Texas Health and Human Services Losing Executive Staff

According to a story in today’s Texas Tribune, a large number of experienced executive staff of Texas Health and Human Services have exited the mega-agency due to conflicts with current Executive Commissioner Charles Smith.  So far,  these include, according to the Tribune,  Jami Snyder, chief deputy director of the state’s Medicaid program, Gary Jessee, the former medical and social services director; Lisa Carruth, the former chief financial officer; Lisa Kirsch, who helped oversee Medicaid and the Children’s Health Insurance Program; and Pam McDonald, the former director of rate analysis.

Executive Commissioner Smith accused of pushing political agenda

Smith, appointed by Gov. Greg Abbott, continues to have the governor’s full confidence and was recently re-appointed.  Current and ex-employees, quoted anonymously for fear of reprisals from the agency and government, expressed concerns to the Tribune that Smith ” has allowed Abbott’s office to pressure the agency into many high-profile, controversial policy decisions that they said would have been rejected by previous commissioners.”

These include:

• Staff requiring approval from agency seniors before taking outside work.
• A hiring freeze ordered by Abbott earlier this year though the freeze was lifted Sept. 1.  The agency has staff shortages.
• The elimination of the agency’s refugee assistance program.
• An effort, now paused, to remove Planned Parenthood from the state’s Medicaid program.
• The awarding of a women’s health contract to the Heidi Group, an anti-abortion organization whose funding was recently scaled back after it failed to serve the high volume of patients it claimed it could.
• A rule that would require medical providers to cremate or bury fetal remains from abortions and miscarriages that occur at a healthcare facility.

Slow response to Hurricane Harvey

Morale problems within the agency are said to have caused the slowing of relief efforts to victims of Hurricane Harvey.

Specifically, sources inside and outside the commission told the Tribune that the agency was slow to act in providing guidance and assistance to Texans affected by Harvey who qualify for public programs such as food stamps and Medicaid.

Doctors have complained that basic information, such as whether displaced Medicaid patients could seek care outside of their insurance network or get prescription medications refilled, was slow to emerge from the agency, and advocates for low-income Texans were frustrated to see a flurry of revisions to information posted on the agency’s website as victims sought government assistance.

Others pointed to the delay in rolling out disaster food stamps benefits. Hurricane Harvey made landfall in Texas on Aug. 25, and the health commission began rolling out disaster food stamps on Sept. 13, nearly three weeks later, but only in some counties. Houston, Corpus Christi and other areas that suffered some of the most extensive damage from the storm were not included in the initial rollout.

By comparison, when Hurricane Ike struck Galveston in 2008, then-Executive Commissioner Albert Hawkins announced the agency would provide emergency food stamps five days after the storm made landfall.

Will Medicaid ever stabilize in Texas

One wonders if HHS and Texas will eventually run afoul of the Frew settlement again.  It seems quite likely.

The bottom line is that Medicaid in Texas is an oxymoron.  How can a state government fundamentally opposed to entitlement programs run a federal entitlement program?  It just won’t ever work out and the victims will be the people who depend on it and the providers who service it.  We see this time and time again.