By: TAHP | Monday, March 29, 2021

March 29, 2021

By: Jamie Dudensing

Access to care is an essential part of any health care delivery system, and the Texas Medicaid program is no exception. Like private health insurance, Texas Medicaid managed care organizations (MCOs) establish a network of providers to connect Texans to the personalized care and support they need to stay healthy and live the fullest lives possible. As a result, Medicaid managed care allows Texans on Medicaid to access and choose from a variety of doctors and hospitals in their area.

Texas MCOs Increase Access to Care

• According to HHSC’s most recent network adequacy report, “MCOs continue to perform well in meeting requirements related to providing access to preventive care, with nearly all MCOs compliant with access standards for primary care providers (PCPs)”
• Currently, more than 80% of all Texas doctors are currently in Medicaid managed care plan networks
• Texas Medicaid has better access to primary care than the general population — the ratio of Medicaid PCPs to MCO patients (1:154) is almost 9 times better than the ratio of PCPs to all Texas patients (1:1,320)
• All Texas MCOs exceed state and national standards of having two primary care providers willing to take new patients for more than 90% of enrollees
• Satisfaction with care covered by Texas MCOs continues to exceed national rates
• Access to urgent care, specialist appointments, and routine care in the Texas MCOs STAR Kids program also exceeds national rates

Understanding Network Adequacy in Medicaid Managed Care

To meet Texas’ network adequacy standards, Texas Medicaid managed care plans are held to strict state and federal access standards. MCOs in Texas must ensure that at least 90% of members have access to a choice of primary care physicians with open panels within a specified distance or travel time. HHSC also monitors the length of time a recipient must wait between scheduling an appointment and receiving treatment from a provider. Finally, HHSC surveys Medicaid clients and providers and asks several questions that measure clients’ experience trying to schedule appointments and providers ability and willingness to take new Medicaid clients.