HUSKY/PCCM update

Yesterday’s meeting of the Medicaid Managed Care Council was lively, but ended before addressing some important issues. The Commissioner acknowledged that they are still assessing the costs of the program under the current non-capitated arrangement. He stated that they know that the current system costs more than before Nov. 2007 when the capitated contracts ended; data brought to the Council in October bears that out. However using their numbers, the current system is costing less per member per month than the new capitated rates, which include a 24 % increase granted to the HMOs by DSS this summer. Nationally state Medicaid costs rose 5.5 % last year. (CT’s state budget overall grew by 8.8% for FY 2008 when the national average was 5.3%).

Despite not having information on the costs of the current program vs. the new capitated HMOs, the state intends to go forward anyway with requiring all HUSKY members to choose an HMO by the end of January. At the meeting we learned that members who do not choose a plan will be defaulted February 1st, but not into all three HUSKY HMOs, but only into the two new ones. Those plans, Aetna Better Health and AmeriChoice, have faced severe challenges recruiting providers and have significantly weaker capacity than the other plan CHN, which is based on CT’s community health clinic system and has participated in the program since its inception. It is expected that, given the significant problems in the program over the last year, numerous transitions and resulting confusion among members, that the default rate will be very high this month. Advocates are very concerned that forcing families into inadequate HMOs will reduce access to care, increase ER visits, and reduce access to preventive care services. Unfortunately, we never reached this part of the agenda during the meeting, so DSS never explained their reasons for limiting default enrollment to just the two new HMOs. But, as always, the decision appears to be made anyway without any chance for input, so it really doesn’t matter.
Ellen Andrews