Assessing the Impact of Medicaid and SCHIP Reimbursement Rates on Access to Care in Texas

Adequacy of the provider network in the Medicaid program has been a longstanding area of concern to policymakers, program administrators and providers. Dissatisfaction with Medicaid reimbursement rates has deterred some providers from participating in Medicaid and has pushed others to limit their Medicaid clientele. Since reimbursement rates in the State Children’s Health Insurance Program (SCHIP) are similar to Medicaid rates, there is also concern that such rates may not be high enough to ensure adequate levels of provider participation. In general, Medicaid reimbursement rates in Texas appear to be average when compared to other states. However, within the state, Medicaid and SCHIP rates are significantly lower than those of Medicare and commercial payors. It is unclear what impact Medicaid and SCHIP reimbursement rates in Texas have on the adequacy of the provider network. Surveys reveal provider dissatisfaction with rates, but the network of providers in Texas appears to be sufficient in most areas. Reimbursement rates in the border area merit special attention because of the unique population, culture and other healthcare issues that surround this geographic location. Medicaid clients and providers alike are forced to overcome barriers that do not exist in the rest of the state. In order to help make better-informed decisions about how to use limited funds to enhance provider reimbursement rates in Texas, the creation of a central depository of reimbursement data is needed, along with additional studies to evaluate Medicaid reimbursement rates and methodologies.