Pain, profit and accountability in Medicaid managed care

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

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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