More than 4 million Texans receive high quality health care services through Texas Medicaid each month. Texas Medicaid’s risk-based managed care covers all of Texas’ 254 counties and has yielded nearly $9 billion in savings for the state and federal governments since its inception in 2011. More than 90 percent of Texas Medicaid enrollees are estimated to receive services through a managed care plan now through 2019. Texas hospitals support Medicaid funding and programs that adequately reimburse providers for care they provide and promote access to timely care for Medicaid clients. The Texas Hospital Association tracks and will educate lawmakers in their efforts to:
- Evaluate the Texas Health and Human Services Commission’s efforts to ensure Medicaid managed care organizations' compliance with contractual obligations and the use of incentives and sanctions to enforce compliance. Assess THHSC’s progress in implementing competitive bidding practices for Medicaid managed care contracts and other initiatives to ensure the best value for taxpayer dollars used in Medicaid managed care contracts. Senate Health and Human Services
- Monitor the THHSC's implementation of Rider 219 in Article II of the 2018-19 General Appropriations Act related to prescription drug benefit administration in Medicaid. Analyze the role of pharmacy benefit managers in Texas Medicaid. House Committee on Human Services
- Review THHSC’s efforts to improve quality and efficiency in the Medicaid program, including pay-for-quality initiatives in Medicaid managed care. Compare alternative payment models and value-based payment arrangements with providers in Medicaid managed care, the Employees Retirement System and the Teachers Retirement System, and identify areas for cross-collaboration and coordination among these entities. Senate Health and Human Services
- Review the history and any future roll-out of Medicaid managed care in Texas. Determine the impact managed care has had on the quality and cost of care. In the review, determine:
In addition, review THHSC’s oversight of MCOs, and make recommendations for any needed improvement.
House Committee on Human Services
- Initiatives that MCOs have implemented to improve quality of care.
- Whether access to care and network adequacy contractual requirements are sufficient.
- Whether MCOs have improved the coordination of care.