According to today’s Wall Street Journal (subscription required): “Disclosure Push Roils State Medicaid Program,” the small number of managed care plans in the Connecticut Medicaid program are heading for the door or have already left. Could something like this happen here? Hard to imagine. Then again, hard to imagine in CT:
The dispute began in late 2004 when Sheldon Toubman, a staff attorney at the New Haven Legal Assistance Association, filed a request under Connecticut’s freedom of information law to get health-maintenance organizations to disclose how often the HMOs’ computers rejected pharmacy requests to fill Medicaid enrollees’ prescriptions. …
Three years later, the governor demanded more accountability, essentially treating them as a public agency. When two companies refused to follow the order, the state program, known as Husky, stripped all four companies of duties such as setting provider rates. Last month, two HMOs pulled out and a third is scheduled to leave on July 1.
The state plans to sign new contracts by July 1 with three providers who pledged to abide by the public-disclosure requirement. But two providers have no existing Husky networks of doctors, hospitals and other health-care providers. A legislative effort to stop new contracts until the state had studied whether HMOs were the best way to provide Husky health care died when the state legislature adjourned last week. …
… this past April 1, two dropped out completely, forcing 120,000 Medicaid enrollees to transfer to other companies or to traditional fee-for-service Medicaid. For some, it meant delays in care, unfamiliar doctors or using facilities that were far away. On July 1, the third managed-care company will start leaving the Connecticut program, and by the end of the year, some 226,000 Husky enrollees will be reassigned — some for the second time.
What happened in CT is not a cautionary tale at all, but rather a large ray of hope for improving access to care for Medicaid recipients. The Wall Street Journal story is somewhat misleading in suggesting that our Medicaid program for families is in any way threatened by the imposition of the requirement of public accountability under the Freedom of Information Act as a condition of HMOs receiving taxpayer dollars under that program. Right now, the program for 333,000 is stabilized, with enrollees being included either under one of two non-risk managed care plans or under the smaller fee for service plan run directly by the state Medicaid agency.
In addition, the absence of capitated HMOs is hardly cause for concern. CT advocates and state officials are quite optimistic about the October 1st rollout of primary care case management (PCCM) for this population- a non-risk, non-HMO system of coordinated health care increasingly being adopted by states to supplant or work in tandem with HMOs under their Medicaid programs. Besides improving the quality of care, some states have found that PCCM also saves money compared to HMO-managed care.
The changes to the CT Medicaid program in April, when two HMOs left the program entirely, were difficult but necessary, while the changes facing our clients in July are far more threatening (affecting far more people, forcing them into new for-profit HMOs with no Medicaid networks, etc.) — and completely unnecessary. The July changes have nothing to do with the FOIA and are a result of a plan by our Governor to have capitated HMOs return to running the program starting on July 1st, despite the fact the two HMOs currently responsible for about 85% of the enrollees on a non-risk basis are willing to continue running their portion of the program exactly as is indefinitely (and the state can continue to run the small fee-for-service program on its own). This was all explained to the WSJ reporter, who wrote a full discussion of this aspect.
But the article was altered substantially by the editors. It is unfortunate that the final article seems to imply that the current threat to CT Medicaid recipients is due to our effort to bring public accountability to the HMOs, rather than the Governor’s intended action.
Thus, the CT Medicaid program formerly run by capitated HMOs is now stabilized and would continue to be stable until at least July 2009, with the opportunity to carefully study all options including the use of PCCM before making any further major changes, if the Governor relented on her plans.
Of course, even if, contrary to the facts, our effort were the cause of the impending threat to 333,000 Medicaid recipients, one has to question the acceptability in the long run of not holding 100% taxpayer-funded HMOs accountable to the public. Only through such accountability is a semblance of quality care through for-profit HMOs possible.