HHSC eliminates Medicaid payments of Medicare Part B coinsurance, deductibles for dual-eligible patients

posted 01.24.12

As part of an effort to reduce the cost of Medicaid to the state, the 82nd Legislature directed the Health and Human Services Commission to stop paying for Medicare Part B coinsurance and deductibles for patients covered by both Medicare and Medicaid — so-called dually-eligible patients — if the allowable payment for a service exceeds what Medicaid would pay for the same service. The policy went into effect on Jan. 1, 2012, and TAFP has begun receiving calls from concerned physicians.

“These cuts affect some of our state’s most vulnerable people: low-income senior citizens and patients with disabilities,” says TAFP President I.L. Balkcom IV, M.D. “This is a population that already has a difficult time accessing medical care, particularly in rural areas, and this decision will exacerbate those difficulties.”

The commission estimates the change will save more than $400 million in general revenue over the 2012-2013 biennium. Physician advocates say this policy amounts to a 20 percent cut for many services provided to dually-eligible patients.

TAFP has joined TMA and other physician organizations in arguing against the change. At an HHSC meeting on Nov. 4, TMA President Bruce Malone, M.D., testified against this action, saying that while it will save millions, the savings “come at the expense of the health and well-being of some of the state’s most vulnerable citizens.”

He continued, saying that the proposed rules “penalize the physicians who care for the sickest and frailest Medicare patients. They hit particularly hard practices in rural, inner city, and border Texas since those practices serve a disproportionate number of dually eligible Medicare patients. In addition to compromising the financial viability of these practices, we fear that the rules could result in fewer physicians willing to set up a practice in the communities that most need them.”

On Jan. 9, representatives from specialty societies including TAFP met with HHSC officials to discuss possible methods for mitigating the effects of the new policy, but no such action has been taken to date.

At the meeting, HHSC Associate Commissioner and Texas Medicaid Director Billy Millwee pointed out that as of January 2013, Medicaid rates would be equal to Medicare rates for primary care services in accordance with the Patient Protection and Affordable Care Act, saying there is “some light at the end of the tunnel. Don’t think it’s a train.”

TAFP CEO Tom Banning says this policy decision is one of several tactics the state is implementing to slow increasing Medicaid costs. “The Academy will continue to work with the commission to try to alleviate the downstream effects of these cuts.”