Wednesday, February 15, 2012


Anything which saves the taxpayers money is generally good.  The decision to put the LRGV medicaid recipients into managed care is probably a good thing.  It is not how I would do it.  My view has been that medicaid recipients should be treated like veterans.  They should have to go to state owned clinics.  The savings nationally would be in the billions.  But as we know the Republicans oppose any change in medicaid or medicare which cuts into corporate welfare and welfare for doctors.  The government has no business being worried with how doctors and corporations make money.

I was preparing a post for Balancing the Issues on the political integrity of Santorum and Paul, when I got just one too many phone calls from a father who is frustrated with the changes.  I have been getting these calls for two weeks from a lot of parents.  I have done everything I can do to help the families, but you cannot fix a cluster phuphu. 

Rene Oliviera gets an A+ for his efforts to educate his constituents on the need to choose a managed care provider.  But somewhere along the way the system failed the recipients of medicaid.

A big issue for the families is making sure  they choose a plan which covers three different groups of doctors - the primary care physician, the dentist, and  the specialist.  In some cases it is not possible.  About two weeks ago is the first time I  tried to work on this for one family.  The medicaid officials seems to have been provided zero training in how to help the families.  It seems to me their data base should have had the name of all the doctors.  It seems to me a family should be able to tell the clerk the names of the PCP, dentist and key specialists and then be told which provider covers all the doctors.  This was not an option.

The concept of aligning your doctors with one provider proved too much  for the medicaid clerks, providers, and parents.  In one case while on the phone with the medicaid office the clerk told me to just do nothing.  She said when a person has multiple doctors it is best if they do not choose a plan.  Wrong!!! If you do not choose a plan, medicaid will choose for you and you could find yourself in a plan which covers none of your doctors.

Our next step was to have the families I was trying to help call all of the doctors and dentists to find out which plans they would accept.  Disaster.  I cannot tell you how many times staff at the doctor's offices simply stated they take medicaid.  I would explain what is going on, and the response was always the same - "we take medicaid."  If the doctors failed to train their staff, the families were screwed.  But in another call to medicaid I was told they could tell you in which programs your PCP chose to enroll.  The medicaid people were ill prepared to help.

In one case we found a program in which  the specialist and the PCP were enrolled.  But the dentist is not enrolled in the program.  This means the family will have to change dentists - assuming the dentist's staff understood the question.

I asked the medicaid clerks, what parents were to do if they already have appointments with specialists who do not use the same coverage as the PCP.  I have one family whose PCP does not use any of the programs used by a key specialist.  We were told to either change the specialist or PCP.  Changing a PCP and specialist for a very sick child could prove costly for the child, and to be crude even the taxpayers.

None of this would be a problem if medicaid recipients had to use state owned clinics wherein the doctors, labs, and testing were all done at the state owned clinic.  When  the VA clinic in Harlingen got their MRI machine is was the most powerful MRI south of San Antonio, and in fact at the time more powerful than the MRI at the VA hospital in San Antonio.  The taxpayers are not paying profits into the coffers of doctors and corporations so that veterans can get MRI's.  The government owns and operates the MRI clinic.  The savings to the taxpayers is enormous.

The mess which is managed care for medicaid recipients will remain as is until the Republicans end their demand for corporate welfare.  It is not the government's job to insure corporations and doctors make profits. 

For now many families who use medicaid will find themselves without the specialists they need for their children for no better reason than incompetence at  the level of the medicaid office.   A simple computer program could have aligned patient and doctors.  This was well beyond the skill sets of the state employees who manage the medicaid program.

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