TEXAS: Judge Orders Improvements in Children’s Medicaid

      U.S. District Judge William Wayne Justice last Tuesday called Texas' Medicaid programs "badly flawed," ruling that the state must improve its efforts to administer preventive medicine and health care to children, the New York Times reports. Justice found that Texas breached a 1996 consent decree, failing to provide adequate health care to more than 1.5 million Texas children eligible for Medicaid. While most of the ruling focused on the Early Periodic Screening Diagnosis and Treatment program, a comprehensive package of benefits for children enrolled in Medicaid that includes both mental and physician health assessments and immunizations, Justice also said that the state failed to educate poor families about available treatments and did not provide transportation to see doctors (Oppel, New York Times, 8/30). "A poor and often isolated population should not be robbed of their right to services upon request when they have not been informed of those rights," Justice wrote in his 175-page opinion (Lee, Dallas Morning News, 8/30). In addition, Justice claimed that Texas' managed care plans, which serve about one-third of the state's residents, have "not provided appropriate care," citing "inadequate and incomplete" medical examinations and cases where HMOs had "improperly blocked" children's access to specialists (Oppel, New York Times, 8/30).

Justice Delivers Justice?
      Susan Zinn, the lead plaintiffs' attorney, lauded Justice's decision, saying, "The judge found that the defendants were violating the consent decree in almost every single thing that we raised" (Lee, Dallas Morning News, 8/30). "Basically, what we have is a Medicaid program in shambles," she added. Zinn originally filed the class-action suit on behalf of seven Medicaid families in 1993, resulting in the 1996 consent decree, but plaintiffs returned to court earlier this year claiming that the state failed to meet the requirements of the order (Merle, Wall Street Journal, 8/30). Andrea Horton, a spokesperson for Texas Attorney General John Cornyn's (R) office, called the state's Medicaid efforts "adequate," pointing to almost five million "outreach" contacts to clients last year, a 300% increase in the medical transportation budget and Texas' $7.6 million contract for Medicaid outreach services (Oppel, New York Times, 8/30). However, Consumers Union analyst Lisa McGiffert criticized Texas' Medicaid record. "As a state, we flat out don't do outreach for Medicaid. It wasn't a priority 10 years ago, and it isn't a priority today," she concluded (Dallas Morning News, 8/30).

Attorney General Appeals Ruling
      Cornyn announced Aug. 30 that the state will appeal the ruling, according to the San Antonio Express-News. "We believe that neither the law or the facts support Judge Justice's decision," Horton said (Bell, San Antonio Express-News, 8/30). The decision surprised Texas Gov. George W. Bush (R), who had not reviewed the ruling, but said, "we have a good record signing people up to Medicaid." Presidential contender and Bush rival Al Gore used the issue to criticize the governor's record on health care. Gore spokesperson Mark Fabiani said, "It's basically a sweeping indictment of the way George Bush has run his state's Medicaid system. No issue is more important to voters than health care." But Bush spokeperson Dan Bartlett asserted, "This is a decade-long challenge that Texas is addressing. We are aggressively working to provide health care to those children" (Meckler, AP/Philadelphia Inquirer, 8/31). Bush spokesperson Karen Hughes added, "If Vice President Gore wants to complain about Texas, then he'd better complain about America because it's worse in America" (Kellman, AP/Cincinnati Enquirer, 9/1). However, more than a dozen Democratic state legislators on Sept. 1 urged the state not to pursue the appeal, arguing that the issue is "too serious to tie up" in the courts. "We call on the attorney general to comply with the consent decree instead of trying to litigate this for a decade," state Sen. Rodney Ellis (D) said, adding, "Some issues in public life ought to be above politics, and this is one" (Kuempel, Dallas Morning News, 9/2).