By Mason Lerner
Killeen Daily Herald
Medicaid is going through a lot of changes that will directly affect Bell County.
Over the years Medicaid, a federal-state entitlement program designed as a complement to Medicare to provide medical care to low-income Americans, has changed considerably.
Bell County officials have been proactive dealing with the new changes, said Dr. Monica Wendel, director of the Center for Community Health Development at the Texas A&M Health Science Center School of Rural Public Health in College Station.
There are currently 34,952 Bell County residents enrolled in the Medicaid program and 25,804 of those are children, according to statistics provided by the Texas Health and Human Services commission.
Wendel says the Texas 1115 Medicaid Transformation Waiver, received in December, will allow healthcare providers to offer improved services such as extended hours at primary care clinics and increased integration for patients being treated for multiple issues. The changes go into effect Oct. 1.
Wendel offered people who are dealing with obesity, diabetes and depression as an example.
"There are some pretty significant overlaps, and the waiver will allow us to tie those things together when people have multiple needs," Wendel said. "It reduces fragmentation, duplication of services and is more efficient."
The U.S. Department of Health and Human Service's website explains Medicaid funded mostly disabled and chronically ill patients placed in an institutional setting in its early years. This "institutional bias" began to disappear due to numerous amendments and changes to federal law over the decades. By the 1980s, Medicaid began to increase the healthcare options it covered in non-institutional settings.
Stephanie Goodman, communication director for the Texas Health and Human Services Commission, explained Medicaid is currently available to the elderly, disabled and pregnant single mothers.
"Medicaid doesn't have a lot of coverage for low income patients," Goodman said. "The only exception is low income parents for children who qualify for TANF (Temporary Assistance for Needy Families)."
That might all change in the near future if Texas decides to expand Medicaid through the Affordable Care Act. The expansion would grant coverage to patients who earn up to 133 percent of the poverty level, Goodman said.
"This would authorize expansion to low income adults," Goodman said.
But whether it will depends on politics.
While the Affordable Healthcare Act allows states to expand Medicaid coverage, Texas Gov. Rick Perry has indicated he will not opt into the plan. On the other hand, Texas Attorney General Greg Abbott wrote in a July 9 letter to the Louisiana Court of Appeals, Fifth Circuit that Texas would be able to fill the gap left by defunding Planned Parenthood "assuming that all clients will be eligible for Medicaid following the expansion of the Medicaid program in January 2014."
"The governor has said Texas won't be taking part in that expansion, so we're not planning for that," Goodman said.
Deciphering who is eligible for Medicaid is not as difficult as one might think. The Texas Health and Human Service's website, www.hhsc.state.tx.us, offers a lot of information on Medicaid availability. There also are options for people who do not have internet access.
"There are a variety of ways you can be deemed eligible for Medicaid," said Vickie Hill, Director of Patient Access and Patient Financial Services at Metroplex Health System in Killeen. "The best thing to do to find out if you are eligible is call 211, which is the number for Help in Texas. That is a resource that is little known and not used to its full capacity."
Hill says Help in Texas can alleviate a lot of uncertainty for people before they ever set foot in a healthcare facility.
"I hope people who are confused about their eligibility will pick up the phone and dial 211," she said. "They are experts in the area, and they should have all the answers."
Contact Mason Lerner at email@example.com or (254) 501-7567.
TEXAS MEDICAID FACTS
Across the state, more than 3.3 million Texans are enrolled, including more than 2.5 million children. One in four Texas children are covered by Medicaid. Two thirds of people living in nursing homes get at least some support from the program.
TEXAS MEDICAID EXPENDITURES
2009: $24.6 billion
2011: $29.4 billion
BELL COUNTY EXPENDITURES
2010: $190.2 million