Two insurers on the falling side for bids for Louisiana’s Medicaid controlled care contracts become complaints about the state’s conclusion, saying the method was flawed and biased. According to the Louisiana Department of Health, Louisiana Healthcare Connections is one of five Medicaid MCOs paid $7.6 billion by Medicaid during the fiscal year 2018 to cover more than 1.7 million enrollees. It was also reportedly the biggest MCO inside the state.
The current contracts, which expire December 31, include United Healthcare Community Plan, AmeriHealth Caritas, and Healthy Blue. The Louisiana Department of Health stated that they would contract with only four Medicaid MCOs: AmeriHealth Caritas Louisiana, Community Care Health Plan of Louisiana (Healthy Blue), Humana Health Benefit Plan of Louisiana, and United Healthcare Community Plan, and the new contract began on January 1, 2020. It cost them billions of dollars just for the contract. Aetna says it is contesting the decision. Louisiana Department of Health reported on Aug 5 that Aetna Better Health of Louisiana would not reward a contract for the 2020 Healthy Louisiana Medicaid program.
Aetna was disappointed with their own decision given the strength of our bid and the work we currently do to support 120,000 Medicaid members across the state through our Aetna Better Health of Louisiana plan. Aetna confidently filed a poster letter with LDH to appeal the decision after evaluating competitor applications and scoring results. They participated in guided care organizations given a monthly fee based on a per member-per-month basis.
Most maximum Medicaid enrollees receive healthcare through the managed care delivery model, except for long-term supports and services. The protests claim improper bias, conflict of interest, and inconsistency in scoring methods forbids, among other claims, including an objection to Humana getting the bid. The state bid process began in February with a demand for proposals.
Office of State Procurement will order on the protests. Rulings can be attracted to the Commissioner of Administration, next to the courts, a method that could take months, according to the real advocate. Rep. Cedric Richmond, state lawmakers, and US representatives question the bid decision. The report asked whether the new companies will absorb more than 550,000 enrollees from the Louisiana Healthcare Connections network and Aetna.
The news appears as Centene Corporation declared the growth of its track in the affordable care act. Louisiana Healthcare Connections has proclaimed a data breach that affects more than 13,000 Medicaid recipients. Jan 27, 2020, The Louisiana Attorney General’s Office arrested an individual who betrayed using another individual’s data to download a list of LHCC members that the person then gave to a provider who should not have received it. It allegedly denied payment for screening performed on more than 4,600 patients. Humana Inc. received a lawsuit from the maker of the new test for colorectal cancer, which would violate state and federal law.
According to the Oklahoma-based Bristow Endeavor Healthcare has filed a lawsuit against the Blue Cross Blue Shield Association, blaming it for teaming up with competitors to drive them away from its services. Healthcare spending has decreased considerably in recent years, a trend advocates of the Affordable Care Act associate to implementing the healthcare law. But a more intimate look reveals other factors at play. Federal leadership in reducing preventable hospital charges among nursing home residents has yielded encouraging early results: Medicare expenditures fell for all seven demonstration sites, and all-cause hospitalizations and potentially avoidable hospitalizations fell across areas.
