Rick Perry is grandstanding again. He has asked HHSC to seek a block grant from the federal government for Medicaid. Anyone who has followed the Medicaid issue over the last few years knows that the probability of getting the feds to agree to a block grant—with all of the exceptions Texas is seeking—is about the same as shooting a unicorn on a hunting trip. Texas previously asked for, and was granted, a five-year waiver that was predicated on the willingness of Texas to expand Medicaid. Medicaid expansion was supposed to be paid for by reducing reimbursement to hospitals, which would be made whole by a reduction in uncompensated care. As we know, Texas did not expand Medicaid, and now the question is, what happens to the 1115 waiver when the state does not expand Medicaid? Is that grant money lost to the state forever? Will the feds try to recoup money from the state? It is my understanding that the state is going to start the next session with a huge hole in the budget due to Medicaid, perhaps as much as $5 billion. This is all about Perry trying to stay relevant by blaming the feds for something he knew was never going to happen on his watch. The things he wants in a block grant would never be approved by the feds, such as an assets test. This was a non-starter. Another issue is whether the counties will be willing or able to fund their 50% to 60% share of Medicaid reimbursement. In short, it’s just another Perry gimmick that allows him to vent his loathing for the federal government. Now the question is whether Greg Abbott will follow Perry’s lead or make an independent determination about what the state should do about its Medicaid problem.

AP Photo | Richard Shiro