Perry’s anti-Obamacare purism has helped shape his national persona. Perry seeks cash from Obamacare

Gov. Rick Perry wants to kill Obamacare dead, but Texas health officials are in talks with the Obama administration about accepting an estimated $100 million available through the health law to care for the elderly and disabled, POLITICO has learned.

Perry health aides are negotiating with the Obama administration on the terms of an optional Obamacare program that would allow Texas to claim stepped-up Medicaid funding for the care of people with disabilities.


The so-called Community First Choice program aims to enhance the quality of services available to the disabled and elderly in their homes or communities. Similar approaches have had bipartisan support around the country. About 12,000 Texans are expected to benefit in the first year of the program.

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One line of thinking as to why the Texas governor, who has honed his national image in no small measure by denouncing Obamacare, would make such a seemingly inconsistent move goes like this: Treating disabled and elderly people is less politically charged than a sweeping national law forcing people to buy health insurance. Perry recently decided against seeking reelection next year but is mulling a second presidential bid in 2016,

Perry spokesman Josh Havens said in a statement that the governor has long sought to help people with disabilities.

“Long before Obamacare was forced on the American people, Texas was implementing policies to provide those with intellectual disabilities more community options to enable them to live more independent lives, at a lower cost to taxpayers,” the statement read. “The Texas Health and Human Services Commission will continue to move forward with these policies because they are right for our citizens and our state, regardless of whatever funding schemes may be found in Obamacare.”

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Still, the move comes as a surprise coming from a governor who has insisted he won’t implement the Obamacare reforms, and who slammed Health and Human Services Secretary Kathleen Sebelius for touting the law during a trip to the Lone Star State earlier this month.

“With due respect, the secretary and our president are missing the point: It’s not that Americans don’t understand Obamacare, it’s that we understand it all too well,” Perry said at the time. “In Texas, we’ve been fighting Obamacare from the beginning, refusing to expand a broken Medicaid system and declining to set up a state health insurance exchange.”

Perry’s anti-Obamacare purism has helped shape his national persona. He’s has called the law a “monstrosity” and taken steps to block Texas’s participation in some optional components. So his decision to embrace an element of the law, even though he has the support of his state’s Republican Legislature, could present a messaging challenge on a bigger stage.

Advocates for the disabled said the governor is doing the right thing.

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“Adding CFC will mean that approximately 12,000 Texans with intellectual and developmental disabilities who have been waiting for comprehensive waiver services will be able to receive some of the basic supports they very much need now,” said Jessica Ramos, public policy director at the Texas Council for Developmental Disabilities. “For some, CFC will mean the difference between being able to live at home rather than having to move to a nursing home or other type of institution.”

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The Texas Legislature approved the program earlier this year, and Perry signed it into law as part of a larger package of health reforms, as well as in the state budget. Now, his administration is working win approval from the Obama administration to fit the program into the state’s existing Medicaid framework.

“Efforts are under way to develop and submit an application to the Centers for Medicare and Medicaid Services for participation,” said a spokeswoman for the Texas Department of Aging and Disability Services. The goal is to implement the initiative by Sept. 1, 2014.

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Supporters of home care contacted by POLITICO worried that even a news story about the connection between the Community First Choice program and Obamacare would spook the Perry administration from participating.

“[I]t would be worse than a shame if Texas’s moving ahead with CFC or BIP policies — both are from the ACA — was hurt as the result of scrutiny from a press inquiry,” said one Texas-based advocate.

Added another local advocate, “I would hate for the CFC to become a political football.”

An official with a prominent national advocacy group noted that Texas isn’t the only resistant state to quietly accept some lower-profile components of the health law. Louisiana, Mississippi, Georgia, Maine and others have already been approved for 2 percentage point increases in their Medicaid fund through a little-known provisions of the health law, the advocate said.

“I think some of those [provisions] are easier because they’re not as high profile and people don’t connect home and community services with Medicaid,” according to the advocate.

But everything’s bigger in Texas. And with the possible exception of Sens. Marco Rubio (R-Fla.) and Ted Cruz (R-Texas), few other politicians have made as big a stink about Obamacare as Perry has.

Several activists and Democrats accused the Republican governor of hypocrisy. Ginny Goldman, director of the Texas Organizing Project, called the move “shameful.”

“It’s simply a shame that Perry is willing to accept $100 million in Affordable Care Act dollars that would help some … but to at the same time reject $100 billion in federal funds turns his back on 1.5 million people” who would be eligible for Medicaid expansion, she said.

“Rick Perry has accepted federal funds in the past. He’s accepted federal funds on a regular basis when it suits his needs, whether it was using federal stimulus dollars to balance the state budget or accepting FEMA money. … Sadly, he is driven by his political interests above all else and when it comes to the Affordable Care Act, he’s willing to turn his back on 1.5 million people who need health care.”

One Democratic strategist said it illustrates “how impossible it is to be ideologically pure on this.”

Eddie Vale, spokesman for the pro-Obamacare group Protect Your Care, had a more positive spin.

“This is yet another sign that common-sense Republicans, and now even Rick Perry, are realizing that Obamacare will benefit millions of people in their states,” he said. “As people continue to work together in a bipartisan manner to implement Obamacare it will leave the extremist repealers like Cruz and DeMint increasingly isolated.”