U.S. District Judge William Wayne Justice says the state was not adequately providing dental care, regular checkups, transportation to doctors or information about what services are available to children in Medicaid, despite its promise four years ago to make changes.
The decision immediately became fodder for the presidential candidates, with Democrat Al Gore criticizing Republican rival George W. Bush, the governor of Texas.
Gore's campaign cited the ruling as an example of what it says it Bush's lack of leadership on child health issues.
The vice president regularly complains that there are 1.4 million Texas children without health insurance and that Bush tried to limit eligibility for a new program aimed at getting health care coverage to the children in working poor families.
Bush and top aides traveling with him Wednesday were caught off guard by the decision. He told reporters that he had not reviewed the order by Justice, who is a Democrat.
``But we have a good record signing people up to Medicaid,'' Bush said, without mentioning the services children get once they are signed up ? the subject of the case.
The state attorney general plans to appeal. The ruling gives the state 60 days to come up with a solution ? making it due just before the Nov. 7 presidential election.
Gore declined to comment, saying he hadn't read the decision. But others weighed in for him.
``Governor Bush has an obligation to explain that strong and very troubling court decision,'' said running mate Joseph Lieberman.
Bush's campaign said he is committed to improving the program and pointed the finger at the Democratic administration that preceded him. Bush was elected in 1994. The class-action lawsuit that sparked the latest ruling was filed in 1993.
``This is a decade-long challenge that Texas is addressing,'' said spokesman Dan Bartlett. ``We are aggressively working to provide health care to those children.''
The state signed a consent decree promising change in 1996. The court issued a ruling Aug. 14 saying the state had failed to fix the program, which serves about 1.5 million Texans under age 18. Another 1.4 million are uninsured, about 600,000 of whom are eligible for Medicaid but not enrolled.
Children's advocates said they want to move beyond court fights and political battles.
``This is about the children of the state of Texas,'' said state Rep. Garnet Coleman, vice chairman of the House Public Health Committee. ``The time that we spend on fighting a lawsuit we could spend on making sure that the children who have not seen a doctor have that opportunity.''
Lisa McGiffert, a policy analyst with the Austin office of Consumers Union, an advocacy group, agreed the state's energy could be better spent. ``I guess when I hear that there's going to be an appeal that says to me that their efforts are going to go to defending what they're doing rather than changing it or trying to do it better,'' she said.
In his 175-page ruling, Justice said Texas had failed to inform families about the benefits available ? even when they asked. About 1 million kids never saw a dentist last year, and most who did were there for emergency treatment, such as an inability to eat, that could have been prevented.
The court also found major problems with transportation programs and for children enrolled in health maintenance organizations and other managed care plans.
``A poor and often-isolated population should not be robbed of their rights to services,'' wrote Justice.
Like other states, Texas is in the process of moving its Medicaid population into managed care, which is cheaper and has a reputation for providing strong preventive care.
But the court found that the checkups ``were grossly inadequate and incomplete'' taking just 12 to 20 minutes when a proper exam would take an hour.
The ruling also concluded that Texas failed to address the needs of about 13,200 abused and neglected children under state supervision.
Bartlett said the state had added staff and increased budgets in an attempt to reach more children and provide more families with transportation. But the court found that much of the data used to show improvement was inflated.
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