Health Care

Missouri lawmakers blast ‘bungled’ roll-out of controversial Medicaid amendment

Rep. Scott Fitzpatrick said he was upset with the way the Department of Social Services "bungled" the implementation of a controversial Medicaid amendment.
Rep. Scott Fitzpatrick said he was upset with the way the Department of Social Services "bungled" the implementation of a controversial Medicaid amendment. Missouri House Communications

Missouri legislators criticized the Department of Social Services’ implementation of a controversial Medicaid amendment during a hearing this week, with one key lawmaker saying the agency “bungled” the roll-out.

The amendment cut by 10 percent some reimbursements to hospitals that don’t participate in the state’s three privatized Medicaid managed care plans. Officials from the hospitals affected, including Truman Medical Center, have called it disastrous financially.

Rep. Scott Fitzpatrick, the chairman of the House Budget Committee, said during Tuesday’s hearing that the state should ask the managed care companies to delay the amendment because of technical malfunctions and erroneous deadlines during the mandatory public comment period.

“If I were them and I were smart, I would be willing to delay that provision of the contract to prevent the blowback that could potentially and may inevitably occur as a result of the way that this was bungled,” said Fitzpatrick, a Republican from Shell Knob. “I consider it a problem, and I’m pretty upset by it.”

Hospitals said the amendment was rushed into effect. Department of Social Services officials disputed that, saying it had been in discussion since last November. But they acknowledged problems with the public comment period last month.

There were technical difficulties with the phone line that stakeholders — mostly hospital officials — used to call into a hearing in Jefferson City, and the department left the online comment system for the amendment open until July 9, even though the amendment had gone into effect eight days earlier.

Fitzpatrick told the department’s director, Steve Corsi, and deputy director, Jennifer Tidball, that “would indicate you had no intention of considering the comments and it was kind of a sham process from the outset.”

Tidball said that wasn’t the case, that it was just a mix-up. But she and Corsi both said it shouldn’t have happened.

“I don’t know that we have much in defense at all,” Corsi said. “We clearly were in the wrong. We clearly made mistakes.”

Still, Tidball said the department read all the comments submitted after the amendment went into effect and is taking them into account.

When asked if there would be any delay in implementing the Medicaid amendment, department spokeswoman Rebecca Woelfel said via email that it’s already in effect, but “the Department of Social Services will be executing a subsequent amendment in response to stakeholder comments.”

She didn’t respond to a followup request for information on what the next amendment would be or when it would be posted publicly.

Nearly every state has managed care agreements in which they contract with private companies, usually health insurers, to run parts or all of their Medicaid programs. Those companies then negotiate with hospitals and other medical providers to decide what they will pay for procedures and services for people on Medicaid, which in Missouri is mostly the elderly, disabled, children and pregnant women.

Rep. Marsha Haefner, a St. Louis Republican, asked Corsi and Tidball “What was the rush?” during Tuesday’s hearing, adding that the roll-out of the Medicaid amendment furthered animosity between the hospitals and the managed care plans.

“I’m a big fan of managed care, but there has to be a better working relationship between the providers and the managed care companies, or the people who really need the help will be caught up in the middle,” Haefner said.

Dave Dillon, the vice president of the Missouri Hospital Association, said the hospitals remain “disappointed” about the amendment and it will give the managed care plans more negotiating leverage even over hospitals that are already in their networks.

“We’ll be watching to see if the change influences behavior at the plans,” Dillon said. “I’m sure we’ll be working with lawmakers on the managed care issue in 2019.”

Those 12 will immediately feel the cut, which will lop 10 percent off what they’re currently paid when they treat someone who’s part of a plan they don’t participate in.

Charlie Shields, the CEO of Truman Medical Centers, said it “will continue to provide the high level quality care our patients deserve.”

“We are confident that Governor Parson, the lawmakers who represent Missourians and the Department of Health and Senior Services will reach a solution that will allow for care of all patients,” Shields said in a statement.