB-7 would change long-term care for the disabled and managed care for the elderly from paying per treatment to a formula based on outcome.

It's companion, SB-8, includes banning providers found guilty of fraud and creating a program allowing the Office of Inspector General to analyze claims data in order to find fraud earlier.

"Certainly the doctors don't support fraud. I think that the question is you want to make sure you're going after fraud and not an error," said Texas Medical Association Vice President Darren Whitehurst.

While supportive of measures to reduce fraud, Whitehurst warns care should be taken not to punish good providers who may have made a mistake.

"We don't disagree with any of that," said Whitehurst. "I think that we believe once a doctor is accused of fraud, there should be some sort of process to weed out who truly is a fraudulent provider from those who are not."

The most contentious issue regarding Medicaid could be what Texas likely won't do this session - expand the program as specified under the Affordable Care Act signed into law by President Obama.

The budget outlined by Dewhurst Monday promised to fund growth in Medicaid enrollment, but state leaders oppose expanding the program to more than a million parents of Medicaid-eligible children.

Citing increasing administrative costs and federal requirements, Dewhurst and Gov. Rick Perry have advocated for Medicaid funds to be distributed to the state as a federal block grant.

"One size does not fit all in the health care area," Dewhurst said Wednesday.

Asked whether expansion was completely off the table for the current legislative session, Dewhurst confirmed, "At the present time it is."

"We cover lots of kids in Medicaid, but almost none of their parents, and the same thing would be true for low-income adults who are just as poor but don't have kids at home," said Anne Dunkelberg, a health care specialist at the Center for Public Policy Priorities.

Pointing to data provided by the Health and Human Services Commission, Dunkelberg says that for roughly $9 billion in state funds, Texas would receive nearly $79 billion in federal matching funds over the next ten years.

By not expanding Medicaid, she argues the state would lose a net $70 billion that Texas taxpayers will be paying for either way.

"The taxes will pay for California and New York," said Dunkelberg. "And as it happens, New Mexico and Arizona."

This week Gov. Jan Brewer (R-AZ) announced plans to expand Medicaid after heatedly opposing it, however, the development in Arizona seems unlikely to sway opinion at the Texas Capitol.

When questioned Wednesday, Dewhurst brushed off Brewer's reversal, "We're going to do the best thing we can for Texas here."

It's another debate that will likely resume once lawmakers return next week.