States plot Medicaid managed care changes; Kansas managed care plan met with skepticism

Apr 12 2012

In Ohio, Molina Healthcare loses its Medicaid managed care contract. In Texas, a plan to save money by incorporating Medicaid drug benefits into a managed care program gets pushback. And, Kansas counties weigh in on a plan to shift Medicaid beneficiaries to managed care.

The Wall Street Journal: Molina Loses, Aetna Wins In Ohio Medicaid Decision
A surprise decision by Ohio to shake up the providers of its Medicaid health plan marked a sharp setback for incumbent insurer Molina Healthcare Inc., which lost its contract (Kamp, 4/9).

Bloomberg: Medicaid Insurers Plunge As Ohio Dumps Old Business For New
Ohio's decision to shut out Molina Healthcare Inc. and two other health plans that contract to manage 1.5 million of the state's Medicaid patients sent the shares of the companies plummeting. Molina, based in Long Beach, California, declined the most in almost seven years in intraday trading today while Centene Corp. fell the most in four years and Amerigroup Corp. decreased the most in four months. Ohio is streamlining its Medicaid programs in an effort to save taxpayers $1.5 billion (Armstrong, 4/9).

Texas Tribune: Interactive: Mapping Medicaid Patients' Pharmacy Access
State lawmakers expect to save more than $100 million by including pharmaceutical reimbursements in Medicaid managed care, which was rolled out across the state this year. But pharmacists and small-business owners are crying foul, saying the lowered rates could run independent pharmacists out of business and greatly reduce Medicaid patients' access to medication. The interactive map below shows Medicaid patients' access to pharmacies across the state by comparing the location of pharmacies serving Medicaid patients as of March 2012 to the percentage of the county population enrolled in Medicaid as of August 2011 -- the most current available enrollment data (Aaronson, 4/10).

Kansas Health Institute: Counties Weighing In On KanCare
County officials across Kansas are raising doubts about KanCare, Gov. Sam Brownback's plan for letting insurance companies manage the state's $2.8 billion Medicaid program. ... Johnson County is Kansas' most heavily populated county. [Ed Eilert, a Republican member of the Johnson County Commission ] said he expected the commission there soon would pass a resolution urging the governor to "carve out," or exclude from KanCare, the long-term care services Medicaid provides for people with a developmental disability. According to local officials contacted by KHI News Service, at least 20 counties have passed similar resolutions asking the governor to reconsider the reach of KanCare. At least three more are considering a resolution (Ranney and Shields, 4/9).

In other news --

The Lund Report (an Ore. news service): Deschutes County Audit Could Result In Medicaid Payback
An August 2011 audit performed by Accountable Behavioral Health Alliance on Deschutes County Health Services is showing how difficult it is for some organizations to meet the requirements and provide the type of care expected of coordinated care organizations (CCOs). According to the audit, which examined nine patient records and 81 claims in those records, Deschutes County Health Services had nearly a 20 percent error rate. With such a high error rate, Deschutes County could have to pay back some of its Medicaid dollars depending on another audit under way by the Addictions and Mental Health Division (Waldroupe, 4/9).

Georgia Health News: State's Share In WellCare Case: $33 Million
The Tampa-based company runs one of three HMO-like organizations that, as a group, supervise care for more than 1 million Medicaid and PeachCare members in Georgia. The $33 million will be in federal and state funds, with Georgia's net amount being $13 million. Medicaid is jointly financed by the states and federal government. …The alleged manipulation of enrollment of members included targeting low-cost and healthy people, while discouraging, failing to enroll, or disenrolling, undesirable recipients, those considered high-cost and chronically ill, the Olens statement said (Miller, 4/9).