What Happened at the Edinburg Medicaid Managed Care Townhall Meeting in May

Back on May 19, Sen. Chuy Hinojosa and Rep. Richard Peña Raymond hosted a town hall meeting for providers on Medicaid managed care in Edinburg at the Edinburg Conference Center at Renaissance.

It has taken a while but here are some collected observations about what occurred at the meeting.

Well attended but geared more for medical providers

First of all, the meeting was well attended.  So much so that the meeting moved from a large conference room to the auditorium at the conference center.  It is estimated about 200 providers attended.

While the attendance generally was good, the number of dentists who attended was small.  Apparently, only four or five were there including Dr. Joey Cazares of McAllen Dental Associates and president-elect of the Texas Dental Association, Dr. Chad Evans of Smile Magic and Dr. Juan D. Villarreal of Harlingen Family Dentistry.  It appeared that the meeting was set up more for medical Medicaid providers.

This fact was highlighted further as neither MCNA or Dentaquest were among the six managed care organizations that were on the dais to answer questions.

Joining Sen. Hinojosa and Rep. Raymond on the dais were Rep. Bobby Guerra, Charles Smith, the current deputy commissioner of the Health and Human Services Commission and their host Dr. Carlos Javier Cardenas along with six MCO representatives.  About-to-retire HHSC Executive Commissioner Chris Traylor, Medicaid director Gary Jesse and Inspector General Stuart Bowen participated by phone as bad weather had prevented their travel to the valley from Austin.

Key dental issues raised – main dental home and credentialling

Here are the takeaways from the meeting:

1. Providers are having problems with MCOs similar to dentists with Dentaquest and MCNA.  They complained about denial of necessary procedures, a burdensome administrative process to get kids basic care, recommended treatment by a specialist being denied by a lesser trained individual at an MCO.
2. Two issues relating to dental care were brought up by Dr. Evans and Dr. Cazares.  The first was credentialing of new dentists.  It is taking up to six months by Dentaquest.  MCNA is taking about two to three weeks. It was learned that, per their contract, the dental MCOs are supposed to credential a new dentist to an existing practice within 30 days or at least allow them to bill within 30 days if they can’t complete the credentialing.  The HHSC reps said that HHSC will fine and penalize the dental MCOs if this is not occurring.
3. The second issue is that of main dental home for Medicaid patients.  Dr. Evans told a story about a dentist he works with who recently bought a practice from his brother who is also a dentist.  By the time the changeover of ownership had taken place, every Medicaid patient in the practice had been reassigned a new dental home by Dentaquest and MCNA.  The new owner had no idea where they had gone.  Dr. Cazares made the same point as his office staff have to check every patient at their appointment to ensure their dental home has not changed.  It is basically a disaster.
4. The consensus among providers was that the MCOs were up there giving all the right answers about how the program is supposed to go but this didn’t mesh with reality and their experience at all. Worse, there’s nobody holding them accountable and making them administer the program the way it is supposed to be administered.

Provider MCO workgroup to be established

As a result of the town hall, Rep. Raymond is establishing a provider workgroup to be organized this summer.  It will consist of both providers and representatives from the MCOs so they can work together on a more intimate level and resolve these issues.  

Dental providers who wish to participate can email him at  richard.raymond@house.texas.gov.