Medicaid Acute Care Programs
Purchaser: Texas Department of Health Programs: Medicaid Acute Care Services
Description: The Texas Department of Health (TDH) is responsible for Medicaid acute care services, the Vendor Drug program, Medicaid Family Planning, Medicaid Medical Transportation, Texas Health Steps and the Medically Dependent Children Program.
Acute care services include hospital, physician, and other medical services provided to eligible recipients. Services are provided either through a fee-for-service contract with the National Heritage Insurance Company (NHIC) or though managed care organizations that contract with Medicaid.
The Vendor Drug program pays contracting pharmacies for prescription medications. The Medicaid Medical Transportation program pays for transportation to and from the nearest Medicaid-allowable service when recipients have no other means of transportation and the transportation is authorized in advance.
Family Planning Services are delivered through performance-based contracts with local health departments, medical schools, hospitals, rural health clinics, community-based centers, private nonprofit agencies and TDH rural health clinics.
The Medically Dependent Children’s Program is a Medicaid waiver program that helps medically fragile children stay with their families rather than in nursing facilities. A Medicaid waiver is an exception to federal law. Medicaid waivers enable states to provide a wider range of services to a more narrowly-defined population than Medicaid ordinarily provides. Waivers also can be used to broaden eligibility requirements for certain groups without broadening requirements for the entire Medicaid population.
Texas Health Steps is the Texas name for the federal Early Periodic Screening, Diagnosis and Treatment Program. It provides periodic medical and dental screens to detect and treat health problems before irreversible damage occurs.
TDH spent $5.4 billion in state and federal funds on Medicaid acute health care services in fiscal 1998.
Texas Total, Fiscal 1998
Amount Spent: $5,438,040,118 Type of Funding: $3,499,081,225 Federal Medicaid Match $1,938,958,893 State Medicaid Match Number of Recipients: The average number of recipients per month in fiscal 1998 was 1,863,106. Average Amount Spent: Average monthly expenditure per recipient in 1998 was $242.
Source: Texas Department of Health