For Families With Disabled Children, The Managed Care System Is Making Health Care Harder To Find

When managed care companies don’t pay service providers on time, it’s children with disabilities, and their families who suffer.

By Jill AmentJuly 31, 2018 12:58 pm| ,

Obtaining and maintaining adequate care for children who have special medical needs is a big challenge for parents. The struggle can be even greater if a child’s care is paid for by Medicaid. Imagine the shock of being told that a pediatric specialist will no longer take a parent’s insurance, limiting their ability to access care at all. That’s just what has happened to some families with Blue Cross and Blue Shield of Texas Medicaid plans. Julie Chang is covering the story for the Austin American-Statesman.

Chang spoke with several families affected, as well as a few physicians, about why claims filed under these plans are being rejected. She says BCBS is not paying providers for Medicaid claims in a timely manner, or at all.

According to advocacy groups, this is a problem across the state.

“This is just one of many problems that families have told lawmakers that they’ve had with managed care,” Chang says.

She says the state of Texas has increased its reliance on managed care providers as part of the Medicaid program.

“Just in case you need a refresher of what managed care is – over the last couple of decades, the state of Texas has transferred management of Medicaid to private insurance companies and, in some cases, hospital systems.”

This change in management seems to be affecting families whose children have disabilities the most, Chang says. Managed care companies argue that delays in payment represent prudent use of taxpayer dollars.

“But if you talk to other people, including physicians, they will say that they feel like managed care companies are finding every way possible to save the state money,” Chang says.

The biggest problem for the families is finding the services they need for their children. That problem is twofold – either parents can’t get managed care approval for services of treatment, or they have difficulty finding a physician who will provide the services directly.

“These families rely on services paid through Medicaid to keep their children alive,” Chang says.

Written by Sarah Yoakley.