Olga Rodriguez

Access to Healthcare for the
Uninsured: A Texas Perspective
Texas Association of Community Health Centers (TACHC)
Olga O. Rodriguez
August 9, 2014
Texas Statistics on Uninsured
• Number of uninsured*
– Uninsured estimate: ~ 6 million (24% uninsured rate)
– Uninsured without Medicaid expansion (marketplace only): ~ 4.2
million (16% uninsured rate)
– Uninsured with full Medicaid expansion: ~ 3 million (12% uninsured
rate)
• Hispanic Uninsured ~ 39 percent of total uninsured** compared to
31% nationally (given 15% uninsured rate nationally)
• Uninsured after age 65
* U.S. Census Bureau, March 2012, Current Population Survey
** Kaiser Family Foundation, http:kff.org/uninsured/state-indicator/rate-by-raceethnicity/
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Serving the Uninsured in Texas
• Federally Qualified Health Center (FQHCs)
• State and local safety net programs
• 1115 Transformation Waiver: Project driven
and payment based on outcomes
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Challenges to Serving Uninsured
• FQHCs and funding cliff
• Reductions in state and local funding for
health care
• Linking funding sources primarily with
hospitals under current 1115 Transformation
Waiver
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FQHCs: Fiscal Funding Cliff
• ACA assumed FQHCs would have additional
funding source through Medicaid expansion
• Marketplace and HOW patients are covered
• Federal funding uncertain after 2015
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State and local safety net programs
• Federal block grants to states– Reduce
funding or restructure use of funding
–
–
–
HIV funding through Ryan White
Maternal and Child Health funding through the Maternal and Child Block Grant
Mental health and substance abuse block grant
• State Budgeting– Maintain, reduce or
increase state funding for services given at
least marketplace roll out
• Health insurance versus project funded
projects at local level, such as health insurance
premium assistance or direct care funding
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1115 Transformation Waiver in Tx
• Linked HMO managed care expansion statewide
with hospital refinance mechanism
• Locally driven and financed projects
• Total funding for DSRIP projects currently
limited to “performing providers” such as
hospitals, academic health science centers, local
mental health authorities, and local health
departments
• Value driven versus cost driven
• Payment from CMS based on outcome of project
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Principles of Closing the Gap
• Statewide
• Cover required populations
• Develop commercial insurance product
administered by existing Texas Medicaid
HMOs
• Require safety net providers in network
• Develop actuarially sound rates
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Strategy for Closing the Gap in Tx
• Effectiveness of Fact and Figures
• Civic Engagement
• Protect Access to Care for Uninsured via
Health Centers
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Key questions to ask community
Local Government Questions:
• What is the stability of the current system to care
for the uninsured?
• Will local projects address access to health care
issues for more complex medical conditions?
• How do we protect existing access to care points
for the uninsured?
• How will local communities address health care
needs if your local community health center had
to close its doors?
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Key questions to ask community
State Government Questions:
• Are there current Medicaid 1115 waivers that
impact the uninsured?
• If so, do uninsured have health insurance
coverage or access to a set of projects?
• How have we explored state specific solutions
to close the coverage gap?
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