Lawmakers Seek Medicaid Spending Information From HMOs

By Susan Haigh

Associated Press

HARTFORD — State lawmakers are demanding access to information from insurers that receive state Medicaid funds to care for poor children.

Legislators are worried that some children may not be receiving the medical care they need. They cited a recent study that showed only 26 percent of calls seeking appointments with physicians covered under the state’s HUSKY plan for low-income children and their families actually resulted in appointments being made.

“My concern is, we’re spending $700 million and we have a partner that’s hiding the books,” House Majority Leader Christopher Donovan, D-Meriden, said December 1.

A superior court judge ruled last week that the health maintenance organizations must make public their reimbursement rates and how often prescribed drugs are rejected.

The decision was in response to an appeal by three insurers after the Freedom of Information Commission ruled that they must disclose their reimbursement rates to physicians under Medicaid because they are performing a public function.

Anthem Health Plans, Community Health Network of Connecticut, and Health Net of Connecticut Inc appealed the FOIC decision, arguing such disclosure amounted to an unconstitutional “taking” of their trade secrets.

Alice Ferreira, a spokeswoman for Health Net, said her company has worked and will continue to work closely with the Department of Social Services on the HUSKY program. She says the insurer shares information, but is concerned about broadly sharing proprietary information, such as rates.

“Health Net is very committed to these members and ensuring that they have access to quality health care and we will continue to pursue our legal options,” she said.

Legal aid groups originally sought the data to determine whether low reimbursement rates to doctors are the reason that poor people often have difficulty obtaining care from medical specialists in Connecticut.

Marisol Pratts of Seymour, who has a child on Connecticut’s HUSKY insurance program for children, described how difficult it is to get appointments with doctors. Many of the doctors complain that they can’t afford to take Medicaid patients because the reimbursement rate set by the HMOs is too low.

“Basically our state is being robbed blind by these companies,” Pratts said. “We’re paying them but we’re not getting service.”

The state is set to spend $3.3 billion — nearly 20 percent of the entire state budget — on Medicaid this year.

Representative Peter Villano, D-Hamden, co-chairman of the Human Services Committee, said his panel plans to hold public hearings about the state’s Medicaid programs next year, when the new legislative session opens.

Lawmakers, he said, will look at clarifying the law to require health insurers to provide reimbursement rates and other data to the state. Also, he said they may consider revamping the Medicaid program to make it more responsive to the poor.

Attorney General Richard Blumenthal said a legislative review of health care services delivered to the state’s poor is critical. He said low-income families are being denied access to quality care because of actions by the HMOs, such as imposing low reimbursement rates on physicians.

His office, he said, will work to make sure HMOs comply with this week’s court ruling and disclose their rates.