Gov. M. Jodi Rell put her foot down Monday and terminated the state’s contract with the four HMOs that run the state’s HUSKY insurance program for low-income families.
The termination of the contract is the culmination of a two-year battle to get the insurance companies to disclose their doctor reimbursement rates and other criteria health care advocates and legal aid attorneys claim the state needs in order to help families who receive these benefits gain greater access to the health care system.
Mrs. Rell said Anthem Health Plans Inc. and Health Net, two of the four largest HMOs, have consistently refused to recognize the state’s Freedom of Information law. She said while in contract negotiations with these companies, they stated that if they were forced to comply with FOI law they would drop their HUSKY services with only 15 days’ notice. Rell called this tactic “utterly deplorable.”
Starting Dec. 1, the four HMOs will no longer make decisions authorizing coverage or reimbursement rates to doctors under the HUSKY program. The Department of Social Services will assume the direct operation of most of the HUSKY services. The insurers will only handle claims and processing.
Three of the four companies consistently refused to comply with the state’s FOI laws, despite two rulings by the Freedom of Information Commission and a court ruling to the contrary. The court ruling, which found the HMOs provide a government function in administering HUSKY and therefore are subject to FOI law, was not enforced by Superior Court Judge George Levine who decided to delay enforcement in order to give the legislature time to act and give the state time to renegotiate the contracts.
WellCare Health Plans Inc. of Florida and Community Health Network of Connecticut – expressed willingness to accept FOI compliance through the fiscal 2008 contract period ending June 30, Rell said in her press release Monday. WellCare, covers 35,239 HUSKY enrollees, while the non-profit Community Health Network of Connecticut covers 60,410 HUSKY enrollees.
WellCare and Community Health Network could not suddenly absorb the combined enrollment of Anthem and Health Net and shoulder all of the managed care responsibilities for the program. Anthem insures 142,171 enrollees and Health Net insures 87,710 enrollees.
The contracts for all four HMOs expired on June 30 and the state has been renewing them on a month-to-month basis, until today.
David Dearborn, spokesman for the Department of Social Services, said Tuesday that it was unfortunate the two smaller contractors were swept up in the FOI battle, but it won’t be long before they will be able bid on the proposal for the combined HUSKY and Charter Oak Health Plan. In fact, all four contractors terminated by Mrs. Rell will be allowed to bid on the new contract, if they’re willing to abide by the state’s FOI laws, he said. The RFP for the combined programs will go out to bid in seven months.
Attorney General Richard Blumenthal said in a press release Monday that “We have repeatedly stated to the governor that the state cannot be held hostage by these organizations when they threaten to walk away from their contracts because they must assist in an orderly transition to any other providers. I renew my pledge to take any legal action necessary to force these companies to honor all their commitments and duties under their contracts.”
Sheldon Toubman, a legal aid attorney who fought against the HMOs in court said, “We stand ready to work alongside the Governor and with DSS to implement an effective transition plan that will minimize disruption and bring long-needed reform and transparency to the Medicaid system. This common goal will benefit everyone: taxpayers, medical providers, and most importantly, Connecticut’s kids and families who are living in poverty.”
Randi Mezzy from Connecticut Legal Services said, “We are gratified that Governor Rell is taking this strong stand in order to do what is right for needy Medicaid recipients, as well as for the taxpayers. It is simply not acceptable for companies receiving state dollars to hide from the public how they are spending its money. This is especially so in the critical area of health care. The Governor has made the right decision on behalf of all of Connecticut’s citizens.”