Texas Judge Approves Settlement To Boost Medicaid Payments To Physicians, Dentists Who Treat Children

U.S. District Judge William Wayne Justice on Monday approved a court settlement intended to improve access to health care for Texas children covered by Medicaid, the Houston Chronicle reports (Fikac, Houston Chronicle, 7/10). The settlement involves a class-action lawsuit filed in 1993 on behalf of Texas families who alleged that the state had violated Medicaid rules and is intended to encourage more providers to accept new Medicaid beneficiaries as part of an effort to ensure children are receiving regular medical and dental checkups.

Under the agreement, which affects 1.8 million children covered by Medicaid, the state will bring more providers to underserved areas and improve a toll-free hot line that answers parents' questions about obtaining coverage for their children. The state also agreed to hire additional case workers to help parents navigate the state health care system. In addition, the state agreed to determine whether children are receiving incomplete checkups and whether corrective action should be taken when managed care companies do not provide comprehensive checkups (Kaiser Daily Health Policy Report, 4/11). The plan also will ensure that necessary prescriptions for children are not delayed if the medications are not on the state's preferred drug list.

Lawmakers budgeted nearly $1.8 billion over two years to implement the terms of the settlement, with $706.7 million coming from state general revenue and the rest from federal matching funds (Houston Chronicle, 7/10). Total spending on Medicaid will increase by 14%, according to plaintiff's attorney Susan Zinn.

Increased Reimbursements
Three-fourths of the new funds will be used to increase physicians' and dentists' participation in the Medicaid program (Garrett, Dallas Morning News, 7/10). The state will increase Medicaid reimbursement rates by 25% for physicians and by 50% for dentists. However, rather than across-the-board increases, funds will be used to increase rates for key services (Houston Chronicle, 7/10).

For dentists, $662 million of the new funds will go toward doubling reimbursement rates for the 35 most common procedures; other services will receive lesser increases. Physicians will receive $637 million of the funds, with higher reimbursement increases for office visits and immunizations, according to John Hellerstedt, medical director of the state Medicaid-SCHIP division. Physicians will receive a 60% increase in reimbursements for administering shots, and checkups will be reimbursed at levels similar to federal reimbursements for Medicare, Hellerstedt said. In addition, reimbursements for anesthesia, medical evaluations and certain mental health-related services will be increased by more than 25%, according to Hellerstedt (Dallas Morning News, 7/10).

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