Nursing homes are also finding it difficult, according to the Texas Health Care Association.
"We care for 60,000 elderly and disabled Texas seniors dependent upon Medicaid, and our facilities simply cannot continue to operate at current staffing levels if Medicaid funding remains well below the actual cost of caring for our elderly," said Julie Sulik, chair of the group's nursing council. The Legislature would need to boost reimbursement rates more than 16 percent to cover the actual cost of caring for the elderly poor, the group said.
President Barack Obama's Affordable Care Act will boost reimbursement rates for eligible primary-care doctors this year at no cost to the state, and pending state legislation would boost payments to obstetricians and gynecologists because they serve as primary care providers for many women. Doctors in other specialties would see no change.
Democrats have said the only problem with Medicaid is the Legislature's decision not to fund it. They recommend closing tax loop holes or raising taxes.
"People will swallow increasing taxes for certain things; they are not going to swallow raising taxes for the indigent health care program," Zerwas said.
He has submitted legislation that would request federal waivers to allow Texas to find savings from places other than provider rates. Part of that solution is subsidizing private insurance for working adults who don't get it through their employer and cannot afford it. The ACA calls for those adults to join Medicaid, but conservatives oppose any expansion of Medicaid and even Zerwas' private sector alternative faces an uphill battle.
Gov. Rick Perry is pushing for a block grant, where the federal government gives Texas all of the funding without any regulations attached. The last time Texas made that request, the Bush administration turned it down.
"I'm a believer in a block grant, but I'm enough of a realist to understand that probably is not going to happen," Zerwas said.
House Bill 3791: http://www.legis.state.tx.us/BillLookup/History.aspx?LegSess=83R&Bill=HB3791