House lawmakers have given an early okay to Rep. Lois Kolkhorst’s bill to ask Washington for a block grant to run Medicaid — the joint state-federal health care program for children, the disabled and the very poor — as Texas sees fit.

Kolkhorst said states can seek all kinds of waivers from the Centers for Medicare & Medicaid Services; Texas sought one unsuccessfully during the Bush administration. Her measure would direct the state's Health and Human Services Commissioner to ask Washington to consolidate all the funding it currently provides for Medicaid, and give Texas five years worth of those funds to try out its own state-run Medicaid program. Kolkhorst is betting Texas can use money more efficiently and cover more people under Medicaid than are currently covered without cutting benefits — via vouchers, health savings accounts and “sliding scale” coverage.

But opponents have argued that's a pipe dream, and the only way Texas could operate Medicaid on its own is by slashing benefits for people who need them. They have said block grants won't take into account medical inflation over the five-year time period, leaving Texas in the hole. And they argue there’s no way the Obama administration will sign on to a plan that effectively cedes control of Medicaid to Texas, even though they've approved such waivers in small states like Rhode Island.

No one spoke against the bill on Tuesday, even Rep. Garnet Coleman, D-Houston — who said that Kolkhorst added some mental health language that was particularly important to him.

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"The most important thing when we do a waiver, or when any of us looks at the Mediciad program, is to just remember that these are people at 100 percent of poverty or below," Coleman said.  

And Kolkhorst said that the Obama administration has already seemed far more flexible with Medicaid than the Bush administration.

“I call this the ‘permission bill’ from CMS, to see if we can work with them to find a common ground in trying to cover more, and have a little bit more flexible of a program,” she said. 

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