Aetna expresses deep disappointment over exclusion from new Kansas Medicaid contracts

The state has recently awarded new KanCare contracts after going through a thorough determination process that began in October of 2023. This decision has been met with disappointment from a former provider who was not selected for the new contracts. Sherman Smith from the Kansas Reflector reports on this development.

A health care insurance company has announced its plan to protest its failed bid for the state’s privatized Medicaid program, just a week after the announcement of new contracts by the state.

Kansas health officials made an announcement on May 14th regarding the selection of three managed care organizations to oversee KanCare, the state’s Medicaid program. The bids of Sunflower Health Plan and United Healthcare Community Plan, the current providers, were accepted for the new contracting cycle. However, Aetna was replaced by a new organization called Healthy Blue.

During a Wednesday meeting of the Kansas Mental Health Coalition, Becky Austin-Morris, the behavioral health director for Aetna Better Health of Kansas, expressed her intention to protest the decision.

“We are extremely disappointed. The journey in Kansas has been both fulfilling and challenging,” expressed Austin-Morris. “Overall, it has been a positive experience, and we were not anticipating this particular outcome.”

The bidding process for these contracts began in October 2023, which is the first time it has been conducted in six years. The three existing KanCare contracts are set to expire on December 31, 2024. The newly awarded contracts will be effective from January 1, 2025, until December 31, 2027.

KanCare offers healthcare services to low-income families, which include a large number of elderly residents in Kansas, as well as children from low-income households, and individuals with developmental, intellectual, or physical disabilities. According to the Kansas Department of Health and Environment, KanCare serves a total of 458,000 Kansans.

“We have a strong desire to remain as an MCO in Kansas, allowing us to continue our commendable efforts in expanding behavioral and mental health services in the state,” expressed Austin-Morris. She further added, “This matter evokes deep emotions within all of us.”

Aetna Better Health of Kansas has faced numerous complaints in the past, particularly regarding issues of transparency in health provider coverage and payment errors. In fact, in 2019, Aetna officials went before the Legislature to offer their apologies after the state issued a notice of noncompliance due to the organization’s failure to adhere to its contract, as reported by the Topeka Capital-Journal.

Seven candidates, including Aetna, CareSource, Healthy Blue, Moline Healthcare of Kansas, Sunflower State Health Plan, UCare of Kansas, and United Healthcare of the Midwest, participated in this round of bids. As of now, no protests have been filed on the KanCare page, and it remains uncertain if any unsuccessful bidders intend to protest. Bidders have a 30-day window after the contract is awarded to submit their protests.

The KDHE Office of Communications did not promptly reply to a request from the Kansas Reflector regarding the MCO process and Aetna’s protest.

Amy Campbell, lobbyist and coordinator for KMHC, expressed her optimism about the recent announcement regarding the lifting of the MCOs. She noted that during the past few months, many things seemed to be on hold, as if everyone was holding their breath. However, with this announcement, Campbell is hopeful that things will return to normal. She emphasized the importance of filling vacant positions and resuming regular business operations moving forward.

The state has made the contract announcement alongside the completion of its extensive Medicaid review process. Due to the federal “continuous coverage” provisions implemented during the COVID-19 pandemic, Medicaid administrators were unable to terminate healthcare eligibility unless specific circumstances occurred, such as relocation, death, or a request to end coverage. As a result, the number of individuals participating in KanCare rose from 410,000 to 540,000 during this challenging period.

In April 2023, the process of determining Medicaid eligibility restarted nationwide, following the expiration of federal protections.

The Kansas Department of Health and Environment (KDHE) experienced a challenging start to the unwinding process, leading to some Kansans losing their eligibility due to administrative issues. These issues included delays in mail delivery and a lack of clear communication from the state regarding renewal requirements.

According to the latest data, a total of 318,791 individuals have been approved for services, while 75,532 people have been discontinued from receiving them. Additionally, there are 75,420 Kansans who will need to reapply as they missed the reinstatement window.

According to the state’s data collection, a total of 3,151 Kansans who discontinued from services were aged 65 or older. Additionally, the data reveals that 10,351 children aged 4 and under were also removed from services.

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