Texas pediatricians stop accepting managed Medicaid members, citing payment concerns

Several pediatric specialists in Austin, Texas, have notified managed care Medicaid members they cannot access services, claiming health insurers are failing to adequately reimburse them, according the Austin American-Statesman.

Parents of the pediatric patients have argued Texas' managed Medicaid system is partially to blame. In the past several months, state lawmakers have scrutinized the program after reports of frequently denied services surfaced. Some pediatric specialists claim services like prescriptions, at-home nursing care, medical equipment, and physical and occupational therapies are not being covered.

An American-Statesman report published July 20 revealed one of the Medicaid managed care health plans — Superior HealthPlan — has denied Medicaid claims for pediatric foster care 394 times between June 7 and July 13, according to statewide data. Superior HealthPlan disputed the state's numbers.

While families contend finding a pediatric specialist who will accept certain health plans has become more difficult during the past two years, Texas Health and Human Services Commission officials said provider access has been a continuous problem for the state's Medicaid program.

"Having an adequate network of providers is a longstanding challenge for Texas that predates managed care. Lack of access to specialists, particularly pediatric specialists, is a healthcare challenge for Texas that is mirrored in the Texas Medicaid program," Christine Mann, spokesperson for the commission, which oversees the managed care network, said in a statement to the American-Statesman.

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