BATON ROUGE, La. (AP) — A Louisiana Medicaid managed care contractor that wasn't chosen to continue the job next year intends to challenge that decision, as some lawmakers question the wisdom of reshuffling one-third of the program's patients to new health plans.
Four companies were selected by Gov. John Bel Edwards' administration to manage the multibillion-dollar government-financed health coverage of 1.7 million Louisiana Medicaid patients under new deals slated to start in January. They include three who currently do the work and one new company. Two of the current ones, Louisiana Healthcare Connections and Aetna Better Health, lost out on the new contracts.
Louisiana Healthcare Connections — which provides coverage for about 26% of the state's Medicaid managed care patients — will file a formal protest of the contract awards to the state procurement office, said Randal Johnson, a lobbyist for the managed care organization.
"We're working on a protest now," Johnson said.
He said the company is surprised that its proposal for another contract received the lowest score in the bid review process after its work drew positive evaluations in performance surveys conducted by the health department.
"We rank high with providers. We rank high with members in satisfaction," Johnson said.
When Edwards showed up Tuesday to register for his re-election bid, a dozen orange-shirted Louisiana Healthcare Connections employees whose jobs are at risk greeted the Democratic governor. Johnson said the company has about 675 Louisiana workers.
Edwards defended the bid solicitation and review procedures.
"I'm quite certain based on everything I've been told that that process played out the way that it should have," he told reporters. He added: "If they have some reason to believe that there was a flaw in the process, they certainly have the ability to bring that to the attention of the right authorities. There's a protest that they can file."
Louisiana contracts with managed care companies to oversee services provided to 90% of its Medicaid recipients. The state pays a monthly fee for each person enrolled in a health plan with the companies — mostly adults covered by Medicaid expansion, pregnant women and children. The enrollees get services through a network of primary care doctors, specialists and hospitals.
While some lawmakers have questioned the bid review and scoring process, Senate Health and Welfare Chairman Fred Mills said that process is the health department's job to handle. But he has a logistics concern: How will the department shift 560,000 Medicaid patients from Louisiana Healthcare Connections and Aetna to other managed care health plans in a three-month open enrollment period starting in October?
"My hope is that the process is seamless for Medicaid recipients for their coverage, their prescriptions, their visits," said Mills, a St. Martin Parish Republican. "I think it's extremely challenging in such a tight time frame."
Rep. Jack McFarland, a Winnfield Republican, also worried about the number of people who will have to choose a new coverage plan, and he said health providers in his district have concerns about losing the largest Medicaid health plan in the area, Louisiana Healthcare Connections.
The current Medicaid managed care deals, negotiated by former Gov. Bobby Jindal's administration, expire Dec. 31. Terms of the new deals remain to be negotiated with the Edwards' administration.
Louisiana Healthcare Connections and Aetna oversee the health care coverage of about 33% of the managed care program, according to data from the health department, with Louisiana Healthcare Connections accounting for 443,000 of them. Aetna hasn't publicly said if it will formally dispute the decision.
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