In Texas, more than in many states, one of the hottest — and most controversial — topics on the House’s docket this session has been the question of how to make Medicaid work without crippling state financial resources.

Last Thursday, the Texas House passed a bill designed to accomplish this goal, including several amendments that covered key issues like Medicaid fraud, abortion and expanding managed care services. Predictably, there were varied responses to these amendments on blue and red sides of the House, but all three passed with tentative approval.

Amendment #1: Minimizing Medicaid fraud

Least controversial among these was the issue of Medicaid fraud. An amendment to deepen the punishment for pharmacy benefit managers who commit fraud passed almost unanimously. Managers convicted of this crime going forward will face a steep $500,000 fine and will be barred from rejoining the Medicaid program. Rep. John Zerwas, R-Simonton, objected that the amendment had “the potential to limit access to pharmacy services,” but the amendment still received just three votes against it.

Amendment #2: Cutting funding for abortion services

Despite some pronounced initial objections, Rep. Jim Landtroop, R-Plainview, managed to pass his amendment to cut off funding to clinics and health care providers that perform abortion-related services, excluding those that have done so in the face of a medical emergency. The emergency clause was added to protect providers that have given sonograms, prescribed the morning-after pill or helped a woman after a botched abortion, all of which could otherwise have been found liable under new law.

Amendment #3: Expanding managed care coverage

Projected to save $290 million, the greatest cost-saving measure of the bill would expand the managed care services already in place in larger cities like Dallas, Houston, San Antonio and Austin to the Rio Grande Valley, a large area that faces a shortage of Medicaid providers as well as a number of specific health concerns, such as a high rate of diabetes. Under a managed care plan, the state will pay selected health providers to manage the care of Medicaid participants. The hope is that by employing “best practices” these providers will slow down the state’s financial burden.

Representatives from South Texas expressed concerns that what works in urban areas many not translate to the population of the Rio Grande Valley. Rep. Veronica Gonzales, D-McAllen worried that access to care would become more limited under this new arrangement, creating “a recipe for disaster.”

“When we start limiting access to care, it’s going to cost us on the back end,” Gonzales said.

Her objections were tabled, however, under the argument that honoring them would be giving the Valley “special treatment.”

Past Texas news coverage from ASJ:

Health Care Reform Could Be a Boon (and Bust) to Texas

TexHealth: The Lone Star State’s New Medicaid?

Texas Health Care Coverage: A Year in Review