West Virginia

Department of Health, Department of Health Facilities, and Department of Human Services

Department of Health
Department of Health Facilities
Department of Human Services

Statement from BMS Acting Commissioner Cindy Beane regarding Medicaid Managed Care ruling

6/10/2015

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.

Contact Information

Allison C. Adler, DHHR Communications Director, Allison.C.Adler@wv.gov, 304-558-7899
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