Medicaid Advocates Ask Governor To Stop Review of Program

Citing a conflict of interest, a group of Medicaid advocates are criticizing the state Department of Social Services' choice of a consultant for a review of the process through which Medicaid members are receiving services.

The consultant in question – Manatt Health, a consulting firm – is conducting this analysis along with Accenture in what is being called a Medicaid Landscape Analysis.

The letter – signed by several advocacy groups including Disability Rights CT, CT Health Policy Project, and Connecticut Legal Services – was sent to Gov. Ned Lamont's office last week. Advocates said through the letter that Manatt has "clients that include not only individual insurance companies which run Medicaid managed care plans but also the association of such MCOs," the letter states. "This outfit chosen to do the 'independent' analysis is serving the economic interests of the Medicaid managed care industry and individual managed care entities."

The state's Connecticut Medicaid program – known as HUSKY – was run by Managed Care Organizations (MCOs) from 1996-2011. The state now has a managed fee-for-service program, which the advocates say has resulted in better access to healthcare, higher quality healthcare, and more funding for health care for low-income residents instead of going to company profits and marketing costs, said Sheldon V. Toubman, an attorney with Disability Rights Connecticut.

"It is a little surprising," Toubman said of the choice of consultant. "There are all kinds of choices of entities which do this kind of work and that are reputable and don't serve the insurance industry."

Toubman said advocates are concerned that Manatt will not be able to conduct an objective review. The letter does request that the state abandon this review.

According to a news release posted by the DSS on their website, the analysis will look at the Medicaid program – taking a look at what is working and what is not.

"The analysis will include whether there are opportunities to explore managed care options to improve the Medicaid program," according to the release. "We want to hear from Medicaid members, providers, and other stakeholders on what you think is working well and what needs to be improved."

DSS has already hosted one stakeholder meeting, and will host another on Thursday.

David Bednarz, spokesman for Lamont, said the review is necessary to ensure the best services for residents receiving Medicaid that are also cost efficient. He added that Lamont is not proposing any policy changes – administratively or legislatively – on this topic.

"Governor Lamont believes state government should be doing everything it can to ensure that Medicaid members are receiving access to high quality, equitable care. This review will provide the administration and the General Assembly with information on whether there are improvements to achieving this goal that we can implement, and we shouldn't be afraid of receiving that data," Bednarz said.

According to the letter, the current Medicaid program has saved billions, with 2.75% of program cost on administration, compared to the US average of 8.5%.

"Compared to states with MCOs, Connecticut spends 7.7% less of our state budget on Medicaid," the letter states. "Indeed, CT's taxpayers have literally saved billions of dollars since the shift away from capitated managed care to paying entities that actually manage care."

The letter also outlines ways to improve the current program.

"The further innovations on the table are all premised on the state maintaining active control over all basic policy decisions, such as provider payment rates, breadth of services and the determination when prior authorization is applied – policies which, as a practical matter, in CT in the past and currently in other states, are handed over to the MCOs under managed care," according to the letter.