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White Paper: Examining the Need for a Rate Increase to IDD Community-Based Providers

I. Background

Medicaid Overview

With a total FY 2018-2019 biennial appropriation of $61.8 billion all funds (AF), the Medicaid program makes up just over 28% of the entire state budget.[i]And, because the program is an entitlement with open-ended funding, and is largely ruled by federal laws and regulations, the state has limited control in curbing Medicaid population growth and costs. In State Fiscal Year (SFY) 2017, Texas Medicaid served just over 4 million low-income, elderly, and individuals with disabilities.[ii]The program funds about 53% of all births in Texas, and covers 62% of all nursing facility residents.[iii]

Even though our state has one of the nation’s largest Medicaid programs,[iv]Texas largely covers only mandatory populations required by the federal government. The table below shows the population groups that are covered by Texas’ program, and which are mandatory versus optional.

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