Medicaid Managed Care: Complicating Care in Texas Nursing Homes

The introduction of Medicaid Managed Care (MMC) into the state’s long term care system continues to present significant administrative and financial challenges for Texas nursing homes already contending with the consequences of two decades of chronic underfunding by the state. Managed care’s bureaucratic maze has required the hiring of additional staff to navigate the process, increasing costs for nursing homes and failing to improve the care provided to senior Texans.

A lack of coordination and uniformity within the MMC process has added a layer of complexity to caring for the state’s aging population. Nursing homes are forced to seek reimbursement using 10 separate portals, each requiring different procedures from the login process to the steps involved in submitting claims. When there are issues with submitted claims, there is no standardization across the managed care organizations, adding time to processing that diverts resources away from providing care. Unpaid accounts receivable balances remain at levels well above where they were prior to the rollout of managed care.

Service coordination continues to fall short of expectations despite multiple opportunities for improvement. The credentialing process has been plagued by inefficiencies, including time-consuming duplicative documentation requirements.

House Bill 2221 has been filed to simplify the process by requiring a single, uniform portal that allows participating providers to review, manage, and edit claims in the same manner as if such claims were submitted to the portals provided by each separate managed care organization.