Senator Eliot Shapleigh - El Paso, Texas

AUSTIN - The chairman of the House Appropriations Committee says he is now confident legislators can deal with the implications of looming Medicaid lawsuit without wreaking havoc on the state budget.

Rep. Warren Chisum, R-Pampa, said his panel was already working with the Health and Human Services Commission and medical professionals on the cost of implementing a package of measures that will help improve health care access for the 2.8 million Texas children on Medicaid.

The lawsuit, long argued over in various courts, is known as Frew v. Hawkins and was brought by San Antonio attorney Susan Zinn and Woodlands attorney Jane Swanson on behalf of many economically disadvantaged families from across the state.

The attorneys have successfully argued that Texas does not provide good enough access to health care for children in the Medicaid program.

“We realize we need to get out in front on this. We plan to bring in some mobile dental clinics, start to raise reimbursement rates for doctors, and bring more people on board to treat the kids,” Chisum told the Guardian.

“It will not be cheap but we think we can do it without breaking the budget. It will not solve the problem and the judge will not release us from our obligations but we think it is a reasonable place to start.”

Chisum's comments are the clearest indication yet that state attorneys now believe they have exhausted all legal avenues.

At a hearing in Austin on April 9, 87-year-old federal Judge William Wayne Justice is expected to issue a corrective action plan the state must adhere to in order to improve access to health care for 2.8 million Texas Medicaid children.

There has been speculation that the total cost of implementing the corrective action plan will reach $5 billion. Chisum said he does not believe it will be that high. He said he is confident that if the state commits $500 million this year, with, possibly, a similar amount next year, Justice will agree.

“We think we can take certain actions and go with these to the judge. We can make $500 million this year without having to make across the board cuts,” Chisum said.

As an act of good faith, the Appropriations Committee on Monday added $2 million to the state budget to fund a pilot project for a series of mobile dental clinics.

Rep. Ryan Guillen, D-Rio Grande City, who proposed the measure, told the Guardian that the pilot project would start out in Starr County, one of the most impoverished counties in the nation.

“We want to see all the kids show up and get help,” Chisum said. “They will not have to bring a card, like they do when they go to the emergency room.”

Chisum said that by putting more emphasis on preventative and primacy care, the state would, in the long run, save a lot of money. “We will be able to reduce costs and the overload in our emergency rooms.”

Chisum laughed off suggestions that Republican leaders believed their best hope of avoiding a huge bill for the corrective action plan was for Judge Justice not to make it to April 9.

“I have heard that talk but I hope he lives to a ripe old age,” Chisum said. “I have dealt with him in the past and, at the end of the day, I know he can be a very reasonable person.”

Swanson said the big winners in the lawsuit would be the poorest families in the state, many of whom live on the border.

“More than 1.4 million indigent Texas children didn't even get one medical checkup in 2005, which is the most recent information Texas Medicaid officials have given us,” Swanson said. “The number is even higher for basic dental care.”

According to HHSC’s Web site, the most recent data on children under-19 enrolled in Medicaid is for May 2006. That month, there were 134,134 children under-19 enrolled in Medicaid in Hidalgo County, 104,898 in El Paso, 71,362 in Cameron County, and 37,663 in Webb County.

“About one third of our state’s children have Medicaid. If they don’t get care when they need it, their health will suffer. They won’t be able to achieve their full potential in school or later as adults,” Zinn said.

Swanson said she had little sympathy for lawmakers bleating that the state could not afford to implement the court ruling.

“The costs would have been a lot less in several respects had the state complied a lot earlier,” Swanson said. She cited a Children and Pregnant Women Managed Care program that had been left “moribund” for years.

If, as the lawsuit called for, the state had put more money into primary and preventative care, there would have been far less visits to the emergency room by Medicaid children, and thus a lower bill for the state, Swanson said.

“It would be really great if the representatives would work with us on a corrective action plan but there is no indication the state attorneys will do so,” Swanson added. “It’s a shame they will not work with us. It’s not as if they have a great track record going down the legal path they chose to go down.”