Medicaid Managed Care Council Update

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First, at Friday’s meeting the Council decided to meet in August (on Friday the 13th) – we rarely do that – because of the many challenges and opportunities facing the program. At the meeting, DSS reported that they have sent a letter to CMS seeking guidance about how to move HUSKY from the current, controversial capitated arrangement to a non-capitated ASO model, as directed in this year’s budget. The letter notes that the state expects to save $72 million this year from the switch and $17 million each year going forward. The letter incorrectly states that the legislation requires DSS to use the current HUSKY HMO networks suggesting to some that DSS does not intend to re-bid the program. Advocates have argued that opening up the program for bidding under a new non-capitated ASO arrangement could attract new entities, foster competition, and improve provider participation, resulting in better access to care for families at a better price for the state.

In describing their plans to move forward with PCCM enrollment in Putnam and Torrington, DSS modified their policies on marketing by the HMOs and allowing providers in current area towns to participate in the program. At the April PCCM Subcommittee meeting, DSS stated that providers practicing in towns that are not adjacent to New Haven, Hartford, Waterbury or Willimantic but whose patients live in adjacent towns could serve as PCPs in PCCM. When asked by Rep. Cook if this needed legislation, DSS responded that only a letter to the Commissioner was necessary. The letter went out from legislators to DSS months ago. While they have not received a response, we were told that DSS was denying the policy change. Legislators raised objections, first because they were assured that the minor change would be made, and secondly that DSS delayed responding until the session is over and legislation is not an option.

DSS also noted that, despite assuring the Council and the PCCM Subcommittee, that the HMOs were prohibited from marketing their programs, in fact “a huge amount is being done” by the HMOs in outreach, health fairs, among other marketing activities. Equivocating, DSS maintains that they only allow HMOs to market to their own members, but in open public forums with their logos on the materials. It was described as “a loophole you could drive a truck through.” DSS still refuses to devote any resources to PCCM marketing, to counter the vast marketing resources available to the HMOs. Advocates and legislators objected to the lack of a level playing field and deliberate efforts by DSS to minimize PCCM enrollment. Legislators echoed their strong commitment to PCCM as an option for HUSKY families and frustration with DSS in undermining the program.

DSS also reported that they expect to have a recommendation about the high risk pool to the Governor by July 15th on whether to take the federal option or to build on the existing HRA program. DSS outlined about thirty of the Medicaid changes in the national reform act – some voluntary opportunities and some mandatory.
Ellen Andrews