Texas already has the narrowest Medicaid eligibility standards and spends the second least of any state on health care for the poor per capita. But that hasn’t stopped Gov. Rick Perry from advocating that Texas to opt out of Medicaid altogether and receive less generous block grants that would allow it to institute even harsher limits to the program.
The three-term governor recently signed legislation that would effectively petition the government to block grant the Medicaid program , which the Obama administration will likely reject. But back in 2008, he tried his luck with President Bush. Perry’s request asked for two big things: authority to implement enrollment caps in Medicaid and additional federal dollars to establish a “Texas pool to help low-income people buy private insurance.”
The Bush administration denied the waiver, arguing that Perry’s Medicaid reforms were too restrictive. From the federal government’s August 7, 2008 letter to the Texas Health and Human Service Commission:
The proposal to include a benefit limit of $25,000 on the parents/caretaker relatives, is one that cannot exist under Medicaid for this group. In addition, there is no precedent under CMS-approved demonstrations to approve an annual benefit limit as low as $25,000 even for an expansion population.
The proposal did include several progressive elements. Texas sought to use additional federal dollars to provide premium assistance to children enrolled in the children’s health insurance program and infrastructure grants for community-based programs. Most interestingly, the state also requested authority to cover immigrant “children with family income below 200 percent” of the federal poverty line” who had not yet met the 5-year waiting period. In 2008, “federal law required a 5-year waiting period before many legal immigrants were permitted to enroll in Medicaid and CHIP, although many States offered health coverage to these populations with State-only funds.” President Obama lifted the 5-year ban in 2009.
Still, the fact that Texas’ Medicaid stinginess was ultimately rejected by the Bush administration — itself no fan of government health care — speaks volumes of Perry’s disinterest in covering the poorest Americans and explains his state’s high uninsurance rates.