Making Democracy Work

Health Care for the Elderly

Elderly Couple

Updates by Lynda Ender Health Care for ElderlyTexans Issue Chair


Coalitions and Resources


  • Texas Senior Advocacy Coalition The mission of the Texas Senior Advocacy Coalition is to develop and actively support public policy to protect and enhance the quality of life for older adults and their families.


Acronyms: What Does That Mean?

Position LWV-TX


The League of Women Voters of Texas supports a comprehensive health care system for older Texans that ensures a seamless continuum of quality care. Access to health care should include:

  • statewide and local information and referral networks which provide clear, correct, and consistent information about publicly funded health care programs and eligibility requirements

  • development of programs to provide adequate and affordable transportation for clients and health care providers.

Health care for older adults should include:

  • integration of health care services, including developing an individual health care plan and providing a continuum of services, such as health care screening, prevention services, acute care, long-term care, and hospice care

  • a variety of long-term care services and alternative housing options in sufficient quantities to provide the level of care appropriate for each individual

  • options that include home and community-based services, in addition to institutional care

  • programs that address limitations to access in rural and other medically underserved areas for dentistry, hearing and vision services, mental health services, and long-term care

  • innovative programs that use waivers and blending of funds to customize services to fit individual and community needs

  • access to prescription drugs which is not limited by the ability of an individual to pay for them.

Actions to achieve high quality health care should include:

  • adoption and strict enforcement of high standards for all long-term care services for older Texans

  • programs to improve the training, pay, benefits, and retention of personnel engaged in planning, regulation, and delivery of care

  • policies that promote training in geriatrics at all levels of medical and nursing education

  • coordination of benefits from Medicare, Medicaid, and other publicly funded programs in order to serve individuals who are eligible for more than one program

  • sufficient funding to support comprehensive, high quality health care for older adults.

Position LWV-US

Issue Studies and Explanation

Reflecting a widespread interest in issues surrounding health care, delegates to the 1999 LWV- TX Convention approved the Continuum of Health Care for Older Adults study. Focused on health care options for older adults, the study examined existing laws and regulations relating to health care for older adults; a wide range of health care options for indigent and non-indigent older adults at varying states in their lives; and accessibility to available health care options including the financial implications of these options. A study committee produced a Facts & Issues: A Continuum of Care: Health Issues for Older Adults, 2000, which was distributed to League members, public officials and agencies, and other interested groups and individuals. Consensus was reached in the fall of 2000 and the state board approved the new position in November of that year.

History of LWV-TX Action

2001: The League followed a large number of bills related to long-term care, nursing homes and related areas. Many of the bills passed and indicate that Texas is taking health care more seriously than in the past. Bills related to pharmaceuticals will allow more information about pharmaceutical assistance programs, bulk purchasing of prescription drugs and a state prescription program for certain Medicare beneficiaries. Other bills would allow for dental services to some recipients of medical assistance, require health maintenance organizations to provide periodic health evaluations, establish a medical assistance buy-in pilot program for certain people with disabilities, and establish a program of all-inclusive care for the elderly. Other bills that passed will improve case management for Medicaid recipients and improve services through telemedicine.

Other bills that passed will improve health care in rural areas, further protect nursing home residents, and provide an opportunity for nursing homes to purchase liability insurance from the Texas Liability Insurance Underwriting Association as well as allowing the state to make grants to nursing homes that demonstrate "best practices." A temporary measure to rescue nursing homes as a result of the current crisis in liability insurance also passed. This law includes means to insure quality of care with an early warning and amelioration process and a quality assurance fee (or bed tax) for nursing homes in order to increase nursing home reimbursement rates.

2003: The 78th Legislative session was faced with a budget crisis that resulted in decreased funding of health care for the elderly and disabled. Community care programs were reduced. Medical services for the elderly on Medicaid will no longer cover counseling, podiatric and chiropractor care, eyeglasses, hearing aids, and other optional benefits. The personal needs allowance for those on nursing home Medicaid was also reduced although legislation was proposed in the first special session to reverse this.

Health and Human Services is being reorganized and a state agency created called Department of Disability and Aging will be responsible for programs that were originally under the Department of Aging. Whether these changes will be more efficient is yet to be seen. The budget crisis drove the legislative session and hence this was not a good session for the advancement of care for the elderly.

2005: The major concern for the 79th Legislative Session was funding of programs and the hope that cuts from the 78th Session would be restored. Funding to provide eyeglasses, hearing aids, mental health services and podiatry benefits for adult Medicaid clients was restored. The 79th budget provides funds to increase enrollment in a number of non-entitlement community care and health programs that had been reduced in the previous session. The budget assumes lower caseloads for Medicaid and cost per client and includes funding to reduce waiting lists. There is some anticipated cost savings from greater management care for the aged, blind and disabled Medicaid clients. Proposed change to Medicaid Managed Care was most controversial. Some compromises were made and some models will be implemented in the Dallas area.

Long-term care programs now reside in the Department of Aging and Disability Services (DADS). Most DADS services are through Medicaid. Nursing facility rates were not restored nor increased and there is a possibility of a nursing home deficit. At the last minute, the governor vetoed "a quality assurance fee," a type of bed tax on nursing homes that would have provided funds for rate restorations and increases to nursing home facilities. Consequently this leaves DADS without state funding for nursing home rate restorations or updates and without basic operating funds. Medicaid provider rates were not increased nor restored to previous rates, but remain at the 2003 rates. In addition the personal needs allowance remains at the 2003 level.

2007: The 80th Legislature passed no major legislation for senior health care. The personal needs allowance for Nursing Home Medicaid recipients was increased to $60/month. A bill was passed to establish the creation of nursing home family councils. Legislation was passed to make long term care insurances for Medicaid consistent with federal law under the Deficit Reduction Act of 2005.

2013: The debate over Medicaid overshadowed much of the session. Sweeping changes were proposed relating to how the state administers the program. Some of the changes came from studying the changes to Medicare in the Affordable Care Act. Many of the changes are expected to improve the quality of care and cost effectiveness of the Medicaid program and to combat fraud. SB 7 and SB 8, by Senator Jane Nelson, contained some of the largest changes to the way the state administers Medicaid. SB7 redesigns long-term and acute care services for the elderly, which are among the most costly services provided by Medicaid, and allows Medicaid managed care to cover services provided in nursing homes. SB 8 bars providers who have been found guilty of Medicaid fraud in Texas or elsewhere from participating in the Texas program.

Legislators turned down Medicaid expansion and the $90 billion it would provide over 10 years.

Medicaid reimbursement for many services did increase. For example, nursing home reimbursement increased 2% the first year and 4% in the second year. Attendant care salaries were increased $.50 in 2013 and $.50 more in 2014.

Legislation passed to establish a reuse program for durable medical equipment provided to recipients under the Medicaid program.