Medicaid In Texas

In my recent visit to Texas, I decided to research how Medicaid works there.

How Medicaid Works in Texas

Information for Users of the Medicaid Program

MANAGED CARE-Health Maintenance Organizations (HMO)
In Managed Care, each client has to choose a Primary Care Provider (PCP) who is then responsible for administering the preventive and primary care of the client, including medical screens and immunizations. The client may only choose a PCP from the network of providers that the Managed Care plan has contracted with. When the client needs specialized or acute care, the PCP refers the client to other health care specialists who are part of the network for those services. The HMO receives a monthly capitation payment for each member enrolled based on a projection of what it may typically cost to treat that patient.

MANAGED CARE-Primary Care Case Management (PCCM)
In Managed Care, PCCM is a fee-for-service alternative to capitated HMOs. In it, each client has to choose a Primary Care Provider (PCP) who is then responsible for administering the preventive and primary care of the client, including medical screens and immunizations. When the client needs specialized or acute care, the PCP refers the client to other health care specialists for those services. The client may only choose a PCP from the network of physicians that the State has contracted with.

FEE-FOR-SERVICES (FFS)-Traditional Medicaid
In a Fee-For-Services system, each client may choose any physician or health care specialist who is a Medicaid provider as and when needed. The State directly contracts with physicians and health care specialists who receive payment for services rendered.

In the Bexar County area, Medicaid Managed Care is delivered through the following models:
Health Maintenance Organization (HMO) model, and
Primary Care Case Management (PCCM) model.
In the Bexar County area, the State contracted with the following HMOs:
Community First
HMO Blue
Humana/PCA
The State contracted with Birch and Davis (Texas Health Network) to administer the PCCM model.
At the local level, the project works closely with organizations and individual providers serving CSHCN. These include the Bexar County Case Management Coalition, local agencies and organizations serving CSHCN, and families of CSHCN through out Project Advisory Committee. The project is a member of the Regional Medicaid Managed Care Advisory Committee, and functions as Chair of the Sub-committee on CSHCN.

The project has formal memoranda of understanding with the two largest providers of services to CSHCN, Any Baby Can of San Antonio and The ARC of San Antonio, who support project research and survey activities.

Visiting Texas Kids Center

The Texas Center for the Study of Children with Special Health Care Needs was established in 1994 in response to the implementation of Medicaid Managed Care (MMC) in Texas.

texas

Texas began implementing Medicaid Managed Care (MMC) in 1993. All of the state’s large urban areas have implemented some form of MMC – usually a mix of HMOs (Health Maintenance Organization) and PCCM (Primary Care Case Management) models. The only model targeting members with special health care needs began operating in the Houston/Harris County area in March 1998. This “wrap-around” model integrated preventive, primary, acute care and long-term care into a single demonstration program. The Center operates in an area that is a mixed HMO PCCM model.

In 1997, the Texas Legislature passed Senate Bill (SB) 1165. This legislation recognized the need to address concerns about CSHCN in MMC. The bill charged the Texas Health and Human Services Commission (HHSC) with developing a definition, identification, and monitoring approaches of CSHCN. The Center was part of the SB 1165 Working Group created by HHSC to help guide policy development.

This background describes the activities in Texas which helped to identify the projects goals and objectives. The following grants were awarded by the Maternal and Child Health Bureau.

Projects
Identifying and Monitoring Children with Special Health Care Needs in Medicaid Managed Care (1998-2002)
The project aims to access and describe the impact of Medicaid Managed Care upon CSHCN and their families in the San Antonio/Bexar County Area.

A project supported in part by 5 H93 MC 00059-02 from the Maternal and Child Health Bureau (title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services.

Texas Medicaid Managed Care and Children with Special Health Care Needs (1994-1998)
The project addressed the problem of the absence of universal access to services for CSHCN and their families in five South Texas counties.

A project supported in part by MCJ-48RO24-01-0 from the Maternal and Child Health Bureau (title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services.

As part of consumer education, the Center has provided information for users of the Medicaid Program with a quick reference on what Medicaid delivery models (e.g. traditional Medicaid, PCCM, or HMO) are currently in effect in Texas. The Center has provided information through developing tools and presentations to help consumers to better understand the complex delivery system for children with special health care needs under Medicaid.

An Ode to the City Slicker!

[Edit – One of the anonymous locals sent me this poem, it made me chuckle I thought I’d post it lol!]

Let’s begin by shattering an illusion. For those who saw City Slickers and are convinced you’d happily pay good money to fulfill the fantasy of that kind of rough and tumble cattle drive, better think again.

In point of fact, being a cowboy on most cattle drives means little more than working under extremely arduous conditions, from sunup to sundown, where you just push and push and then push some more, all day long, with no stops along the way to rest your weary butt, or even take time out for lunch.

You must mind your overworked horse with all its accompanying accouterments, put up and take down your own tent, be responsible for your personal luggage, bolt down hastily prepared, mostly dreadful meals, and – perhaps the final indignity – go without showers for days on end. Should the realism of that less than bucolic scene paint a pretty picture for you, have at it.

The week-long Powder River Wagon Train & Cattle Drive, out of Broadus, MT, provides a far superior alternative. “We’d like to think we run the Cadillac of cattle drives,” says Wagon Master Tracy Fruit, and is he ever on the money.

The folks from Broadus provide you with a full-tilt, live-action cattle drive which kicks off from a ranch just outside town, then ends up, six days later, back in beautiful downtown Broadus. However in a conscientious effort to bolster the commerce of their small community, they’ve also turned the circuitous journey into a relaxing western excursion.

Between the kitchen staff, the transportation crew, the Guest Wranglers, et al, there are more than 50 in help, which amounts to practically one staffer for each guest.

The eclectic group of guests is composed of families with kids, (mom/dad/sis & bud); single women hoping to find a little romance with real life mountain men; big city young men in cowboy hats looking to stretch the outer limits of their machismo; plus your every day garden variety of grandmothers, bankers, lawyers, horse people, and of course cowboy/cowgirl wannabes.

On a typical day, you’ll steer the herd of mobile beef into camp about four in the afternoon and find – to your complete relief – that your personal tent has already been set up for you. Furthermore, your luggage has been delivered in advance of your arrival from last night’s camping spot.

Generators set up at each campsite power a half dozen showers. You have no idea how great a cool, bracing shower feels after a hot day’s ride. There are also, right across from the showers, a bank of sanitary and not-unpleasant portable toilets already in place. Sure beats the daylights out of having to run off into the bushes whenever nature calls.

You are also welcomed by an enormous red and white striped tent, which serves as a combination town hall/dining room/saloon/opera house/dance hall. After showering, you might choose to mosey on over to the main tent where you can belly up to the bar to pop open a chilled beer, belt down a whisky, drink some lemonade, participate in a spontaneous game of cards, practice your lassoing, or simply relax until you hear the dinner bell.

Montana is cattle country, a land where vegetarians are still regarded as heretical eccentrics, so be prepared to find various presentations of meat (steaks, prime ribs, bacon, barbecued beef, sausages, etc.) at every meal. Clearly, this is no place for vegetarians to be hosting a convention. Still, for those who subscribe to the philosophy of Red-Meat/Red-Death, there are also enough servings of salads, veggies, pastas, beans, cornbreads, fresh fruits and desserts to keep malnourishment at bay.

Each evening, after dinner, some form of entertainment four-wheels all the way in from town and in short time, a singer is belting out country/western songs to the accompaniment of amplified electric guitars. Guests become fast friends, joining in to learn the basics of country western dancing.

Come 7:00am, your gentle wake-up call arrives when a pair of Guest Wranglers goes from tent to tent slipping welcome cups of freshly brewed coffee into outstretched hands, making it that much easier for you to rise and shine.

After a hearty (and I do mean hearty!) breakfast of pancakes, bacon, scrambled eggs, muffins, fruit, biscuits with gravy, you pack up your luggage, deposit it outside your tent, and head for the corral. There, the horse (with whom you have been bonding since it was first assigned to you) gets saddled up and, by 9:00am, the entire wagon train is ready to roll out.

The horses used on this drive are not your typical tired trail horses, more used to moping along, nose to tail. These are genuine ranch horses of varying temperaments, from subdued to spirited, which have been designated based upon your ability as a horse person. Thus, depending upon your skill (and your courage) you can either gallop to your heart’s desire, straight across seemingly endless plains, hell bent for leather or; if you’re less inclined toward maintaining breakneck speeds, you can assist in steering the cattle, clippity-clopping along the trail at your own leisurely pace.

There are water and lemonade stops along the way to quench your thirst. There’s also a leisurely buffet luncheon of salads, lunch meats, cheeses, watermelon and cookies served daily, in the shade, alongside the chuckwagon.

Should you feel to achy-breaky one morning from either too much horseback riding or too much line dancing the night before, you can always opt to sit-this-one-out and spend the day as a passenger in one of the teamster-driven covered wagons which accompany the drive.

While riding, you pass beneath Montana’s aptly-named Big Sky, through some of the most beautiful country you’re likely to see anywhere. Not a day passes when you won’t be spotting pockets of antelope, mule deer, jackrabbits, pheasant, and even patriotic eagles soaring overhead.

City Slickers may have looked like fun, but you can bet it wasn’t comfortable. So the choice is yours. Be a real cowboy on a genuine cattle drive, cough up about $950 for the experience and work all day and stay filthy and eat lousy meals and sleep out in the rain. Or, “For a Few Dollars More” (per Clint Eastwood), you can not only be a real cowboy or cowgirl for a week, you can also be one living comfortably along the magnificent Montana trail on the Powder River Wagon Train & Cattle Drive, the Cadillac of cattle drives.

Finding a good hotel in Powder River

Finding a good hotel isn’t easy, especially when you’re in this small place that we call home. Fortunately, there are a few things that you can do to make it easier for you.

There aren’t many hotels in the Power River Area. In my opinion, your best best is to go for The Wright Hotel (there’s not many others in town!).

Hotels star rating system is an internationally recognized ranking system which gives an idea about the overall quality and luxury of the hotel. The purpose of the star rating is to serve as a guideline for the customers before booking a hotel. It’s usual to book this through a big site like booking.com or lastminute.

The star ratings are generally scaled from 5 to 1; where 5 star indicating the best and 1 star representing the worst. Though the star ratings are common throughout the world, there is no standard way to describe a particular rated hotel. For example, facilities provided by a 3 star hotel in one country may be provided by a 2 star in another country. Some hotels even claim to be a 7 star hotel, but there is no official statement regarding that. 7 star hotels are nothing but a 5 star hotel and it is just an advertising gimmick to claim as a 7 stars.

The star ratings are given by considering many factors such as size of a room, amenities provided, restaurant quality, entertainment and facilities like gym, spa and many other such factors. These ratings are generally given by the travelers or by the tourism department. In many countries, the rating is given by the automobile clubs such as AAA (American Auto Association) which also printed hotel guides. Forbes, a business magazine launched its travel guide and introduced the star rating system. Each organization has their own way of allocating star ratings.

Basic Idea of How Do Hotel Star Ratings in Powder River Work

Though there is no standard way to classify the hotels according to the star ratings, the following guideline gives a basic idea.

1-Star: Small hotel with basic accommodation and facilities may or may not include a TV in a room. These generally do not have a restaurant.

2-Star: Basic accommodation with few facilities like TV in a room, laundry service and may or may not have a restaurant.

3-Star: These have spacious accommodations with multiple room options and with facilities like a good restaurant, pool and fitness center.

4-Star: Large rooms and suits with multiple options. Facilities like restaurants, bar, business facilities, one or more swimming pools, valet parking, and complimentary breakfast are available.

5-Star: Luxury accommodation with all the facilities and services mentioned above. These hotels offer a high degree of personal service, room service generally available for 24 hours, flawless guest service, and amenities with highest comfort standards.

You may still not get the facilities mentioned above for a particular star if you book a hotel. It is better to see the star ratings and user reviews given in various websites of that particular hotel at the time of booking.

How to get a hotel job in Powder River

The hotel industry provides rewarding opportunities for potential employees. Whether you are willing to work in the security department, supplies, kitchen, reception, cleaning and IT or any other department, the intensity or work and remuneration varies. The problem is that many potential employees do not know how this is industry works let alone what to expect when employed there.

So, is hotel work hard in Powder River? Well, yes and no in the sense that several factors come into play when determining whether working there is worth your time. For instance, your attitude, temperament as well as your set of skills are crucial in answering this question.

If you are fond of dealing with guests, the front desk is for you. Booking rooms, directing lost guests, battling language barrier and managing the front office is all yours. However, be sure to deal with crazy number of guests if there is a conference or expo in town. On the other hand, there are cleaners who have to deal with cleaning hundreds of rooms including the bedding, hall ways, lounges and recreational facilities if they are included in the hotel infrastructure. The problem is that you have to meet crazy timelines handling tons of bedding and huge floor area. The plus is that there are cleaning devices and machines provided by many hotels to ease the process.

Hotel employees working in the kitchen area are the ones facing serious challenges. The chefs, dish washers, supply department, waiters and waitresses are the ones who always work endlessly.

All work schedules have to be completed on time while keeping up with huge number of orders. The time of the day or night does not matter here. The good thing is that there are shifts so if you hate early rising or working late, the work description is definitely flexible. Working in a hotel is all about fulfilling your goals and doing what you love and this should make your life easy. If you work just to make money, it surely will be hard every single day.

If you are looking to get a job in Powder River, then the best idea for you is to visit. Here’s a few hotels in the Powder River Area.