Medicaid patients focus of lawmakers

Gregoire urged to keep protective language in budget

By Marissa Harshman, Columbian health reporter

Published:

 

Update

Previously: Sen. Craig Pridemore, D-Vancouver, added language to the Senate’s proposed budget that would require the Health Care Authority to certify that Medicaid managed care plans have enough providers to meet the population’s needs prior to entering contracts.

What’s new: State representatives from Southwest Washington successfully worked the language into the negotiated supplemental operating budget approved last week. The legislative delegation and Clark County providers and Medicaid members are urging Gov. Chris Gregoire to keep the language in the budget.

What’s next: Local legislators are trying to schedule a meeting with Gregoire before she gives final approval on the budget.

State representatives from Southwest Washington are continuing the work they say protects Clark County’s Medicaid population, even though the special legislative session ended a week ago.

Last month, state Sen. Craig Pridemore, D-Vancouver, added proviso language to the Senate’s proposed budget that would require the state Health Care Authority to certify that Medicaid managed care contractors have established networks of acute, primary and specialty care providers sufficient to meet the needs of the anticipated enrollees.

Other local representatives joined the effort and successfully worked the language into the negotiated supplemental operating budget approved last week.

But their work isn’t done yet.

The budget is awaiting final approval from Gov. Chris Gregoire, who said she will likely veto portions of the budget. Rep. Jim Moeller, D-Vancouver, is trying to set up a meeting between the governor and the Southwest Washington legislative delegation to urge Gregoire to keep the HCA language in the final budget.

The language was added after questions arose surrounding the HCA’s procurement process that awarded out-of-state, for-profit companies with contracts to provide health plans to the state’s Medicaid managed care members.

The HCA in January selected five health insurance plans to provide services to more than 700,000 Washington residents, including more than 65,000 in Clark County. The selected insurance plans will manage care for the state’s Healthy Options and Basic Health members, who are mostly low-income women and children.

Columbia United Providers, owned by PeaceHealth Southwest Medical Center and other local providers, has provided those services in Clark County since 1994 but was not among the five plans selected.

During the bidding process, the state required each plan to demonstrate it could develop a network to the state’s standard. The plans needed to have letters of commitment from providers in order to submit a bid application but did not need to have a provider network in place at the time of application.

If the selected plans cannot meet the contract requirements, the state could choose to rebid the service area or assign all of the county’s Medicaid members to fee-for-service plans.

The budget proviso language would prohibit the state from implementing a fee-for-service program. Instead, it would require the state to accept new bids from each of the original applicants and continue the process until finding a plan that meets the requirements.

“To simply turn over our most vulnerable population to a brand-new provider that doesn’t have signed provider contracts in the community to provide those services seems irresponsible,” Moeller said.

Moeller said he’s optimistic the language will make it into the final budget, however, he said the state agency will likely urge Gregoire to veto the language.

“They like to play hardball,” Moeller said. “They want what they want, when they want it.”

Jim Stevenson, spokesman for the HCA, said the agency won’t advocate either way for the legislation.

“We wouldn’t take a position independent of the governor’s office,” Stevenson said.

The language could potentially benefit Vancouver-based Columbia United Providers, which has launched a letter-writing campaign urging Gregoire to adopt the budget with the HCA language.

CUP is asking providers, members and community partners to send letters through its Patients Lose Out website, http://www.patientsloseout.com. Since Thursday, the community has submitted more than 600 letters.

CUP -- joined by another current Clark County plan that wasn’t selected, Community Health Plan of Washington -- filed a lawsuit against the state, arguing the state signed contracts with plans that do not have adequate provider networks.

CUP is awaiting the ruling of an injunction hearing held last week. If granted, the injunction would stop the state from executing its contracts with the selected insurance plans until the lawsuit is settled.

U.S. District Court Judge Benjamin H. Settle said he would issue a decision by the end of this week.

Marissa Harshman: 360-735-4546; http://twitter.com/col_health;http://facebook.com/reporterharshman;marissa.harshman@columbian.com.