As the end of the COVID-19 Public Health Emergency approaches, the Texas Health and Human Services Commission (HHSC) is actively preparing to complete a large number of eligibility and enrollment actions. Beginning as soon as mid-October, an estimated 3.7 million Texans will need to have their Medicaid eligibility redetermined. For those individuals who found themselves needing Medicaid for the first time during the pandemic, this will be their first experience with the redetermination process. 

Health plans focus not just on the health of individual members, they also invest in the health of communities. By helping to build strong communities, health plans support better health outcomes for everyone. Since the beginning stages of the pandemic, Superior HealthPlan has worked with more than 70 schools and organizations in Texas to launch and fund hygiene closets for lower-income neighborhoods. Grants to the community-based organizations hosting the closets help organizations meet people’s basic needs and create community connection.

In 2021, 34.2% of adults in Texas reported symptoms of anxiety and/or depression. Experiencing mental health challenges can have long-lasting consequences, especially for vulnerable populations. Every Texan deserves access to mental health services. Today’s Texas Medicaid managed care organizations provide a broad spectrum of screenings and treatment services for mental health conditions and substance use disorders with timely access for members and appropriate follow-up care. Managed care allows for flexibility in developing new models of service delivery that are not possible in traditional fee-for-service. 

People with health insurance have better access to care, and importantly that includes mental health care. Two recent studies show that people with insurance not only have better access to mental health services, but they are overwhelmingly satisfied with the services they receive.

In Texas, the 1115 Medicaid Transformation Waiver allows the state to expand managed care, which allows for innovations not permitted in traditional fee-for-service Medicaid. Since the inception of managed care, ensuring high-quality care for members has been the work of managed care organizations. Here are some ways Texas managed care health plans go beyond the walls of a doctor’s office to increase community access to services, reduce unnecessary hospitalizations, and improve the quality of members’ lives.

Today it was announced that since the No Surprises Act went into effect at the beginning of the year, Americans haveavoided more than 2 million surprise bills. The law protects patients from most surprise medical bills and removes them from the middle of negotiations between providers and insurers when it comes to disputes on what should be paid. That’s the good news.

The use of emergency rooms for primary care services is decreasing, thanks to Medicaid managed care. A recent report by the Texas Health and Human Services Commission (HHSC) shows a 15.5% decrease in the number of potentially preventable emergency room visits in Texas Medicaid and CHIP programs. This is great news for both Medicaid members and taxpayers. Utilizing preventative and standard care before conditions become emergencies leads to better health outcomes and to less costly care.

Can driving just a few miles save a patient thousands of dollars? If they’re in the market for health care, the answer is yes. In Dallas, according to a recent article in D Magazine, the cost of a gallbladder removal surgery can range from $5,000 to $35,000. And rarely are prices posted online—even though they’re supposed to be.

Did you know National Nurses Week is now Nurses Month? Extended in 2020 to recognize the extraordinary efforts of nurses during the early days of the pandemic, the American Nurses Association adopted the evergreen theme “Nurses Make a Difference.” At TAHP, we want to acknowledge the positive impact Medicaid managed care nurses have on the lives of their patients.