Enrollment in Texas Medicaid—4.7 million—is larger than the entire state population of Kentucky. For 2017, Texas has allocated $30.6 billion for its Medicaid program. That is more than the GDP of the entire country of Bahrain.

Texas Medicaid is a huge program that was intended to serve the medically vulnerable in the state of Texas. Ironically, 3 million of the 4.7 are some of the least sick people in Texas: children under the age of 18. So, where is all that money going? When $30.6 billion is divided by 1.7 million people, Texas is spending $18,000 per adult Medicaid enrollee per year. 

The Texas Medicaid Fund comes partly from Washington (58 percent) and partly (42 percent) from state General Revenue. However, decisions regarding how to spend are made 100 percent at the Centers for Medicare and Medicaid Services (CMS), 7500 Security Boulevard, Baltimore, Maryland 21244.  

ObamaCare insurance regulations strictly control Texas Medicaid eligibility, verification, reimbursements, benefits, and compliance oversight. Those are the major cost drivers of the Medicaid program. The American Health Care Act, despite promising to increase flexibility at the state level, makes no attempt to repeal the ObamaCare regulatory mandates. Thus, Texas has essentially no say in how and where $30.6 billion in Medicaid monies are spent.

Ask yourself two rhetorical questions. Who knows what is best for Texans—Washington or Texas? Who is more responsive to your telephone calls, your concerns, and your vote: your Texas legislator, or your Congressional delegation?

Your answer will determine whom you want in charge of your healthcare. I suspect that person lives in Texas, possibly down the street from you.

Texans understand that medical concerns in Midland County are quite different from what people need in Hidalgo County. The medical needs in downtown Austin are not the same as in downtown Detroit. Washington’s one-size-fits-all approach doesn’t work.

The person most likely to get Texans the care they need when and where they need it should be the one who controls the money. That is not the case at present. For the welfare of nearly five million Texans enrolled in Medicaid, Texas should control the program.  

Our state and federal legislators should work diligently to return control of Texas Medicaid to Texas. That starts with a waiver of all federal mandates and a no-strings block grant. This will allow Texas to design a system more effective for our Medicaid population that stops taking money away from other vitally important state spending on activities such as education and infrastructure.

The way to accomplish release from federal Medicaid handcuffs is detailed in a just-released paper titled, “The Saga of 1115—A Waiver Can Fix Texas Medicaid, But Only Temporarily.” Texas should start with a waiver, but waivers are transient. They generally last five years or less. While the waiver is in effect, the Lone Star State should do what is necessary to obtain permanent control of its own Medicaid program.