Medicare, a federal program, pays for dialysis for over 80% of dialysis treatments. However, many issues concerning dialysis patients are actually handled at the state level.

Individual states have to provide certain basic services under Medicaid, but they also have flexibility in how they structure their plans and set their reimbursement rates. In addition, some states have the authority to determine the need and location for additional dialysis facilities (this is often referred to as certificate of need). Because dialysis patients’ care can be affected by state officials as well as federal officials, DPC members are becoming more active on state issues—ensuring the patients’ voice is heard locally as well as nationally.

Medicaid Update
The state passed a provider reimbursement rate cut of five to seven percent for care of patients solely covered by Medicaid, effective October 1, 2011. There will be a 5% Medicaid reimbursement cut to dialysis providers for care of patients solely covered by the state’s Medicaid program. That is down from an originally proposed 10% cut. While this will not directly impact patients’ insurance coverage, DPC is concerned about the impact this might have in rural areas of the state where there is an increased possibility that facilities will be forced to cut services or close down. 

The state’s Kidney Health Care (KHC) program, a non-Medicaid benefit program for ESRD patients who meet certain eligibility requirements, had its budget reduced by $4 million. The state has yet to determine whether these cuts will be to the program as a whole or to specific benefits the program offers. Patients who rely on the program for financial assistance with dialysis treatments, access surgery, drugs, travel to health care visits, or with Medicare premiums may be impacted by these cuts.

There are some positives to this budget decision. The state had originally proposed to eliminate Medicaid reimbursement to dialysis providers for care of patients dually covered by Medicare and Medicaid. However, thanks to DPC members’ advocacy, these proposed coinsurance reimbursement cuts were avoided. There is a chance that these reimbursement cuts will be on the table for next year’s budget decision. The Texas Health and Human Services Commission will likely go through a rulemaking process to determine when and how the agency will handle the Medicaid secondary payments in the future.

>DPC’s original comment letter to the state of Texas on these cuts
>State of Texas’ response to DPC letter
>DPC’s Action Alert on these cuts

>Archives of previous Action Alerts for the state of Texas

Texas Dialysis Patient Resources

Texas Department of State Health Services
Kidney Health Care Program
A non-Medicaid, completely state-funded program for persons who have End Stage Renal Disease.  It pays for the dialysis treatment only.  The only requirements to enroll in this program are: the recipient must be a U.S. citizen, legal resident of the state of Texas, and they must get regular dialysis treatments or have received a kidney transplant.  In addition, participants in this program cannot receive Medicaid medical, drug or travel benefits.  Participants may also not make more than $60,000 per year.  Patients should find and complete all the necessary documentation through their social worker at the dialysis clinic they currently utilize.  

The Kidney TRUST
Assists dialysis patients needing help with co-pays, co-insurance and deductibles for medical treatment, services, and prescription drugs. Please note that the Kidney Trust has specific application periods during each year. Please check before you apply.
1-866-399-7634

Texas Renal Coalition
The Texas Renal Coalition has represented patients and families with kidney disease for over 16 years, providing public awareness of the disease, promoting educational resources among the numerous councils, agencies, and legislative bodies involved with kidney and related issues, and advocating change where needed of state and federal programs.  The TRC does this through a network of partners.
7014 Whispering Oaks Drive
Austin, TX 78745
1-512-441-3444

#14 End Stage Renal Disease Network of Texas
4040 McEwen Road, Suite 350
Dallas, TX  75244
1-972-503-3215

Texas Medicaid Program
1-877-541-7905
or In State dial 211

• Adult Programs: Programs include Medicaid buy-in programs, insurance premium assisance and help for the disabled.  
• Programs for Children: Texas families with uninsured children may be able to get health insurance through the Children's Health Insurance Program (CHIP).
• Medication Programs: The Vendor Drug Program can provide links to prescription resources.
• Additional Programs: The Kidney Health Care Program (KHC) Provides assistance to Texas residents with a diagnosis of End-Stage Renal Disease.