Which Health Insurance Is Best In Texas - Texas did not expand Medicaid under the Affordable Care Act (ACA). As a result, Texas has the largest coverage gap in the country, with approximately 771,000 residents who are not eligible for Medicaid, as well as premium subsidies to offset private payments in an exchange.
HHS reports that 45% of Texas adults (ages 19-64) with incomes below 138% of the poverty level will be uninsured by 2020, the highest rate in the nation (if Texas expands Medicaid).
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Studies and reports show that health outcomes are lagging and that the decision to expand Medicaid in Texas has low uninsured rates, at least nationally. Some health workers say the state's 17.4% uninsured state is pushing state lawmakers to consider expanding Medicaid in the 2021 legislature.
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As the ACA was written, it required the expansion of Medicaid for legal residents with incomes up to 133% of the poverty level (138%, excluding 5% of household income). But in 2012, the Supreme Court ruled that states could not be penalized for refusing to expand, and Texas chose to stick with its pre-2014 Medicaid eligibility.
This means that people with disabilities who do not have minor children are not eligible for Medicaid, regardless of how low their income is. Parents of minors are only eligible if the children are enrolled in Medicaid and their family income does not exceed approximately 14% of the poverty level (Texas uses a dollar amount for this eligibility, but CMS converts it to a percentage) Single mother of two children If the parent is on Medicaid and the children are on Medicaid, they can only be eligible for Medicaid
Texas political leaders are generally not interested in expanding Medicaid. Instead of pushing legislation to expand Medicaid, Texas officials negotiated with CMS to secure funding for uncompensated care coverage in the state. The state's 1115 waiver was originally passed in 2011 and was intended to provide temporary funding for uncompensated care before Medicaid expansion. But after a 2012 Supreme Court decision made Medicaid expansion optional for states, Texas rejected Medicaid expansion and continued to rely on federal Section 1115 payments for coverage.
The Obama administration previously noted that uncompensated care funding is often not needed if states expand Medicaid, but the Trump administration wants to work with states that reject federal funding to expand Medicaid.
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Texas officials got the Trump administration to agree to a five-year extension of the state's uncompensated care waiver, resulting in Texas receiving federal funding from 2018 to 2022. (Information on the 1115 state waiver is available here. ) In January 2021, the Trump administration agreed to extend the 1115 waiver until 2030.
The Biden administration terminated the position as soon as it took office. A few months later, a judge temporarily blocked the federal government's 1115 extension. But in September 2021, the federal government suspended payments to the state over concerns about how Texas was funding its share of the costs. This fund was restored in March 2022 to $7 million per day.
That's more than $2.5 billion in annual federal funding. But Texas will receive about $6 billion in federal funding each year through Medicaid expansion, and the impact of that federal cash flow will have an impact on the state's economy of about $100 billion over a decade. Medicaid expansion would be a financial boost for Texas.
In addition to low-income people who are elderly, blind, or disabled (who receive SSI benefits), the following populations are eligible for Medicaid in Texas:
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Most Medicare beneficiaries get help from Medicaid to pay Medicare premiums, pay for prescription drugs, and cover costs not covered by Medicare, such as long-term care.
Our guide to financial assistance for Medicare enrollees in Texas includes reviews of these benefits, including Medicare savings programs, long-term care, and assistance eligibility guidelines.
If Texas were to expand Medicaid, an estimated 1.7 million people currently uninsured would be eligible for the new payments. Of those people, 771,000 are currently in the coverage gap and do not have access to any health insurance. They are not eligible for Medicaid, but their income is at the poverty level, which means they cannot receive subsidies in an exchange.
But despite the state's choice of federal funds to expand Texas Medicaid, Texas Medicaid/CHIP enrollment has grown 27% since 2013, by more than 1.1 million people.
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Much of that progress is due to the COVID pandemic and the Families First Coronavirus Response Act. Passed in March 2020, this law provides additional federal funding to states (which all states have passed), but with the condition that no one be disenrolled from Medicaid until the public health emergency (PHE) COVID is over. The PHE has been extended until mid-October 2022 and may be extended again if the COVID situation warrants.
When PHE ends, millions of Americans will be re-determined for Medicaid eligibility (some for the first time since early 2020), and some will lose coverage as a result.
As of 2014, Texas had the highest uninsured rate in the country, and still does. According to US Census data, 22.1% of Texas residents were uninsured in 2013. In 2019, it reached 18.4%, which remains the highest uninsured rate in the country.
By refusing to expand Medicaid under the ACA, Texas has already lost billions in federal funds that flowed to the state to provide medical care to its low-income residents. Additionally, the state's emergency rooms are not compensated for $5.5 billion annually in treating uninsured patients (as noted above, the state receives $2.5 billion in federal funds each year for uncompensated care). If Medicaid eligibility were expanded, uncompensated care would drop significantly, so hospitals and business groups across the state are urging lawmakers to oppose Medicaid expansion.
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Because Texas refused to expand Medicaid, the federal government warned that continued access to federal funds to cover uncompensated care would be at risk (because expanding Medicaid would solve most of the uncompensated care problem). But Gov. Greg Abbott rejected Medicaid expansion and described the federal government's tactics as "coercive."
Because residents of states that did not expand Medicaid still had to pay federal taxes, there was a significant influx of Texas residents to fund Medicaid expansions in other states. Over ten years (starting in 2014), Texans will pay $36.2 billion in federal taxes to pay for Medicaid expansion in other states.
That's the highest of any state: The next highest is Florida, where residents will pay more than $20 billion for Medicaid expansion by 2022 (data compiled in 2014, when Texas was expected to miss out) that opted out participate in Medicaid expansion. federal funding over the decade; Updated data shows Texas is saving $100 billion over a decade by rejecting Medicaid expansion, after taking into account the impact of additional federal funding. affect the economy of the State).
In the 2013 legislative session, Republican John Zerwa sponsored HB3791, which would have directed the state to come up with a "Texas solution" for Medicaid expansion. But it didn't happen. The bill called for reforming the state's Medicaid system while accepting federal funding to expand the program. It would also include "private responsibility" measures, such as copayments and deductibles, and premium assistance programs to help people buy private insurance as a preferred alternative to traditional Medicaid.
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Also, in 2013, Republican Texas lawmakers passed a measure that would have required the state Health and Human Services Commission to get legislative approval before any decision could be made to expand Medicaid. Ultimately, while the governor supports Medicaid expansion, the decision rests with the Texas Legislature. Given lawmakers' general rejection of the idea, it makes future expansion very difficult.
If Medicaid eligibility remains unchanged from 2013 guidelines, the cost of uncompensated care in Texas hospitals is about $5.5 billion a year, paid for mostly by tax dollars and higher health insurance premiums for those covered. federal funding provided by the state through an 1115 waiver.
Former Gov. Rick Perry has repeatedly rejected Medicaid expansion. In the 2014 gubernatorial race, Republican Greg Abbott (who won by a landslide) sided with Perry and opposed accepting federal funding to expand Medicaid (both agreed to advance 10% of state spending through 2020. would be too much for the budget in operation). Democratic candidate Wendy Davis supported Medicaid expansion in Texas, but she
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