Texas Association of Business: Medicaid Managed Care Is A Win-Win For Taxpayers and Texans on Medicaid
Feb 04, 2017 | 1890 views | 1 1 comments | 17 17 recommendations | email to a friend | print

Texas Association of Business: Medicaid Managed Care Is A Win-Win For Taxpayers and Texans on Medicaid

TAB Urges Legislature to Allow for Managed Care Health Plans to Fully Manage Medicaid Rx Benefit

 

AUSTIN—Pointing to significant taxpayer savings and more efficient care, the Texas Association of Business (TAB) today urged the Texas Legislature to allow for the transition of the Medicaid prescription drug benefit to private health plan management to occur as scheduled. As the Senate Finance Workgroup on Health Care Costs meets today to look for cost savings, this could mean significant savings to the state.

“Employers and citizens of Texas deserve to have the best access to health care throughout our state and to that end, TAB has long supported the successful transition of Texas Medicaid from the former fee-for-service model to the managed care approach,” said TAB Governmental Affairs Manager Amanda Martin. “That approach has not only saved taxpayers billions of dollars but also dramatically improved outcomes for Texas on Medicaid.

At a time when health care costs are rising across the board and forcing Texas employers to make tough decisions, the Legislature would be wise to continue the transition to Medicaid managed care and allow health plans to fully manage the Medicaid prescription drug benefit,” Martin said. “Texas health plans have demonstrated they have the time-tested tools and private market leverage to achieve significant savings while improving care, and their management of the drug benefit is sure to yield similar results.”

TAB supports allowing managed care organizations (MCOs) to use their own formularies and their own prior authorization for prescription drug coverage as part of the continued transition to Medicaid managed care from the former fee-for-service payment model.

New analysis by the Health and Human Services Commission finds that allowing MCOs to fully manage the prescription drug benefit in Medicaid will result in roughly $40 million in state general revenue savings and $100 million in all funds savings for Texas taxpayers annually.

 

Background

Because of the managed care model’s successful track record in improving patient outcomes while also achieving significant savings, in 2011 the Texas Legislature adopted the full expansion of managed care statewide. This included the integration of the prescription drug benefit through a step-process, with the final step scheduled for August of 2018. Some would like to delay this transition, but TAB feels it should continue because of the ongoing benefit to patients and cost savings that will be realized by the state.

 

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As the state chamber of commerce, the Texas Association of Business is the most influential and dominant voice for public policy issues affecting business in Texas.   Through proven results-oriented advocacy and member services, TAB develops a climate in Texas which enables thousands of our business members and their employees to operate efficiently and profitably, thus creating new jobs.  TAB is proud to be the official state partner of the National Association of Manufacturers.

 

 
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feeforservice
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February 11, 2017
Seems like the history of this win win is not yet known.

The real two parties in this issue are providers and Texans in Medicaid.

Providers can not exercise their provider right of practice and Medicaid beneficiaries are not getting service's needed.

MCO win are restraining providers to perform the true treatment needed meaning reducing expenses and adjusting budget by no paying providers and keeping the capitation moneys from tax payers. And patients no getting the services needed.

Of course HHSC is a winner by having to pay less over all.

All this happen when the Medicaid remuneration fee when up because it was needed to compensate providers accordingly . Then the expenses of Medicaid when up because more providers got in as Medicaid providers and procedure fees increased.

The strategy was to involve third parties MCO to contract with providers to be able to take providers right of practice and cut the payments arguing no medical necessity, asking for pre authorizations, threating with recoups on wrong manage audits investigations of fraud .

The only win win are HHSC and MCO's the losers are providers and Texans beneficiaries all to adjust HHSC the budget.

Tax payers will pay the same amount of taxes regardless the cut of payment from MCO and Medicaid. and Texans on Medicaid will keep getting the limited health services.

And now going for more with the prescriptions