State court upholds challenge to Medicaid contracts
A state court this week ruled in favor of insurers that challenged the process for awarding contracts, which could mean the state has to start over again.
If it does, it would be the third time since 2015 the state has issued requests for proposals (RFP) from insurers for its Medicaid managed care program, known as HealthChoices. The contracts at issue cover the provision of physical health services. Separate insurers cover behavioral health and long-term care.
At stake are billions of dollars in Medicaid spending
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The decisions came down from Commonwealth Court on Tuesday and Wednesday in cases brought by
The three insurers challenged the bid process, focusing in part on a
The department rejected the protests. But they were upheld by the court, which said the December meeting violated the state‘s procurement code.
As a result of the violation, the court wrote, "the remedy the court shall order is limited to canceling the solicitation or award and declaring void any resulting contract."
In such situations, the bidding process typically starts over again, said
"That‘s typically what‘s done when a bid protest is upheld in a court," Adler said. He represented an insurer in an earlier dispute over the same contracts
"We are pleased with the Commonwealth Court‘s decision and look forward to continuing to serve the more than 1 million Pennsylvanians who have entrusted us with their health care needs," the company said in a statement.
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Medicaid recipients, meanwhile, are unlikely to see much impact, said
Nonetheless, he said, the legal challenges are frustrating in that they hold up efforts to bring new insurers into Pennsylvania‘s Medicaid program, which he described as well-managed.
"That‘s not a judgement about United‘s challenge or Aetna‘s challenge or existing insurance companies," he said. "It‘s just that it is, I think, a sign of good systems when you evaluate and make some choices about who stays in and who needs to leave. We haven‘t really been able to get to final decisions on that for about three years now."
Under the state‘s Medicaid program, known as Medical Assistance, the state is carved into five regions, with managed care insurers selected to serve beneficiaries in each region.
The existing insurers were supposed to be replaced starting in 2017 with a new crop of insurers, with similar changes taking place in the other four regions. But the bid protests and legal challenges delayed the process. An initial RFP went out in
A spokesperson for
Gov.
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