Statement from BMS Acting Commissioner Cindy Beane regarding Medicaid Managed Care ruling
The Department of Health and Human
Resources (DHHR), Bureau for Medical Services (BMS) stands firmly opposed to a
ruling in favor of a petition for injunctive relief regarding the State
Medicaid managed care contracts.
The petitioners sought to arbitrarily
invalidate State Medicaid managed care contracts that provide affordable
medical coverage to hundreds of thousands of the neediest and most vulnerable
West Virginians. Petitioners claim they
brought this suit as concerned taxpayers, yet, ironically, the remedy they
sought would harm, not help West Virginia’s fiscal health, as granting an
injunction in this case will upend the West Virginia Medicaid program and
needlessly cost the State millions of dollars.
Based on independent actuarial
analysis, the projected cost savings from these contracts to taxpayers in
fiscal year 2016 is as high as $58 million for which $35 million results from
the inclusion of Medicaid expansion and behavioral health into managed care in
July.
The financial impact on the Medicaid
program and the State of West Virginia will be devastating. The purported
relief sought by petitioners is based on a seriously flawed understanding of
how managed care contracts are required to be priced. Rates have been set as low as they can be as
permitted by the Centers for Medicare and Medicaid Services (CMS).
This could impede delivery of critical
services to some of West Virginia's Medicaid members. Recipients will lose services provided only
by managed care, quality assurance will be reduced, and providers will likely
see a reduction in rates, which could in turn lower the number of providers
willing to take Medicaid and further reduce the availability of care in this
State.
In light of the West Virginia’s
behavioral health and substance abuse crisis, efforts to derail progress are
viewed with alarm. The State cannot allow the continued segregation of
individuals with behavioral health and substance use disorders, instead of
using the evidenced-based model of care that integrates both physical and
behavioral health services that is occurring all over the nation.
DHHR is working to transform Medicaid
by introducing private market concepts into the program to benefit members and
state taxpayers. Last minute efforts to
derail these strategies before the July contracts go into place puts the future
solvency of the Medicaid program in jeopardy.
DHHR and BMS are currently weighing
their legal options.
Allison C. Adler, DHHR Communications Director, Allison.C.Adler@wv.gov, 304-558-7899