With a handful of weeks to go in the session and another key deadline approaching, many of the Texas Medical Association’s budget asks have been answered – with medicine still working hard to ensure they’re permanent.
As the Conference Committee process begins – during which House and Senate members hash out the differences in their respective budget drafts (House Bill 1 and Senate Bill 1) behind closed doors to come up with a final version – Medicaid, women’s health, and medical education are all winners so far and all top TMA priorities this session as part of its overarching goal to boost access to care.
“Our organizations are committed to improving the health of all Texans. But to achieve this goal, physicians rely on having robust, effective, and efficient safety-net programs … all of which join to form the backbone of Texas’ health care delivery system,” TMA Council on Legislation Chair Zeke Silva, MD, testified earlier this session.
Building on momentum from the 2023 session – when TMA helped secure the first Medicaid physician payment raise in more than a decade – the House version of the 2026-27 budget as of this writing includes an amendment with a 5% Medicaid rate increase for services provided by physicians whose primary practices are physically located in Health Professional Shortage Areas, including telemedicine.
Also under the Texas Health and Human Services Commission umbrella for Medicaid and the Children’s Health Insurance Program (CHIP), the House and Senate budget proposals allot enhanced funding to:
- Modernize and resolve backlogs within the Texas Integrated Eligibility Redesign System ($300 million total), which helps determine eligibility for Medicaid and other public assistance programs; and
- Bolster the Provider Enrollment and Management System ($23 million total), the electronic system for enrolling physicians and others in Medicaid, CHIP, and other state programs.
Again stacking onto last session’s gains, HB 1 and SB 1 include additional monies for the state’s women’s health programs, namely Healthy Texas Women, Healthy Texas Women Plus Family Planning Program, and Breast and Cervical Cancer Services, and for caseload growth.
Regarding the Department of State Health Services (DSHS) budget, however, TMA lobbyist Matt Dowling cautioned there will be “big hits” as the federal government moves forward with cuts to public health programs related to vaccines, tobacco use prevention, and emergency preparedness, for instance. Much of the federal funds, he explained, reach the state and trickle down to local public health programs in the form of grants that are unlikely to be renewed.
TMA remains in communication with DSHS as the agency evaluates the federal cuts and their impact. Continue to read Texas Medicine Today for coverage.
Home grown doctors
Medical education also emerged as top priority for lawmakers, who’ve also emphasized access to care as a major challenge for Texas.
Both the House and Senate versions of the budget include an additional $75 million (8.8%) in state per-medical student funding, or formula funding, to keep up with recent growth in Texas’ medical school enrollments. HB 1 and SB 1 also allotted additional support for graduate medical education including:
- A $6 million increase (5%) for state per-resident formula funding to keep pace with growing number of residents training in the state; and
- An extra $71 million (30.5%) to maintain the new residency positions created through the State GME Expansion Grant Program. A majority of positions within the program are in primary care and psychiatry, as reported by the Texas Higher Education Coordinating Board.
Meanwhile, the association is working to solidify a pair of amendments on the House side that:
- Dedicate $2.64 million to create one-year transitional residency programs for unmatched Texas medical students; and
- Add funding for $1,000 stipends for community-based physician preceptors who dedicate their time to training medical students in clinical care as part of a four-week clerkship.
TMA continues to advocate for continued funding to support the state’s loan repayment program at $35.5 million and primary care preceptorship program at $4.85 million, and to seek additional funding for several physician workforce development programs, although as of this writing, SB 1 and HB 1 maintain funding levels for the state’s:
- Family Medicine Residency Program ($16.5 million total);
- Joint Admission Medical Program ($12 million total); and
- Rural Residency Training Program ($3 million total).
House and Senate conferees have until the close of session – or sine die – on June 2 to finalize the budget.
Senate conference committee members include Sens. Joan Huffman (R-Houston), chair; Brandon Creighton (R-Conroe); Lois Kolkhorst (R-Brenham), Robert Nichols (R-Jacksonville); and Charles Schwertner, MD (R-Georgetown).
House conference committee members include Reps. Greg Bonnen, MD (R-Friendswood), chair; Mary Gonzalez (D-San Elizario); Angelia Orr (R-Itasca); Stan Kitzman (R-Pattison); and Armando Walle (D-Houston).
Bills on the move
Meanwhile, as House committees hurtle toward a May 15 deadline to hear bills, here’s a rundown of key TMA-backed – or opposed – bills that remained in motion at press time. Senate committees do not have a similar deadline and can continue meeting until the last day of session.
- The Life of the Mother Act, Senate Bill 31, is “moving in a good direction” after clearing the Senate State Affairs Committee, with TMA “very involved” in changes being worked out as it heads toward a floor vote, says TMA chief lobbyist Clayton Stewart.
- Both the House and Senate versions of the so-called “information-blocking” bills TMA supports to protect sensitive test results – Senate Bill 922 and House Bill 1699 – were voted out of the House Public Health Committee.
- On prior authorization, TMA’s trio of priority bills – House Bill 3812 and Senate Bills 1380 and 547 – remain pending in committee.
At press time, still only one scope bill had made it out of committee – House Bill 4099 allowing patients more liberal direct access to physical therapists without a referring physician.
The major nurse scope expansion of the session – House Bill 3794 – had not yet come up for a committee vote as TMA worked to keep it and a similar measure, Senate Bill 3055, from advancing.
On the other hand, a TMA-backed scope-solution bill – Senate Bill 2694 – was scheduled to be heard in the Senate Health and Human Services Committee on April 23.
Texas Medicine Today will have coverage of the hearing and other fast-moving bills. Now is also the time to watch for TMA email alerts urging action on a particular piece of legislation.
Check out TMA’s Grassroots Action Center for more information on these Action Alerts and other ways to stay involved in TMA state advocacy. And be sure to sign up for the final First Tuesdays at the Capitol advocacy event of the session on May 6.