Former Medicaid Official shares troubled MCO history
In comments to DSS for their landscape study, former Medicaid official Steve Colangelo warns against returning the program to MCOs. He worked in the program before and after the MCOs left in 2012. He outlines the problems that plagued the program and DSS staff under the MCO model.
He details how the MCOs refused to comply with FOI transparency laws that forced Governor Rell to terminate their contracts.
“Almost daily meetings were held to determine which plans would be allowed as a choice by our MCO broker on that particular day, depending on ongoing negotiations. As the largest MCO exited, the Department needed to rapidly communicate the change to its members and advise them to call our broker to pick a new MCO. This was a major undertaking that required the help of our other MCOs, 211 (who provided HUSKY support), and our broker. The Department’s staff focus, for some time, had to be solely on the ongoing negotiations and the final exit of this MCO…not on improving the performance of the program and the health of Medicaid members.”
He documents that one of the MCOs was investigated by DSS and the DOJ for cherry-picking Medicaid clients through marketing. The MCO eventually settled the matter by paying $137.5 million plus interest. “Again, this long investigation by State and Federal Staff was a poor use of resources that should have been spent on the performance of the program and health of Medicaid members.”
He blames DSS under-staffing for many problems that led to one MCO being unable to contract with large CT hospitals, access to care problems that led to high levels of members switching plans, and inaccurate MCO provider lists including some who had passed away that were driving members into one plan. This would’ve removed any state leverage to solve problems and harmed consumer choice.