Dive Brief:
After providers and stakeholders aired their concerns in front of Kansas lawmakers over Aetna’s less-than-stellar performance in delivering benefits to Medicaid beneficiaries, the Kansas Hospital Association says it’s optimistic that longstanding issues will be corrected.
- The hearing in front of an oversight committee was held Monday, about a month after the state of Kansas warned Aetna it was in jeopardy of losing its contract due to inadequate service. The state outlined a list of concerns including issues with credentialing providers and incorrect payment rates.
- Aetna issued a corrective action plan on Aug. 7, noting many issues had been resolved and others were being addressed.
Dive Insight:
The issues come after a less than smooth transition from the previous Medicaid managed care provider in Kansas.
Aetna Better Health of Kansas won the contract over Amerigroup, and the company filed suit in an attempt to keep the contract it had since 2012, according to the Kansas City Star. Amerigroup lost the suit in 2018 after the judge ruled the bidding process was fair, the Star reported.
“We have raised the problematic issues and are working with the new leadership team that has been put in place at Aetna,” Cindy Samuelson, VP of Member and Public Relations at the Kansas Hospital Association, told Healthcare Dive. “We are optimistic that the long-standing issues will be addressed.”
State Medicaid contracts have become a lucrative business for managed care providers. For states, it provides a predictable expense as they pay insurers a fixed rate, typically referred to as a per member, per month rate.
In recent years, as part of the Affordable Care Act, many states chose to expand their Medicaid programs to cover more low-income adults, creating more opportunity for insurers who contract with states.
For some Medicaid managed care providers, the loss of a contract can mean losing out on significant revenue. Centene and Aetna are both contesting bids they lost in Louisiana this year. The two filed formal protest letters with the state.
In fiscal year 2018, Louisiana’s Medicaid program paid $ 7.6 billion to five managed care organizations. “These payments covered more than 1.7 million Medicaid enrollees,” the Louisiana Department of Health said.