HOUSE CONCURRENT RESOLUTION 1-1 WHEREAS, The Texas-Mexico border region suffers from an 1-2 inadequate medical infrastructure that has led to disparities in 1-3 access to health care between the border region and the rest of the 1-4 state; and 1-5 WHEREAS, Statewide in 1998, there was an average of 270 1-6 Medicaid-eligible patients for every physician participating in the 1-7 Medicaid program, but in the border counties where there were 1-8 participating physicians, the number of eligible patients per 1-9 physician ranged from a low of 416 in El Paso County to a high of 1-10 1,361 in Starr County; in two counties, Presidio and Zapata, there 1-11 were no participating physicians at all to serve the 1-12 Medicaid-eligible population; and 1-13 WHEREAS, The border region historically has had high 1-14 patient-to-physician ratios, resulting in limited access to health 1-15 care services and reduced utilization rates for these services; in 1-16 addition, the availability of medical care in Mexico may also 1-17 reduce utilization rates for the region; and 1-18 WHEREAS, Low utilization rates along the border create a 1-19 distorted assessment of the actual demand for services and 1-20 inappropriately drive down the capitated reimbursement rates for 1-21 both Medicaid and the Children's Health Insurance Program (CHIP); 1-22 and 1-23 WHEREAS, The average per-recipient reimbursement for the 1-24 border region is 16 percent less than the statewide average, which 2-1 creates a disincentive for health care providers to locate and 2-2 provide services to Medicaid clients in the region; furthermore, 2-3 low reimbursement rates complicate already limited access to health 2-4 care as existing providers either leave the program or limit their 2-5 participation; and 2-6 WHEREAS, Current Medicaid and CHIP reimbursement rates simply 2-7 trap the Texas-Mexico border counties in a cycle of limited access 2-8 to care, low utilization rates, and low reimbursement rates, all of 2-9 which further damage the medical infrastructure of the region and 2-10 create greater barriers to health care access for Medicaid and CHIP 2-11 clients; and 2-12 WHEREAS, The unique issues facing the border may not be 2-13 apparent when evaluations of the state as a whole mask 2-14 discrepancies between the border and the rest of the state; 2-15 calculating the federal share of the state's Medicaid costs, or the 2-16 Federal Medical Assistance Percentage (FMAP), using the state's per 2-17 capita income may not provide an accurate assessment of the border 2-18 region's needs; and 2-19 WHEREAS, Establishing a separate FMAP for the border region 2-20 would recognize these unique circumstances and allow current state 2-21 Medicaid funding in the region to draw down additional federal 2-22 funds that would help eliminate the reimbursement disparity; and 2-23 WHEREAS, Unless this disparity is resolved, the region will 2-24 continue to suffer from an inadequate health care infrastructure 2-25 that is unable to address the medical needs of the border 2-26 residents; now, therefore, be it 2-27 RESOLVED, That the 77th Legislature of the State of Texas 3-1 hereby respectfully urge the Congress of the United States to 3-2 establish a separate Federal Medical Assistance Percentage for the 3-3 Texas-Mexico border region; and, be it further 3-4 RESOLVED, That the Texas secretary of state forward official 3-5 copies of this resolution to the president of the United States, to 3-6 the speaker of the house of representatives and the president of 3-7 the senate of the United States Congress, and to all the members of 3-8 the Texas delegation to the congress with the request that this 3-9 resolution be officially entered in the Congressional Record as a 3-10 memorial to the Congress of the United States of America. Chavez Gutierrez _______________________________ _______________________________ President of the Senate Speaker of the House I certify that H.C.R. No. 214 was adopted by the House on May 5, 2001, by a non-record vote. _______________________________ Chief Clerk of the House I certify that H.C.R. No. 214 was adopted by the Senate on May 22, 2001, by a viva-voce vote. _______________________________ Secretary of the Senate APPROVED: __________________________ Date __________________________ Governor