Texas Legislators Suggest Dropping Medicaid

A recent Kaiser Health News article discussed a suggestion by some Texas state legislators to have Texas drop out of Medicaid.  While the legal and practical matters are unclear, Republican representatives (who now have a majority in the Texas House Chamber) say they are motivated by an estimated $25 billion state budget deficit and stringent federal rules about how Medicaid is administered.  They also suggest that if Texas drops Medicaid, then low-income people would be able to enroll into state exchanges slated to begin operating in 2014.   There are 3.6 million Texans enrolled in Medicaid and seven out of ten Texas nursing home residents rely on Medicaid to pay for their care.  Even with restrictive income limits, the biennial bill for Medicaid in Texas is $45 billion (representing 20% of the state budget), of which the federal government pays 60% of the bill.   The authors explain that almost a dozen other states (including AL, MS, WA, WY) are also considering either dropping Medicaid or remaking it with only state financing and/or seeking federal waivers to change parts of their Medicaid programs.  For more information, visit:

Kaiser Health News

Website Explains How Each State Is Implementing Affordable Care Act

The National Academy for State Health Policy (NASHP) has created a website that tracks each state's implementation of the Affordable Care Act.   The website is divided by issue areas, including state timelines, workplans, fiscal analyses, implementation websites, and state laws.  The executive committee of NASHP identified ten priorities for states in implementing the Affordable Care Act and the website also includes reports on how states are addressing these priorities.  For more information, visit:

National Academy for State Health Policy

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New Report On Medicaid Payment Practices As Program Expands

A recent report from the Center for Health Care Strategies addresses current Medicaid payment practices in the context of Medicaid growing to become the nation's single largest insurer by 2016, with an estimated 20 million additional beneficiaries.  Because the Centers for Medicare and Medicaid have provided somewhat limited guidance, stakeholders have turned to the courts to interpret federal statutory mandates, which can be a cumbersome and time-consuming process.  The authors examine several of these court cases and conclude by suggesting that Medicaid will have to become a more sophisticated purchaser of health care (for example, by better leveraging its market position) as the number of beneficiaries increases.  A recent USA Today article profiled some of the nation's largest Medicaid health plans whose leaders hope to expand under the Affordable Care Act.  However, many patients and doctors interviewed in the article complained about difficulties finding doctors in their networks, low reimbursement rates and long waits for specialists. For more information, visit:

Center for Health Care Strategies
USA Today "Medicaid Managed Care Programs Grow; So Do Issues"

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