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Medicaid changes delayed until January

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Medicaid changes delayed until January

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State health officials say they will delay a plan to transfer many West Virginians' Medicaid benefits to managed-care companies, after criticism from lawmakers, providers and advocates.

The Charleston Gazette
Sunday, September 19, 2010

CHARLESTON, W.Va. -- State health officials say they will delay a plan to change the way many West Virginians get Medicaid benefits.

The Department of Health and Human Resources will hold off until Jan. 1 transferring tens of thousands of West Virginians to managed-care programs, spokesman John Law said.

"We have listened to our colleagues and partners and have agreed to move forward more slowly in order to ensure a smooth transition for our Medicaid members and health-care providers," Law said in a prepared statement.

Lawmakers, providers and advocates had raised concerns about the planned changes to the state/federal health insurance program for the poor.

The DHHR wants to transfer the Medicaid benefits of roughly 55,000 people who receive Supplemental Security Income to three companies -- Carelink, The Health Plan and UniCare. That change had been planned for Dec. 1.

Also, about 160,000 people who receive cash assistance would have their behavioral-health and children's dental benefits transferred to the companies. That changed was planned for Nov. 1. The group already receives medical benefits through the three managed-care organizations.

"We believe this program will offer better coordination in the delivery of medical and behavioral-health services that will result in improved health outcomes and overall coordination of care for Medicaid members," Law said.

Lobbyist Randy Cox, head of the West Virginia HMO Association, said the companies are eager to start the plans.

"We'd like to get going," he said, "but we understand the [Medicaid] commissioner's position, and we accept it."

Criticism of the transition has come from several angles. Health providers -- including dentists and behavioral-health centers -- say it would cause administrative headaches. They also complained that the DHHR didn't seek their input before starting such a sweeping shift.

Managed care requires people to visit doctors, dentists and other health professionals who belong to a managed-care company's network, so critics also warn that Medicaid recipients could lose access to care if too few providers join the networks -- especially in rural areas.

Advocates have worried that the transition could disrupt health-care services. Many SSI recipients, whose health care is very expensive, are severely disabled or chronically mentally ill.

At the Capitol earlier this week, representatives of the managed-care companies told lawmakers they offer programs that help Medicaid recipients manage chronic diseases, eliminate unnecessary emergency room visits, and understand their health benefits. They also said they can help detect untreated behavioral-health issues.

Advocates are not totally against the changes but want evidence that the MCOs can deliver on their promises, said Renate Pore, a health policy analyst at the West Virginia Center on Budget and Policy, which is a member of the West Virginia FACES on Medicaid Coalition.

"Maybe they can do a better job than the state can do on this, but I want to see the data," she said. "We support these goals of promoting integration [of behavioral health and medical care], of promoting personal responsibility, creating efficiencies, and not overpaying."

The DHHR agreed to the delay after meeting with lawmakers this week, said House Health and Human Resources Chairman Don Perdue, D-Wayne.

Lawmakers also are concerned about the way the DHHR handled the contracts for the managed-care companies, he said. The state already pays the companies about $275 million a year to manage the care of people who receive cash assistance, Perdue said.

Adding SSI beneficiaries will tack another $300 million onto that, he said.

The state changed the contracts with the managed-care companies without a bidding process. The DHHR is exempt from state Purchasing Division regulations for contracts and change orders.

"The procurement process . . .  eliminated any real competition," Perdue said. "I don't know that's in the best interest of the state."

The managed-care model helps states better predict Medicaid costs. In it, the state pays a monthly fee for each person enrolled in Medicaid. Under West Virginia's current fee-for-service system, doctors, dentists and others are reimbursed for each service they provide.

Medicaid and education are the state's two biggest expenditures, together making up about two-thirds of the general revenue budget.

Reach Alison Knezevich at or 304-348-1240.