Top state lawmakers from both parties say they’re anxious to learn more about the drawbacks and benefits of the state reverting back to a managed care system for Medicaid recipients that advocates fear will reduce access to quality healthcare.
“I’ve heard a lot about why it is that we should not (revert to a system the state changed in 2011),” said House Majority Leader Jason Rojas, D-East Hartford. “I want to hear why it is that we should.”
Gov. Ned Lamont’s office has said the administration owes it to patients and taxpayers to consider changes to the Medicaid program. A spokesperson said Lamont would seek input from lawmakers and stakeholders before any were made.
House Speaker Matt Ritter, D-Hartford, said he plans to more closely examine the issue after the current legislative session adjourns on May 8.
A top Republican, House Minority Leader Vincent J. Candelora, said any changes would need to ensure quality of care is protected and that progress continues to be made toward making healthcare more individualized.
At least one Democrat – Sen. Saud Anwar – says he’s open to the idea of the state reverting to a managed care plan for Medicaid recipients. But Anwar, a physician, said such a move should only be considered if there’s proof that patient outcomes would improve.
“We can’t do it randomly or immediately,” he said. “We need to make sure we’re not harming an already stretched delivery system. I’m keeping an open mind.”
Rep. Jillian Gilchrest, D-West Hartford, has said a move back to so-called “capitated” managed care would limit quality healthcare for the state’s most vulnerable residents.
Gilchrest and Anwar co-chair the state’s Council on Medical Assistance Program Oversights (MAPOC), which advises the state on issues related to its Medicaid HUSKY plan.
Then-Gov. Dannel P. Malloy moved the state’s HUSKY and Charter Oak health plans out of capitated managed care in 2011 after a variety of concerns, including costs, access to care, and control over the programs. It’s a system used by many states to manage healthcare for Medicaid beneficiaries through private managed-care companies.
Previously, the state paid the companies to set fees for each beneficiary. Malloy moved Connecticut into a self-insured system in which the state pays medical claims.
CTNewsJunkie previously reported that Lamont is considering moving the state back to capitated managed care.
Capitated managed care provides private health insurers an up-front flat fee. The state contracted with companies before 2012 to manage care for hundreds of thousands of beneficiaries. Connecticut now has nearly one million residents in the multi-billion-dollar HUSKY program.
Among the criticisms was that the old system gave managed-care companies an incentive to deny care since they could keep money not spent on patients’ medical needs. Advocates also said there were concerns over a lack of accountability since private insurers and other companies controlled the program, as opposed to the state.
Gilchrest has said an example of how a lack of state control has harmed patients is the program that provides non-emergency medical transportation for Medicaid patients. Run by a private company, she said there are ongoing problems with patients not being picked up and payments not being made.
The current fee-for-service system has reduced denials for service and increased accountability while reducing complexities, patient advocates say. It is administered through the state Department of Social Services.
The question of whether Lamont can unilaterally revert to the previous system could be a matter of debate. Gilchrest said she believes the General Assembly has more than an advisory role in making the decision and that it can pass legislation blocking a change.
Additionally, the oversight council will discuss the issue at its next meeting, she said.
The state is currently undertaking a two-year study of Medicaid rates and needs to find a way to increase its investment in Medicaid, not cut it, Gilchrest said.
Susan Halpin, executive director of the Connecticut Association of Health Plans, has said her industry is open to the direction Lamont appears to be considering if there is adequate funding and the complexities of the previous plan were addressed.
