Tom Suehs, executive commissioner of the Texas Health and Human Services Commission (HHSC), had the final presentation on Saturday. Suehs spoke mostly of a Medicaid crisis and highlighted the fact that the program takes up a growing proportion of the state budget. More than half of the Medicaid budget is spent on hospital care and these payments take the form of lump-sum allocations for the cost of services, which is not always the same as the cost of care for individual patients.

Suehs believes there is enough money in the system to provide the necessary level of care in Texas if only we could find a way to spend more efficiently. This seems to be at odds with some of the access to care data. For example, there are over 100,000 people on the interest list to receive community-based services for the aging and disabled, many of whom experience mental illness, intellectual disabilities and developmental disabilities.

Suehs was also able to provide some very useful information on what the agency is doing to improve Medicaid. HHSC’s six broad initiatives include: (1) the expansion of managed care (largely through a Section 1115 waiver), (2) the development of quality payment systems, (3) attempts to maximize federal funding, (4) encouraging personal responsibility in the utilization of Medicaid services, (5) preventing fraud and abuse, and (6) facilitating health care collaboratives.