Texas is facing a shortage of physicians who are willing to accept our growing number of new Medicaid and CHIP
patients. Advanced Practice Registered Nurses (APRNs) are able to serve as primary care providers and can help
alleviate this shortfall if insurance barriers are removed. Currently, APRNs may only see patients in a Medicaid
managed care plan if the APRN’s delegating physician also participates in that plan. HB 1225 is permissive
legislation that will allow health plans to utilize APRNs without requiring their delegating physician to participate in
that plan.
In 2013, the Legislature attempted to address the critical lack of primary care providers by amending
§533.005(a)(13) of the Government Code to require the state’s Medicaid managed care plans to use APRNS in
their primary care provider networks. Unfortunately, the change did not go far enough. Medicaid Managed Care
plans, which cover almost four million Texans, must still place both a delegating physician and the APRN in their
network - regardless of whether the physician will ever see any of the APRN’s patients. This means APRNs can
only accept a Medicaid insurance plan if their delegating physician also accepts that plan.
According to the Texas Medical Association, only 34% of physicians see all new Medicaid Patients, and the
number is shrinking. Without a change in policy, the refusal of physicians to see Medicaid patients will result in
fewer and fewer APRNs being able to see Medicaid patients, even if the APRN wants to see Medicaid patients.
This Legislation is permissive. It will amend §533.005 of the Government Code, §62.1551 of the Health and Safety
Code, and §843.312 and §1301.052 of the Texas Insurance Code to allow health plans to include APRNs as
primary care providers in their provider network, regardless of whether the APRN’s delegating physician is also in
the provider network. Allowing health plans to utilize APRNs, regardless of whether their delegating physician
wants to accept the same health plan, is a common-sense solution that will increase primary care access,
especially in areas of the state where the number of providers are limited.