Curator, KY, Managed Care, Roundtable Show
Clipped from: https://www.bizjournals.com/louisville/news/2020/11/18/medicaid-mediation-starts-at-loggerheads-over-memb.html
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Curator summary
KY MCO lawsuits continue, but with a focus on mediation by early December.
Court documents show that there are hurdles just to get mediation in the case over how the state awarded its Medicaid contracts started.
Mediation among the eight organizations at the heart of the controversy surrounding the state’s Medicaid program has started off with conflicting visions for the process.
Court documents filed on Friday show differing views on matters such as timing, how to handle a pending motion in Franklin Circuit Court and disputes over a proposed precondition to the outcome of mediation.
On Nov. 12, Franklin Circuit Court Judge Phillip Shepherd ordered that the two government agencies and six Medicaid companies in the suit try to resolve the matter through mediation and to set a date to do so before Dec. 12.
Under dispute
The two government agencies — the Kentucky Cabinet for Health and Family Services and the Finance and Administration Cabinet — filed a joint status report with Medicaid companies: Aetna Better Health of Kentucky Insurance Co., Anthem Kentucky Managed Care Plan Inc. and Molina Healthcare of Kentucky Inc. in which they proposed a mediator: John Van Winkle of Indianapolis-based Van Winkle Baten Dispute Resolution.
They also hope to set a mediation date of no sooner than the week of Nov. 30 and no later than the court-mandated Dec. 12, the report reads. But UnitedHealthcare of Kentucky Ltd. and Humana Health Plan Inc. want to see mediation no later than or on Nov. 26, Thanksgiving, according to a joint status report that also included WellCare Health Insurance Company of Kentucky.
UnitedHealthcare brings one of the most specific demands to the table before the mediation takes place.
“[P]rior to the mediation and included with each party’s mediation statement, each [Medicaid company] must acknowledge a willingness to permit reassignment of its membership,” UnitedHealthcare states.
WellCare and Humana reject the precondition of the Medicaid companies forfeiting members, which is a major sticking point for the lawsuit that preceded the order for mediation. The two government agencies and Aetna, Molina and Anthem reject any preconditions to the mediation talks.
How we got to this point
On Oct. 23, Judge Phillip Shepherd ordered that the state must allow Anthem to remain in the Medicaid program, expanding the number of participant companies from five to six, despite Anthem’s inability to win a contract in two RFP process in the last year.
In court, UnitedHealthcare filed a motion calling for Shepherd to amend his order to release the state from providing a contract to Anthem and to eliminate Molina Healthcare from the program and assign the members of the two companies to United.
With Anthem remaining in the Medicaid program and Molina taking over Passport’s members, UnitedHealthcare contends that there won’t be enough members in the program to make it viable or enough members for the state to meet its contractual obligation to provide enough members to help new Medicaid companies get started.