This week, Rep. Capriglione filed legislation to give Texas employers the flexibility to select the best value in health insurance for their employees. HB 1001 would allow health plans to offer coverage that meets all the protections of insurance but is exempt from mandates that go beyond federal requirements.

TDI’s new biennial report on the state’s surprise billing law shows Texas patients are being protected from surprise billing, but that some physicians groups are misusing the law with overuse of arbitration and excessive billed charges.

88% of Texas voters say it’s important to have a strong, sustainable Medicaid program according to a new Morning Consult poll. Why it matters: Texas Medicaid provides coverage…

Glenn Hamer, President & CEO, Texas Association of Business, released the results of the group’s survey of employers on…

What’s New With the No Surprises Act? Final rules for the arbitration process of the No Surprises Act have…

Today’s Texas Medicaid is more than health care coverage—it connects Texans to the personalized care and support they need to stay healthy and live the fullest lives possible. Medicaid managed care gives Texans with complex medical needs access to caring health plan nurses that provide one-on-one support and walk families through every step of the complicated and overwhelming health care system.

Yesterday, President Biden signed broad ranging legislation that includes several major health care initiatives, including extending the enhanced subsidies for ACA health plans. First part of the American Rescue Plan Act, these enhanced subsidies help make coverage affordable for many Americans, but were set to expire at the end of this year. Under the new legislation, the enhanced subsidies will go through 2025.

As the end of the COVID-19 Public Health Emergency approaches, the Texas Health and Human Services Commission (HHSC) is actively preparing to complete a large number of eligibility and enrollment actions. Beginning as soon as mid-October, an estimated 3.7 million Texans will need to have their Medicaid eligibility redetermined. For those individuals who found themselves needing Medicaid for the first time during the pandemic, this will be their first experience with the redetermination process. 

Health plans focus not just on the health of individual members, they also invest in the health of communities. By helping to build strong communities, health plans support better health outcomes for everyone. Since the beginning stages of the pandemic, Superior HealthPlan has worked with more than 70 schools and organizations in Texas to launch and fund hygiene closets for lower-income neighborhoods. Grants to the community-based organizations hosting the closets help organizations meet people’s basic needs and create community connection.

In 2021, 34.2% of adults in Texas reported symptoms of anxiety and/or depression. Experiencing mental health challenges can have long-lasting consequences, especially for vulnerable populations. Every Texan deserves access to mental health services. Today’s Texas Medicaid managed care organizations provide a broad spectrum of screenings and treatment services for mental health conditions and substance use disorders with timely access for members and appropriate follow-up care. Managed care allows for flexibility in developing new models of service delivery that are not possible in traditional fee-for-service. 

People with health insurance have better access to care, and importantly that includes mental health care. Two recent studies show that people with insurance not only have better access to mental health services, but they are overwhelmingly satisfied with the services they receive.

In Texas, the 1115 Medicaid Transformation Waiver allows the state to expand managed care, which allows for innovations not permitted in traditional fee-for-service Medicaid. Since the inception of managed care, ensuring high-quality care for members has been the work of managed care organizations. Here are some ways Texas managed care health plans go beyond the walls of a doctor’s office to increase community access to services, reduce unnecessary hospitalizations, and improve the quality of members’ lives.

At $15.3 billion annually, Texans spend more on prescription drugs than any other state in the country. Big Pharma continues to raise prices, making lots of prescription drugs unaffordable. During the COVID pandemic alone, Big Pharma raised prices on 832 drugs. Patients are taking to Twitter to express outrage and shock at the rising price of the sometimes life-saving medicine they need.

Today it was announced that since the No Surprises Act went into effect at the beginning of the year, Americans haveavoided more than 2 million surprise bills. The law protects patients from most surprise medical bills and removes them from the middle of negotiations between providers and insurers when it comes to disputes on what should be paid. That’s the good news.

The use of emergency rooms for primary care services is decreasing, thanks to Medicaid managed care. A recent report by the Texas Health and Human Services Commission (HHSC) shows a 15.5% decrease in the number of potentially preventable emergency room visits in Texas Medicaid and CHIP programs. This is great news for both Medicaid members and taxpayers. Utilizing preventative and standard care before conditions become emergencies leads to better health outcomes and to less costly care.

Can driving just a few miles save a patient thousands of dollars? If they’re in the market for health care, the answer is yes. In Dallas, according to a recent article in D Magazine, the cost of a gallbladder removal surgery can range from $5,000 to $35,000. And rarely are prices posted online—even though they’re supposed to be.

Did you know National Nurses Week is now Nurses Month? Extended in 2020 to recognize the extraordinary efforts of nurses during the early days of the pandemic, the American Nurses Association adopted the evergreen theme “Nurses Make a Difference.” At TAHP, we want to acknowledge the positive impact Medicaid managed care nurses have on the lives of their patients.

By Jessica Lynch As the public health emergency winds down, millions risk losing Medicaid coverage, not because they no…

by Jamie Dudensing and Alicia Pierce A recently announced change to the administration of the Affordable Care Act will…

By: Jessica Lynch and Alicia Pierce In an essay in the New York Times, health care expert Elisabeth Rosenthal…

New Census Data reports show that Texas still has the highest uninsured rates in the nation at 17.3 percent— a full 3 percentage points higher than the state with the next-highest uninsured rate, Oklahoma. Why does this matter? Because study after study shows that when families have health care coverage, they have better health care outcomes. Texans with insurance are more likely to receive preventative, primary, and specialty care services. 

There is a new billing scheme that is misleading Texas patients with  hidden costs—facility fees. These excessive hospital based fees, often in the thousands of dollars for very basic services, have long come under criticism from patients and consumers for creating surprise medical bills that Texans cannot afford. But, it’s not only hospitals that are charging these hidden fees anymore. The out-of-control expansion of these unreasonable fees is driving up the cost of premiums and out-of-pocket costs for Texas families and employers.

Throughout the COVID-19 pandemic, Texans have been tricked into a new type of health care price gouging – outrageous COVID-19 testing.

February 11, 2022 Jamie Dudensing Today, the Texas Association of Health Plans formally announced that Jessica Lynch will join…

Physician groups are facing far-ranging opposition in their lawsuit to overturn rules implementing new surprise medical billing protections. Opponents to the physician-led attack on the new law now include employer coalitions, unions, patient and consumer groups, health policy experts, and essentially any group that cares about controlling health care costs.

A record number of Americans signed up for health care coverage through Affordable Care Act marketplaces at the same time a number of new plans joined the market. About 14.5 millions Americans signed up for an ACA plan during the enrollment period that ended January 15. That’s 2 million more than ever before.

By: Madeleine Richter-Atkinson, Jamie Dudensing Social isolation, defined as having few relationships or infrequent social contact, was a common experience in…

Starting January 15, individuals with private health insurance will have coverage for up to eight at-home COVID tests per month, per covered family member.

Looking for some good news to start the year? We’ve got you covered. After a years-long debate, the end of unfair and outrageous surprise medical bills is finally here.