Audit: Disabled Youth Program Sees Scaled-Back Care, Issues

Texas health officials aren't doing enough to ensure youth and children with disabilities are getting appropriate access to care in its Medicaid managed program, according to a new audit.

The state's Legislative Budget Board identified a drop in critical services, such as speech and physical therapy, provided to children and youth in the STAR Kids program, the San Antonio Express-News reported. The number of children with disabilities receiving occupational and physical therapy declined by 13 percent in the months after Texas launched the Medicaid managed care program in 2016, auditors said.

The program covers roughly 160,000 children and adults ages 20 and younger who have disabilities.

Texas spends $3.3 billion a year paying managed care organizations to provide services through the STAR Kids program. But auditors found that some contractors may not have adequate networks of medical providers to link up clients with physicians and specialists, while others aren't meeting state requirements regarding visits.

The audit also found that gaps remain in the Texas Health and Human Services Commission's oversight of the STAR Kids program. State health officials haven't conducted reviews to ensure contractors are meeting the children's needs, auditors said.

The commission declined to comment. The state is planning to implement the reviews next year.

The audit comes as lawmakers consider multiple bills to reform Texas' Medicaid system following a Dallas Morning News investigation last year that uncovered state-hired contractors had profited from denying essential services to adults and children with disabilities.

Superior HealthPlan, one of the companies named in the newspaper's investigation, was also identified in the recent audit for its high denial rates and appeals among the roughly 29,500 children enrolled in its health plan. Auditors claimed that Superior denied or scaled back services over 17 percent of the time from March 2017 to February 2018.

The managed care company received 406 appeals about patient care from families in the STAR Kids program over a three-month period in 2017, which was more than five times as many as any other contractor, the report said.

Superior declined to comment on the audit, which hasn't been publicly released yet.

"Until a report is made available publicly, we cannot provide comment as this data has not been verified," the company said in a statement.

Corpus Christi resident Tiffanie Harris has a 15-year-old daughter who's enrolled in the STAR Kids program and covered by Driscoll Health Plan, a contractor that was also named in the audit for denying or scaling back services.

Harris said managed care is working for her family, but she's heard concerns about other contractors.

"The managed care organization is supposed to make money as well," Harris said. "So if they are going to cut corners ... who is monitoring that?"

Copyright AP - Associated Press
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