CareSource, Ohio’s largest Medicaid managed care provider, promised greater transparency in moving to a new contract with Express Scripts.
Except that contract will not be public.
CareSource, which covers 1 million Ohio Medicaid beneficiaries, broke off its deal with CVS Caremark amid controversy over spread pricing and joined up with Express Scripts instead. But experts are questioning whether a contract kept secret will allow similar practices to spring up, the Columbus Dispatch reported.
CareSource officials say the deal is transparent because it will be made available to leadership in the Medicaid program and an independent third party will oversee performance, according to the Dispatch. The contract is under review by the state.
If the contract were released publicly, the insurer said, then it would take away a competitive advantage by clueing competitors in to the deal’s structure.
“We believe that we’re creating a new and novel solution for the people of Ohio, and if we disclose that to the general public, then all of our competitors would understand that as well and possibly replicate it,” Clayton Edwards, senior vice president at CareSource, told the Dispatch.
Here’s a look at some of the other Medicaid stories from across the country, including:
Montana legislators send reauthorization bill to the Senate
A crucial bill that would reauthorize Montana’s Medicaid expansion was sent to its governor Thursday after it was passed by the state House, according to the Associated Press.
The bill passed in its state Senate, a vote that came down to the wire, on Tuesday, 28-22, Montana Public Radio reports. In addition to extending the expansion, the bill, if finalized, would also add work requirements to the program. About 96,000 were added to the Medicaid rolls in Montana under expansion.
State senators delayed the bill over the weekend, setting up a race to meet the Tuesday deadline. Some Republicans criticized the bill, saying its changes don’t go far enough.
“It’s the most pathetic example of a work requirement that one could ever dream up,” Senate Majority Leader Fred Thomas said.
Medicaid work requirements have been controversial and face legal challenges in several states.
TennCare added 24K kids to its rolls in past two months
Tennessee’s Medicaid program, TennCare, enrolled 24,000 children in February and March after a multiyear “purge” of kids from the program that rankled parents and physicians.
An investigation by the Tennessean found that 128,000 children had been culled from the rolls in TennCare and CoverKids, another insurance program, over the past two years. The report led to an outcry from the state’s medical community and lawmakers, according to the newspaper.
TennCare officials told lawmakers Tuesday that no children were removed from the program without their parents’ knowledge.
OIG to investigate Medicaid managed care organizations
The HHS Office of Inspector General will review whether Medicaid managed care organizations are improperly denying care to people with disabilities.
The review was requested by Sen. Bob Casey, D-Pa., who cited reports in Des Moines and Dallas newspapers that showed these organizations denying patient care.
The Des Moines Register reports that the OIG could issue an evaluation by 2020. Iowa shifted its entire Medicaid program to private management in 2016, which officials argue leads to significant savings.
Critics have countered that it’s leading to service denials and higher administrative burdens.