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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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.

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. 

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?

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 remain in legal limbo, the contractor that approved the procedures is still being paid more than $100 million annually by the state.

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 providers who treat the state’s poorest patients, a settlement between the state and a Medicaid provider raises questions about how the state 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

Thousands of residents of Texas colonias could 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.

A patient at The People's Community Clinic pays her bill as the cashier’s desk.  The Community Health Assistance Program, a program that helps Texans get access to insurance, will run out of federal grant money in a few weeks.
A patient at The People's Community Clinic pays her bill as the cashier’s desk. The Community Health Assistance Program, a program that helps Texans get access to insurance, will run out of federal grant money in a few weeks.

Perry, Obamacare and the Uninsured

Texas Weekly

In the same week that the U.S. Census Bureau released new data showing Texas again ranks highest for the rate of people without health insurance, Gov. Rick Perry quietly laid out his next efforts to derail Obamacare.