Gov. M. Jodi Rell moved to terminate most of the responsibilities of four health care companies that receive state Medicaid funds to provide health care to many needy children.
Starting Dec. 1, the insurers will no longer make decisions about authorizing coverage or payment levels to doctors under the HUSKY program, Rell said.
Instead, the state Department of Social Services will make such decisions, much like the state’s current Medicaid program for elders and people with disabilities. The insurers, she said, will only handle claims and processing.
HUSKY enrollees will not be affected by the change, Rell said.
Rell’s order comes after years of wrangling over whether the insurers should make public their reimbursement rates and how often prescribed drugs are rejected. The companies have argued that such disclosures amounted to an unconstitutional “taking” of their trade secrets.
“These companies refuse to abide by our public disclosure law, despite being required to do so, and they were also willing to walk away from providing services to our children if they had to live up to this requirement,” Rell said.
She alleged that Anthem Health Plans Inc. and Health Net threatened to drop their HUSKY services with 15 days notice if they were required to comply fully with the state Freedom of Information Act.
However, Anthem spokeswoman Leslie I. Porras said Monday the managed care company would provide the state with as much notice as required under state law. Meanwhile, the company hopes “that we can come to a mutually acceptable agreement to continue to serve our HUSKY members,” she said.
A spokesman for Health Net said the insurer had been negotiating with the state and that Rell’s announcement came as a surprise.
“But at this point, we’re going to respect the governor’s decision and begin work immediately on an appropriate transition plan that ensures all members receive uninterrupted coverage and ongoing access to health care services,” said David Olson, senior vice president for Health Net.
Asked if Health Net was willing to only handle claims and processing, Olson said the company will fulfill whatever role asked of it during the transition.
Calls for comment were left with WellCare Health Plans and Community Health Network of Connecticut, the other two managed care companies involved with HUSKY.
Both expressed a willingness to comply with FOI laws, Rell said. Wellcare did not join the other companies in a court appeal, for example. But the two companies would not be able to suddenly absorb the combined enrollment of Anthem and Health Net.
David Dearborn, a spokesman for the Department of Social Services, said the state has been operating on a month-to-month basis with the insurers until June 30, 2008.
DSS will then determine if any managed care companies are willing to handle HUSKY and the governor’s new Charter Oak Health Plan for uninsured adults, so long as they comply with FOI.
If no insurers are willing to comply with FOI, the state determine after that how to proceed, he said.
Legal-aid groups originally sought the data to determine whether low reimbursement rates to doctors are the reason that poor people often have difficulty obtaining care from medical specialists in Connecticut.
At a news conference in January, Marisol Pratts of Seymour described how difficult it is for her to get appointments with doctors for her child on HUSKY. Many doctors have said they can’t afford to take the patients because the reimbursement rate set by managed care companies is too low.
Started in 1998, HUSKY provides health care benefits to more than 229,000 children and teenagers in families of all incomes, as well as more than 96,000 parents, caregivers and pregnant women with low incomes.
Anthem and Health Net are the two largest managed care organizations in the HUSKY plan, insuring 142,171 and 87,710 enrollees, respectively.
The state spends more than $700 million on the HUSKY program. Considering that is such a large sum, Rell and numerous legislators argued that the state deserves to know from the insurers how that money is spent.
“I am happy that the governor is insisting that these insurers meet all the FOI requirements,” said Senate Majority Leader Martin Looney, D-New Haven.
He has been working with Senate President Donald E. Williams Jr., D-Thompson, since October 2004 to determine how much public money is being paid to doctors and other providers.
“There is so much state money involved here that these insurers are essentially acting as a governmental agency,” Looney said. “Accountability and openness on their part are essential in order to guarantee that hundreds of millions of dollars in state funds are being well-administered and that these important services are being provided in an appropriate manner.”
Rell’s decision was also praised by state Attorney General Richard Blumenthal and legal aid organizations that challenged the insurers.
“We stand ready to work alongside the governor and with DSS to implement an effective transition plan that will minimize disruption and bring long-needed reform and transparency to the Medicaid system,” said Sheldon V. Toubman, attorney for New Haven Legal Assistance Association.
“This common goal will benefit everyone: taxpayers, medical providers, and most importantly, Connecticut’s kids and families who are living in poverty,” he said.
