The Texas Medical Association is cheering a move by the state's Legislative Budget Board to partially restore cuts to reimbursements to doctors who care for patients who are on both Medicare and Medicaid.
Medicaid is the federal-state program for the needy, aged, blind and disabled, and for low-income families with children. Medicare is the federal health care program for those 65 and older and for the disabled.
Patients who qualify for both programs are known as "dual-eligible" -- often the poorest and sickest Texans, according to the TMA. The payment issue stems from the 2011 Texas Legislature, which ordered the Health and Human Services Commission to slash dual-eligible payments to doctors as a way to save money in the face of a major budget shortfall.
The interaction between Medicaid and Medicare payments to doctors is complicated. The way the changes were implemented prevented Medicaid from paying for the entire amount of dual-eligible patients' $140 annual Medicare deductible. It also stopped Medicaid from paying more than the Medicaid-allowable charge for a service, which in turn prevented Medicaid from paying the Medicare co-pay.
The recent move reinstates coverage of the Medicare deductible in 2013, though HHSC is working out the details. It's good news for doctors whose reimbursements took a big reduction as a result of the 2011 Legislature's decision. The TMA said the cuts were devastating to doctors with high numbers of dual-eligible patients, since Medicaid reimbursements are already at rock bottom. Many of those doctors are in the Rio Grande Valley.
Javier Vazquez, executive director of the Cameron Willacy County Medical Society, said it's not unusual for dual-eligible patients to comprise 80 to 90 percent of a Valley physician's patient load. In metro areas such as Dallas, it might be as little as 5 percent, he said.
In the Valley, refusing to take Medicaid patients usually isn't a realistic option. Instead, doctors hunkered down and, in many cases, borrowed money to keep their practices going.
"It created a cash flow issue," Vazquez said. "Some offices were on life support. A lot of doctors were taking loans. All in all (the reinstatement) does provide some breathing room."
The CWCMS was among the organizations lobbying to have the cuts restored, he said.
"We invited the commission down here," Vazquez said. "We brought them down to the Valley. We brought them to Brownsville. We brought the TMA down here. We brought anyone who would listen and sent representatives to meet with the speaker and the lieutenant governor and the governor."
State Sen. Juan "Chuy" Hinojosa, D-McAllen, organized a meeting last week in Austin with Lt. Gov. David Dewhurst, House Speaker Joe Straus, TMA board vice chairman Dr. Carlos Cardenas of Edinburg, and Dr. Javier Saenz of La Joya.
There's still work to be done, however, Vazquez said. Although the deductible has been reinstated, physicians would be in better shape if Medicaid were once again allowed to cover the Medicare co-pay, he said. Vazquez said he expects Hinojosa to submit legislation during the next session in 2013 that would also reinstate the co-pay coverage.
"This is a two-pronged fight," Vazquez said. "The fight's not over."
Distributed by MCT Information Services
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