Texas Managed Care Program Continues Amid Complaints From Beneficiaries

Main Category: Seniors / Aging
Also Included In: Eye Health / Blindness;  Health Insurance / Medical Insurance;  Caregivers / Homecare
Article Date: 07 Jan 2009 - 2:00 PST

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The Dallas Morning News on Sunday examined how Evercare of Texas -- contracted to coordinate medical and long-term care for more than 80,000 elderly, disabled or blind state residents -- continues to receive state support despite being fined millions of dollars by the state and garnering complaints from many beneficiaries and advocates. Evercare, a unit of UnitedHealth, is contracted by Texas' Star Plus Program, which uses an HMO model to deliver care to elderly and disabled Medicaid beneficiaries in 29 northern Texas counties. The plan was expanded from a single county in 2007 -- a move the state said would save $110 million over two years by encouraging preventive care that could reduce emergency department visits and hospital admissions.

However, many have complained that Evercare has failed to provide adequate access to care for beneficiaries. From February 2008 to December 2008, the Texas Health and Human Services Commission filed more than 1,300 complaints about Evercare. In addition, the state has fined Evercare more than $1 million in the last year, ordering it to increase the size of its staff and fix other problems. The state has not conducted research into the "financial and human costs" of problems linked to privatizing government-provided care, the Morning News reports.

The firm said the problems experienced by beneficiaries are typical for a start-up program that aims to serve tens of thousands of people. "It was a massive undertaking," Evercare regional Executive Director Beth Mandell said, adding, "In working out the different systems, the workflows, there were some challenges," but "Evercare has a history of delivering these kinds of programs pretty successfully, and that is what we're focused on right now" (Jones, Dallas Morning News, 1/4).

The Morning News in several other articles profiled Texas residents affected by Evercare. The "State of Neglect" series is available online.

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