Obama Administration Tells Texas It Could Play Medicaid Hardball There, Too

The Centers for Medicare and Medicaid Services holds a call with Lone Star State officials, as the drama in Florida heats up.

National Journal
April 17, 2015, 1:16 p.m.

The Obama ad­min­is­tra­tion looks to be tak­ing its Medi­caid hard­ball tac­tics to Texas.

The Cen­ters for Medi­care and Medi­caid Ser­vices in­dic­ated to Texas of­fi­cials Thursday that wheth­er the state ex­pands Medi­caid un­der the Af­ford­able Care Act would factor in­to the re­new­al of a mult­i­bil­lion-dol­lar Medi­caid fund­ing stream next year, ac­cord­ing to state of­fi­cials.

Fed­er­al of­fi­cials re­ques­ted a call with the Texas Health and Hu­man Ser­vices Com­mis­sion, dur­ing which they out­lined their po­s­i­tion, Linda Ed­wards Gock­el, a spokes­wo­man for the Texas health agency, said in an email to Na­tion­al Journ­al.

The call came the same day that Flor­ida Gov. Rick Scott said he would sue the Obama ad­min­is­tra­tion, ac­cus­ing CMS of push­ing the state to ex­pand Medi­caid by lever­aging $1 bil­lion in fed­er­al Medi­caid fund­ing, which is up for re­new­al this sum­mer and helps cov­er some un­com­pensated care.

CMS said in a let­ter to Flor­ida this week that one of the three prin­ciples it would use to eval­u­ate the pro­gram, known as the Low-In­come Pool, was that “un­com­pensated care pool fund­ing should not pay for costs that would be covered in a Medi­caid ex­pan­sion.”

In the phone call with Texas of­fi­cials, “CMS said they re­cog­nize each state is dif­fer­ent, but they in­tend to use the same three prin­ciples out­lined in their let­ter to Flor­ida as they eval­u­ate un­com­pensated care fund­ing pools in all states,” Ed­wards Gock­el said. “We don’t have more de­tails than that at this point.”

A CMS spokes­man con­firmed that the agency would use the prin­ciples out­lined in the Flor­ida let­ter, which in­clude a state’s Medi­caid ex­pan­sion status, when re­view­ing un­com­pensated-care fund­ing pools in oth­er states like Texas.

“We will also use these prin­ciples in con­sid­er­ing sim­il­ar pro­pos­als in oth­er states,” CMS spokes­man Aaron Al­bright said in an email, “but dis­cus­sions with each state will also take in­to ac­count state spe­cif­ic cir­cum­stances.”

Texas’s un­com­pensated-care fund­ing pool, part of a broad­er Medi­caid waiver, is com­ing up for re­new­al in Septem­ber 2016. Ac­cord­ing to the Texas Hos­pit­al As­so­ci­ation, the pro­gram provides more than $3 bil­lion to Texas hos­pit­als for un­com­pensated care.

The Lone Star State is the biggest state not to ex­pand Medi­caid un­der Obama­care; about 950,000 low-in­come Tex­ans would re­ceive health cov­er­age if the state did ac­cept the ex­pan­sion.

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