Care tenuous for Texas children on Medicaid managed care plans
One practice, Central Texas Pediatric Orthopedics, the only specialist of its kind in the
The troubles underscore the challenges
State lawmakers have scrutinized managed care for the past several months amid complaints that managed care organizations, in an effort to cut costs, are frequently denying services, including at-home nursing care, medical equipment, physical and occupational therapies, and prescription drugs.
The
"If you have a medically complex child, you feel like you're a project manager on top of everything else," said
Families have said that finding providers has become more difficult over the past two years, but officials with the
"Having an adequate network of providers is a longstanding challenge for
Payment concerns
Several parents of children covered by Medicaid, including Bradshaw, were told this month that they'd lose their only pediatric orthopedic provider in the
In a
"We have had multiple attempts to find a workable solution, but
"It makes me sick to my stomach to think that I have a child who is in serious need of medical care and we're put in a situation where we might not be able to get care for my child," Romero said. The state "needs to hold both physicians and insurance companies accountable for making sure these kids are taken care of."
Although the
"
Central Texas Pediatric Orthopedics declined to comment.
In May, families told the
"If you look at the income physicians are traditionally making, pediatricians are second to the lowest after family practice. I didn't go into this field for money. I genuinely care for my patients and find value with working with families and watching the kids grow and thrive," said
The pediatric group has about 40 employees, including physicians.
The practice still works with
"This was a two-year process to finally terminate. It's not like we woke up one day and say we're done. We were pretty tolerant because we didn't want to put difficulties on patients," Comstock said.
'Opportunities for improvement'
During the May hearing at the
Texas
Inadequate payment is among the biggest reasons physicians stop accepting Medicaid, which reimburses half of what commercial insurance plans reimburse, said
"Managed care does present some very unique opportunities which are good. Trying to work together to improve care and making sure we're using our limited dollars responsibly are important,"
He applauded Driscoll Health Plan, a managed care organization in
He said state lawmakers should increase payments and eliminate "red tape."
"There needs to be standards set because right now, it's like the wild West," Mehta said.
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