Medicaid Managed Care Council update

We got a first look at the HUSKY HMOs’ provider networks at Friday’s Medicaid Managed Care Council meeting and it wasn’t good. CHN, which has been a part of HUSKY from the beginning, has robust panels of providers across the state. However, the two new HMOs – Americhoice (United) and Aetna – have a long way to go. As of July 11th CHN had 2,109 primary care providers available to serve HUSKY consumers, while Aetna Better Health had 367 (190 of those are in New Haven County), and Americhoice had only 140 primary care providers statewide. Both Aetna and Americhoice each have a county with only two primary care providers taking HUSKY and Charter Oak patients. And the HMOs are still in negotiations with hospitals for contracts.
We also learned that undocumented immigrants are not eligible for Charter Oak, even the unsubsidized portion of the program. We learned more about how cost sharing the in the program works – the out-of-pocket maximums are on top of the deductibles and copays. Many on the Council were concerned that the state is still at financial risk for behavioral health and drug costs under Charter Oak. Sen. Harp noted that during budget negotiations this spring, HUSKY expenditures were down significantly – suggesting that the state was saving considerable sums without capitation. CMS has asked for that analysis – how much the state spent before and after the state removed capitation in November. DSS also stated that they have no intention to respond to the state’s budget deficit by proposing cuts to HUSKY or Charter Oak.
Ellen Andrews