1-1     By:  Chavez (Senate Sponsor - Shapleigh)             H.C.R. No. 214
 1-2           (In the Senate - Received from the House May 7, 2001;
 1-3     May 7, 2001, read first time and referred to Committee on Business
 1-4     and Commerce; May 10, 2001, reported favorably by the following
 1-5     vote:  Yeas 6, Nays 0; May 10, 2001, sent to printer.)
 1-6                         HOUSE CONCURRENT RESOLUTION
 1-7           WHEREAS, The Texas-Mexico border region suffers from an
 1-8     inadequate medical infrastructure that has led to disparities in
 1-9     access to health care between the border region and the rest of the
1-10     state; and
1-11           WHEREAS, Statewide in 1998, there was an average of 270
1-12     Medicaid-eligible patients for every physician participating in the
1-13     Medicaid program, but in the border counties where there were
1-14     participating physicians, the number of eligible patients per
1-15     physician ranged from a low of 416 in El Paso County to a high of
1-16     1,361 in Starr County; in two counties, Presidio and Zapata, there
1-17     were no participating physicians at all to serve the
1-18     Medicaid-eligible population; and
1-19           WHEREAS, The border region historically has had high
1-20     patient-to-physician ratios, resulting in limited access to health
1-21     care services and reduced utilization rates for these services; in
1-22     addition, the availability of medical care in Mexico may also
1-23     reduce utilization rates for the region; and
1-24           WHEREAS, Low utilization rates along the border create a
1-25     distorted assessment of the actual demand for services and
1-26     inappropriately drive down the capitated reimbursement rates for
1-27     both Medicaid and the Children's Health Insurance Program (CHIP);
1-28     and
1-29           WHEREAS, The average per-recipient reimbursement for the
1-30     border region is 16 percent less than the statewide average, which
1-31     creates a disincentive for health care providers to locate and
1-32     provide services to Medicaid clients in the region; furthermore,
1-33     low reimbursement rates complicate already limited access to health
1-34     care as existing providers either leave the program or limit their
1-35     participation; and
1-36           WHEREAS, Current Medicaid and CHIP reimbursement rates simply
1-37     trap the Texas-Mexico border counties in a cycle of limited access
1-38     to care, low utilization rates, and low reimbursement rates, all of
1-39     which further damage the medical infrastructure of the region and
1-40     create greater barriers to health care access for Medicaid and CHIP
1-41     clients; and
1-42           WHEREAS, The unique issues facing the border may not be
1-43     apparent when evaluations of the state as a whole mask
1-44     discrepancies between the border and the rest of the state;
1-45     calculating the federal share of the state's Medicaid costs, or the
1-46     Federal Medical Assistance Percentage (FMAP), using the state's per
1-47     capita income may not provide an accurate assessment of the border
1-48     region's needs; and
1-49           WHEREAS, Establishing a separate FMAP for the border region
1-50     would recognize these unique circumstances and allow current state
1-51     Medicaid funding in the region to draw down additional federal
1-52     funds that would help eliminate the reimbursement disparity; and
1-53           WHEREAS, Unless this disparity is resolved, the region will
1-54     continue to suffer from an inadequate health care infrastructure
1-55     that is unable to address the medical needs of the border
1-56     residents; now, therefore, be it
1-57           RESOLVED, That the 77th Legislature of the State of Texas
1-58     hereby  respectfully urge the Congress of the United States to
1-59     establish a separate Federal Medical Assistance Percentage for the
1-60     Texas-Mexico border region; and, be it further
1-61           RESOLVED, That the Texas secretary of state forward official
1-62     copies of this resolution to the president of the United States, to
1-63     the speaker of the house of representatives and the president of
1-64     the senate of the United States Congress, and to all the members of
 2-1     the Texas delegation to the congress with the request that this
 2-2     resolution be officially entered in the Congressional Record as a
 2-3     memorial to the Congress of the United States of America.
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