Texas Tribune
Texas churches responding to growing mental health needs
by Stephen Simpson, The Texas Tribune – 2024-03-28 05:00:00
SUMMARY: The Texas Tribune outlines the mental health crisis in Texas and how local faith communities are stepping in to fill gaps left by a shortage of mental health professionals. Rev. Michael Marsh of St. Philip's Episcopal Church in Uvalde helped establish long-term mental health services following a tragic school shooting. Churches across the state are now increasingly offering mental health care, often partnering with secular mental health organizations. This trend of integrating faith-based support is rooted in data indicating people often consult clergy over mental health professionals. Some churches, especially within Black and Hispanic communities, have overcome cultural barriers and started to actively participate in mental health initiatives. There has been a paradigm shift among faith leaders who now openly discuss mental health from the pulpit, helping to destigmatize the topic and guide congregants toward healing.
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For 24/7 mental health support in English or Spanish, call the Substance Abuse and Mental Health Services Administration's free help line at 800-662-4357. You can also reach a trained crisis counselor through the Suicide and Crisis Lifeline by calling or texting 988.
The Rev. Michael Marsh stood before his congregation at St. Philip's Episcopal Church in Uvalde, knowing his grieving community needed more from him than prayer.
It had only been a few days since a gunman killed 19 children and two adults at Robb Elementary School in 2022, and with very few mental health resources in the city of 16,000, Marsh knew he had to find a long-term solution to heal his community not just spiritually, but mentally as well.
“I was talking to my own therapist, and she told me to contact the Children's Bereavement Center of South Texas in San Antonio because they're well-respected and credible. I reached out to them, and in a couple of days, a parishioner told me the Children's Bereavement Center was looking for a space to set up long-term here in Uvalde,” Marsh said.
Two years later, there's a partnership between the mental health organization and St. Phillips Episcopal Church. The Children's Bereavement Center of South Texas in Uvalde is housed inside the church's former storage building. This collaboration has allowed the center to expand its services to not only children affected by the deadliest school shooting in Texas history but also adults, first responders, teachers, and anyone else who might need it.
“I have had people whose children were directly impacted by the shooting come up to me, and I will ask them if they are going to counseling, and they will say, ‘Well, my child doesn't' want to go to counseling,' Marsh said. “I said ‘it's not a question of whether he or she wants to go. If your child broke his arm, would you let him decide whether or not to go to the doctor? If the answer is no, then why would you let them decide whether to see a counselor?”
Tragedy may have led the Uvalde church to forge a mental health partnership, but their move is part of a growing trend among churches to offer more services to congregants and the public, particularly after so many experienced depression and isolation during the coronavirus pandemic. And many Texans emerged only to discover the state's severe mental health workforce shortage.
Christian churches have offered a limited array of counseling services to their followers, either from church leaders or fellow members, more are stepping in to expand existing programs and services or banding together with other churches to offer a network of help. In some ways it's a no-brainer. A 2003 study found that people were more likely to consult clergy for mental health treatment than to seek services from a mental health provider, even if they weren't religious.
Some, like The Potter's House in Dallas, the megachurch run by well-known pastor T.D. Jakes, has a counseling center staffed with licensed mental health professionals who incorporate faith-based teachings into improving members' overall ability to cope during stressful life events. Saint John's United Methodist Church in Austin has had a mental health ministry team dedicated to removing the stigma of mental illness for the past four years. Community Bible Church in San Antonio has had mental health groups since 2007 focused on those experiencing mental illness because of trauma and a group dedicated to helping teens deal with life's ups and downs.
“I believe there is still a sort of stigma about seeing a counselor, psychologist, or therapist,” Marsh of St. Philip's in Uvalde, said. “But I also think for rural communities, it's just more challenging to find mental health professionals, and sometimes the clergy are more readily available.”
No where is this more true than in Texas, which faces a mental health workforce shortage. Today, 98 percent of the 254 counties in Texas are federally designated “mental health professional shortage areas” because there's only 1 clinician for 30,000 residents. That number is expected to worsen.
This workforce shortage has prevented private and state-run mental health hospitals from operating at total capacity, created long waitlists for therapy services, and forced many private providers from taking on new clients as the demand has exceeded scheduling capacity.
Mental health providers in Texas believe if adequately resourced, pastors and other religious leaders can offer a valuable contribution to taking on the mental health crisis in Texas. It's a role more churches are taking on.
“The church needs to be able to provide actual care rather than telling the person to pray more or be more spiritual,” said Denise Espino, a mental health provider and director of Mental Health Support Groups for Community Bible Church.
She said one of the main challenges she has witnessed is church leaders being fearful of letting someone with mental illness in their own lives participate in support groups on their campus.
“Many church leaders are more willing to allow family members to meet [meet with pastors or deacons], but when it comes to the person with a diagnosis themselves, they shy away from providing support,” she said.
However, now there are entire curriculums dedicated to faith-based mental health to educate clergy on how to respond to mental illness in their communities.
“Resources are out there – the church just needs to make a commitment and jump in,” Espino said.
Partnering with secular resources
This alliance between secular mental health providers and churches is one that has slowly grown over the last few decades.
“For a long time, there has been a disconnect between clergy and psychiatrists,” said Doug Beach, chairperson of the NAMI's FaithNet Advisory Group. “I think there has always been skepticism on the part of psychiatry about faith. But now the data has made it clear the importance of community to mental health, and we have recognized that if faith is important to you, then it's important to your mental health.”
A 2023 study found that people who are deeply religious usually have better mental health as long as they stay connected to the church. But the study also found older congregants with depression relied more on prayer and were less likely to seek mental health treatment.
Beach, of NAMI, said that when he started holding mental health wellness classes over a decade ago at his San Antonio church, he noticed that most of the people attending the meetings were from other churches, not his own.
“I had a woman after one of my classes tell me where she lived, and I told her you know there is a church in your neighborhood that does classes like this, and she told me she already knew, but people might recognize them there,” he said.
Historically, there's been a stigma around mental illness in many Christian denominations. But since World War II, there's been a growing conversation within faith communities about mental illness and treatment. In 1993, Pope John Paul II spoke before the international delegation of psychiatrists to express the church's esteem of psychiatric medicine.
“The idea of demonic possession and stuff like that when it comes to mental illness was probably 15 to 20 years ago. I hardly run into anybody anymore who says that,” Beach said. “I am sure there a few pastors who still do, but they're pretty much in the minority today.”.
Christians aren't the only faith considering how to reach followers in need of mental health help. This renewed focus on mental wellness has highlighted the mitigation efforts others have established in their community over the years.
While some faith communities have taken to addressing mental health inside their facilities using in-house programs, others have systems built up already that allow them to redirect those who are having a mental health crisis to care that takes their religion into consideration.
Multiple mosques in the Dallas and Fort Worth area carry information about the Al-Shifa Clinic, a charitable Muslim medical clinic in Richland Hill, near Fort Worth. This clinic allows religious leaders to redirect those needing help to a center with licensed social workers and two psychiatrists.
“Initially, the center was established to provide medical and social services to immigrants and refugees arriving from Bosnia, Iraq, Somalia, and other Middle Eastern and South Asian countries,” said Ahmed. “Since 2004, the center has been providing these services to all indigent residents residing in the DFW area, irrespective of country of origin, ethnicity, and religious beliefs.”
Ibn Sina Foundation, a nonprofit organization serving the Houston area for over 20 years, organized the first Muslim Mental Health Conference for Community Leaders in 2022 to address addiction and mental health in their community. Over 30 mosque leaders attended the conference.
Something similar occurs at the Jewish temples across Texas, where Judaism-based health service agencies have been established to give rabbis the ability to redirect them to faith-based mental health care handled by professionals.
Shalom Austin is a program dedicated to adding mental health resources and awareness in Central Texas communities through financial support and collaboration between temples and mental health providers.
“We offer a variety of mental health programs and services for the community,” said Rabbi Amy Cohen, Shalom Austin's chief social services officer for Shalom Austin. “This includes one-on-one counseling with a licensed therapist, support groups, and case management services.”
Cohen said the center is currently offering a five-week program to synagogues titled “Life Transitions” to help people through specific events that might cause someone's mental wellness to suffer.
“Participants will focus on areas such as navigating relationships, career shifts, exploring gender identity, and more,” she said.
Even the federal Substance Abuse and Mental Health Services Administration has a page of links dedicated to getting mental health resources into every religious organization. The agency recommends all faith communities invite mental health experts to speak to their congregations, learn the primary signs of mental illness, and share the 988 Suicide and Crisis Lifeline in their publications.
Despite this new level of mental health awareness, some churches, particularly those in Black and Hispanic communities, have been more reticent. But that too is now changing.
Angela Bigham, the wellness director at Rehoboth Baptist Church in Austin and community engagement director for the University of Texas at Austin School of Nursing, said the hesitancy over the past decade was primarily due to the cultural disconnect between religious leaders and the predominately white mental health field.
“I had an African American woman come up to me saying she wished she could do counseling, but when she went to the psychiatrist, she [the therapist] didn't understand her background,” Bigham said. The provider, the woman told him, insisted that spanking in the home wasn't abuse but discipline, and the woman seeking help felt that the therapist kept trying to pin her problems on spanking as a child.
Bigham also recalled that several years ago, when she was doing volunteer work for the University of Texas in Austin, the school was part of an effort to bring mental health resources into African American churches, but the effort fell flat.
“It turns out they were sending like some young girl … wearing thigh-high shorts and flip-flops, into these churches to tell them how many free resources they have,” Bigham recalled. “These elders don't care if there are free Cadillacs in the parking lot; they are trying to figure out why you are disrespecting their church in your thigh-high shorts and flip-flops.”.
Bigham eventually took over the program and held a town hall event at a Black church where a pastor got up and introduced mental health providers to the congregation and gave them time to describe what free services they had to offer.
“The reaction was great; people were shocked by the things available in their community. They had no idea because there was such a disconnect between everyone,” Bigham said.
Bridges to Care, a program developed in 2020 by the San Antonio chapter of the National Alliance on Mental Illness, connects the clergy and the congregation with mental health service providers and helps improve the congregation's understanding of their mental health. Churches that participate must also invite the other churches near their neighborhood.
“We have learned that the program tends to stick longer when you involve the entire neighborhood. Well, we have had 2,000 people go through our program and have worked with 70 congregations in our community,” Beach said.
Beach said the Bridges to Care program has thrived in east San Antonio, a historically Black area of the city.
“I think one of the reasons is that when we asked church leaders to go get your compadres and work together on this, it became their program and their neighborhood's effort, and it was all being done by their church,” he said.
Beach said the organization is trying to do the same thing on the city's west side, which is primarily Hispanic, a demographic that has been hard for mental health providers to reach.
“Last year at our Pathway to Health conference, we had a session for Hispanic families to educate them on how to talk about mental health,” Beach explained. “People were in tears because they had been living with this mental illness for years but were unable to explain it to their families, or they realized what was happening to one of their family members. It was overwhelming.”
The COVID-19 pandemic revealed to everyone, church leaders say, that mental illness wasn't something happening outside of the church but a crisis within their congregation.
“I haven't met a faith leader recently who doesn't recognize the impact of the pandemic,” Beach said. “I mean, honestly, most of them know members of their congregation who are dying by suicide, or they have family members who have bipolar disorder or are under psychiatric care. It's not like mental illness is hiding.”
The critical piece in solving this problem is for religious leaders to do something that can be pretty hard: show vulnerability to their congregations.
“We have found that if pastors are willing to get up in the pulpit and talk about mental health issues, and, in some cases, talking about themselves or their family, it makes all the difference in the world. Suddenly, they give permission to the people in the flock to talk about these issues,” Beach said.
Speaking from the pulpit
Robyn Bishop, lead pastor of Memorial United Methodist Church in Austin, has always had a strong belief in God's healing power, but in college, she struggled with an eating disorder and needed counseling. Because of this experience, she knew mental health and faith could co-exist, but in 2011, when she was a pastor for a church in Houston, she decided it was time to tell her story during a women's retreat. The response she received was overwhelming.
“I asked afterward if anyone wanted to ask for prayer, and the next two hours, women started coming forward sharing their stories about how this family member was struggling with bipolar disorder, or this family member was struggling with anxiety or addiction,” Bishop said. “It showed me that if I talked about it more than other people would talk about it.”
The people who stand behind the pulpit are considered among Christians to have faith so strong that they can lead others. But even they can struggle with their mental health, and more religious leaders are starting to tell their stories in hopes of helping others.
“We know now that having a mental illness is like having a broken arm. You need to go to the doctor for it,” Bishop said.
Disclosure: Cadillac and the University of Texas at Austin have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.
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Texas Tribune
Charges against state Rep. Frederick Frazier are dismissed
by By William Melhado, The Texas Tribune – 2024-04-26 23:32:07
SUMMARY: State Rep. Frederick Frazier's misdemeanor charges of impersonating a public servant were dismissed after he pleaded no contest and was granted early release from community supervision. This occurred months after accepting probation and fines for targeting an opponent's campaign signs. Frazier compared his legal experience to Trump's, appreciating the former president's situation. Frazier's case dismissal surprised his accuser, Paul Chabot, who lost the Republican primary to Frazier. As Frazier faces a runoff election, his opponent Keresa Richardson focuses on Frazier's legislative performance rather than legal issues. Meanwhile, Governor Abbott and other officials have had varying involvement with Frazier and House politics.
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A Collin County district court dismissed charges against state Rep. Frederick Frazier on Friday after the McKinney Republican pleaded no contest to two misdemeanor charges of impersonating a public servant. The court also granted an early release from community supervision, which resulted in the dismissal as part of Frazier's deferred adjudication.
In December, Frazier pleaded no contest to the two criminal charges, part of a plea agreement stemming from allegations he targeted his primary runoff opponent's campaign signs over a year ago. Frazier accepted a year of probation and a maximum $4,000 fine for each offense.
Earlier this month, Frazier's lawyer filed an application for early release and dismissal of charges. On Friday, Judge Jim Pruitt granted that request, a little over four months after Frazier entered the no contest plea. The order comes one month before Frazier's primary runoff election against Keresa Richardson for a Republican-friendly seat in northern Collin County outside Dallas.
In December, while accepting Frazier's no contest plea, Pruitt wrote, “Court finds that the evidence and Defendant's plea substantiates the Defendant's guilt of the offense beyond a reasonable doubt as charged in the indictment.”
He has separately pleaded guilty to a misdemeanor charge of criminal mischief.
Frazier was indicted in June 2022, in which he was accused of impersonating a McKinney city code enforcement employee on two occasions instructing people to “remove campaign signage.”
The campaign signs belonged to his opponent in the 2022 Republican primary for House District 61, Paul Chabot. In his first run for the House, Frazier had the backing of former President Donald Trump. Chabot lost that race.
Chabot told The Texas Tribune that the judge's order on Friday took him by surprise. He had intended to provide a victim impact statement at the end of the year, when Frazier was scheduled to complete his community supervision.
On Friday, Frazier announced on social media that the judge had dismissed his case. He said his legal troubles had given him appreciation for Trump, who is facing four criminal cases in which he is accused of election interference, mishandling classified documents and falsifying business records.
“I cannot compare my situation to Donald Trump's, who has been hounded by radical Democrats with little or no proof,” Frazier said. “It gave me a small taste of what President Trump faces now.”
Frazier's campaign did not return a request for comment as of Friday evening.
Frazier represents House District 61, a Republican-friendly seat in northern Collin County outside Dallas.
Gov. Greg Abbott backed Frazier during his reelection campaign as part of a blanket endorsement of dozens of House Republicans who sided with Abbott in favor of school vouchers.
Frazier is among the dozens of House Republicans that Attorney General Ken Paxton tried to defeat after the House impeached him on abuse-of-office allegations in May. The Senate acquitted Paxton in September.
Richardson, his opponent in the May 28 runoff, said his legal problems weren't the reason she entered the race, but rather it was his performance in the Texas House that pushed her to challenge Frazier. Richardson won 40% of the votes; Frazier won 32% of the votes.
“We'll let the people decide who they would rather have in the House,” Richardson told The Texas Tribune on Friday. “It's up to the constituents.”
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Texas Tribune
Texas DPS investigating FOX 7 journalist arrested at protest
by By William Melhado and Annie Xia, The Texas Tribune – 2024-04-26 17:58:30
SUMMARY: The Texas Department of Public Safety (DPS) may probe a news cameraman arrested during a University of Texas at Austin protest after being accused of hitting a trooper with his camera. Despite Travis County dismissing trespass charges against all 57 arrested—including the FOX 7 photojournalist identified as “Carlos”—DPS is referring the case to its criminal investigations division. Footage shows a physical encounter between Carlos and officers as he covered the protest. Carlos contends he didn't hit an officer, suggesting he was pushed. Kelley Shannon of the Freedom of Information Foundation of Texas emphasized the importance of press freedom and condemned his arrest.
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The Texas Department of Public Safety could launch a criminal investigation against a broadcast news cameraman arrested at this week's University of Texas at Austin demonstration, the agency said Friday. That announcement came shortly after Travis County officials said they dismissed misdemeanor criminal trespass charges against all 57 people known to have been arrested at the protest.
The photojournalist for FOX 7 in Austin was among the people arrested. He was covering the protest and law enforcement response, and identified himself only as “Carlos” to local media. Neither DPS nor the television station have publicly named him.
In a statement Friday, DPS accused him of hitting a trooper with his camera.
“The department believes strongly in a journalist's right to cover events of the day in a safe way; however, that does not except a person from following the law or the rules that have been put in place for the safety of others,” Sheridan Nolen, DPS press secretary, said in a Friday statement.
The agency said the matter has been referred to its criminal investigations division for further investigation.
Kevin McPherson, news director at FOX 7, said the organization was not able to comment at this time. But the station posted a copy of the DPS statement on its website.
Multiple videos from the scene posted on the social media site X show a crush of protesters, officers and journalists chaotically moving across the campus' South Lawn as DPS troopers clear the area. It's not clear who filmed the videos. A television photojournalist, loaded with a large shoulder camera and backpack, can be seen near the edge of a line of troopers pushing the crowd off the lawn.
From multiple angles of the melee captured in several videos, including one filmed by the journalist, it's clear his camera collides with an officer during the scuffle.
Video then shows a trooper pulling the photojournalist's backpack and, along with another officer, throwing him to the ground. As the cameraman was being led away by a state trooper, he said to KXAN that he told law enforcement he was with the press. He also said he was being pushed, but didn't say who was pushing him.
“They were pushing me and … they say I hit an officer,” he says in a video posted on X. “I didn't hit an officer. They were pushing. They were pushing me.”
The author of the post did not respond to a request for comment from the Tribune.
Carlos' camera continued rolling after he was slammed to the ground.
“I was moving, I was moving,” Carlos can be heard saying on the footage from his camera. He explained that he was pushed and almost fell.
The officer leading him away said, “I wasn't there to see it.”
FOX 7 reported the photojournalist was booked in Travis County Jail after 8 p.m. on Wednesday and was released before noon on Thursday.
Travis County Attorney Delia Garza announced on Friday that law enforcement lacked probable cause in the 57 criminal trespass cases stemming from Wednesday's arrests. There had been no felony charges filed as a result of the demonstration as of late Thursday, according to the Travis County district attorney's office
In a Thursday statement, Kelley Shannon, executive director for the Freedom of Information Foundation of Texas, said that the photojournalist was charged with criminal trespass, along with the protesters who were arrested.
Shannon denounced the arrest and called on law enforcement to respect the rights of free press.
“The police should not interfere with a working journalist doing his job covering the news in a public place,” Shannon said.
Annie Xia contributed to this story.
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Texas Tribune
State’s premature release of bid documents touches off new battle over Medicaid contracts
by By Karen Brooks Harper, The Texas Tribune – 2024-04-26 17:27:27
SUMMARY: Aetna, poised to secure a multibillion-dollar Texas Medicaid contract, inadvertently received rivals' sensitive bids early due to a state agency error. HHS wouldn't comment but acknowledged the mistake. This premature disclosure may have compromised the fairness of a $116 billion, 12-year procurement process. Competitors argue that the mistake benefits Aetna unfairly and call for a redo. Eight insurers have protested the tentative awards, surprising many who saw long-established plans dropped for new entrants. Superior Healthplan, facing a $900 million contract loss, has taken legal action for transparency. The controversy raises issues about procedures for government contracts, with accusations of an unbalanced bidding process and consequential impacts on Texas Medicaid recipients.
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Aetna, which is set to win a multibillion Texas Medicaid contract, got a peek at sensitive information submitted by 17 rival health plans during the bidding process after the state Health and Human Services agency erred and sent competitors' proposals to the health insurance giant too early, according to emails and documents obtained by The Texas Tribune.
Neither officials with HHS nor those representing Aetna's Medicaid division – Aetna Better Health Texas – would discuss the matter with Tribune. But the agency confirmed the error in emails it sent to Aetna and others earlier this year, according to a court filing in Travis County this week.
The court documents include the state agency's own admission to the insurance bidders that the release of the information to Aetna was in error.
“The PIA copies were sent to you in error as this procurement is still in the open stage,” reads a Jan. 12 email to Aetna from a legal assistant for the agency, referring to redacted copies of the bids required by the Texas Public Information Act. “As a courtesy, would you please destroy the copies? Once the Notices of Award are issued, we will provide the PIA copies to you.”
The early release of documents throws into doubt the legitimacy of a procurement worth about $116 billion over the next 12 years because it gave a single competitor a look at the other bidders' playbooks while the procurement game was still on, several bidders argue.
“One of the basic tenets of procurement law is that a procuring government entity must ensure a level playing field for all respondents,” attorneys for Superior Healthplan wrote in an April 19 protest letter to HHS. “This procurement utterly failed in that regard, among others.”
Superior Healthplan stands to lose its $900 million contract if the new Medicaid bids are finalized, a move expected later this year.
The competing bidders who are complaining about Aetna's potential unfair advantage say the responsibility for that imbalance lies with the state, not with Aetna, which made a legal and publicly available request for the documents through the proper channels.
But at present, Aetna Better Health Texas is set to win seven new Medicaid contracts once the state finalizes its awards, which were announced March 7. Because records related to the bid evaluations are largely being withheld by the state, it is unclear whether or how any of that information might have been used during the decision-making process.
So far, eight insurance plans have filed protests in response to the state's intent to award the new six-year contracts to Aetna and other winners, one of which is brand new to Texas Medicaid. Each of those contracts can be extended up to a total of 12 years.
The list of winning bids shocked many in the health care community because it dropped three Texas children's hospital-affiliated plans — in Fort Worth, Houston and the Rio Grande Valley — in favor of competitors new to either the region or the state Medicaid programs. It also gutted the coverage areas of some long-standing for profit plans, including WellPoint and Superior.
On Wednesday, Superior Healthplan asked a Travis County district court to compel Texas HHS to release scoring, evaluation notes, audio and video and other records related to the procurement, signaling a contentious battle ahead.
The ‘error'
Medicaid in Texas provides health insurance for more than 4 million people, mostly mothers and children. HHS manages the program but pays contractors to handle individual billing and payments to medical providers.
Each time the state has to reassess and collect new bids from companies that will actually issue insurance coverage to these residents, it can bring a cutthroat battle between companies and the state over who will win those multibillion contracts.
As part of any contract process, companies routinely look for advantage. And one way is by filing open records requests to a state agency to get a handle on what competitors are proposing.
It's a perfectly legal move to request the documents through public information channels, and the onus is on the state to determine if it's appropriate to release them.
But during this STAR/CHIP contracting round, those documents were released before the bid winners were announced – and indeed before the competitors had even been interviewed by the state's evaluation teams – and that has resulted in the losing companies crying foul.
The Aetna request was made in August, long before the awards were announced last month, emails between Aetna representatives and Texas Health and Human Services show.
One other Medicaid contract bidder received the same records in October, but Aetna was the only bidder to receive them while the companies were still presenting their cases to the evaluation team. Another requestor, a research clearinghouse with no affiliations to any bidders, received the records in August as well.
Oral presentations — hours-long interviews before a panel of evaluators that were part of the scoring process — did not conclude until mid-October.
In January, HHS notified all three companies to “destroy” the documents because they were “sent to you in error as this procurement is still in the open stage.” The email said that once the state announced who they intended to award the contracts to the following month, they would re-release those documents.
Curiously, the error was made despite two Texas attorney general rulings that stated the agency had grounds to hold records private until after the procurement process because releasing them could unfairly affect the outcome.
HHS officials said the records contained no confidential information but declined to comment further.
“The agency's misconduct created an unlevel playing field that advantaged one competitor to the detriment of all others in this procurement for the largest state contracts in Texas,” Superior attorneys wrote in the April letter. “The only appropriate remedy is to cancel … and start over. Any other response would simply be a waste of taxpayer dollars and government resources in a misguided attempt to defend HHSC's indefensible actions.”
Aetna declined to comment specifically on the release of the records or the procurement.
“While we defer to the state of Texas to comment on its procurement process, we remain confident in Aetna's ability to deliver excellent service and value across these Medicaid contracts,” according to a statement emailed to the Tribune by an Aetna spokesperson.
New contracts, new battles
In March, Texas HHS announced its intentions to drop children's health plans that are run by three legacy children's hospitals and award the majority of Medicaid STAR and Children's Health Insurance Program contracts to national for-profit health chains.
More than a week ago, two major children's hospitals that had previously held Medicaid insurance plan contracts but lost them this round, announced they would likely have to shut down those programs if the deals are signed.
Some 1.8 million Texans who receive Medicaid coverage from six managed care organizations – the health insurance providers that actually issue the coverage – across the state would lose their current health plans and be shifted to new insurers next year if the decision is finalized.
Lawmakers, angered at the plight of the children's Medicaid plans, have called on HHS to delay the procurement so that they could strengthen laws governing the process and better protect high-quality legacy plans.
Officials with managed care organizations, or MCOs, who lost contracts said they were troubled by the possibility that information they had assumed would be kept private until the end of the procurement process could have been used to compete against them.
“We are aware of this situation and are deeply concerned about the questions this raises about the process,” officials from Cook Children's Health Plan said in a written statement.
Officials at Driscoll Health Plan, which is likely to shut down if it loses its long-standing Texas Medicaid contracts, said they were stunned to learn that one of its competitors had gotten a look at their bid proposals while the plans were all still being evaluated.
They have already filed a protest saying that the new scoring system used in the evaluation phase was unfair, arbitrary, and did not take into account legally required quality measures, among other failures.
“For this procurement attempt to be riddled with so many substantive failures — including the failure to meaningfully evaluate the actual, historic performance of health plans and the failure to involve local community and stakeholder feedback in the selection process — that we believe the process is already fundamentally flawed,” said Craig Smith, Driscoll Health Plan's president and CEO, in an emailed statement. “To now add such serious questions as to the procedural integrity of the procurement attempt, we believe unequivocally that it is due time to set this attempt aside.”
If the procurement is negated, it would be the third failed attempt in six years by Texas HHS to award contracts for the Medicaid programs that encompass the vast majority of state health insurance's low-income Texas recipients.
If it stands, it would mean a reduction in the number of MCOs that administer STAR and CHIP, a shift toward for-profit companies in most areas of the state, a smaller number of top-rated plans administering care, and the introduction of new national plans to regions historically served by local MCOs.
Among those who would be affected are a collective 700,000 families, pregnant women and children covered by Cook Children's Health Plan in the state's Tarrant service area, Texas Children's Health Plan in the Harris region, and Driscoll Health Plan in South Texas, all which formed when the CHIP program was created two decades ago.
Why so many contractors
Texas Medicaid STAR and CHIP programs cover the cost of routine, acute and emergency medical visits. STAR is primarily for pregnant women, low-income children and their caretakers. CHIP provides health care to low-income children whose family's income is too high for Medicaid, which has some of the lowest income limits in the country. Their members compose the vast majority of Texans on state Medicaid programs.
HHS contracts with health plans to provide, arrange, and coordinate preventive, primary, acute care, behavioral health, non-emergency medical transportation, and pharmacy covered services for pregnant women, newborns, children, and parents with limited income.
The state's privatized Medicaid program divides the state into 13 service areas, and multiple contracts are awarded for each service area so enrollees can have a choice of plans, as required by federal law.
Texas law allows three two-year renewals on the six-year Medicaid STAR and CHIP contracts, which are combined into a single service contract so that every MCO that gets a STAR contract also gets a CHIP contract. After the contracts have been in place 12 years, HHS must run a new procurement.
The last completed STAR/CHIP procurement was in 2012.
When the health plan companies submitted bids beginning in 2022, they included redacted “Public Information Act” versions, or PIA copies, of their proposals in their application packets. The PIA copies are required per state law that mandates such information be made available to the public.
Companies were advised from the start that they should not include information in the PIA copies that they do not want released to the public.
But the state's request for proposals did not specify when that information might be released. Texas law does not say explicitly that the state may not release the proposals while the competitors are still being actively evaluated or before the awards are announced.
Attorney General Ken Paxton's office gave HHS the authority to withhold procurement documents in two rulings last year specifically on the STAR/CHIP procurement — once in June and once in October.
Paxton said the state has the right to withhold procurement-related documents while it was still open “if a governmental body demonstrates that release of the information would harm its interests by providing an advantage to a competitor or bidder in a particular ongoing competitive situation.”
Two months after the first ruling, in late August, HHS released thousands of pages of redacted bid proposals by the 18 health plans to Aetna, according to emails contained in this week's court filing.The companies' oral presentations — hours-long, in-person interviews and presentations that were scored alongside the proposals as part of the overall evaluations — weren't scheduled to end until Oct. 13.
The redacted copies that were released to Aetna contained answers to a list of technical questions posed to bidders as well as written arguments for why each company believed they should get or keep a contract.
The bids include sensitive information including company business and marketing strategies or what innovations the bidder has made in dealing with provider shortages — any and all of which can be discussed during the oral presentations.
Shortly before the orals came to a close in October, Paxton's office issued the same ruling in response to a new inquiry by HHS. But a few days after the companies' oral presentations were done, the agency released the redacted proposals to an attorney for the Houston-based Texas Children's Health Plan.
Then in January, HHS attempted to claw them back from Aetna, TCHP and Health Management Associates, a health care consultancy and clearinghouse that routinely requests procurement records and also had received them in August.
Even without a state law regarding the timing of public information releases, the Texas Administrative Code instructs the state to “provide for consistent and uniform management and procurement and contracting processes,” in a “fair consideration of proposals.”
Scorned health plans argue that sending the competing bids, even the redacted ones, to a single competitor halfway through the procurement process runs counter to both of those ideas.
“HHSC's disclosure to Aetna of its competitors' proposals before the oral presentations and while the evaluation of proposals was ongoing destroyed any semblance of a level playing field and gave Aetna an unfair competitive advantage,” Superior attorneys wrote in the company's protest.
Superior is taking HHS to court over the agency's refusal to release dozens of additional records Superior officials requested in March and April after the contracts were announced — including audio and video of the oral presentations, scoring notes and meeting minutes, the identity of the people on the scoring teams who made the decisions, internal communications regarding the evaluation process, and similar information.
Superior argues that because the state already announced who would win the contracts, the competition was over and the records could no longer affect the outcome.
HHS, meanwhile, has asked Paxton for yet another opinion, this time regarding Superior's request, arguing that the additional records would interfere with the negotiations, with potential litigation, or with the evaluation process should the procurement be canceled and the competitors forced to go through it again.
The current fight over public records in government contracts is not a new one to HHS. The agency's record of refusing or delaying release of public information related to Medicaid contracts triggered a lawsuit in November of last year.
Wellpoint, a long-standing contractor of HHS, sued the agency over the $10 billion STAR+PLUS program and what the company, formerly known as Amerigroup, described its lack of effective due process in procurement and barriers to information that is legally public.
Wellpoint's lawsuit also claims that the agency has withheld documents even after the Texas Attorney General directed HHS to produce them.
The agency uses the state's open records law as both a sword and shield – delaying bidders' access to critical information and evidence, and then summarily dismissing protests without proper consideration or justification because the protester failed to provide the very evidence that HHSC itself is withholding,” the lawsuit stated.
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The post State's premature release of bid documents touches off new battle over Medicaid contracts appeared first on TexasTribune.org.
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