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By W. Gardner Selby April 25, 2016

Greg Abbott's vow to seek block-grant Medicaid funding unfulfilled

Greg Abbott stumped for governor by saying the state should seek federal approval to receive Medicaid aid via block grants with the state, he said, better managing how such money is spent.

Some 15 months into Abbott's governorship, it doesn't look like he's made that block-grant request. We speculate that's because Congress has to act for such block grants to be possible.

Medicaid, launched by Congress in the 1960s, mostly guarantees health coverage to the elderly, adults with disabilities and children living at or near the federal poverty line; federal aid covers more than half the costs. As of 2016, some 4 million Texans were beneficiaries, according to preliminary counts.

In the Healthy Texans plan issued by his campaign, Abbott wrote that federal waivers previously granted for the state to control some federal spending had proven inefficient. In 2011, he said, the state won approval of a Medicaid "transformation" waiver to establish a risk-based incentive pool allowing regional healthcare providers to focus billions of dollars in funding over five years on experimental programs to improve health outcomes.

But federal approvals weren't secured, Abbott said, until May 2013 with about 200 additional projects not OK'd until summer 2014. "Many of the approved projects required two years to implement," Abbott said. "The time and resources exhausted in administering this five-year demonstration waiver could arguably have been better spent if the state was allowed to operate its Medicaid program without the constant need for approval from the federal Centers for Medicare and Medicaid Services."

We spotted no signs of Abbott seeking to fulfill this promise.

To our inquiries, neither Abbott's office nor the Texas Health and Human Services Commission offered substantive comment. Commission spokesman Bryan Black suggested we check on campaign promises with Abbott's office and Abbott's state spokesman, John Wittman, didn't reply to queries.

We did hear back from Anne Dunkelberg of the Austin-based Center for Public Policy Priorities, which advocates for programs serving low-income Texans. Dunkelberg, indicating the center has seen no Abbott movement on achieving block-grant funding of Medicaid, floated a potentially big reason why. By email, Dunkelberg said that only Congress, rather than the U.S. Department of Health and Human Services or its subsidiary Centers for Medicare and Medicaid Services, can authorize Medicaid funding by block grants--and Congress hasn't done so.

That is, Dunkelberg said, key Medicaid provisions can't be waived absent Congress changing the law. One proviso is that all individuals designated by a state as Medicaid-eligible be served, she said, the other is that each state's entitled to matching federal dollars for services provided its eligible residents.

Correct, echoed an expert with the liberal Washington, D.C.-based Center for Budget Policy Priorities. Judy Solomon said by phone that block-grant advocates sometimes invoke a complicated deal reached by Rhode Island toward the end of George W. Bush's presidency as demonstrating that block funding can occur absent congressional involvement. The reality, Solomon said, is that Congress has yet to approve changes in law permitting states to run Medicaid with block grants.

Our search of the Nexis news database yielded no accounts of Abbott or fellow Republican leaders pitching and wooing federal officials to block-grant Medicaid. A March 2015 Houston Chronicle news story said Lt. Gov. Dan Patrick and other Republicans had just declared a willingness to widen access to Medicaid in Texas, in accord with the Obamacare law, if President Barack Obama's administration agreed to various actions -- though the requests didn't evidently made no mention of block-granting Medicaid.

Finally, we heard back from Aaron Taylor, a spokesman for the Centers for Medicare and Medicaid Services. Taylor said by email federal officials hadn't received a Medicaid block-grant proposal from Texas.

Abbott inaction? PROMISE BROKEN.

Promise Broken – The promise has not been fulfilled. This could occur because of inaction by the executive or lack of support from the legislative branch or other group that was critical for the promise to be fulfilled. A Promise Broken rating does not necessarily mean that the executive failed to advocate for the policy.

Our Sources

Emails, Bryan Black, press officer, Texas Health and Human Services Commission, Feb. 9 and 17 and April 18, 2016

Emails (excerpted), Anne Dunkelberg, associate director, Center for Public Policy Priorities, Feb. 10, 2016 and April 18, 2016

Telephone interview, Judy Solomon, vice president for health policy, Center for Budget Policy Priorities, April 18, 2016

News story, "Texas Republicans demand Medicaid flexibility from Obama," Houston Chronicle, March 2, 2015

Emails, Aaron Albright, director, Media Relations Group, Centers for Medicare and Medicaid Services, April 21, 2016

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