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A Cautionary Tale from CT on Medicaid Managed Care Plans

A Cautionary Tale from CT on Medicaid Managed Care Plans

May 13, 2008

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.