Expands health insurance coverage. Provides health insurance coverage for up to 1.5 million adults age 19-64 who earn less than138% of the federal poverty level (i.e., about $1,500/month for an individual or $3,00/month for a family of four), who can’t afford health insurance (or healthcare), at a $90-$10 federal match to state funding.
Promotes personal responsibility. Participants contribute to a health savings account, receive incentives for healthy behaviors, a plan- supported financial pathway to private or employer-sponsored health insurance, and job placement assistance.
Offers enhanced benefits, including vision and dental services for individuals who make consistent contributions to their health savings accounts.
Invests in Social Determinants of Health (SDoH). Allows flexibility in the use of Medicaid dollars to address “upstream” cost factors like housing, nutrition and food insecurity, transportation, and interpersonal violence, to produce better health and wellness and resulting “downstream” savings.
Encourages physician participation through Medicaid-Medicare reimbursement rate parity and incorporating value-based payments from MCOs.
Leverages the strength of Texas’ MCO (managed care) system. Texas’ MCO system has proven cost-effective and able to foster private sector innovation to improve participant health.
Provides an escape hatch / self-destruct mechanism. The program terminates if the federal government takes away the 90/10 match, or if the costs of the program exceed its benefits.