Senator Eliot Shapleigh - El Paso, Texas

AUSTIN -- Lawmakers are working to put more children on the state Children's Health Insurance Program and Medicaid, but even if they succeed, those kids may have a tough time finding doctors in El Paso willing to see them.

The problem, according to physicians' groups, is that doctors' pay from state-funded health-care programs is simply not enough to maintain a viable business.

A 2008 survey taken by the Texas Medical Association showed that only 42 percent of the state's doctors said they would take on new Medicaid patients. The numbers were even lower -- 34 percent -- for CHIP patients.

"It's a business proposition," said Dr. Raj Marwah, spokesman for the El Paso Medical Society.

Marwah said that private physicians essentially run small businesses and see state-funded patients at a loss. A mix of privately insured patients and state-funded patients is ideal, he said, but a practice cannot remain financially viable with many CHIP and Medicaid patients.

Of El Paso's 230,000 children, 120,000 are enrolled in either CHIP or Medicaid according to the Paso del Norte Health Foundation, meaning many patients for El Paso doctors come from those low-paying state programs.

Dr. Jane Rider, a San Angelo pediatrician with the Texas Medical Association, said a doctor may also refuse to take on additional CHIP or Medicaid patients due to a complex compensation process and arduous re-enrollment paperwork that results in some children losing enrollment in the coverage they need.

After their first birthday, children must be re-enrolled in Medicaid every six months. The difficulties of re-enrollment mean sometimes a child will have insurance and sometimes not, she said.

"It's really difficult for us to manage children with chronic diseases when they go on and off coverage and when they get can get medicines sometimes and others they can't," Rider said.

State Sen. Eliot Shapleigh, D-El Paso, said the low pay rates for public health programs means doctors can't afford to invest in new technology to provide better care for their patients.

"Reimbursement rates in CHIP and Medicaid are below costs," Shapleigh said.

Shapleigh has filed bills that would make children in families with incomes of about $63,600 or less eligible for the program and extend Medicaid enrollment to periods of 12 months at a time instead of six months. The Texas Medical Association supports both measures, and also wants to see Medicaid pay raised for doctors.

Shapleigh said significant health-care funds will be available this session to raise pay for doctors. In the compromise federal economic stimulus bill passed Thursday by the Congress, $87 billion was designated to help states pay for Medicaid costs. A bill signed by President Obama could also increase the state's CHIP allocation by 72 percent.

"We're all committed to giving the kids the care they need we just have to have the tools to do it," Rider said.

In the 2007 session, the Texas Legislature raised compensation rates for doctors across the board by an average of 25 percent and by 50 percent for dentists.

Rider said that in 2007 her organization saw the number of physicians participating in the program slightly rise after four years of declines.

With even more state support, Rider said, more Texas children could have access to doctors and necessary health care.