Texas Senate Bill SB1190

Texas 2021 - 87th Regular

Caption

Relating to a direct primary care model pilot program for Medicaid.

Impact

If enacted, SB1190 will amend existing state law by introducing a framework for direct primary care within the Medicaid program. Physicians participating in the pilot are not required to enroll as traditional Medicaid providers, which may attract more healthcare professionals to participate. The program also stipulates specific eligibility criteria for both physicians and recipients, such as age limitations for Medicaid recipients and the requirement that physicians must not accept third-party payments for their services. This could lead to a shift in how primary care services are delivered to Medicaid recipients, emphasizing a more personalized care approach.

Summary

Senate Bill 1190 aims to establish a Direct Primary Care Model Pilot Program for Medicaid in Texas. This program allows Medicaid recipients to enter into medical service agreements with participating physicians, who will provide primary medical care services in exchange for a direct fee. The objective of this pilot program is to test the feasibility and effectiveness of direct primary care as a model for improving access and lowering costs within the Medicaid system. The program is designed to bring direct contracts between patients and providers, thereby reducing reliance on third-party insurers for primary care services.

Contention

Despite its potential benefits, the introduction of a direct primary care model raises notable concerns among stakeholders. Critics may argue that this model could inadvertently limit access to care for certain populations, particularly in areas where physicians are unwilling or unable to participate in the program. Additionally, there could be fears around the financial implications of such a model, including out-of-pocket costs for Medicaid recipients. The bill also sets a termination date for the pilot program, which could foster ongoing debate about its long-term viability and effectiveness in improving healthcare delivery for Medicaid recipients.