Dewhurst, Nelson unveil changes to Medicaid

AUSTIN (AP) — Lt. Gov. David Dewhurst and a top lawmaker unveiled legislation Wednesday that they say will improve health care for the poor and disabled while fighting fraud, but they ruled out expanding Medicaid under an Obama administration effort to provide health care to 1.5 million uninsured poor people.

Dewhurst and Sen. Jane Nelson, R-Flower Mound, said her Senate Bill 7 would change how health care providers are paid to encourage quality of treatment over quantity or procedures, while redesigning long-term care for the profoundly disabled. Nelson said the state lost $6 billion in Medicaid fraud between 2004 and 2011 and her Senate Bill 8 would detect fraud earlier and more effectively punish those responsible.

"When you defraud the system, you are stealing from the taxpayers, children, the frail, the poor, the elderly and Texans with disabilities. It is crime against our most vulnerable citizens, and we have to change our approach to stopping it," Nelson said.

Medicaid is a joint state and federal program in which Washington provides roughly $2 for every $1 the state spends. In return, the state must follow federal regulations.

Dewhurst said health and human services have grown from being 20 percent of the state budget to 30 percent since 2003, and Medicaid costs have doubled. During that same period, though, Texas lawmakers have cut spending to other programs and federal lawmakers have expanded the number of services required under Medicaid.

As part of the Affordable Care Act designed to make sure all Americans have health insurance, the Obama administration has offered to pay Texas almost all of the costs of expanding Medicaid coverage to an additional 1.5 million to 2 million poor and uninsured people. Health care advocates almost universally support Medicaid expansion and some economists say it will financially benefit the state.

Gov. Rick Perry, though, has rejected the proposal saying it undermines states' rights, and Dewhurst on Wednesday reiterated his opposition.

"We carefully cover under Medicaid those populations that we feel need the help of the state and cannot care for themselves," Dewhurst said. "In 2003 we made a decision to exclude adults — able-bodied — who can go out and work, and that's the target population for Obamacare."

Dewhurst said he would rather see the federal government exempt Texas from most Medicaid regulations and allow the state to spend the money how it sees fit, something known as a block grant.

"Our care would be better if the state of Texas had the flexibility to focus on where needs are because one size does not fit all in health care," he said. "But we have not been successful under either the Bush or Obama administrations to get a block grant."