Kyle Janek, who used to represent Galveston County in the Texas Senate and who is now the new executive commissioner for health and human services, is going to have a lot to say about the way Texas complies with the Affordable Care Act. He recently made the case that Texas would best served by trying to redefine Medicaid.
The federal law gives the secretary of health and human services broad discretion in making rules. Janek, a physician, says the state should be arguing for more flexibility in handling the Medicaid program.
Here’s one example of how that added flexibility might be used to address a problem that officials at the University of Texas Medical Branch have been talking about for years. Officials at the medical branch have argued that Texas needs more positions for training residents — doctors who’ve just graduated from medical school.
Many physicians settle down and practice medicine in the communities where they completed that training. The argument is that it makes little sense for Texas to send students through medical school, only to have them go to New York for residency training and then settle down to provide medical care to New Yorkers.
Funding for graduate medical education slots are frozen, and Texas and other growing states don’t have enough. But what if Texas won more flexibility in Medicaid rules?
What if the Texas Legislature took advantage of that flexibility and appropriated money to medical schools that were willing to take on more Medicaid business? A $1 million state appropriation would be matched with $1.4 million from the federal government.
A medical school aggressively seeking that business would have $2.4 million it could use to create its own residency positions. In Janek’s view, the advantage would be that the state’s investment would go toward creating a more robust medical community within the state.