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Public Statements

Letter To Kerry Weems, Acting Administratior, Centers For Medicare and Medicaid Services

Letter

By:
Date:
Location: Washington, DC

Members of Connecticut's Congressional delegation called on the Centers for Medicare and Medicaid Services (CMS) to immediately issue a moratorium on the enrollment of Connecticut Medicaid and State Children's Health Insurance Program (HUSKY A and B) recipients into two Medicaid Managed Care Organizations (MCOs) in a letter to CMS Acting Administrator Kerry Weems. Because of inadequate provider networks, these Managed Care Organizations threaten to disrupt and limit access to care for this vulnerable population.

"While we appreciate the fact that CMS and the State of CT have delayed mandatory enrollment in the MCOs at least until February 1, 2009, we are concerned that the DSS letters have given HUSKY A and B participants the impression that changing their enrollment is or will become mandatory, and as a result, hundreds of families who are trying to follow DSS instructions are enrolling in inadequate MCOs that could significantly undermine their access to care," the Members wrote in the letter. "We strongly urge you to protect access to care for our constituents and impose an immediate moratorium on any further 'voluntary' enrollments in HUSKY MCOs with insufficient networks, and to maintain such a moratorium until the standards under federal law for provider network adequacy are met."

With the Anthem HUSKY plan and Traditional Medicaid HUSKY plan coming to an end on December 31, 2008, the state has contracted with the three managed care organizations to cover these beneficiaries. However, two of these MCO's lack sufficient provider networks. CMS issued a letter on September 30th stating that the state of Connecticut cannot mandate enrollment in these two plans and the state agreed to postpone mandatory enrollment for two months.

Below is the text of the letter.

November 13, 2008

Kerry Weems, Acting Administrator
Centers for Medicare and Medicaid Services
Department of Health and Human Services
Room 314G
Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Washington, D.C. 20201

Dear Mr. Weems:

We write to ask that CMS put an immediate halt to the enrollment of Connecticut Medicaid and SCHIP (HUSKY A and B) recipients into two Medicaid Managed Care Organizations (MCOs) whose inadequate provider networks threaten to severely disrupt and limit access to care for this vulnerable population. As you know, Connecticut's Department of Social Services (DSS) recently contracted with three MCOs to cover over 200,000 HUSKY A and B recipients who have been enrolled in either the Anthem HUSKY plan (Blue Care Family Plan) or the Traditional Medicaid HUSKY plan - both of which DSS has stated will be ending this year. Two of the MCOs, Aetna Better Health and AmeriChoice (a United Healthcare subsidiary), have wholly inadequate provider networks, according to both state and federal standards.

In just one example of the inadequacy of provider coverage in these plans, New Haven Legal Assistance Association has found that Aetna's provider directory lists only one pediatrician available to HUSKY participants in the entire city of New Haven, and AmeriChoice does not have any pediatricians in that city. Similarly, according to DSS reports, there are only six pediatricians available through Aetna and only one through AmeriChoice in all of Middlesex County. We are further disturbed by reports that in addition to the severe lack of primary care providers in their networks, Aetna and AmeriChoice do not appear to be contracting with enough specialists or hospitals to meet the need of HUSKY participants - two-thirds of whom are under the age of 21.

Your agency, recognizing that the new MCOs do not have adequate provider networks as required by federal law, has already stated that "Connecticut is not authorized to begin any mandatory enrollment" in these MCOs, as had been previously planned for December 1, 2008. However, "voluntary" enrollment in these plans is continuing in response to letters that DSS has been sending to families since August, informing them that the Anthem and Traditional Medicaid plans would be coming to an end on December 31, 2008, and "ask[ing] [the recipients] to change to another health plan between now and December." [1] DSS has stated that as of Friday, November 7, over 17,000 HUSKY participants had already switched to Aetna and AmeriChoice, and hundreds more participants are switching into these plans every day.

While we appreciate the fact that CMS and the State of CT have delayed mandatory enrollment in the MCOs at least until February 1, 2009, we are concerned that the DSS letters have given HUSKY A and B participants the impression that changing their enrollment is or will become mandatory, and as a result, hundreds of families who are trying to follow DSS instructions are enrolling in inadequate MCOs that could significantly undermine their access to care. We are also encouraged by reports that your agency wants DSS to send clarifying notices to HUSKY participants, and that CMS intends to continue monitoring enrollment in the plans.[2] We believe, however, that the situation requires immediate action if Anthem is going to leave the program on December 31, 2008, because HUSKY families are legally required to receive written notice at least 30 days prior to changes in health care coverage. In that case DSS would need to send notices to all Anthem enrollees within the next couple of weeks. As a result, we urge your agency to not wait but take all necessary steps now to prevent disruption of care to thousands of children and families.

For all these reasons, we strongly urge you to protect access to care for our constituents and impose an immediate moratorium on any further "voluntary" enrollments in HUSKY MCOs with insufficient networks, and to maintain such a moratorium until the standards under federal law for provider network adequacy are met.

Thank you for your immediate attention to this request.

Sincerely,

Christopher Dodd
United States Senator

Joseph I. Lieberman
United States Senator

Rosa L. DeLauro
Member of Congress

John Larson
Member of Congress

Joe Courtney
Member of Congress

Chris Murphy
Member of Congress

http://lieberman.senate.gov/newsroom/release.cfm?id=304961&&


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