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No Progress in Hearing on Medicaid Managed Care Organizations

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The light at the end of the tunnel … is a train.

On Wednesday, the Texas House Human Services Committee, chaired by Rep. Richard Raymond (D-Laredo) (above), held the first in what will undoubtedly be a series of hearings on the issues with Medicaid managed care organizations illuminated in the Dallas Morning News’ recent “Pain & Profit” series.

Representative Raymond’s committee heard testimony from two of the managed care  plans that administer the Texas Medicaid program — Superior HealthPlan and AmeriGroup — and from one family who claims their toddler son is in a “persistent vegetative state” because of Superior’s inaction. 

The buck apparently stopped nowhere.

Superior CEO Mark Sanders opened his testimony by asserting the health plan had done nothing wrong in the case of 3-year-old D'ashon Morris, who in October 2016, pulled out his tracheostomy tube, closing off his airway, according to reports. Records show Superior officials had been warned of that possibility if the boy didn’t have a nurse watching him around the clock, which Superior denied, according to reports. 

“We strenuously disagree with the reporting,” Sanders told lawmakers, adding that the Morning News series was one-sided and that company representatives were not contacted until late in the reporting process.

The mother who testified merely asked for an apology, which never came.

"I strongly believe that they don't have any passion for what they do," she said. "I strongly believe that."

In thanking the health plans for their attendance and participation, Chairman Raymond said that the legislature would “stay on” the health plans.

Future hearings are expected to get much more direct and possibly contentious. 

Next session, the legislature is expected to ratchet up its scrutiny of Texas Medicaid, as the state looks for answers to the problems bedeviling the managed care organizations caring for Texas’ most vulnerable populations. 

Despite the failures and let downs so far, there seems to be light at the end of the tunnel. But right now it’s coming from a train headed in health plans’ direction. 

TMA will keep you apprised of developments and progress.

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