Children's Health Legislative Update 
the Children’s Hospital Association of Texas (CHAT)

As federal lawmakers discuss extensive reform of the Medicaid program, CHAT wants to remind you of the vital role Medicaid plays in keeping Texas children healthy.
More than three million Texas children are enrolled in Medicaid, which provides coverage for basic preventive services as well as for highly specialized care for children with complex medical conditions. Children with access to Medicaid are more likely to attend school, graduate from high school, and go to college, becoming healthier adults who will earn higher wages and pay more in taxes than children who do not have appropriate health care. 
We hope particular attention is paid to the following topics:

  • Improving medical care for children in state conservatorship;
  • Appropriate funding for health care services for children; and
  • Ensuring that Medicaid continues to provide developmentally and age-appropriate care for children to help them become healthy and productive adults.

Children in Foster Care
Need Improved Medical Care

As you look at plans to overhaul the Texas foster care system, CHAT is advocating for two main changes:

  • A required initial health screening exam within 72 hours of a child entering foster care.
Currently, the earliest that most children entering foster care in Texas must be seen by a physician is within 30 days. During this month, any number of physical, developmental, and mental health conditions may go undiagnosed or unaddressed, resulting in poorer outcomes for children as well as inappropriate, delayed or disrupted foster care placement.

It was reported last year that foster care children receive this initial exam within the first 30 days only about half of the time. Receiving this initial screening exam will make placements more successful because foster parents will receive information about the child and will have a medical home for that child.  Screening will also identify issues that are not readily apparent that specialists who treat abused and neglected children can identify and treat.
  • A state-funded Child Protective Services (CPS) worker to be placed in children’s hospitals and/or specialty foster care clinics to avoid placement disruptions and lengthy hospital stays beyond days that are medically necessary. 

Placing CPS workers in children’s hospitals and clinics that provide a comprehensive array of services designed for children in foster care will avoid unnecessary days in the hospital and help ensure proper placement of children. A CPS worker in the hospital could reduce hospital stays (which helps reduce overall costs), reduce disrupted placements and ensure more in-home support is provided.

Additional resources:

A Safe and Timely Discharge for Children with CPS Referrals at the Children's Hospital of San Antonio - Crystal Davenport, MD, FAAP

Improving the Medical Care Provided to Children in Foster Care

Ensuring Children Entering Foster Care Receive Timely Health Care

Maintain the Safety Net Add-On to
Inpatient Hospital Rates 

CHAT supports maintaining the safety net add-on to inpatient hospital rates and the use of general revenue to fill any gap in trauma funds to make the safety net payments as provided in the House budget, as filed. 
Why the Safety Net Add-On Is Important
Adequate Medicaid funding is vital to the survival of these unique treatment centers for children.
  • Medicaid makes up over 55% of the revenue at children's hospitals.
  • The 84th Legislature provided $128 million in trauma funds to increase inpatient reimbursement for hospitals that treat a high percentage of Medicaid and low-income uninsured patients during the 2016-17 biennium.
  • 10% of the $128 million is devoted to incentive awards for hospitals that achieve certain quality milestones for potentially preventable complications and potentially preventable readmissions.
  • Children's hospitals will receive about $24 million in safety net add-on reimbursement and $8 million in awards for achieving quality metrics in the current biennium
  • Trauma funds are generated from penalties related to the Driver Responsibility Program (DRP), which is in jeopardy of abolishment or significant change.
  • Regardless of these changes, the trauma funds balance has been depleted.
  • The House budget, as filed, ensures that general revenue funds will fill any gap in trauma funds for the safety-net payments during the 2018-19 biennium.      
The state should maintain the safety net add-on for the 2018-19 biennium and fill any gap in funding by using general revenue.

Children’s Health Care Issues in the News

Click on the following links to learn more about some of the issues impacting children’s health care in Texas.
“What Led to the ‘Broken’ Foster Care System in Texas”
“Texas Lawmakers Fired Up About State CPS and Foster Care Woes”
“Judge in Foster Care Case Pushes Texas for Swift Improvements, Demands More Information
Copyright © 2017, Children's Hospital Association of Texas, All rights reserved.

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