Texas Ends Contract With Managed Care Program After Complaints From Beneficiaries

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Seniors / Aging
Article Date: 20 Mar 2009 - 6:00 PDT

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The Texas Health and Human Services Commission on Monday announced that it will terminate its contract with UnitedHealth's Evercare program effective May 31, the Dallas Morning News reports. The program sought to improve medical care for more than 74,000 elderly and disabled Medicaid beneficiaries in North Texas by coordinating preventive care services (Jones, Dallas Morning News, 3/17). However, many beneficiaries complained that Evercare has failed to provide adequate access to care. From February 2008 to December 2008, the commission filed more than 1,300 complaints about Evercare. 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 (Kaiser Daily Health Policy Report, 1/6).

Albert Hawkins, executive commissioner of health and human services, in a statement said, "This program has not been able to deliver the level of service that our clients deserve," adding, "Our first priority is to improve services as quickly as possible, and the best way to do that is to move clients into other proven Medicaid programs as fast as we can without disrupting their care." The contract was supposed to run through August 2010 (Dallas Morning News, 3/17). Evercare's North Texas beneficiaries' plans will roll over into traditional fee-for-service Medicaid plans and the Star Medicaid program, an HMO model, on June 1, according to commission spokesperson Stephanie Goodman (AP/El Paso Times, 3/17).

State Sen. Bob Deuell (R) on Friday filed a bill (SB 2417) that would repeal the current integrated care management program for North Texas and allow the state to try other models of care, according to the Morning News. Hawkins said he plans to consult with the Texas Legislature on long-term options such as continuing the integrated care management program under a different contractor or implementing a new model.

Evercare regional Executive Director Beth Mandell in a statement said that the integrated care model "proved complex, often making it challenging to provide timely service to members" (Dallas Morning News, 3/17).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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