Tuesday, December 05, 2006

Opinion: Texas Medicaid seeks to improve women's health, save tax dollars

Staff EditorialHouston Chronicle12/5/2006

It's taken well over a decade. Other states have been doing it for years. But next month Texas will embark on an efficient plan to save as much as $430 million – and incalculable social costs – by averting unintended, Medicaid-paid pregnancies and many illnesses related to them.

Early in December, the federal government gave verbal approval to Texas ' request for a Medicaid waiver to give extensive health screenings and birth control to 1.5 million uninsured women. Under Texas ' five-year demonstration project, Medicaid will waive some of its ordinary eligibility rules.

In Texas , a single mother with two children can't make more than $308 a month and be eligible for Medicaid. That's about 14 percent of the federal poverty line. The new waiver allows women 18-44, who are at 185 percent of the FPL or less, to get a wide range of health screenings, family planning information and birth control.

The savings, both monetary and societal, should be enormous. In 2002, Medicaid paid for a staggering 52 percent of all Texas births. Each routine delivery cost about $9,000. Now consider this: In 2003, according to state officials, 45 percent of the documented 328,311 live births here were reported as unintended.

What if Texas Medicaid hadn't had to finance so many unplanned deliveries? What if the low-income mothers who gave birth to those unplanned infants had had counseling, information about birth spacing and contraception to keep their families the size they desired?

Finally, what if more Texans could be born into families — and a community — better able to care for them, emotionally, physically and financially?

This was the vision the 2005 Legislature pursued when it finally authorized the state to seek the Medicaid waiver. Lawmakers had tried to pass previous versions of the bill since 1993 without success. During that time, more than a dozen other states successfully took advantage of this expanded health care opportunity.

Now Texas will be on board, starting in January. It's strictly a demonstration project: The federal government will only renew it if Texas can satisfactorily answer a set of evaluating criteria. Among them is the $430 million question: "To what extent did the waiver reduce the number of unintended pregnancies resulting in live births for women who are at, or below, 185 percent of the poverty level?" *Now, does everyone realize that these cases are going to be worked in TIERS statewide? That any woman that applies for this benefit will then become a "TIERS client"- no matter her location in the State? By doing so, any case she has from that point forward- Food Stamps, Medicaid for her children- will then also be in TIERS. Which means they get to call the "call centers" for certification. In other words, if 50% of our cases locally have a woman in that age group who will qualify for the new program will then be in that convoluted system? Good luck with that.

This will be a special challenge, as the Texas waiver does not include coverage of teens or emergency contraception, both of which could help the state meet its savings goal. Texas also has to keep the project budget neutral — for Washington and Texas both.

Luckily, the federal government is arming the state for success, paying $9 for every $1 Texas spends. The feds are willing to invest this because it's well-established that higher levels of poverty correlate to lower insurance and higher levels of unintended pregnancy and poor health outcomes.

The equation shouldn't have taken Texas so many years to add up. By finally taking advantage of this chance to improve women's health care, however, the Legislature will save Texas millions in Medicaid costs. What can't be quantified will be the corresponding benefit: families with fewer health problems and with children who are wanted, cared for and better prepared for adulthood.

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