Football is back in Texas. And so is the legislature – even though their session has ended.
The Longhorns and Texans are off to hot starts, and the legislature is putting in the early work to deliver a win for taxpayers in the next budget season.
That’s why the Texas State Senate is holding a special hearing to learn how Gov. Greg Abbott’s Health and Human Services Commission (HHS) is combatting waste, fraud, and abuse in Medicaid, a program that accounts for more than 40 percent of the state budget.
While this public hearing in the middle of September might seem like a blip on the radar compared to the presidential election or the crisis at the southern border, the future of Medicaid is closely linked with the outcomes of these two issues.
Texans should care deeply about the actions leaders in Austin are taking to protect the integrity of this program for taxpayers and the truly needy.
Medicaid is a federal entitlement program administered by the states that provides taxpayer-funded health coverage to low-income seniors, people with disabilities, and children in low-income households. ObamaCare allowed states to expand this coverage to low-income able-bodied adults, and 40 states have taken up that offer.
Texas has been wise so far to reject Medicaid expansion.
States that did expand have seen enrollment and costs far outpace projections, greater rates of hospital closures, and no real improvement in health outcomes. More than four million Texans currently receive coverage through Medicaid, which makes up more than 40 percent of the state’s spending. While staggering, those numbers would increase dramatically if Texas expanded coverage to able-bodied adults.
The situation for the Medicaid program nationwide is more dire.
Since 2000, the number of Americans enrolled in Medicaid has increased from roughly 35 million to more than 96 million, a 174 percent increase. This dramatic increase has largely been driven by the expansion of coverage to able-bodied adults under ObamaCare. And as enrollment has surged nationwide, labor force participation has dropped to the low sixties. This is no surprise, as more than 50 percent of able-bodied adults on Medicaid do not work at all.
The Medicaid program is also rampant with fraud and waste. The Centers for Medicare & Medicaid Services (CMS) estimated more than $50 billion in improper payments, including nearly $2 billion in Texas. The runaway growth in Medicaid nationwide is driving up debt and inflation, hindering our workforce, and making more Americans dependent on the federal government.
These trends in enrollment, costs, and fraud were exacerbated by the COVID public health emergency, when the federal government forced states to lock in ineligible recipients to the program – something the Biden-Harris administration is fighting to prolong.
To make matters worse, in June of this year, CMS finalized a rule that will severely limit states’ ability to keep non-citizens off their Medicaid rolls. Combine all of this with the open border policies of the Biden-Harris administration, and we have a recipe for disaster.
While the outlook is dim, states are not powerless to counter the reckless policies of the federal government.
Since the public health emergency ended, Texas has moved aggressively to restore sanity to its Medicaid program by removing nearly 2.5 million ineligible individuals from the rolls and rejecting many federal waivers designed to keep enrollment up. However, Texas HHS is still using some of these waivers under pressure from the Biden-Harris administration. Particularly egregious is one that allows HHS to enroll individuals in Medicaid by using food stamp applications, another federal program that is rife with abuse.
While Texas continues to fight to secure its southern border that the federal government has abandoned, it should simultaneously reject any waivers offered by the Biden-Harris administration to weaken eligibility standards for its largest welfare program.
Gov. Abbott has also wisely moved to get a grip on the issue of illegal immigrants receiving Medicaid coverage by requiring publicly funded hospitals to be transparent about the uncompensated care they are providing to that population. But the legislature should not rely solely on the Abbott administration alone to carry out program integrity efforts.
When lawmakers hear from HHS this week, they should be curious to know what additional steps the agency is taking to verify eligibility before individuals are enrolled, what accountability measures are in place to ensure hospitals, as the largest managed care providers in the state, are doing their due diligence to not enroll ineligible individuals, and what guidance or directives the agency is receiving from the federal government to further erode the state’s program integrity efforts.
If policymakers in Austin see problems, they should act in the 2025 session to pass legislation codifying program fixes that are proven to reduce fraud, waste, and abuse in the state’s largest entitlement program. That way, program integrity can’t easily be undone by future administrations – even as the Biden-Harris administration seeks to expand enrollment and loosen eligibility checks.
After watching the big wins this weekend, make sure to tune into the legislature’s offseason work to deliver big wins for taxpayers. Their efforts now will ensure the Medicaid program continues to serve only those who are eligible and truly in need in the future.
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