Texas Officials, Federal Government Reach Agreement on Medicaid Coverage for Hurricane Evacuees
The federal government and Texas officials on Thursday said they reached an agreement on how to over the next five months pay for health services of Hurricane Katrina survivors who evacuated to Texas, the Houston Chronicle reports (Elliot, Houston Chronicle, 9/16).
Under the agreement, Texas will be permitted to create a new Medicaid eligibility category for evacuees. The new eligibility category will include only those traditionally eligible for Medicaid, unlike a bipartisan bill pending in the Senate that would allow all evacuees to enroll in Medicaid, regardless of standard eligibility rules (Heil/Rovner, CongressDaily, 9/16).
The agreement also allows the state to replace standard documentation requirements needed to qualify for Medicaid and SCHIP with a simplified form (Houston Chronicle, 9/16). Under the plan, Texas also will waive beneficiaries' standard premiums (Embry, Austin American-Statesman, 9/16).
According to CongressDaily, details about how many evacuees will qualify for benefits and how "they would be paid for were few" (CongressDaily, 9/16). However, according to the Chronicle, the federal government will cover the full cost of evacuees who qualify for Medicaid. Previously, the state believed it might be responsible for 39% of evacuees' Medicaid costs and began working with the federal government on a plan, according to the Chronicle.
For evacuees who are ineligible for Medicaid or SCHIP, an uncompensated care pool will cover the cost of physician and prescription drug services. The federal government will fully reimburse Texas for those costs, according to the Chronicle. Coverage for both programs will be retroactive to Aug. 24, the Chronicle reports (Houston Chronicle, 9/16).
There is no available cost estimate for the agreement, and it is "not immediately clear" whether the federal government will pay providers the usual Medicaid and SCHIP rates, the Austin American-Statesman reports (Austin American-Statesman, 9/16). Texas officials on Thursday estimated that as many as 373,000 evacuees are in the state (Houston Chronicle, 9/16).
CMS Administrator Mark McClellan said there is "no firm number" of how many of the 200,000 registered evacuees in Texas will seek health services through Medicaid or the uncompensated care pool (CongressDaily, 9/16). Federal officials said Texas will "come up with a way to prevent using the federal money to pay for health care for people whose insurance works in Texas or have other ways to pay for it," the American-Statesman reports (Austin American-Statesman, 9/16).
McClellan said, "Texas' own view is that this approach is meeting their needs. But we'll be keeping a close eye on this to make sure needs are being met" (CongressDaily, 9/16). McClellan said he will work with Congress to ensure that funding for the plan is included in Katrina relief programs.
HHS Secretary Mike Leavitt said, "Texas has been providing immediate and lifesaving services to thousands of its neighbors, ... and our nation is grateful" (Houston Chronicle, 9/16). Leavitt also said that the Texas arrangement could be a model for other states that are temporarily housing hurricane survivors (CongressDaily, 9/16).
Texas Gov. Rick Perry (R) said he is "glad" about the state's agreement with the federal government, adding, "Texas would certainly welcome an extension of this waiver" because "many evacuees may be displaced for a longer period of time." Texas officials expressed concern that evacuees with insurance would still have no way to pay for physician visits in Texas and instead would crowd public clinics and emergency departments (Austin American-Statesman, 9/16).
Robert Greenstein, executive director of the Center on Budget and Policy Priorities, said it is unrealistic that evacuees left uncovered by the Bush administration's plan would be able to receive coverage at free clinics and EDs. He added, "In the best of times that's a problem, but in the aftermath of the hurricane, it's a problem of great severity" (CongressDaily, 9/16).
"Many evacuees are likely to remain permanently in other states," making some officials concerned about their long-term Medicaid budgets, the AP/Daytona Beach News-Journal reports.
Arkansas Gov. Mike Huckabee (R) and Arizona Gov. Janet Napolitano (D), chair and vice chair of the National Governors Association, this week wrote to members of Congress asking to fully reimburse states for any medical care provided to evacuees. They also are asking Congress to reimburse Medicaid costs for evacuees in 2006.
Alabama Medicaid Agency Commissioner Carol Herrmann said the state "can't absorb" the cost of evacuees' medical care, adding, "I know I can speak for Mississippi, Louisiana and Texas in saying the same thing" (AP/Daytona Beach News-Journal, 9/15).
Health care experts have noted an "unusual phenomenon" following Katrina: the "health care safety net has temporarily expanded for hundreds of thousands of uninsured Gulf Coast residents, and some patients' long-standing illnesses are finally being diagnosed and treated," the AP/Long Island Newsday reports. For example, health care workers at a clinic in Atlanta said they have seen as many as six undiagnosed cases of high blood pressure per day and up to four cases of undetected diabetes, the AP/Newsday reports.
Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured and executive vice president of the Kaiser Family Foundation, said, "We know the uninsured generally delay getting care," and thus it is not surprising many people are receiving disease diagnoses and treatment as a result of the hurricane.
Ken Thorpe, a health care policy professor at Emory University and a health policy adviser in the Clinton administration, said it is important for people entering the health care safety net because of the hurricane to remain in the system. He added, "Hopefully the discussion about cutting Medicaid [by $10 billion over five years] is off the table" (Stobbe, AP/Long Island Newsday, 9/15).