U.S. District Judge William Wayne Justice says the state was not adequately providing dental care, regular checkups, transportation, or information about what services are available for 1.5 million low-income youngsters in the state's Medicaid program, despite its promise to make changes.
The judge's decision quickly became fodder for the presidential candidates, with Democrat Al Gore criticizing Republican rival George W. Bush, the governor of Texas. Democrats planned to highlight the ruling Thursday in a number of ways, including in paid advertising, sources said.
Bush, criticizing the judge as "an activist, liberal judge," dismissed the Democratic assertions and defended his record.
"The reason the Gore campaign is pounding me ... is they're trying to go on the issue on which they are extremely vulnerable," Bush said. He criticized the federal government for refusing to grant waivers that would have made the process easier for Texas.
Bush's spokeswoman, Karen Hughes, said that in many cases, parents have refused the state's offer to provide Medicaid coverage.
Gore's campaign called the ruling an example of 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.
"Governor Bush has an obligation to explain that strong and very troubling court decision," said running mate Joe Lieberman.
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 ruling gives the state 60 days to come up with a solution - making it due just before the Nov. 7 presidential election.
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."
Texalegislators who have been studying the state's Medicaid program say they will propose changes to address serious problems that were highlighted this week after a federal judge's critical ruling was made public.
The state Senate Committee on Human Services will submit its final recommendations Friday to Lt. Gov. Rick Perry and other legislative leaders looking ahead to the next biennial session in January.
In a copy of the recommendations, the committee proposes measures to improve communication between Medicaid recipients and the state, to make the Medicaid application process easier, to eliminate rules that require the state to count assets such as cars when reviewing applications and to expand support for recipients leaving welfare for work.
Our ultimate goal is to ensure health care is available to all Texas children and that those children are safe and healthy, said state Sen. Judith Zaffirini, a Laredo Democrat and the committee's chairwoman.
Although many of the recommendations address problems outlined in the court ruling, legislative committees have been working on Medicaid reform in the years in between sessions.
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.