Medicaid Managed Care

Make Medicaid Managed Care More Efficient - 04/09/2019

HB 4178 is the culmination of work by physicians, hospitals, and health plans to reduce Medicaid red tape. Physicians feel heavily burdened not only by the number of prior authorizations they must complete but also the complexity of the process. The system must be reformed to make it more accountable, transparent, and simpler.


Medicaid Eligibility Verification Website to Be Shuttered Friday - 12/13/2018

The Texas Health and Human Services Commission (HHSC) will decommission the YourTexasBenefitsCard.com website and the Medicaid eligibility verification Interactive Voice Response system at 7 pm (Central) on Friday.


Summit Seeks Medicaid Improvements - 10/22/2018

Physicians, hospital administrators, and health plan executives gathered at the Texas Medical Association building last week in search of common ground to improve the state’s Medicaid system.


Capitol Matters: TMA Weighs in on Medicaid MCO's, Telemedicine Before Texas Legislature - 09/20/2018

Committees in both chambers of the Texas Legislature are studying complex issues throughout this year to prepare for the next legislative session in 2019. As the year progresses, we’re periodically looking at the health care related issues


Medicaid Is Vital; Let’s Improve the Medicaid Managed Care Program - 08/29/2018

Texas’ Medicaid managed care system faces grave but surmountable challenges that must be addressed with all due haste, beginning with enhanced scrutiny not only of the health plans but also of how the state’s own actions, including deep funding cuts and insufficient agency staff, jeopardize Medicaid’s ability to care for the neediest among us.


Working the Capitol - 08/01/2018

TMA weighs in on opioids, Medicaid, cost transparency.


Pediatricians Offer Five Solutions to Improve Medicaid Managed Care - 06/28/2018

Pediatricians continuously encounter instances of managed care plans placing road blocks — some warranted, many not — between the pediatrician’s recommendations for care and the child receiving that care. These battles are now a way of life in every pediatrician’s office. We must find a way — in the best interest of our children accessing needed care — to create a lasting solution.


Medicaid Managed Care Needs Better Oversight, Networks, Care Coordination, and Physician Payment - 06/28/2018

Texas’ Medicaid managed care system faces grave but surmountable challenges that must be addressed with all due haste, beginning with enhanced scrutiny not only of the health plans but also of how the state’s own actions, including deep funding cuts and insufficient agency staff, jeopardize Medicaid’s ability to care for the neediest among us. At the same time, we must recognize not all Medicaid MCOs are created equal. Some are quite clearly poor performers while others go above and beyond what the state asks of them to ensure their enrollees receive the care they need, including expanding availability of specialty services and improving maternal health outcomes. Texas must learn from and replicate the best practices of the highest- performing plans rather than just punishing the bad apples.


No Progress in Hearing on Medicaid Managed Care Organizations - 06/22/2018

On Wednesday, the Texas House Human Services Committee held the first in what will undoubtedly be a series of hearings on the issues with Medicaid managed care organizations. The buck apparently stopped nowhere.


Modernize Medicaid MCOs with Value-Based Payment Initiatives - 05/17/2018

As managed care has proliferated, so too has the amount of red tape. Texas has multiple health plans for each product type — STAR, STAR+PLUS, and so forth. Physicians who contract with multiple Medicaid MCO plans must contend with different PA requirements for each, though such red tape brings no concomitant increase in quality. Most prior authorization requests are ultimately approved, so imposing them only increases physician overhead while delaying care.


Driving Quality - 04/19/2018

Private payers aren't the only ones eyeing quality-based payment reform to control costs while improving patients' health. Now that Texas Medicaid has moved into managed care almost completely, the state is intent on similar strategies. The Texas Health and Human Services Commission won a $3 million federal grant to design innovative delivery and payment systems. It hopes to win as much as $50 million to later test the models under the Centers for Medicare & Medicaid Services State Innovation Models initiative. From accountable care organizations and medical homes to health information technology and bundled payments, the state is looking to physicians, health plans, and others to figure out what it takes to successfully implement such models for Medicaid patients across the multiple payers and providers that manage them.


Though Far from Perfect, Medicaid Matters to Patients - 04/06/2018

Medicaid Managed Care Quality and Compliance


Medicaid HMO Credentialing – and Recredentialing – Just Got Easier - 04/03/2018

Starting this week, Texas physicians can save time getting credentialed and recredentialed for Texas' 19 Medicaid managed care plans.


New Guidance on Medicaid Prior Authorizations Related to Harvey Issued - 09/18/2017

The Texas Health and Human Services Commission (HHSC) has released new information and guidance on Medicaid prior authorizations as well as temporary electronic visit verification policies for physicians and other health care providers affected by Hurricane Harvey.


Simplify Medicaid HMO Administrative Requirements - 05/20/2016

HB2731 would help standardize and streamline Medicaid HMO administrative requirements. Standardization will make it easier for my practice to participate in Medicaid, while also lowering my practice costs. Medicaid is the lowest payer in most physician practices, so any reduction in administrative costs is essential to enhancing physician Medicaid participation.


Medicaid Roadblocks - 05/13/2016

It's caused problems for physicians and their patients, but Medicaid managed care is here to stay. State officials are committed to it to reduce costs in a growing program that consumes a quarter of the state budget. Still, some physicians are not convinced Texas Medicaid is better off under managed care.