SB 1475 Establishes Medicaid Managed Care Consumer Supports

CPPP was joined by a large and diverse group of Texas organizations in supporting SB 1475 by Senator Sylvia Garcia, establishing a Medicaid Managed Care Consumer Support System. Texas Medicaid Managed Care was first piloted in four counties in 1994, and is now in all 254 counties. Over 3.6 million of Texas’ 4 million Medicaid clients are enrolled in an HMO, and more will be added under SB 7 from the 83rd Legislature.
For these Texans in Medicaid Managed Care, barriers that pop up include difficulty locating health care providers; technology glitches between the Social Security Administration and HHSC eligibility and enrollment systems; and issues with providers of medical and community care services. When these problems appear, consumers need to know there’s a place to call or visit to get their problems fixed before a gap in medical care creates a real health or safety risk.
The first Medicaid Managed Care Consumer Assistance Program was created in 1995 by the 74th Legislature, and the law has not been updated since. The Medicaid Managed Care help line created under that 1995 law is now part of HHSC’s Ombudsman Division. They are known for their good work, but staffing levels have not kept up with HMO enrollment. SB 1475 gives clear direction to HHSC to ramp up resources and coordination to support Medicaid Managed Care consumers. It also starts to build a new local component for the support system, beyond the current Austin-based toll-free line. Local supports are especially needed for the vulnerable populations being added to Medicaid Managed Care: nursing home residents, individuals with intellectual and developmental disabilities, seniors with dual Medicaid-Medicare coverage, and medically fragile children.
The impetus for SB 1475 comes from many directions: HHSC’s Statewide Medicaid Managed Care Advisory Committee recommended enhanced supports to the Legislature, as did a combined taskforce of the Senate Hispanic Caucus and the Mexican American Legislative Caucus. The Sunset Commission’s report on Texas Health and Human Services systems called for improved consumer access to help lines and call centers, and increased authority for the HHSC Ombudsman’s office to resolve problems. Having an “Independent Consumer Support System” is also a condition of Texas’ Medicaid 1115 Transformation Waiver, which brings about $3.6 billion in federal funds each year to offset uncompensated hospital care and to build innovations and capacity in Texas’ healthcare systems.
The Committee Substitute (translated: second draft) of SB 1475 designs the new HHSC duties described above to keep the bill within a modest $1 billion state-dollar cost for 2016-2017—which becomes $2 million with federal matching dollars. If a $1 million tab does not sound modest, consider the context: Texas HHSC projects total Medicaid payments to medical and long term care providers in 2015 will total $26 billion; and reported over $10 billion in Medicaid Managed Care contracts in 2013. This number is sure to be much larger when 2015 figures are tallied.
But it’s not all about billions of dollars and cents. As one witness who works with seniors and adults with disabilities in Medicaid Managed Care put it,

We receive calls from consumers who’ve lost eligibility in error and, thus, lost their medical and long-term services and supports. A consumer support system needs to look at the big picture and resolve Medicaid issues timely to protect life and safety. And beneficiaries need to be better informed about who can help them if they encounter problems.”

SB 1475 awaits a vote to send it to the full Senate, and then must be approved by the House. CPPP will stay engaged throughout to help raise the bar on consumer supports for over 3.6 million Texans enrolled in Medicaid Managed Care.

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