The broker model appropriations rider – the now infamous
Rider 55 – was inserted in the Texas appropriations bill in 2009. The broker
lobby had at least one compelling argument at the time: if the full-risk model
was implemented statewide the state would enjoy a higher federal/state match
rate: 60 – 40 from 50 -50 (only four regions at the time qualified for a 60 –
40 match according to the Center for Medicare and Medicaid (CMS). In a state
hard pressed for cash the increased federal match was quite an inducement.
What would be the estimated gain to the state – financially
speaking – if the whole state turned broker? This question and many other
interesting questions were posed by the Rep. Joe Pickett, D-El Paso, then
Chairman of the House Committee on Transportation to HHSC. The formal HHSCresponse is posted here.
The verdict? If HHSC went to a statewide full-risk broker
and received the 60 – 40 match the additional federal yearly benefit -- $6
million. That’s $6 million as part of a nearly $200 million MTP program that in
turn is part of a $12 billion Medicaid program.
But money is money right? Correct. In the final analysis,
efforts should be made to achieve savings irrespective of the amount.
So in October of 2010 Rep. Ryan Guillen, D-Rio Grande City
worked with transportation consultant David Raphael, and HHSC to submit a 1915b
Medicaid waiver to CMS. That waiver allowed Texas to obtain the higher 60 – 40
match WITHOUT moving to a statewide broker system. Here’s a copy of the waiver.
That waiver was awarded by CMS to Texas on April 1, 2011
(ironically as anti-broker factions beat back another attempt to on the House
floor to expand the broker model.) Most likely the waiver was awarded on the
strength of the existing transportation networks in Texas.
Texas has been receiving the higher match since then.
So savings to Texas by full implementation of the broker
model?
Zero.
Next: Frew Lawsuit Redux: Broker Pied Piper Trek to Yet
Another Lawsuit (this time it won’t take 14 years)
Last August I head a speaker out in west Texas our family's church who brought up some critical facts that seem to be ignored in planning by the legislatures, for health, transportation, and overall safety “if they’re truly interested in saving money.” That is the serious omission of projecting total costs when a service is changed, not implemented, or continued unfairly to all such as the reimbursement across all waivers in Texas now.
ReplyDeleteWell, I know that when someone is hurt, scared, or abandoned and they ae disabled the police and EMS go to them if they're found in time. That is far more expansive than a ride.
In reading this blog, it seems that the state implemented this broker thing without first checking Logisticare's legal status, at least with the DMV in each state it operated. I found out about them and I'm not that savvy. Now, it also seems that holy H should have been raised by the TTA well before this ever got to this point, back with that nut in Houston. So, now I have to agree with our speaker who said that ultimately with blame easily placed on both sides, "let's just fix it."
It does seem that there is too much corporate lobbying going on in health care here and now in transportation. No one would have looked twice at Logisticare unless they were 1) donating to the legislators and/or 2) received tax incentives to work in Texas, which only further harms our small businesses in the state. Maybe we keep electing the wrong peoople. Out with them, fast. "Let's just fix it!"
TTA did raise Holy H at the time and has continued to fight this wrongheaded policy. Here's the problem - Medical transportation as an issue falls between two issue areas: Healthcare and transportation. The healthcare policy folks understand the Medicaid piece and the transportation policy folks get the role of public transportation. Problem is you can't find 5 folks up at the Capitol who thoroughly understand both. That's how Logisticare did it. But it's not over! Let your house and senate members know your thoughts. They'll listen.
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