Managed Medicaid

Hawaii Launches QExA Medicaid Program, Says Plan Networks Are Robust

Reprinted from Feb. 5, 2009, issue of MEDICARE ADVANTAGE NEWS, biweekly news and analysis on the Medicare (and Medicaid) managed care programs.

By Judy Packer-Tursman, Editor, (tursman@comcast.net)

After a year of protests and delays, Hawaii began its controversial Medicaid managed care program for 39,000 aged, blind and disabled (ABD) Medicaid recipients Feb.1. And despite ongoing concerns about the two participating plans' network adequacy that led to the program's initial delay from Nov. 1, a state official tells MAN that the program is now on track.

In 2007 Hawaii decided to shift the ABD population from fee-for-service Medicaid into managed care plans in an effort to achieve cost savings. Hawaii got a federal waiver to accomplish this, issued the request for proposals in October 2007, got five bids in December 2007, and in February 2008 awarded the $1.5 billion contract for the new QUEST Expanded Access (QExA) program to subsidiaries of two for-profits: UnitedHealth Group's Evercare subsidiary and WellCare Health Plans, Inc.'s Ohana Health Plan.

That led to an unsuccessful protest by not-for-profit AlohaCare, which was created in 1994 by federally qualified health centers to care for low-income, fragile populations, over an allegedly flawed procurement process. Ed Kemper, AlohaCare's outside counsel, told MAN Jan. 30 that an appeal in federal court is pending. Separately, a consumer group called the Hawaii Coalition for Health filed a federal court action in December that is still pending, state officials said.

"Everything's happening according to plan. We're on schedule to have our start date Feb. 1," Hawaii State Dept. of Human Services spokes-woman Toni Schwartz told MAN Jan. 30. "Both plans said they have more than 1,000 physicians each signed up, and physicians are calling on a daily basis for more signing up - and can sign up after Feb. 1."

Schwartz said there are 24 hospitals in the islands, and all but one has agreed to participate in the QExA program. She said the state is still in the process of negotiating a contract with the remaining hospital, which she did not identify, and remains confident that it will sign up soon.

The state now is focusing on plan enrollment efforts, Schwartz said.

Schwartz noted that state officials are keeping a close watch on the proceedings. "There's always concern," she said. "We had a question there might be services that some island might not have that other islands will….[But] we can take people to other islands, and we can take providers and vendors to the people. We can even take them to the mainland. We have done so for fee-for-service…so it's no different for managed care."

United spokesman Jon Stone told MAN Feb. 2 that Evercare is providing services under the QExA program to about 17,500 people on the islands of Kauai, Oahu, Maui and Hawaii. He said EverCare has a network providing "a full range of primary care, acute, behavioral health and long-term care services."

WellCare spokeswoman Amy Knapp did not return a call for comment on its network.

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