Insurers Dropping Out Of Connecticut Medicaid Program

The Wall Street Journal on Tuesday examined how efforts bythe state of Connecticut to expand disclosureamong the HMOs in its Medicaid program have resulted in insurers dropping outof the program and have "left Connecticut'sMedicaid program in turmoil, jeopardizing health care for thousands of poorresidents."

According to the Journal, the "dispute" between the HMOsand the state began in late 2004 when Sheldon Toubman, a staff attorney at the New Haven Legal Assistance Association, filed a request under the state's freedom ofinformation law to discover the frequency that HMOs rejected pharmacy requeststo fill Medicaid enrollees' prescriptions. In 2007, Gov. Jodi Rell (R)"demanded more accountability" from HMOs participating in Husky, thestate's Medicaid program, "essentially treating them as a publicagency," according to the Journal. When two of the four HMOsparticipating in the Husky program refused to cooperate with Rell's requests,Husky officials took over administrative duties for the program, including theability to set provider rates and managing the pharmacy benefits. In November2007, Rell said she would terminate contracts with any HMO that refused tocomply with her demands for greater disclosure.

In April, two of the HMOs pulled out of Husky. As a result, 120,000 Medicaidbeneficiaries were forced to transfer to another insurer or to traditional Medicaid,which for some "meant delays in care, unfamiliar doctors or usingfacilities that were far away," according to the Journal. Athird HMO will begin leaving the Husky program on July 1, and an estimated226,000 beneficiaries will be reassigned -- some for the second time -- by theend of the year.

Anthem Health Plans and Health Net ofConnecticut arechallenging the public disclosure requirement in the Connecticut Supreme Court,while not-for-profit Community Health Network ofConnecticutrecently dropped out of the lawsuit. WellCare HealthPlans had agreed tocomply with the disclosure requirement but later opted to withdraw from Husky.

Although contracts with three new providers -- who have agreed to follow thepublic disclosure requirement -- should be signed by July 1, two of theinsurers "have no existing Husky networks of doctors, hospitals and otherhealth care providers," according to the Journal.

Keith Stover, a spokesperson for the ConnecticutAssociation of Health Plans, said the HMOs "made every effort to come up with a reasonable andrational compromise." However, the state did not address the HMOs' mainconcern that public disclosure of the contracts could put the insurers'proprietary information at risk, according to Stover (Zhang, Wall StreetJournal, 5/13).

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