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Wednesday, July 11, 2007
Volume 12 Number 132
ISSN 1091-4021

News: Medicaid

HOUSTON, TX - A federal judge July 9 approved a settlement in a class action that aims to significantly improve health care services for some 2 million poor children enrolled in the Texas children's Medicaid program and increase reimbursement rates to doctors and dentists (Frew v. Hawkins, E.D. Tex., No. 3:93CV065WWJ, 7/9/07).

Senior U.S. District Judge William Wayne Justice signed off on the settlement of the 14-year-old lawsuit after the Texas Legislature in April allocated more than $700 million over the next two years ensuring changes will be made to the children's health care program (No. 72 HCDR 4/16/07 ).

The settlement's 11 corrective action orders require the state to:

• hire more Medicaid case workers;
  
  
• improve transportation options to help children get to medical appointments;
  
  
• increase reimbursement rates for dentists by 50 percent;
  
  
• increase reimbursement rates by varying amounts for physicians based on treatment provided;
  
  
• provide case management services to all class members who need and want these services; and
  
  
• establish family outreach initiatives so families will know what health care services are available.

The orders further require low-income children to get regular medical and dental checkups, be provided preventive care and counseling, and be offered referrals for other needed diagnosis and treatment, according to the settlement. Checkups also must be provided to newly enrolled beneficiaries within 90 days after enrolling in Medicaid unless recipients voluntarily decline or refuse services.

The order also addresses Medicaid's preferred drug list, requiring pharmacies to provide a 72-hour "emergency" allotment of a prescription to ensure that a child covered by Medicaid is not deprived of needed medicine while prior authorization is requested.

Legislative leaders negotiated the settlement with lawyers representing plaintiffs days before an April federal hearing on remedies to resolve the lawsuit.

TMA Applauds Settlement

The Texas Medical Association (TMA) applauded Justice's approval of the settlement.

"This settlement and legislative support strengthen physicians' ability to preserve patient care and improve the health of Texans, especially those who need it most, our children," TMA President William W. Hinchey said in a statement. Physicians are eager to work with the state to implement provisions of the settlement "to ensure children receive the care they deserve," he said.

Lead plaintiffs' attorney Susan Zinn could not be reached for comment. Zinn is with Texas Rural Legal Aid in San Antonio.

Plaintiff Linda Frew filed a class action in 1993 alleging the state provided inadequate health care for indigent children enrolled in the Texas Medicaid program. Two years later, both sides reached a settlement on a corrective action plan that Justice approved in a 1996 consent decree. However, Frew and other plaintiffs claimed the state failed to comply with provisions of the consent decree.

Text of each of the 11 correction action plans in the settlement are posted. The court's joint motion for each of the corrective action plans also are posted.