Medicaid Managed Care Council meeting

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Friday’s Medicaid Managed Care Council meeting was very frustrating. Upon questioning, DSS made clear that they will not be recovering the $50 million in overpayments to the HUSKY HMOs that were identified by independent auditors commissioned by the Comptroller, proposed by the Governor to cut for the current state budget and agreed to by the General Assembly. To be exact, they stated that they are “in negotiations” but in response to questions they stated that they are concerned that the HMOs might choose to leave the program and echoed the perennial, tired complaint that the HMOs aren’t making enough money. They claimed that the Milliman audit was based on earlier financial information. (Leaving aside the issue that DSS refused to share more recent financial information with the auditors.) They had no answer when reminded that the HMOs have always whined that they don’t make enough money on this program, including the years that Milliman used in their analysis. They also raised the threat that any cut to the HMOs will result in reduced services to consumers. Why the HMOs can’t manage on rates comparable to what other states are paying, and why DSS wouldn’t enforce their contracts was not addressed. Apparently, re-bidding the program is too hard, which led to the point that if DSS is not willing to lose any of the HMOs, it can’t be much of a negotiation. They also conveniently forgot that the advocates and the General Assembly have given them an alternative, a bargaining chip (not to mention a better option for consumers based on patient-centered medical homes) in PCCM which DSS has been unable and/or unwilling to implement.
Although it was on the agenda, PCCM wasn’t discussed at the meeting, again.
Ellen Andrews