Editor’s note: The original version of this report contained incorrect information about the total of Medicaid payments received by the hospital. The information has been updated to reflect the correct information.
As the Concho Observer began to organize its reporting on changes to government-funded healthcare programs, we began by asking the largest healthcare provider in the area four questions we hoped would help us better understand the full impacts of these national decisions locally.
We were referred to the marketing department, and submitted the following questions.
_QUESTIONS__
Does Shannon have any insight to, or internal estimate of, how many of their patients are likely to lose their health care coverage?
As the largest healthcare provider in the area, what is Shannon Health’s plan to deal with changes to government funding?
Will Shannon, in accordance with the original bequest, step in and pay for those who do not have the ability to pay?
To the best of your knowledge, are there other health care programs or services likely to be impacted by recent changes, and how?
_RESPONSE_
Thank you for sending your questions.
At this point, there is not enough concrete information to predict the specific impact for patients within our region. Shannon, along with all other healthcare providers across the country, is navigating these issues as we receive more information. However, there are points that still must be vetted at both the federal and state levels, and some of these changes are not slated to go into effect for more than a year. As we receive more information and guidance, we will continue to work together with the many healthcare partners in our community so that we can continue to provide access to care for everyone in our region.
Why They Need A Plan
Here is why the Concho Observer thinks it would be a pretty good idea for them to come up with a plan for every possible contingency, posthaste.
While changes to Medicaid have dominated headlines nationally, most changes in that program’s funding will be felt by states that expanded their Medicaid programs to cover more people.
Texas was one of 10 states to sidestep that pitfall by refusing to ever expand Medicaid coverage to more low-income residents.
However, the state is about to have almost 2 million more uninsured residents, experts say, because of changes to the Affordable Care Act, requalification guidelines for most low-income healthcare programs.
According to original reporting from the Texas Tribune, as many as 1.7 million Texans are likely to lose health insurance with the changes.
The Texas healthcare system has struggled for decades to serve a population with the highest uninsured rate in the nation.
According to information from the Center for Medicaid Services and the Texas Department of Health and Human Services, Shannon Medical Center submitted $286,985,625 in Medicaid charge in fiscal year 2023, receiving $55,560,065 in total Medicaid payments, and there were 16,159 Medicaid patients in Tom Green County in FY 2024.
Federal Funding and You
According to information from the Department of Health and Human Services, state-run healthcare in Texas is reliant on the federal government for 64 percent of total funding, which was $34,381,722,512 in 2023.
The DHHS Federal Funding report goes on to explain that Medicaid is the largest recipient at $26.3 billion, accounting for 77 percent of all federal funding.
The Children’s Health Insurance Program is second on that list, at approximately $777.5 million, accounting for 2 percent of federal funding.
All told, Texas HHS used nearly 200 different sources of federal funding, according to the report.
MEDICAID IN TOM GREEN CO.
FY 2024
| Aged | 1,676 |
| Children | 11,118 |
| Disability | 1,609 |
| Parents | 642 |
| Pregnant women | 1,084 |
| Cervical / breast cancer | 29 |
| Under 21 | 11,637 |
| Twenty-one and older | 4,522 |
| Regular CHIP | 489 |
MEDICAID IN TEXAS
Top Providers
- Memorial Hermann – Houston – Jun. 2024 – $2,164,218,995
- Harris Health – Houston – Sept. 2024 – $2,394,927,745
- U.T. Southwestern (UTHS) – Dallas – Aug. 2024 – $2,695,758,920
- Houston Methodist – Dec. 2023 – $2,707,659,970
- Parkland Hospital System – Dallas – Sept. 2024 – $2,815,225,126
- Mem. Hermann Medical Ctr. (MHHS) – Houston – Jun. 2024 – $2,903,280,872
- University Health Sys. – San Antonio – Dec. 2023 – $2,920,050,710
Data Source: CMS Provider of Services and Hospital Cost Report files
THE MEDICAID LANDSCAPE OF WEST TEXAS
According to information from the Texas Department of Health and Human Service, 4,345,808 Texans were enrolled in Medicaid in FY 2024, and the combined Medicaid and CHIP enrollment in the state was 4,484,303.
_____MEDICAID BY COUNTY _____
Poverty Rates in West Texas
- ECTOR – 16.2 %
- MIDLAND – 11.6
- TAYLOR – 16.2
- TOM GREEN – 13.1
- WICHITA – 15.5
_____ADJACENT COUNTIES______
- COKE – 15.4 %
- CONCHO – 20.2
- IRION – 8.6
- MENARD – 20.6
- SCHLEICHER – 16
- STERLING – 12.1
TEXAS FACTS
Median Household Income in Texas
Estimate 2024: $75,780, plus-or-minus $472
Median Household Income in United States
Estimate 2024: $77,719, plus-or-minus $186
—|2023 American Community Survey 1-Year Estimates
In Texas, the CHIP program is a joint state and federal initiative, with the federal government covering a significant portion of the costs. While the state of Texas spends a considerable amount on CHIP, the exact figures fluctuate, and the federal government often covers a larger share. In 2016, Texas spent $93 million on CHIP, while the federal government contributed $1.2 billion.
UNITED STATES FACTS
Medicaid payments
There are 10 states that receive the Federal Minimum Assistance Payments (FMAP) of 50 percent: California, Colorado, Conn, Mass, Maryland, New Hampshire, New Jersey, New York, Washington and Wyoming.
Theses state received the minimum payment because their per-capita income is significantly higher, relative to the national average.
The lowest per-capita incomes are found in: (in descending order)
- Mississippi – 76.9
- West Virginia – 74.22
- Alabama – 72.63
- New Mexico – 71.66
- Kentucky – 71.41
- Washington, D.C. – 70
- South Carolina – 69.53
- Arkansas – 69.23
- Louisiana – 67.83
In FY 2021, Texas had a FMAP rate of 61.81 percent, but that rate was reduced in four of the last five years.
Texas now receives a 59.83 percent rate, representing a total reduction of 1.98 percent.
This places Texas exactly in the middle of the nation income-wise, but the state has the highest percentage of uninsured residents.
What You Need to Know
Authorized by Title XIX of the Social Security Act, Medicaid was signed into law in 1965 alongside Medicare.
All states, the District of Columbia, and the U.S. territories have Medicaid programs designed to provide health coverage for low-income people.
Although the Federal government establishes certain parameters for all states to follow, each state administers their Medicaid program differently.
Texas is now re-checking eligibility for millions of Medicaid enrollees, and individuals who do not respond to renewal requests, or who are no longer eligible, are likely to lose coverage.
The Children’s Health Insurance Program (CHIP) was signed into law in 1997 and provides federal matching funds to states to provide health coverage to children in families with incomes too high to qualify for Medicaid, but who can’t afford private coverage.
Changes to Medicaid eligibility and enrollment will also affect the Children’s Health Insurance Program (CHIP) as children transition between the two program.
INSIDE MEDICAID
Procedural Denials:
A significant number of Texans have been disenrolled due to procedural reasons, meaning the state didn’t have enough information to determine their continued eligibility, often due to paperwork issues or incorrect addresses.
Work Requirements:
New federal legislation proposes work requirements for Medicaid recipients, potentially impacting those who are not exempt due to disability or age, and could lead to increased administrative costs for the state.
1 Comment
The hospital reply is very weak. It makes me believe they refuse to plan, preferring to react (in a haphazard way) instead.