Medicaid problems hinge of Texas doctor, nurse pay

The first question many doctors ask when new patients call for appointments is how they intend to pay. If the answer is Medicaid, the doctor can expect to lose money.

The Texas Legislature has been balancing the state's budget by intentionally paying doctors 40 to 75 percent less for Medicaid patients than what private insurers pay for the same treatment. Doctors generally plan to do some charity work, but more and more physicians are reaching their limit, potentially leaving Texas' most vulnerable in a bind."When you are a physician and you see a Medicaid patient for a sick visit ... it basically costs more money to see them than what I get paid for," said Dr. Jason Terk, a pediatrician at Cook Children's Hospital in Fort Worth. "I accept Medicaid patients, but they can only be a certain percentage of my practice for me to do what I do. For me, it's anywhere between 10 percent and 15 percent of my practice."

More than 3.6 million Texans rely on Medicaid, and of those 2.6 million are children and 538,000 are disabled, according to state figures. About 245,000 are elderly poor people, 128,000 are pregnant poor women and 125,000 are destitute. But while children comprise the vast majority of Medicaid patients, the disabled and elderly take up 58 percent of the budget.

Zerwas said medical costs are growing faster than state revenues, which means every year it becomes more difficult to pay for Medicaid. The program is financed with roughly two federal dollars for every $1 the state spends, but those matching funds come with mandates for who gets treated for what and limits where the Legislature can trim the budget.

The Texas Medical Association has sounded a similar warning. It polled its members and found that only 31 percent of Texas doctors are accepting any new Medicaid patients, while 26 percent will accept only some new patients. The group warns that with an ever-growing population and not enough doctors to keep up, Medicaid patients could find it tough to find doctors if more doctors stop taking Medicaid patients.

Nursing homes are also finding it difficult, according to the Texas Health Care Association.

President Barack Obama's Affordable Care Act will boost reimbursement rates for eligible primary-care doctors this year at no cost to the state, and pending state legislation would boost payments to obstetricians and gynecologists because they serve as primary care providers for many women. Doctors in other specialties would see no change.

"People will swallow increasing taxes for certain things; they are not going to swallow raising taxes for the indigent health care program," Zerwas said.

Gov. Rick Perry is pushing for a block grant, where the federal government gives Texas all of the funding without any regulations attached. The last time Texas made that request, the Bush administration turned it down.

"I'm a believer in a block grant, but I'm enough of a realist to understand that probably is not going to happen," Zerwas said.


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