WellCare Out of Iowa Medicaid Modernization…Almost

Yesterday evening, several Iowa news agencies reported a state official’s announcement that the WellCare contract should be terminated (see the 12/18/15 Gazette story by Chelsea Keenan, http://www.thegazette.com/subject/life/health/iowa-official-wellcare-medicaid-contract-terminated-20151218). WellCare is one of the four managed care organizations (MCOs) who contracted with Iowa Medicaid Enterprise for moving Iowa Medicaid to managed care. Recall WellCare has a large legal cloud over it, which I pointed out at the first of several scheduled University of Iowa Hospitals and Clinics Medicaid informational Forums last week, one of which was cancelled because of the Centers for Medicare and Medicaid Services (CMS) decision on Thursday not to approve the roll0ut of the privatization of Iowa Medicaid for January 1, 2016.

This is the second setback to Governor Branstad’s privatization of Iowa Medicaid. While this doesn’t mean that it won’t happen eventually, it could indicate that some officials are finally listening to the pleas of doctors, patients, and patients’ families to slow down the transition, which has clearly not allowed for enough assurance that patients will have adequate access to mental and medical health care providers.

WellCare is planning to file an injunction against the Iowa Department of Administrative Services decision against it, which was initiated by an administrative law judge who recommended throwing out the contract in the first place. The Governor’s office is still reviewing the decision. However, it’s clear that the decision reflects further thought about the embattled MCO’s problematic legal entanglements as Director Janet Phipps’ remarks show:

“WellCare failed to disclose highly relevant information both in its initial response” and “in its ‘clarifying’ answer,” she wrote in her decision. “In doing so, WellCare not only violated the terms of the (request for proposal) but also deprived the agency decision-makers — both the evaluation committee and Director (Charles) Palmer — of the opportunity to fully exercise their discretion in determining which bid proposals would provide ‘the greatest benefit to the agency'”.

That “highly relevant information” included WellCare’s accumulation of millions of dollars in fines for fraud or mismanagement in other states and the sentencing to prison in 2014 of three former executives convicted of fraud.

Unfortunately, the Iowa Medicaid Modernization hiccups in the last few days will just make things that much harder to figure out how patients and their health care providers will maintain their connections with each other and continue to pursue the goal of better mental and physical health care for all Iowans.

I would not be sorry to see WellCare go, even though it complicates the problem of where patients and their providers will land amongst the three remaining MCOs. And I wonder, now that I’ve learned The University of Iowa Hospitals and Clinics signed a contract with WellCare–what will be UIHC’s position and how will its leaders meet the challenge?

We probably have to take the bad with the good…but shouldn’t there be a level of bad that is unacceptable?