Legislators at odds over QUEST
Community health centers have drawn the Legislature into a battle against a new state policy affecting 165,000 low-income adults and children receiving QUEST health care.
QUEST clients in the past were able to remain in their existing health plan without re- enrolling during annual re- enrollment periods.
Under the new policy, called "positive enrollment," they would have to "positively" re-enroll in a plan during the re-enrollment period, which begins Aug. 1.
House-Senate conferees appeared to be at an impasse in discussions yesterday on an amendment to a bill to prevent the Department of Human Services policy. The legislators were to meet again today.
AlohaCare, a health plan formed by the community health centers in 1994 to serve QUEST enrollees, and the centers say the new re-enrollment requirement would disrupt medical care for the clients and cause chaos.
"What is being planned is to massively disenroll people," said Richard Bettini, chief executive officer of the Waianae Coast Comprehensive Health Center.
"What we're trying to do is bring back competition," said state Human Services Director Lillian Koller, who says competition would result in increased benefits for clients.
She said the same three plans have been retained since 2002 with minor adjustments since three other plans left the program.
Providing plans are Hawaii Medical Service Association, with about 90,690 Medicaid-Quest clients; AlohaCare with 50,045; and Kaiser Permanente with 20,532.
Only AlohaCare is opposing the proposed re-enrollment plan, Koller said.
"Contrary to claims by persons with a financial stake in maintaining the status quo, positive enrollment will not disrupt medical treatment nor break up longstanding doctor-patient relationships," she told legislators.
The Department of Human Services extended the 20-day re-enrollment period to 60 days to address concerns. This will be followed by a 90-day grace period when clients can change plans if they wish.
Those who don't sign up for a plan during the enrollment period will automatically be assigned to the plan with the lowest bid.
Koller said the state has always ended up with a 95 percent selection rate when positive enrollment has been done.
But opponents of "positive re-enrollment" are concerned that thousands of QUEST beneficiaries won't re-enroll when they're dropped July 31 from their present plans and will be reassigned to new plans with different doctors.
Bettini said, "There's not a provider actively involved with QUEST" who believes only 5 percent of clients won't choose a plan.
He said his staff "has lived with re-enrollment efforts before" and "to a person, they were absolutely very critical of this process."
He said most patients don't identify with their health plan but with their doctor. "What is extraordinary to me is this RFP (request for proposal) does not even ask the plans what is their provider network. In other words, the state is asking people to bid without asking the plan to identify their provider network."
Bettini said about 10,000 of his health center's 25,000 clients are QUEST Medicaid clients. "My guess is we will have 4,000 QUEST patients disenrolled from the plan we have a contractual relationship with."
Although they will have an option to change back, he said, "It will be a huge burden. It will create a nightmare for providers, patients and staff."
Koller pulled back the request for proposals Friday to make changes to accommodate the concerns. She said extra safety features were added "to preserve continuity, to make sure there wouldn't be any possibility of delay or denial of service even if one of our Medicaid clients shows up at the wrong place or ends up auto-enrolled in a different plan."