Proposed Rule Change – Medicaid Cost Sharing Payments for Dual Eligibles

Release from HHSC:

The Texas Health and Human Services Commission (HHSC) proposes to amend its rule on payment of coinsurance and deductibles for Medicare services provided to individuals who are eligible for both Medicare and Medicaid, known as dual eligibles. The proposed rule change allows HHSC to pay the Medicare deductible and coinsurance on a crossover claim at a higher amount, if HHSC determines that higher payment for a Medicaid service is necessary to ensure adequate access to care or is more cost-effective to the state. The higher payment amount may not exceed the greater of the deductible and coinsurance or the amount remaining after the Medicare payment amount is subtracted from the Medicaid payment rate for services. HHSC may make the higher payment only when it has been approved by the Centers for Medicare and Medicaid Services, as specified in the Medicaid State Plan.

Scheduled public comment: · May 10, 2012: Medical Care Advisory Committee

Questions and comments may be directed to Carisa Magee, Policy Advisor, Medicaid/CHIP Policy Development, at 512-491-1412 or


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