Deborah BachrachSpeaks on Medicaid Managed Care Programs in States
"Centene's Kentucky Woes Display Pitfalls for Medicaid Managed Care Expectations"
Health Plan Week
November 5, 2012 - Manatt's Deborah Bachrach, a special counsel in the firm's Healthcare Division, spoke to Health Plan Week about what health insurers should consider before agreeing to run a state's Medicaid program.
As reported by Health Plan Week, Centene Corp., a multiline healthcare enterprise that provides programs and services to individuals receiving benefits under Medicaid, intends to exit Kentucky's Medicaid program in 2013, before its contract runs out. Industry experts told the publication that this is likely an indication of things to come as more states turn to managed care to run their Medicaid programs.
Bachrach said "issues will come up increasingly" because states are simply more active in seeking out private insurers to run their Medicaid programs. Even more privatized contracts should be in the offing as Medicaid eligibility expands in 2014 under the health reform law and states continue to view managed care as a viable way to control costs in a structured way, she said. It is likely that if the volume of deals rises, so do the possibilities for more exits and disputes.
Bachrach also told Health Plan Week that it's important for health insurers to know the lay of the land when they enter a state and for states to ensure data is accurate and up to date. States may be using faulty data when they write contracts for Medicaid managed care premiums and enrollment forecasts, including erroneous expectations for medical costs, because data is either old or they have to use so-called "encounter" data that is not always accurate. "States have to be careful, and plans have to think hard" about what they are entering into, she said.