Advocates for people with disabilities and mental health problems are calling on Gov. Manchin and the Department of Health and Human Resources to exercise more care and get more input from affected parties before DHHR expands managed care in the Medicaid program.
They also want contracts with health maintenance organizations (HMOs) to be bid before they are doubled or tripled in size.
"We are dismayed that the department has refused to bid those contracts even though DHHR officials have testified to the Legislature that other managed care companies have expressed interest in participating in the program," David Sanders, consumer affairs executive assistant for the West Virginia Mental Health Consumers Association, said. "Bidding the contracts might attract companies with more experience in providing care to behavioral health populations. None of the three current HMOs is specifically accredited by the National Committee for Quality Assurance for managed behavioral health care."
DHHR already pays three HMOs more than $260 million a year to cover about 160,000 Medicaid beneficiaries, according to the department's reports to the Legislature. Adding about 55,000 West Virginians receiving Supplemental Security Income (SSI) with a higher level of health needs is expected to more than double the size of DHHR's contracts with the HMOs.
In a letter to DHHR Secretary Patsy Hardy, the advocates express concern that neither the department nor the HMOs have been able to explain adequately in any detail how they would accomplish successful integration of behavioral health care and physical health care.
"We are especially concerned about the effects on people with disabilities," Jan Lilly-Stewart, director of the Fair Shake Network, said. "If the HMOs are allowed to take over, many individuals suddenly will find the doctors they depend on are not in the HMOs' networks. Also, some of them are likely to have difficulty getting transportation to in-network providers, especially in rural areas of West Virginia."
In addition to asking DHHR to make better provisions for the expansion of managed care into behavioral health, the advocates are calling on Gov. Manchin to get involved personally to ensure that the transition is handled properly and HMO contracts are not expanded without competitive bidding. In addition to Sanders and Lilly-Stewart, the letter to DHHR is signed by: Sam Hickman, chief executive officer of the National Association of Social Workers' West Virginia Chapter; Renate Pore of the West Virginia Healthy Kids and Families Coalition; and Linda Pauley of the West Virginia Mental Health Planning Council.
"We are grateful that DHHR has delayed until January the proposed transition of behavioral health care to managed care, but unless better provisions are made to handle many fragile individuals, the changes are likely to be disastrous for them," Sanders said. "We agree with the goal of integrating mental health care and physical health care, but we have serious doubts about whether the health management organizations (HMOs) contracted by DHHR can handle it."
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