Insurer Continues Challenge To Its Exclusion From La. Medicaid Program

Other states wrestle with issues regarding Medicaid eligibility, payments and fraud.

The Times-Picayune: Medicaid Privatization Firm Selection Challenged Again
A major insurance firm is continuing to protest its exclusion from the state's planned $2.2 billion privatization of coverage for more than 800,000 of the state 1.2 million Medicaid enrollees. Aetna Better Health Inc., a subsidiary of Aetna Inc., already lost an appeal with Louisiana Health and Hospitals Secretary Bruce Greenstein, who in July announced the selection of five firms slated to run the planned managed-care networks. Now the firm has asked Commissioner of Administration Paul Rainwater to throw out Greenstein's selections. Among several claims, the insurer alleges in a letter to Rainwater that Greenstein's agency did not follow the parameters of its requests for proposals to participate in Gov. Bobby Jindal's signature health initiative (Barrow, 8/23).

The Associated Press/Denver Post: Report: CO Medicaid System Plagued By Delays
Colorado's Medicaid program has had significant delays in determining applicants' eligibility, according to a federal review released Tuesday that raised the question of withholding money from the state if problems are not solved. The review from Centers for Medicare and Medicaid Services also found that Colorado's system does not provide sufficient time for applicants to show proof of citizenship and is not programmed to deny or terminate benefits to those who don't qualify. The report presented to lawmakers in the state audit committee said Colorado is not complying with federal regulations that call for eligibility to be determined within 90 days for people with disabilities — or within 45 days for all other applicants. The report said about half of all applications are not processed within the federal timelines (Moreno, 8/23).

The Associated Press/Columbus Dispatch: Glitches Leave Ohio Medicaid Providers Unpaid
Ohio is moving quickly to ease hardships for hundreds of mostly self-employed health care service providers who have not received state paychecks for weeks because of problems amid the transition to a new Medicaid billing system, officials said Tuesday. The state would make two weeks' worth of emergency payments this week to roughly 450 mainly in-home care providers whose claims to Medicaid have been erroneously rejected as ineligible since the new $115 million computer system went online Aug. 2, said Ben Johnson, a spokesman for the Ohio Department of Job and Family Services (Whiteman, 8/23).

The Associated Press/Houston Chronicle: 11 Cities To Pay Nearly $1.7M Over Medicaid
Eleven Texas cities have agreed to pay a total of nearly $1.7 million to resolve allegations of Medicaid fraud. U.S. Attorney James Jacks on Tuesday announced the agreement with Plano, Frisco, Richardson, Mesquite, Celina, DeSoto, Corpus Christi, Cedar Hill, Rowlett, North Richland Hills and University Park. … Investigators say the dispute involved how claims were coded to be submitted to Medicare and Medicaid for city-dispatched 911 ambulance runs between 2006 and 2010. Certain codes allow reimbursement at a higher rate (8/23).

The Wall Street Journal: Clinic Sues Over Ban
Accusing the Cuomo administration of "cruel, needless guillotine action," a Bronx health-care nonprofit controlled by an indicted former state lawmaker filed papers in court on Tuesday to stop the state from cutting off its Medicaid funding. A lawyer for Soundview Health Center called the state's punishment of the clinics "grossly disproportionate" and said cutting off the center's financial lifeline would wipe out 200 jobs and upend the lives of thousands of patients (Gershman, 8/24).

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