May 08, 2009
Is there a Medicaid issue or not?

Earlier this week, Sen. Steve Ogden and Lt. Gov. David Dewhurst made the claim that Medicaid would require another $1 billion from the budget, and that this would constrain the budget reconciliation committee as it tries to fund everything that's been appropriated. I thought that sounded ominous, but to others it sounds overblown.

[P]owerful lawmakers usually low-ball what Medicaid will cost to help them balance the budget. But now, they are "high-balling," or maybe we should say "true-balling" them? What gives?

Normally, after knowingly putting into the budget too little money for Medicaid, lawmakers then come back the next session and pass a stopgap spending bill. It plugs holes in the soon-to-be-history two year budget, with Medicaid the biggest shortfall, usually. Because Medicaid is an entitlement, recipients get seen and their medical bills get paid.

But this session, [the Legislative Budget Board] has suddenly upped its projections so that they actually exceed the commission's for two of the next three years. How unusual.

I asked [former state Medicaid program official Anne Dunkelberg] if she thought Senate GOP leaders are trying to discourage passage of any more bills that would authorize more spending, in areas such as children's health care or expanded pre-kindergarten instruction.

Her response:

"After 20-plus years of tracking Texas Medicaid budgets, it is hard not to be a little sceptical when there is such a noticeable change in assumptions. For the last decade or more, when major assumptions have changed mid-session, it has always been to lower the Medicaid budget total, so you really take notice when they take it in the other direction. The HHSC agency folks think this is just the LBB coming to their senses about the true cost of the program, but a darker interpretation could certainly be that there is a desire to slow the momentum behind the movement to provide more uninsured kids health care and expand acces to pre-K.

The timing of that is interesting, given that the Senate just approved a buy-in program for CHIP that would provide health care to more uninsured kids. Patricia Kilday Hart says "Senate leaders are choosing to lock up as much money as possible in paying for entitlements. The practical effect is this will make funding of discretionary programs more difficult.", to which Burka adds that this is a "created crisis" that is potentially a large point of contention between the House and the Senate negotiators. Clearly, we need to keep an eye on this.

Posted by Charles Kuffner on May 08, 2009 to Budget ballyhoo
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