Senator Eliot Shapleigh - El Paso, Texas

A year ago, many Central Texas Medicaid recipients who had enrolled in a new managed health care program complained that they couldn't find a doctor willing to take them as patients.

"It was just a big headache," recalled Austin patient Taylor Dickson.

The problem, which surfaced soon after the Star Plus managed health care program started in seven Austin-area counties last February, will cost the Evercare health care plan $645,890.

The Texas Health and Human Services Commission last week ordered Evercare to pay that amount. The agency said Evercare failed to provide an adequate network of doctors in Central Texas.

It's the largest fine the agency has ever imposed on a health plan, spokeswoman Stephanie Goodman said.

"We want to make sure that health plans understand that access to care is critically important," Goodman said.

Evercare has increased the number of doctors in its network, said Beth Mandell, regional executive director of Evercare of Texas LLC.

"We will be paying the fine," she said.

There are 155,242 Texans enrolled in Star Plus, including 14,536 in Central Texas. The Legislature mandated the program to help curb the cost of Medicaid, the federal-state health insurance program for low-income people.

Enrollment in Star Plus is required for certain Medicaid recipients.

Texas suspended enrollment of Central Texans in the Evercare plan from late March to June 1 last year. Enrollment continued in the other Central Texas Star Plus plan, Amerigroup Community Care.

Dickson said he called every primary care doctor in Evercare's network in Travis County last year with no success.

He now has a doctor through Evercare whom he likes ("whenever I need to see him, he seems to be there"). But last year's experience still rankles him.

"All these people on Medicaid really went through hell to find a primary care physician," he said.

Evercare, which serves 5,466 Central Texas patients, has made improvements since then, Mandell said. "We have worked very hard to get more doctors into our network," especially at community clinics already serving Medicaid patients, she said.

Although Medicaid patients across Texas can have difficulty finding a doctor who accepts them, even those who aren't in Star Plus, this "went beyond that," Goodman said. "We saw cases where consumers were told, 'These are doctors accepting new patients,' and they weren't."

Goodman said fining health plans "is a tool we're certainly using more."

The fine represents one month of premiums for Central Texans ($616,740) plus $29,150 to compensate the state agency for having to respond to complaints and review the accuracy of the provider directory, according to a letter the commission sent Mandell.

Half the fine goes to the agency; the other half will be divided between two health-related nonprofit organizations.

The Seton Fund, one of the recipients, plans to use its $161,473 toward expanding care for patients with severe medical needs at the University Medical Center at Brackenridge, spokeswoman Matilda Sanchez said.

Project Access, a Travis County Medical Society program in which doctors volunteer to see low-income patients, will receive the same amount. Director Cliff Ames said he's not sure yet how the money will be spent.

"It's a very nice windfall for us," he said.