"We cannot continue down this road, and we want to provide services -- the best services we can to the most people in need -- and if you look at the projected numbers we can't do it unless something changes," said Sen. Jane Nelson, R-Flower Mound, the chairwoman of the Senate Health and Human Services Committee and author of Senate Bill 7, which would redesign long-term and acute care services for the disabled and elderly. In response to backlash from disability rights advocates on measures in SB 7, Nelson said she met with stakeholders and offered a committee substitute to address their concerns.
Texas spent more than $25 million on Medicaid long-term and acute care services in 2010, according to the Kaiser Family Foundation. Roughly two-thirds of Texas Medicaid dollars are spent on services for seniors and disabled Texans, while those groups make up a quarter of Medicaid enrollees.
SB 7 intends to curb costs by expanding managed care services, establishing pilot programs to try providing services at capitated costs and implementing measures to ensure more efficient monitoring of services. It also sets up the intellectual and developmental disability system redesign advisory committee -- made up of stakeholders from disability rights groups -- to advise the Health and Human Services Commission on ways to efficiently redesign Medicaid acute care services.
The committee will hear public testimony on the bill Tuesday afternoon. Many disability rights advocates in Texas are concerned that managed care organizations would reduce services and interfere in the way they receive care.
"We are not cutting services. To achieve the results we like, we want to coordinate services to provide better care," said Nelson, who emphasized the redesign proposed in SB 7 could extend services to 12,000 disabled Texans currently on waiting lists.
After laying out the provisions in the committee substitute, Nelson invited four witnesses to testify in order to clarify "misconceptions" about the bill.
SB 7 "takes a stab at trying to build a sensible system," said Bob Kafka, a long-term disability rights advocate in Texas. He questioned why other disability advocates were protecting a system that they've said for years needs reform. "Medicaid ain't going to be what it is today, and I think this is actually, really a progressive bill."
The term "managed care" carries heavy connotations, said the witnesses who testified in favor of the bill.
"I don't want my care to be managed, I don't want anybody managing my care except myself," said Lex Friedman, a professor at the University of Texas Health Science Center who broke his neck in a car accident in 1977. Despite the connotations of the term "managed care," in his experience, Friedman said managed care has improved the efficiency and quality of Medicaid services.
Managed care programs "have enabled people with disabilities to live more independently, to avoid hospitalization," he said. And the managed care companies have "put some organization to what really is a very complex program."
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