What does this indicator measure?
This indicator measures the average monthly number of children under the age of 21 in families with low incomes who were eligible to receive healthcare services through Medicaid (from 1990-1994) and the number of Dallas County children under age 19 enrolled in Medicaid and eligible for Texas Health Steps in August, the end of the fiscal year (from 1996-2006). The data was collected in collaboration with
Beyond ABC: Growing Up in Dallas County, 2007, a report issued by
Children’s Medical Center Dallas. The underlying data source for this indicator is the HMGR980K Database, the Texas Department of State Health Services.
Why is this indicator important?Enrollment in Children’s Medicaid is strongly tied to state policies that affect eligibility criteria for families and the difficulty or ease of application. State policies enacted in December 2005 reversed a 5-year trend of strong growth in the number of Texas children enrolled in Medicaid. Between December 2005 and October 2006, child enrollment in Medicaid declined by more than 118,000. Medicaid provides healthcare coverage for the poorest children and pregnant women in Texas, more than half of whom live in families in which at least one person is employed.
Medicaid, the backbone of the healthcare safety net, covers nearly 2 million of the poorest Texas children. Policies enacted in 2001 resulted in a 50 percent growth in the number of children enrolled in Medicaid. Key provisions included using the same simple CHIP application form and mail-in application process, continuous eligibility for six months, re-enrollment by mail or phone, and encouragement of preventive care and treatment in doctors’ offices rather than emergency rooms.
How are we doing?
An estimated 450,000 Texas children are income-eligible for Medicaid but not enrolled, including about 45,000 Dallas County children. Families with earnings at or below the federal poverty level (annual income of $20,000 for a family of four in 2006) fall in the Medicaid eligibility range for school age children, and younger children are eligible at even higher income levels. A large number of working families with low incomes either do not realize their children are eligible for Medicaid coverage or are unable to complete the stringent application process.
Medicaid/Texas Health Steps Clients |
| 1990 | 1994 | 1996 | 1998 | 2000 | 2002 | 2004 | 2005 |
Dallas County | 54,735 | 111,984 | 104,154 | 76,502 | 72,788 | 127,395 | 175,857 | 172,030 |
Source:
Beyond ABC: Growing Up in Dallas County, 2007, a report issued by
Children’s Medical Center Dallas.
In addition to caring for disadvantaged children, this program also supports physician training, pediatric specialty procedures, and high-technology care that benefits the community as a whole. Parkland Health & Hospital System and Children’s Medical Center Dallas are the largest volume Medicaid providers in Dallas County.
Although 47 states have eliminated an assets test for families to qualify for Medicaid, in Texas a family’s cash assets must be below $2,000. Threats to the Medicaid program in Texas include inadequate state funding, inadequate staffing in state eligibility-determination offices, and low reimbursement rates for healthcare providers.
While the number of children enrolled in Medicaid has significantly increased, the number of physicians who accept new Medicaid patients has significantly decreased, limiting children’s access to care. Legislative rate cuts in 2003 for physician services reduced most Medicaid fees below 1993 levels. In 2006, only 38 percent of Texas doctors reported they accepted new Medicaid patients, a precipitous drop from 67 percent in 2000, according to a survey by the Texas Medical Association. Texas should apply annual inflation increases to Medicaid fees, and it should work to bring physician services rates closer to Medicare rates.