Pain, profit and accountability in Medicaid managed care

About Joanne Kenen

Contributing editor to Politico Magazine and former health care editor-at-large, Politico, Commonwealth Fund journalist in residence and assistant lecturer at Johns Hopkins Bloomberg School of Public Health.

Tom Fox/The Dallas Morning NewsA mobility and orientation specialist slowly moves an amber rope light above D’ashon Morris’ eyes during a visual stimulation therapy appointment at his Mesquite, Texas home on March 6, 2018.

A powerhouse series on patient harm under Texas’s Medicaid Managed Care program won the Shorenstein Center’s Goldsmith Prize for Investigative Reporting and was recognized with an AHCJ award.  We’ve posted a “How I Did It” piece by the Dallas Morning News reporters, David McSwane and Andrew Chavez.

Their work showed the lack of oversight endangering about 4 million Texans, including about 720,000 who are medically fragile – both adults and children, including some in foster care.

Among their disturbing findings:

  • How a disabled baby was denied intensive nursing that his doctors said he needed – and he ended up choking and severely brain damaged.
  • How a shooting victim, paralyzed for years, was stuck in bed, alone, immobilized and in intense pain, for hours and hours every day when her hydraulic lift broke (meaning no transfer into a wheelchair) and her nursing hours were cut to seven hours a day.
  • How plans did not have anywhere near enough psychiatrists to treat children – some of whom ended up with expensive and traumatic hospitalization instead of doing OK at home with appropriate medication.

Read through this series and, even if you can’t do a months-long intensive project of this type, there are some simpler, less time-consuming checks you can do, such as just calling to find out if psychiatrists are actually in network, taking new patients, and within a reasonable distance.

And don’t miss part eight of the series about what can be done to fix the problems. See which ones your state has implemented – and if not, why not.

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