West Virginia Residents Plan to Sue; Say Agencies Failed to Put Medicaid Managed Care Contracts Out for Bid

Medicaid managed care is expanding throughout the United States. Iowa is going through a request-for-proposal process, and Kentucky is rebidding its contracts after switching over to managed care in 2011.

A group of West Virginia taxpayers plans to sue to force the state to follow its own bidding laws as it expands Medicaid managed care, according to a statement they issued after giving notice of their plans.

The group seeks to block West Virginia’s Department of Health and Human Resources (DHHR) from adding mental health services to the offerings provided by health maintenances organization (HMOs) until it puts the services out for bid, according to the petition filed Friday in Kanawaha County Circuit Court, the Charleston Gazette reported. The taxpayers’ group also plans to name West Virginia’s Department of Administration and Division of Purchasing.

According to a statement from the citizens, the state seeks to add another 150,000 resident to Medicaid managed care. The statement did not say how many West Virginians are currently served by the Medicaid HMO contracts, which involve 4 groups: the Health Plan of the Upper Ohio Valley, UniCare Health Plan of West Virginia, Coventry Cares of West Virginia, Inc., a subsidiary of Aetna; and West Virginia Family Health Plan, which is owned by providers.

Those seeking to block Medicaid managed care expansion assert that the DHHR and other agencies are in violation passed by the West Virginia Legislature in 2013 and 2014, which they say clarified the need for state agencies to go through a competitive bidding process when entering into managed care service contracts.

At present, none of the HMOs operating in the state received a contract through competitive bidding, they argue; they say the program operates under a CMS waiver. In fact, the group, led by Patricia Rucker of Harpers Ferry, West Virginia, called on state native Sylvia Mathews Burwell, now US Secretary of Health and Human Services, to take an interest in this issue.

“The requirement for competitive bidding is just common sense,” Rucker said. “Just as the average citizen would not buy a car without shopping around for the best deal, state government should not enter into contracts without ensuring that taxpayers get the best deal possible.”

A process known as a request for proposals, or RFP, is typical when states award Medicaid managed care contracts. For example, Iowa is going through such a process right now as that state seeks to move its 564,000 Medicaid beneficiaries in managed care. Iowa already uses managed care for Medicaid mental health services. Kentucky has used managed care for Medicaid since 2011 and is in the processes of rebidding those contracts.

On the Web

Iowa Seeks Formal Bids for Medicaid Managed Care