Uninsured to get state help
The Human Services Department plans to aid 29,000 people by the end of this year
The state Human Services Department hopes to begin giving health care insurance to 29,000 uninsured adults and children by the end of the year, says Director Lillian Koller.
The Centers for Medicare and Medicaid Services in February approved more than an extra $75 million for expansion of the state QUEST Medicaid program under a six-year agreement.
However, a dispute between the department and community health centers over a new QUEST enrollment policy has delayed implementation of new contracts to provide the coverage, Koller said.
AlohaCare, community-based health plan for QUEST beneficiaries, and community health centers tried unsuccessfully during the Legislature to block the department's proposed "positive enrollment" plan.
The 165,000 QUEST recipients would be required under the policy to "positively" re-enroll in a plan during the re-enrollment period or be automatically assigned to the one with the lowest bid.
Community centers argued that massive disenrollment of clients will be chaotic, disrupting health care and patient-doctor relationships.
Koller said the goal is to encourage competition among health plans, which would result in increased benefits for Medicaid-QUEST clients. She said a safety net was built into the process to protect health coverage for clients.
"Now, fortunately, because it didn't get passed by the Legislature, we can get back on track sooner," Koller said, adding that she hopes to get out a new request for proposals for the plans within a few weeks.
The Hawaii Medical Service Association, Kaiser Permanente and AlohaCare, owned by the community health centers, have provided the only QUEST plans since three other groups pulled out in 2002. Three other plans are believed interested in bidding for contracts now.
"Obviously, DHS is committed to do the best job they can, and we're committed to do the best job we can," said John McComas, AlohaCare chief executive officer.
"At this point we want the best possible thing to happen for providers and beneficiaries. We are committed to work actively with DHS and everyone else to make sure they get the help they need and are taken care of."
The Human Services Department pulled back a request for QUEST health plan proposals when the controversy erupted last month over positive enrollment.
Koller said the department re-examined the request "and not only put in an ironclad safety net, but additional features to help us improve quality of care and paper performance incentives."
The department wants accountability and improved health outcomes, and plans to create financial incentives and disincentives "so we know how they're managing certain diseases," Koller said, noting that other changes are being made to address concerns of the Legislature and AlohaCare.
CORRECTION
Saturday, May 13, 2006
» Pay-for-performance incentives will be included in a state Department of Human Services request for QUEST health plan proposals under a new "positive enrollment" policy. No one company per island will get all automatically assigned enrollees who do not choose a plan, but the plan with the lowest bid price will get the most auto-assigned members based on a formula. A Page A5 article Tuesday had incorrect information.
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