Enrollment:
Medicaid | Children's Health Insurance Program | Women's Health Program

Texas’ expenditures on state health programs have increased by more than 150 percent since 2000, and cost the state $33.7 billion in fiscal year 2011, according to the Texas Legislative Budget Board. The federal government pays nearly two-thirds of the costs of Texas’ health and human services agencies, but the state appropriated $55.4 billion, or 32 percent of the total budget, for its share in the 2012-13 biennium.

Those billions budgeted by Texas lawmakers don’t account for increased enrollment, and instead of budgeting more money, lawmakers passed a variety of measures to cut the costs of Medicaid in 2011. The cost-cutting measures include expanding managed care plans across the state and requiring the Health and Human Service Commission to develop “quality-based payment systems” that reward better patient outcomes and reduce preventable readmissions.

The reforms are under way, but far from finalized. The HHSC has formed committees to study and select ways to reduce costs, such as identifying “the ten most overused, unnecessary medical services” and decreasing Medicaid payments for those services. And in December, the federal government approved the state’s plan to expand managed care, which in effect outsources public insurance coverage to private insurers for a set fee each month.

Medicaid enrollees in metropolitan areas such as Houston, Dallas and San Antonio already use managed-care plans. The rollout of managed-care plans across the state is most controversial in South Texas, where a greater percentage of the population is enrolled in Medicaid. Lawmakers from South Texas argued during the legislative session that it would limit Medicaid patients' access to health care, because fewer doctors in an already overcrowded system would accept Medicaid clients.

The map and sortable table below show Medicaid enrollment by county. The Texas Tribune calculated the percentage of each county population covered by Medicaid using Health and Human Services enrollment data for June 2011 and 2011 population projections from the Texas Department of State Health Services. Therefore, the percentage of the population enrolled should be considered a rough estimate.