Texas Care Providers Mount Opposition to Planned Expansion of Medicaid Managed Care Plan to Rural Areas

A plan to extend a Medicaid managed care program into rural areas of Texas has met with objections from some physicians and hospitals who fear that reimbursement rates will not cover the cost of care, the San Antonio Business Journal reports. The Texas Health Network, administered by the Texas Health and Human Services Commission, is a "little known" Medicaid managed care program that operates in 37 counties, most often in "major population centers." Hoping to save about $18 million during the next fiscal year, the commission this January planned to expand the Primary Care Case Management program, or PCCM, a pilot managed care plan that "allows the state to contract directly with health care providers for its Medicaid patients, incorporating managed care principles into the equation." The goal of the program is to give beneficiaries a "medical home," thereby improving access to care and reducing costs, the Business Journal reports. According to commission officials, expanding the program into rural areas is necessary to alleviate the "burden faced by struggling public hospital systems" in the state's urban centers. Many of Texas' rural Medicaid beneficiaries are "draining health care resources" in urban areas, Texas Health and Human Services Commission Commissioner Don Gilbert said.

Provider Hesitation
But according to Kay Peck, executive director of the San Antonio-based Bexar County Medical Society, many doctors and hospitals are concerned about the level of reimbursements the state will provide under the new plan. For instance, the Texas Hospital Association opposes the PCCM rollout. Joe DaSilva, senior vice president of public affairs, said the association does favor a Medicaid "overhaul" but wants to see a "cross between a PCCM and an HMO." Even though Peck said that South Texas care providers historically have received lower reimbursement rates than doctors in the rest of the state, she added that the PCCM program is "the most physician friendly of all the models we were given to choose from." She said that the society, as well as the Texas Medical Association, is attempting to explain the program's benefits to doctors. According to Charles Stuart, a spokesperson for the health commission, commission officials will meet with hospital officials throughout December to "iron out an alternative to the PCCM rollout." Gilbert said, "We have to come to terms with physicians and hospitals" (Bailey, San Antonio Business Journal, 11/23).