Medicaid

First Steps: TMA Secures Medicaid Physician Rate Increases With Hopes for Momentum - 11/18/2024

TMA helped secure the first Medicaid physician rate increases in decades in hopes it will build momentum for future gains.

Physicians Must Validate Email to Avoid Medicaid Disenrollment, Payment Delays - 05/29/2024

Texas physicians who care for Medicaid patients should confirm their email address is valid in the Texas Medicaid and Healthcare Partnership’s Provider Enrollment Management System to ensure effective communication and timely payments from the state Medicaid administrator.

Feds Extend Marketplace Special Enrollment Amid Medicaid Unwinding - 04/19/2024

Texas patients who have been disenrolled from Medicaid in the wake of the COVID-19 public health emergency now have more time to find alternative coverage on the federal marketplace. The extension could mitigate a coverage cliff about which the Texas Medical Association has long raised concerns.

Postpartum Coverage Extension Brings Payment Complexities - 04/05/2024

As the 12-month postpartum coverage Texas legislature approved took effect March 1, physicians and their practice staff should take note of subsequent payment complexities, Texas Medical Association experts caution.

Medicaid, CHIP Postpartum Coverage Extension Will Take Effect March 1 - 02/08/2024

After a multi-session advocacy effort by the Texas Medical Association, specialty societies, and women’s health advocates, Texans who are enrolled in Medicaid or the Children’s Health Insurance Program and who are pregnant or become pregnant will see their postpartum coverage automatically extended starting March 1.

Spending Growth Rate for Physician Services Slows - 01/09/2024

Although spending on physician and clinical services increased 2.7% year-over-year to $884.9 billion in 2022, the spending growth rate fell, due in part to a slowdown in the use of such services and in physician prices. In comparison, spending on physicians and clinical services grew 5.3% in 2021.

On the Mend: Maternal Care Wins Encourage Better Outcomes in Texas - 11/05/2023

Twelve months of postpartum coverage and other maternal wins encourage physicians for better outcomes.

Report Aims to Catalyze Texas Medicaid’s Shift to Value-Based Care - 11/02/2023

A new report aims to accelerate Texas Medicaid’s transition from a fee-for-service payment model to a value-based one, a shift that has been underway for 25 years.

Coming Unwound: Mass Disenrollments Hurt Patients and Physicians Alike - 11/02/2023

The end of continuous Medicaid eligibility has led to mass disenrollments, hurting patients and physicians alike.

Reminder: Revalidate Your Medicare and Medicaid Enrollment - 09/25/2023

Starting Nov. 1, physicians must use a revised Medicare enrollment application. On the Medicaid front, physicians who were due to re-up their enrollment during the COVID-19 public health emergency get a grace period to complete this requirement, but all physicians must review and update their practice addresses. Read more.

TMA Pushes Back Against Planned Vaccine Payment Cuts - 09/06/2023

As the influenza virus continues to spread statewide, the Texas Medical Association and other specialty societies have taken a stand against a plan to cut by almost 36 percent payments to physicians who administer a flu vaccine in their offices.

Zika Reminder: Mosquito Repellent Covered Under Medicaid - 09/06/2023

To protect against Zika, mosquito repellent prescriptions are covered through Medicaid and other state programs, including the Children’s Health Insurance Program.

How to Identify Dual-Eligible Patients - 08/23/2023

The Centers for Medicare & Medicaid Services has been working to rein improper billing of Qualified Medicare Beneficiary program-enrolled patients, who have both Medicare and Medicaid coverage. You can verify patient status in several ways.  

Medicaid Drops Thousands of Texans; Many Still Qualify - 08/07/2023

Texas’ effort to “unwind” continuous Medicaid coverage – a pandemic-era benefit – has resulted in a steep coverage cliff. State officials and advocates urge physicians to help soften patients’ falls. Read more.

Mastering Quality Reporting: Ease the Challenge of Quality Reporting - 07/10/2023

Understanding the maze of quality reporting pathways may help ease the challenge.

Physician-Led Results: Medicaid Rate Increase - 06/28/2023

Texas physicians aimed to win a focused Medicaid rate increase in this year’s Texas legislative session, one designed to improve coverage for children and young mothers. For the first time in more than a decade, they got it.

The Unwinding: What the End of the COVID PHE Means for Continuous Medicaid Coverage - 02/24/2023

After nearly three years and 11 extensions, the federal public health emergency related to COVID-19 is poised to end this spring, and with it, continuous Medicaid coverage for more than 2.5 million Texans.

Marketplace Enrollment Could Help Blunt Potential Uninsured Surge as Public Health Emergency Ends - 11/11/2022

AA number of positive changes expanding access to and affordability of federal marketplace health plans could be coming just in time as Texas’ uninsured rate stands to worsen after the end of the public health emergency.

Commissioned With Change : An Interview With HHSC Commissioner Cecile Erwin Young - 11/11/2022

As leader of the state’s largest agency, Texas Health and Human Services Executive Commissioner Cecile Erwin Young is faced with some of the largest health care challenges among some of the most vulnerable patient populations. She visited the Texas Medical Association’s Winter Conference in late January to talk to Texas physicians about their concerns in caring for those patients, especially during a pandemic.

Address Delayed Care Pileup, TMA Tells House Panel - 10/17/2022

The COVID-19 pandemic strained an already overburdened primary health care system in Texas, making it vital that state lawmakers back measures that encourage patients to see a physician and catch up on delayed care before it gets even worse, Tyler pediatrician Valerie Smith, MD, told the Texas House of Representatives Select Committee on Health Care Reform.

Access to Hep C Treatment in Texas Medicaid Delayed - 09/07/2022

Texas Medicaid patients with hepatitis C will have to wait a little longer to access potentially curative antiviral medications.

Texas Medicaid to Loosen Access to Hepatitis C Treatment - 08/21/2022

Texas Medicaid patients with hepatitis C have struggled for years to access potentially curative antiviral medications. But this will get much easier on Sept. 1.

Texas Children Among Most at Risk of Losing Health Coverage When PHE Ends - 08/19/2022

Texas is one of six states where children enrolled in Medicaid and in the Children’s Health Insurance Program are especially at risk of losing their health insurance when the public health emergency ends.

Medicaid Extends Reenrollment Time Frames - 08/09/2022

To help manage a backlog of revalidation applications stemming from the transition to Medicaid’s new Provider Enrollment Management System (PEMS), the state’s Medicaid claims payment contractor announced it will extend revalidation timeframes for physicians and other health care practitioners and suspend disenrollments related to that process.

The Only Alternative: Medicaid Practices May Not Be Viable Without Value-Based Care - 07/29/2022

For years, the Texas Medical Association has pushed for a significant Medicaid physician pay bump every year that the Texas Legislature meets, without success. As long as that streak continues, physicians looking to make Medicaid more worthwhile for their bottom line have to find another way. Value-based systems – and the alternative payment models that drive them – have been the path Medicaid managed care organizations and practitioners have been methodically walking in recent years.