A state-operated program that allows 56,000 South Texas elderly and disabled Medicaid recipients to live at home instead of a nursing facility may soon come to an end. When the Texas Legislature cut the state budget last year, it mandated that South Texas Medicaid recipients in the Community Care for the Aged and Disabled (CCAD) be transferred to privately operated HMOs in hopes of saving $160 million.
The Texas State Employees Union has initiated a campaign to save these services. “CCAD has an outstanding record for helping people who might not otherwise be able to do so live on their own,” said Mike Gross, TSEU vice-president. “Workers who do this work must be well-trained and dedicated to quality service. This is not work for low-paid, poorly trained employees. We can’t put corporate profit ahead of people’s needs.”
For many years, Texas has been gradually shifting elderly and disabled Medicaid recipients into privately operated HMOs. The STAR+PLUS program as it is called pays HMOs a set rate for each patient served by the program. The HMOs keeps for their profit and administrative expenses any of the money not spent on patient care; consequently, there’s an incentive to limit patient care.
Disability advocates told Gross that one of the biggest complaints they hear from Medicaid recipients in STAR+PLUS is the difficulty they have accessing services. In 2009, the Dallas Morning News reported that patients enrolled in Evercare, A United Health company that operates a STAR+PLUS HMO, weren’t getting the health care services that they needed. “They ought to call it Nevercare,” said Mary Ross an Evercare patient in North Texas to Dallas Morning News reporter Gregg Jones.
Until now, the state has not expanded STAR+PLUS to South Texas because of local sentiment against it and opposition by local elected officials. But after the Legislature’s mandate, the Texas Health and Human Services Commission began seeking proposals to open STAR+PLUS in South Texas.
If STAR+PLUS is fully implemented in South Texas, HHSC estimates that about 400 jobs in CCAD will be eliminated.
“It won’t be easy to protect community care,” Gross said. “There’s momentum building to expand the HMO model to South Texas. Protecting these service will depend a lot on how hard state workers who provide these services are willing to fight for them. If we can increase our union’s membership in the Department of Aging and Disabilities (DADS, which manages CCAD) and mobilize these new members to fight back, I can’t guarantee a victory, but at least we have a fighting chance.”
Organizing is the first priority. “We need to get at least 50 percent union density in DADS offices,” Gross said. Texas is a right-to-work state, so there is no automatic dues check off.
To boost union membership TSEU organizers and activists will strengthen local organizing committees. One committee in Brownsville has already conducted two outreach efforts at two DADS community services offices and signed up 12 new members.
Mobilizing members is also important. “We’ve got to get more of our members, including new members, involved in this fight,” Gross said. Members have already begun to contact legislators and local elected officials to seek their support in maintaining community care.
Members will also be contacting friends, relatives, neighbors, people with whom they attend church, and other potential community supporters to get them to contact elected officials. “We need to generate hundreds of calls to motivate elected officials to stand up for community care services,” Gross said.
Education is the third prong. “We need to give our members timely and accurate information about this fight,” Gross said. To that end, union organizers and members will set up a network to distribute information using various media.
Texas has been privatizing services aggressively with disastrous results. It wasted hundreds of millions of dollars when it attempted to privatize state health and human services. More recently, it hired a private company to oversee infrastructure repair caused by two hurricanes. After the firm spent 90 percent of the money allocated for the repairs, only 20 percent of the projects were completed. “Let’s hope the same thing doesn’t happen to people who need community care services,” Gross said.