For almost two years the Freedom of Information Commission and legal aid attorneys have been entrenched in a battle with the four HMOs that spend more than $720 million in public dollars on health insurance for low-income families.
The battle is for the disclosure of doctor reimbursement rates and other criteria that health care advocates and the legal aid attorneys claim the state needs in order to help families who receive these benefits gain greater access to the health care system.
A secret-shopper survey released earlier this year found only 26 percent of new HUSKY enrollees received calls back from a doctor’s office to set up an appointment, 74 percent did not receive calls back.
Attorney General Richard Blumenthal told a group of advocates and legislators Tuesday that as a citizen and elected-official he is “outraged by a system that gives private entities money then fails to hold them accountable.” Blumenthal said he supports New Haven Legal Aid Attorney Sheldon Toubman’s efforts to obtain the information.
Toubman filed an appeal with the Freedom of Information Commission Monday against WellCare, the only HMO to agree to disclose information it didn’t consider a trade secret. WellCare amended its contract with the Department of Social Services to say it would comply with all FOIA requests, if it had the opportunity to mark documents it felt were exempt from disclosure.
“WellCare is resisting the public release of any of its internal criteria for deciding requests for medical services, except for its criteria for dental or pharmacy services, and any of its internal documents explaining how these criteria are used,” Toubman said in a press release Monday.
In some instances WellCare is claiming “trade secrets” in regard to some of its criteria provided to the Department of Social Services, but Blumenthal assured the new DSS Commissioner Michael Starkowski late Tuesday evening that the state had the right to the information under the contract. Blumenthal said Tuesday that trade secrets may be exempt from the state’s FOI laws, but are not exempt under the contract language.
“Based on the AG’s assurances to Commissioner Starkowski, release of the contested information about medical necessity determination is imminent,” David Dearborn, DSS Communications Director said in an email. He said in the future, “Gov. M. Jodi Rell’s legislative proposal (SB 1127 ) to bring HUSKY managed care contractors under the FOI Act should go a long way to settle most of public information issues once and for all.”
Blumenthal assured DSS that if it released the information he would defend the agency in the event WellCare claims a trade secret violation.
Three of the four HMOs have refused to produce any of the documents, claiming that they are not subject to FOI laws, despite two rulings by the FOIC and a court ruling to the contrary. The court ruling in favor of disclosure is currently not being enforced based on Superior Court Judge George Levine’s decision to delay enforcement of his ruling until the legislature can act or the contracts are renegotiated. The contracts with the HMOs expire on June 30. The contracts will not go out to bid but will be renegotiated by DSS.