Medicaid breakdown


POSTED: Sunday, March 08, 2009

Taking care of and advocating for the rights of Hawaii's most vulnerable population — the aged, blind and disabled (ABD) — requires a tremendous amount of patience and optimism. For our organizations, which are on the front lines of serving these people, it is becoming increasingly difficult to be optimistic that the Department of Human Services' new Medicaid program, called Quest Expanded Access or QExA, is ever going to work.

QExA is meant to provide health care services to Hawaii's 39,000 ABD adults and children under a managed care system instead of the fee-for-service program it had offered previously. The state believes QExA will improve health care services for these people, while bringing down costs. Based on what we've experienced so far, we strongly disagree.

On Feb. 1, 2008, the state awarded $1.5 billion, its largest contract ever, to two mainland for-profit health plans — UnitedHealth Group (Evercare) and WellCare Health Plans (Ohana). Since the launch date of Feb. 1, 2009, QExA has been plagued with problems. At its third legislative briefing last week, covered by Star-Bulletin reporter Kristen Consillio, DHS reported that the state and health plans received 34,750 calls from clients and providers over the past three weeks due to computer glitches, enrollment issues, disruptions in patient transportation services, patients being incorrectly charged a copay for prescriptions, lengthy wait times and busy signals at health plan call centers. The largest percentage of these calls were made by beneficiaries who wanted to switch plans, most likely due to unhappiness with their current plan.

Thousands of Medicaid recipients still have not been assigned a primary-care physician, and others have been turned away from their longtime doctors who have chosen not to participate in the program. Others also are being told incorrectly by these health plans that they can no longer receive health care at some of the community health centers because these centers have opted not to participate in the program. These are Hawaii's most vulnerable, fragile residents, many with life-threatening conditions and ailments. How can Dr. Kenneth Fink, the state's Med-QUEST division administrator, call these astronomical problems “;inevitable”;? Minimizing the impact of these problems will not make them go away.

To make matters worse, WellCare and UnitedHealth continue to have considerable legal and service-related problems — currently, there are multiple criminal and civil suits filed against these companies in 37 states, as well as ongoing federal investigations. On Feb. 19, the U.S. Centers for Medicare and Medicaid Services prohibited WellCare from enrolling new members in its Medicare health plan and prescription drug program in all 50 states. The sanction is a result of WellCare's “;longstanding and persistent failure to comply”; and its rating as one of the overall worst performers among all plans. Medicare accounts for WellCare's largest piece of business. How financially stable is this company? What will happen if WellCare decides to pull out of the Hawaii market? QExA Hawaii beneficiaries will be left with only one health plan — UnitedHealth (Evercare), which also has undergone federal investigations for improper claim denials.

We are all for improving patient care and are willing to work with the state to achieve this goal. But when the state continues to jeopardize the well-being of Hawaii's most vulnerable people, that's when we need to ask: How many more of these informational briefings do we need to have before the state and our legislators come to the same conclusion as we have from the start? Although well-intentioned, QExA is a train wreck waiting to happen. And like a train wreck, it's inevitable that people will be harmed. Unfortunately, these people are the 39,000 aged, blind and disabled Medicaid beneficiaries whom we all sought to protect in the first place. Let's stop the train now and revert back to the former Medicaid program until another viable option can be implemented.



Rev. Bob Nakata is president of Faith Action for Community Equity. Dana Alonzo-Howeth is executive director of the Community Clinic of Maui. Arleen Jouxson-Meyers, M.D., is president of the Hawaii Coalition for Health. May Akamine, R.N., is executive director of the Waimanalo Health Center.