TX could add 2 million more to Medicaid

AUSTIN (KXAN) - In upholding the federal health care law on Thursday, the U.S. Supreme Court also gave the green light for expansion of a program that could help 2 million more low-income Texans – Medicaid.

Medicaid already makes up a quarter of the state’s budget. The program now covers 3.4 million Texans, mostly children, pregnant women, people with disabilities and those over age 65.

The ruling over the Patient Protection and Affordable Care Act gave states the option of increasing that number. The Texas Health and Human Services Commission – which administers the funding – said that it expects such a move in the state would add about 2 million people in the first two years.

“Of that 2 million, 1.3 million is the adults newly eligible for coverage, and the other 700,000 would be their children,” said Stephanie Goodman, HHSC spokeswoman.

Awaiting lawmakers’ decision, HHSC has not yet started working on a Medicaid expansion, which will likely require guidance from the federal government.

However, some Republican officials have said the Legislature should focus on reforming the state’s current funding system, instead of simply enrolling more people.

"Because of the court's decision in favor of the state in the Medicaid expansion, it gives the state more flexibility to work on improving the system, as opposed to just expanding it,” said Texas Attorney General Greg Abbott.

The court said states that opt out cannot lose federal funding for the amount of Medicaid funding that they already provide. Texas lawmakers will have to weigh the cost of such an expansion in the upcoming legislative session.

"It's going to be really difficult for the state of Texas to pay for that expansion, but we're going to have to,” said Dr. Guadalupe Zamora, an East Austin physician working with low-income patients. “We're going to have to find a way to cover those people.”

Indeed, Texas faces tremendous Medicaid challenges ahead. The state has the highest number of uninsured in the nation. And some Democrats fear – left solely to its own devices – the GOP-controlled state Legislature will further underfund Medicaid.

“My concern is that Texas, which has had one of the weaker Medicaid systems, will maintain a second-class system and not provide them the full promises of the federal health care act,” said Congressman Lloyd Doggett, D-Austin.

An expansion could likely result in the state spending millions, perhaps billions more on the program.

In the session ahead, lawmakers must also determine how to cover a Medicaid shortfall from the current biennium – a result of underfunding the program by $4.3 billion.

“We think the actual amount will be lower than that,” Goodman said. Some estimates suggest increased sales tax revenues collected this budget cycle could decrease the shortfall.

While any possible expansion would not go into effect until 2014, the provision could first face further legal hurdles.

"One thing we're going to be evaluating going forward is as the rules and regulations are passed and implemented will it give rise to even more legal challenges,” said Abbott. “That's an answer that I don't have right now.

“If there are any challenges to be made, Texas will be right there with them."