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Lawmakers focus on flaws in Texas Medicaid program after Dallas Morning News investigation

After a report from the newspaper revealing mishaps in the state's managed health care program, lawmakers pushed for answers from representatives from state agencies and private companies involved in the matter.

Rep. Richard Peña Raymond, D-Laredo, speaks to media at his Capitol office in 2016.

State lawmakers spent hours Wednesday pressing state officials, along with private companies that manage health care for Medicaid recipients, about a recent investigation by The Dallas Morning News that revealed how Texas is failing to provide care to some of its most medically vulnerable citizens. 

The House Human Services Committee met to discuss the state's managed care program, in which Texas hires companies to coordinate care for Texans on Medicaid, the federal-state health insurance program. The newspaper report found that Medicaid managed care companies withhold patient care and medical equipment under a system that pays them a flat fee for every Texan in the program.

Part of the investigation focused on twins D'ashon and D'asia Morris, who were born with severe birth defects and were placed in foster care after they tested positive for drugs at birth. While D'ashon Morris was a foster child under Superior HealthPlan — a managed care program for foster children — he was denied 24-hour nursing care that would prevent suffocation, according to The Dallas Morning News' report.

The report said providing that care would have cost Superior Health as much as $500 a day. One day, when D'ashon was in temporary foster care while his foster mother, Linda Badawo, was traveling outside the country, he started choking. After nurses and medics performed CPR for 40 minutes, D'ashon was taken to the hospital, where doctors concluded that he had gone too long without oxygen to his brain — he would be brain dead for the rest of his life.

“Superior is 100 percent responsible,” Badawo, who has since adopted D'ashon, told lawmakers Wednesday, her voice shaking. “I strongly believe that they don’t have any passion for what they do.”

It wasn't until after the accident that Superior gave D'ashon 24-hour care, the Morning News reported. 

"So my question to you was: 'Was this a matter of life and death?'" state Rep. Mark Keough, R-The Woodlands, asked Superior's representatives regarding 24-hour care for D'ashon. 

David Harmon, Superior's chief medical director, said his company did not believe so, based on the information it had. "If we did, we would not have authorized to continue" with 17 hours a day of care instead of 24, he said.

The story, Harmon said, "misrepresented the facts in all of these cases to make us look very bad."

J. David McSwane, one of the Morning News reporters who wrote the investigative series, defended the reporting.

"The data, docs and patients in the stories tell the story," McSwane tweeted during the hearing.

Mark Sanders, CEO of Superior HealthPlan, said Superior proposed using a "soft splint" to prevent D'ashon from pulling out a tube that helps him breathe. Badawo said she was horrified because state regulations bar her from using physical restraint on foster children in many situations. 

Sanders, who showed an example of the soft splint to lawmakers, said the device was "in no way shape or form" like a restraint.

State Rep. Richard Peña Raymond, D-Laredo, told representatives from Superior that the company needed to become more aware that there were going to be members and patients who would need more attention than others. 

“We’re going to stay on you," Raymond warned. “We don’t want these things to happen. But if we don’t do it right, these things will bubble up.” 

Representatives of private companies that manage Medicaid in Texas slammed the newspaper report for what they said were inaccuracies. LeAnn Behrens, west region president of AmeriGroup Medicaid, took issue with the report's assertion that AmeriGroup is withholding care from patients in order to make a profit. 

"As you all know, the state of Texas has set up a system that restricts the amount of profits that a managed care can make," Behrens said. "Members get the best care, they get the right care at the right place — and you have confidence that I am being wise with taxpayer money."

After the Morning News investigation, a survey conducted on behalf of the Texas Association of Health Plans said nearly nine in 10 Medicaid recipients reported that they are satisfied with their Medicaid health care services, adding that the quality of care from doctors and health providers was either "excellent" or "good." 

“Texas Medicaid health insurance companies help walk Texans through every step of the health care system from coordinating appointments, to getting the right doctor or specialist, and even arranging transportation, which is critical since most Medicaid patients are either children, pregnant moms with low-incomes, Texans with disabilities, or older Texans," said Jamie Dudensing, CEO of the Texas Association of Health Plans. 

Lawmakers on the House General Investigating and Ethics Committee and a subcommittee of House Appropriations will meet next week to also discuss the findings of the Morning News report. 

Matthew Choi and Brandon Formby contributed to this report.

Disclosure: The Texas Association of Health Plans has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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