2012 has marked a year of great change for Texas Medicaid participants. The state has been moving from a traditional fee-for-service Medicaid system to a managed care one in hopes of saving money, clamping down on Medicaid fraud, and improving coordination of care. So far, the track record for managed care in reaching those goals has been less than stellar.
The Liberty County Vindicator reports that one major issue has been that “new providers have too much leeway in cutting promised services after signing up new patients. Thousands of recipients fled one HMO in south Texas after the company cut certain services and reimbursement rates.” How's that for saving money and clamping down on fraud? As a result, State Representative Armando Martinez, is looking to create a consumer-protection bill that would stop providers from changing terms after signing up new customers.
Another issue has been with coordination of care. Trelisha Brown of the Texas Legal Services Center's Health Law Program believes that coordination of care has gotten worse in some ways as she now has to field questions from patients who say they now have to “jump through multiple hoops” when they need to see specialists, order equipment or request testing and medical supplies.
And the reduced reimbursement rates have also impacted Medicaid patients looking to get their prescriptions filled. The new pharmacy system has ushered in an era of pharmacies turning away Medicaid patients or closing their doors altogether because the reimbursements aren't covering the cost of acquiring and dispensing patient medications.
The Texas Health and Human Services Commission has estimated that the new managed care system will save $1 billion over the next two year, but we can't help but wonder what it's really going to cost in the long run.
To learn more about how managed care is hurting patients and health care providers, visit Pharmacy Choice And Access Now today!