July 24--The state has delayed plans to turn over the care of 57,000 elderly or disabled Medicaid patients to three health insurance companies.
The Department of Health and Human Resources said in May it would move patients who receive Supplemental Security Income into managed care insurance plans starting December.
The three companies -- Carelink, The Health Plan and Unicare -- would get money from the state to insure SSI patients for whom the state currently handles claims.
Managed care, like a private sector HMO, attempts to coordinate health care while controlling costs. The three companies already manage care for 170,000 Medicaid recipients.
But Nancy Atkins, the head of the state Medicaid program, told lawmakers Monday the rollout had been delayed until next summer.
She said the switch was delayed while officials look at the complex formula they use to reimburse some hospitals.
Now, instead of beginning to switch people to new insurance providers this winter, the state is aiming to begin on July 1, 2013.
In May, critics of managed care questioned whether DHHR had carefully thought out the plan, which would change how thousands of the most fragile, government-dependent West Virginians receive health coverage.
State House Health and Human Resources Chairman Don Perdue, who had been critical of the plan, said he didn't see reason to rush the switch.
"I think there are an awful lot of things that need to be considered here," said Perdue, D-Wayne.
Medicaid is the state and federal health insurance program for low-income people and it is already using managed care companies. But SSI recipients have a different and more expensive set of medical needs than the normal welfare population. To qualify for SSI, a person must be aged, blind or disabled -- a category that includes people with serious mental disorders.
There are two basic reasons the state may be trying to move more people into managed care. First, Medicaid costs are rapidly rising while revenue growth remains slow.
While one DHHR official said in May the goal wasn't to save money, department officials floated various estimates of savings ranging from $6 million to $15 million. Some of those savings would come from changes the state is making to a pharmacy program, which is also expected eventually to be turned over to the managed care companies.
It's not clear how much the plan will cost if it happens next summer.
"There is still not an estimate of how much this expansion will increase payments to managed care organizations," DHHR spokeswoman Marsha Dadisman said in a recent interview.
A second reason for the switch is that managed care is supposed to help make sure patients receive appropriate treatment.
But critics have questioned whether managed companies will do what the state expects.
"I haven't seen the evidence they improve quality of care or reduce cost, so I think they are sort of trying to pull that together to make sure the move is appropriate," Perdue said.
Contact writer Ry Rivard at email@example.com or 304-348-1796. Follow him at www.twitter.com/ryrivard.
(c)2012 the Charleston Daily Mail (Charleston, W.Va.)
Visit the Charleston Daily Mail (Charleston, W.Va.) at www.dailymail.com
Distributed by MCT Information Services