On Medicaid, Ramshaw and Serafini predict that Perry would “shift far more responsibility...to the states, as evidenced by his requests for more flexibility (and control of the purse strings) from Washington.”
Those “requests for more flexibility” deserve a little more discussion, as they offer concrete examples of Perry’s previous efforts at a health-care overhaul in Texas. Broadly speaking, they fall into two categories: similar to the flexibilities requested by the vast majority of other states or too radical to be approved by either Democratic or Republican administrations.
Texas has 16 Medicaid waivers, which is pretty much on par with other states its size (California, for example, has 23 while Florida has 19). But the most interesting waivers are the ones it doesn’t have. In 2008, Texas applied for a waiver that, among other things, would limit the number of beneficiaries and create a new, very sparse benefits plan. The Bush administration rejected that waiver request. There was “no precedent,” an administration official said in a letter explaining the decision, to approve an “annual benefit limit as low as” the Perry administration proposed.
This year, Perry signed a law that compels Texas to apply for block grant Medicaid funding. The idea is that Texas would accept a capped amount of federal funding in return for more flexibility on how to spend this money. But that proposal is likely to hit a dead end in Washington, too: President Obama has opposed the idea of block grants as they could potentially leave a state short of the money to cover all its Medicaid costs.
Back to the 15 waivers that Texas does have: They’re pretty vanilla. The state has one to cover much of its Medicaid population through managed care, along with 26 other states. Texas extends family planning services to some low-income women not otherwise eligible for Medicaid as do 22 other states.
So in many ways, the Texas Medicaid program just tends to run with the pack. Texas is among 36 states that cut provider rates this year to reduce Medicaid costs and one of 30 that also instituted controls on pharmacy benefits.
This is not to say that states, particularly conservative ones, are not testing new ideas of how to manage their Medicaid programs. Georgetown Health Policy Institutes’ Joan Alkers points to Indiana Gov. Mitch Daniels, who introduced health savings account-like plans into his state’s Medicaid program, as a conservative thought leader on the issue. Florida and Utah, too, have steered the course with proposed changes to what Medicaid benefit packages looks like.
It’s just that Texas doesn’t generally get counted among the states leading the charge on Medicaid flexiblity. “They don’t stand out as one who has been at the forefront,” Alkers said. “He doesn’t jump out at me in the way that other states do.”
Perry has put one big Medicaid idea out there: pulling out of the program altogether. He told Fox News’s Greta Van Sustren, in November, that he’d “like to see the states be given the opportunity to opt out of the Medicaid program that we are looking at today.” But that idea hasn’t really gotten traction: Texas Republicans pretty much pulled it off the table after a state analysis showed that it would cost Texas billions in federal funds.