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February 2021 • DALLAS MEDICAL JOURNAL 23
patchwork and featuring inconsistencies
and contradictions and leaving large gaps.
To an appreciable extent, ACA expansion
can streamline processes and consolidate
operations, resulting in greater, not less,
government efficiency.
Overview of Live Well Texas. Some key
elements of the plan include:
• Health savings accounts. Participants
are enrolled in a high-deductible health
plan. The state initially funds the account
in an amount equal to the (high) deductible
or, in the case of the plan option for
advanced benefits, in the amount of the
deductible less the amount the participant
will be expected to contribute to their
own health savings account. For low-wage
workers, the participant’s contribution may
be funded by the participant’s employer (incentivizing
both employment and employer
participation) or by charitable organizations
(calling upon and enabling the participation
of the community).
• Provider participation incentive: Raises
Medicaid reimbursement rates to parity
with Medicare rates. Higher reimbursement
rates correlate to higher provider
participation.
• Utilizes Texas’ existing MCO model,
including value-based payment systems.
• Creates incentives for healthy behavior
modifications. Insurers (MCOs) can reward
participants for healthy behavior modifications,
like smoking cessation and chronic
disease management, by making extra
contributions to their HSA accounts. Smokers
are required to contribute more to their
HSA.
• Medicaid residency and citizenship
requirements apply to plan eligibility.
• Encourages and facilitates employment.
The plan refers unemployed and underemployed
participants to work-search
and job-training programs provided by the
state. Participants who do secure employment
and then, as a result of their additional
income, become ineligible for the
program may continue to draw upon their
HSA account funds while they obtain new
insurance, thus eliminating what otherwise
might be a disincentive for seeking employment.
• Simplifies eligibility. Uses a single, consolidated
application process for all state
health benefit programs, including current
Medicaid and the Live Well Texas program.
Once an applicant is determined to be
eligible, eligibility continues for 12 months.
• Continuity of enrollment and maximum
federal funding for pregnant women,
parents, and caregivers. To the extent
that standard Medicaid for pregnant
women might (now or in the future) provide
benefits beyond what the Live Well Texas
program offers them, women who become
eligible for traditional Medicaid by virtue of
pregnancy will receive all standard Medicaid
benefits in addition to their benefits under
their plan. The program treats parents
and caregivers likewise. This ensures that
participants receive all benefits that the
state has specifically designed for pregnant
women and caretakers. At the same
time, it incentives them to remain enrolled
in the Live Well Texas plan, which for the
state means federal funding at $90-$10
instead of $60-$40 (or another less favorable
rate) under traditional Medicaid.
• Self-destruct: If the federal government
were to decrease the $90-$10 match rate,
the plan ends.
Expansion under the ACA is stable.
With 38 states having opted to expand
coverage under the ACA (either directly or
through an 1115 expansion waiver), representing
228 million people and 53 million
expansion enrollees, we can expect that
Congress will preserve it, just as Congress
continues to provide funding for transportation
and education.
More to do. Coverage expansion under
the Live Well Texas program (or other ACA
$90-$10 expansion model) comprises only
part of the exciting range of healthcare
initiatives being pursued at this moment.
Some will advance this session (I’m pushing
for a few of my own), and some will
have to wait for other legislative sessions.
But ACA coverage expansion is by far the
most comprehensive, powerful, and economically
advantageous measure available
to Texas. DMJ
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