Tribpedia: Medicaid

Tribpedia

MEDICAID
Medicaid is the safety net health insurance provider for children, the disabled and the very poor. It is jointly funded by the federal government and the state, which administers the program with oversight from the Centers for Medicare & Medicaid Services (CMS), part of the U.S. Department of Health and Human Services (HHS).

Both Medicaid and Medicare — the federally ...

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Republican Gubernatorial candidate, Greg Abbott, speaks one-on-one with members of the media following his his appearance at a Congress Ave. coffee house on July 10th, 2014
Republican Gubernatorial candidate, Greg Abbott, speaks one-on-one with members of the media following his his appearance at a Congress Ave. coffee house on July 10th, 2014

Abbott Unveils New Health Policy Proposal

Increased funding for preventive care and luring medical professionals to Texas are at the center of gubernatorial frontrunner Greg Abbott’s health care plan, unveiled at St. Joseph's Women's Medical Center in Houston on Wednesday.

A patient at Sagebrook Health Center, a nursing facility in Cedar Park, kneads putty to build fine-motor coordination and dexterity. Officials from Sagebrook and other facilities have raised concerns about a proposed rule that would have the state close nursing homes found to have the highest-level violations of federal quality standards on three separate days over 24 months.
A patient at Sagebrook Health Center, a nursing facility in Cedar Park, kneads putty to build fine-motor coordination and dexterity. Officials from Sagebrook and other facilities have raised concerns about a proposed rule that would have the state close nursing homes found to have the highest-level violations of federal quality standards on three separate days over 24 months.

"3-Strikes" Plan Spurs Nursing Home Regulation Debate

Legislators in 2015 are poised to take up a proposal that would have the state close nursing homes that rack up high-level federal violations on three separate days over 24 months. Supporters say the plan provides needed protection for the state's seniors, but the nursing home industry says it is already heavily regulated.

Eighth-grader Montanique DeShay waits as Ashlyn Brooks, medical assistant at MedSpring Urgent Care in Austin, comes to check on her on Wednesday. Like many patients visiting urgent care facilities at this time of year, Montanique is having a physical evaluation performed to allow her to participate in sports this school year.
Eighth-grader Montanique DeShay waits as Ashlyn Brooks, medical assistant at MedSpring Urgent Care in Austin, comes to check on her on Wednesday. Like many patients visiting urgent care facilities at this time of year, Montanique is having a physical evaluation performed to allow her to participate in sports this school year.

Hospitals Say They've Lost Insured Patients to Urgent Care

The increasing number of urgent care centers in Texas is proving problematic for hospitals, which say they are competing with the clinics for the same pool of insured Texans at a time when they are also getting less money to cover the cost of treating uninsured patients.

Patients are shown checking out in 2010 at the People's Community Clinic in Austin, a safety-net clinic that serves Medicaid recipients and the underinsured.
Patients are shown checking out in 2010 at the People's Community Clinic in Austin, a safety-net clinic that serves Medicaid recipients and the underinsured.

Rule Changes Address Contraceptive Devices

Texas women who receive state-financed health services may be able to more easily access contraceptive products like intrauterine devices and hormonal implants beginning Friday, when rule changes to the state’s Medicaid program and the Texas Women’s Health Program go into effect.

Yesenia Alvarado holds her daughter, Medicaid patient Melanie Almaraz, 2, while waiting to see Dr. Alberto Vasquez for the treatment of a fever at the Su Clinica Familiar in Harlingen on Jul. 9, 2013.
Yesenia Alvarado holds her daughter, Medicaid patient Melanie Almaraz, 2, while waiting to see Dr. Alberto Vasquez for the treatment of a fever at the Su Clinica Familiar in Harlingen on Jul. 9, 2013.

Texas Sees Rise in Medicaid Signups

More than 80,000 additional Texans have enrolled in Medicaid or the Children’s Health Insurance Program since the rollout of the Affordable Care Act last fall, despite Republican state leaders’ decision not to expand eligibility to poor adults. 

 

Dr. Rose Okoro, a nurse practitioner, who owns Daystar Family Clinic in Katy, is shown on May 12. 2014. She says she has struggled to treat a greater number of Medicaid patients because of state regulations.
Dr. Rose Okoro, a nurse practitioner, who owns Daystar Family Clinic in Katy, is shown on May 12. 2014. She says she has struggled to treat a greater number of Medicaid patients because of state regulations.

Nurse Practitioners Look to Ease Supervision Rules

Nurse practitioners say state regulations, which link them to supervising physicians, limit their ability to treat patients in a state with a looming shortage of primary care physicians. As they seek more freedom in the state Medicaid program, physicians say the the current “team-based” model has proved to be effective.

Dr. Behzad Nazari at his remaining dental clinic in Houston on Friday, April 25, 2014. Nazari sold two of three Antoine Dental clinics after the state began withholding Medicaid payments while they investigated the clinics for fraud.
Dr. Behzad Nazari at his remaining dental clinic in Houston on Friday, April 25, 2014. Nazari sold two of three Antoine Dental clinics after the state began withholding Medicaid payments while they investigated the clinics for fraud.

Texas Cancels Medicaid Contract, Sues Xerox Over Allegedly Misspent Money

Health officials canceled a multi-million-dollar contract with Xerox, and the state sued the contractor on Friday amid allegations it erroneously doled out hundreds of millions of dollars for medically unnecessary Medicaid claims.

Dr. Behzad Nazari at his remaining dental clinic in Houston on Friday, April 25, 2014. Nazari sold two of three Antoine Dental clinics after the state began withholding Medicaid payments while they investigated the clinics for fraud.
Dr. Behzad Nazari at his remaining dental clinic in Houston on Friday, April 25, 2014. Nazari sold two of three Antoine Dental clinics after the state began withholding Medicaid payments while they investigated the clinics for fraud.

When is a State Contract Too Big to Fail?

A Tribune investigation found that while health officials have repeatedly raised concerns with a state contractor for its role in opening the door to a massive Medicaid fraud scheme, they have not severed its multiyear contract worth hundreds of millions of dollars.

Dr. Behzad Nazari at his remaining dental clinic in Houston Friday, April 25, 2014. Nazari operated 3 clinics in Houston with 15 licensed dentists. After the state alleged he had committed Medicaid fraud and began withholding payments, he sold two clinics. He has challenged the state's payment hold in court.
Dr. Behzad Nazari at his remaining dental clinic in Houston Friday, April 25, 2014. Nazari operated 3 clinics in Houston with 15 licensed dentists. After the state alleged he had committed Medicaid fraud and began withholding payments, he sold two clinics. He has challenged the state's payment hold in court.

Company That OK'd Unnecessary Braces Kept Its Contract

While dental providers accused of overbilling Texas' Medicaid program by hundreds of millions of dollars to put braces on poor kids remain in legal limbo, the contractor that approved the procedures — a Xerox subsidiary — is still being paid more than $100 million annually by the state to process claims.    

Helen Hawkins, a certified pediatric nurse practitioner, treats 13-month-old Kevin Gorostieta at Carousel Pediatrics in Austin on Nov. 8, 2012.
Helen Hawkins, a certified pediatric nurse practitioner, treats 13-month-old Kevin Gorostieta at Carousel Pediatrics in Austin on Nov. 8, 2012.

Medicaid Fraud Settlement Worries Health Providers

For health providers who treat the state’s poorest patients, a high-profile settlement between the Texas health commission's office of inspector general and Carousel Pediatrics has raised questions about how the inspector general’s office distinguishes fraudulent intent from human error.

L to R:  Martin Gomez Jr. and his father Martin Gomez Sr. both work, but make so little that they aren't interested in buying healthcare insurance. The Gomez family lives in a colonia near Alton.
L to R: Martin Gomez Jr. and his father Martin Gomez Sr. both work, but make so little that they aren't interested in buying healthcare insurance. The Gomez family lives in a colonia near Alton.

A Focus on Helping Colonia Residents With Health Law

Living in unincorporated subdivisions, where the uninsured rate is between 50 and 80 percent, thousands of residents of impoverished Texas colonias may be largely left with little hope of obtaining health insurance after falling into the "coverage gap.But community-based organizations are working to educate them on their options.

Minister Freedom Gulley led a candlelight vigil in recognition of World AIDS Day on Dec. 1, 2013, in Houston.
Minister Freedom Gulley led a candlelight vigil in recognition of World AIDS Day on Dec. 1, 2013, in Houston.

Many HIV Patients Unable to Enjoy Expanded Coverage

Many HIV patients in Texas are ineligible for subsidies on the new federal health care exchange. Add the state's decision to not expand Medicaid to cover poor adults, and the bulk of those patients are missing out on expanded health coverage.

OIG Loses Another Medicaid Fraud Court Battle

The state health commission’s Office of Inspector General, which says Texas has misspent hundreds of millions on Medicaid orthodontic and dental fraud, has now lost its first three court battles against accused providers. The latest judicial setback has rallied accused Medicaid providers who argue the state’s inability to win in court proves the allegations are unjustified.