Texas' Medicaid program is on the verge of considerable change with the potential for expansion of managed care into both adult and children's programs. At the same time, the Texas Legislature is pushing forward a bill that would place Medicaid recipients in medical homes, focus on weight reduction among children and introduce pay-for-performance for providers serving Medicaid beneficiaries. While the recession hasn't hit Texas as hard as most other states, the Texas High Risk Pool is seeing a reduction in residents able to afford premiums for the insurance pool for those whose medical conditions keep them out of the general commercial market. Cardiovascular and central nervous system drugs accounted for most of the pharmaceutical claims for the 11-year-old Pool. Meanwhile, Scott & White Health Plan, which is better known for its HMO operating in central Texas, is branching out with a statewide administrative-services-only offering for self-insured employers. Aetna and Blue Cross and Blue Shield of Texas are diving deeper into pay-for-performance with a tie-in to the national Bridges to Excellence program; Aetna has begun a cardiac care program while BC/BS of Texas is focusing on diabetes care. Humana hopes to boost its enrollment in southern Texas with an alliance with the San Antonio Hispanic Chamber of Commerce.