Following this letter from Connecticut’s Congressional delegation and a lively debate at Friday’s Medicaid Managed Care Council meeting, Republican Gov. M. Jodi Rell reversed course on plans for her new health insurance plan and the state’s Medicaid program.
After months of struggling to get doctors and hospitals to sign up for both her new Charter Oak Health Plan and the state’s Medicaid program known as HUSKY, Rell agreed to allow medical providers to participate in just one program.
Rell also agreed to ask Anthem to extend its contract with the state to help transition HUSKY enrollees to the two new Managed Care Organizations, Aetna Better Health and AmeriChoice.
The two new MCO’s have struggled to get doctors and hospitals to sign up with their networks. As a result, the state had already asked the Centers for Medicare and Medicaid Services to delay the mandatory transition of enrollees to the two new networks.
“While provider networks have grown from 5,680 to over 9,500 over the past five months, two of the new health plans – Aetna Better Health and AmeriChoice by United Healthcare – do not have adequate capacity for major additions of HUSKY beneficiaries,” Rell said. “This has affected the pace of transition of beneficiaries into the new health plans overall.”
Friday at the Medicaid Managed Care Council meeting in Hartford lawmakers like Sen. Jonathan Harris, D-West Hartford, wanted to know why the Department of Social Services wouldn’t extend its administrative services contract with Anthem, which has volunteered to help the state with the transition to the new MCO’s.
Anthem currently serves about 150,000 of the HUSKY patients and has a network of approximately 7,000 doctors, hospitals, and specialists.
In March, Anthem decided not to bid on the new $3.5 billion HUSKY contract because it was not willing to take on the risk as a managed care organization. Others speculated that Anthem wasn’t willing to bid on the HUSKY contract because it was linked to Rell’s state-subsidized Charter Oak Health Plan for uninsured adults.
The state’s contract with Anthem was scheduled to end on Dec. 31 until around 4:49 p.m. Friday when and the Department of Social Services put out a press release saying Rell had instructed it to negotiate another one-month contract extension with Anthem.
Currently Anthem is not in charge of any managed care responsibilities, such as handling medical claims or setting doctors rates.
Earlier Friday afternoon, Harris said it seems like it would make it easier on the extremely busy state agency to extend the contract with Anthem and have an orderly transition, since mandatory enrollment in the new MCO’s has already been delayed to February 2009.
“It’s like they’re pushing people out the window, while they’re weaving a net to catch them,” Harris said.
New Haven Legal Aid Lawyer Sheldon Toubman said the move to get rid of Anthem at the end of the year is “political.” He said by pushing out Anthem—the plan with the most doctors—it will force patients to move into the new MCO’s.
The danger is that the new MCO’s have inadequate doctor networks, he said.
As a way to entice insurance companies into bidding on her new Charter Oak Health Plan, Rell linked it to bids for the $3.5 billion HUSKY contract. Harris and health care advocates have expressed concern over the two programs being linked together from the start.
Rell’s decision Friday will allow the MCO’s to sign up medical providers in just one program, but the MCOs will still be required to offer both programs through its contract with the Department of Social Services.
As of Friday, over 42,800 HUSKY enrollees have voluntarily joined the newly-contracted health plans and more than 100,000 have signed up with Community Health Network of Connecticut, a coalition of health clinics that has been more successful in securing providers because it has been administering the HUSKY program for a decade.
The joint HUSKY and Charter Oak Health Plan went out to bid last year after three of the four MCO’s that had administered the HUSKY program decided they did not want to comply with the state’s Freedom of Information laws.
Connecticut’s Congressional delegation said in a letter Friday that it’s concerned the state Department of Social Services may have given HUSKY enrollees the impression that “changing their enrollment is or will become mandatory,” when two of the three Managed Care Organizations have an inadequate number of doctors and hospitals in their networks.
The delegation said it’s worried that as a result of these letters, “hundreds of families who are trying to follow DSS instructions are enrolling in inadequate MCOs that could significantly undermine their access to care.”
The letter was signed by US Senators Chris Dodd and Joe Lieberman, and US Reps. John Larson, Joe Courtney, Rosa DeLauro, and Chris Murphy.