Medicaid Managed Care Council/PCCM update

At Friday’s Council meeting DSS announced that not only did they default HUSKY families in Anthem and traditional Medicaid to only the two new HMOs – Aetna and AmeriChoice -- but that they will continue defaulting into only AmeriChoice all through February. Reportedly 63,000 HUSKY members were defaulted on February 1st.The reason given is to prop up the new HMOs’ bottom lines. The disconnect was pointed out between DSS’ policy of deep concern for the HMOs and their finances compared to PCCM policies arbitrarily limiting the number of providers and families with access to this new option. Several Council members mentioned that they have heard great enthusiasm about PCCM from providers. There are only 104 members in PCCM to date due to DSS’ decisions to limit enrollment, which benefits the HMOs. Council members urged DSS to conduct outreach to consumers about PCCM, similar to what the HMOs are funded to do. PCCM providers have as yet received no reporting or other guidelines in the program; providers have also been told that they are “double-dipping” (a prohibited practice) if they have other care managers on their staff care for PCCM members. DSS promised to address these concerns.

A DSS survey of HUSKY providers found that 53% participate in all three health plans. This calls into question the ratios of providers to members used to determine adequate access under the HMO contracts – as over half of providers are triple counted.

In very good news, Donna Balaski, heading DSS’ dental carve out, reported that there are now 469 dentists participating in HUSKY, including 206 newly enrolled dentists. Prior to the carve out, there were only 174 participating in the health plans. This is a 270% improvement in a very difficult environment. Access to dental care in HUSKY has historically been even worse than other health care and dentists’ resistance to HUSKY and the health plans was very strong. Donna deserves a great deal of credit – she has been tirelessly travelling the state, talking to everyone she can find, and working WITH advocates – not standard operating procedure at DSS.
Ellen Andrews