Panel: New behavioral heath plan may need another $100M

BOISE — A group of Idaho lawmakers is digging into the complicated web of Idaho Medicaid contracts in an ongoing effort to control costs of the program that provides health care to hundreds of thousands of Idahoans.

The new Medicaid Review Panel met for the first time Monday in a meeting that lasted nearly five hours and covered the billions of dollars in total on contracts to administer various Medicaid programs.

BEHAVIORAL HEALTH

Monday’s headline item was the state’s $1.4 billion behavioral health contract with the managed care organization Magellan Health to oversee the delivery and coordination of mental health and substance use services and treatment throughout the state — providing this care may be costing the state more than it anticipated for a myriad of reasons, according to Department of Health and Welfare staff.

The health agency’s budget request for the coming legislative session includes a supplemental request of more than $108 million in one-time federal funds for a behavioral health plan provider rate increase.

The new behavioral health system — which brought together previously fragmented services overseen by different divisions — went live July 1, the Idaho Press reported.

Review Panel Co-Chairperson John Vander Woude, R-Nampa, said during the meeting that the “contract amount has substantially increased from the original contract,” and asked health department Deputy Director of Medicaid Juliet Charron to explain why.

Charron responded that the initial amount was estimated in 2019 using a number not developed by actuaries. She said the state has also seen a rise in costs and need for inpatient residential services and other residential care that wasn’t covered in the previous contract.

“We have contracted with Magellan to manage that contract and that’s what we will be holding them to,” Charron said. “We are in the process of a mid-year rate adjustment, where we will be seeing if there are appropriate adjustments we can make. It may include a decrease.”

The current actuarially sound capitation rate paid to providers is $129.18 per member per month, a health department spokesperson told the Idaho Press. The division’s supplemental request to the Legislature said the actuarially sound rates are required by law, and without the additional federal funds, the state’s behavioral health care providers may not get reimbursed and access to these services could be disrupted for Medicaid participants.

“Something went wrong there,” Sen. Kevin Cook, R-Idaho Falls, told the Idaho Press in an interview. “Whether that’s Medicaid, whether that’s the legislators, something is not right.”

Cook sits on the Medicaid Review Panel and on the state’s budget-writing Joint Finance and Appropriations Committee.

He said he is hoping to learn more about how the estimate made for the previous budget request was off and how to avoid this happening in the future.

“These things cost a lot, and we all know that, but I don’t like surprises,” he said.

PLAN’S BUMPS AND SUCCESSES

The huge transition to a new provider and new system for behavioral health has had its “bumps in the road,” Charron said Monday, but overall, she said it was one of the best rollouts she’s been a part of.

“It’s going to help us get to that next chapter for our behavioral health system in the state,” she said.

Under the contract, Magellan is required to pay at least 95% of clean claims — meaning claims for services that have no errors — within 30 days. The managed care organization is meeting this requirement, but the results have varied among providers.

Cook said he’s received complaints from providers in his area that they were not receiving timely payments.

Magellan of Idaho Executive Director David Welsh spoke at the meeting, and said that in August, the organization had paid $1.5 million from clean claims to federally qualified health care centers — which provide these services to patients regardless of their ability to pay. In September, it paid $2 million, Welsh said.

Another bump was that provider payments were sent by paper check for the first 60 days as a security measure because of a national data breach.

The department also sent a letter to Magellan on Aug. 16, notifying them that they appeared to not be in compliance with requirements for communication with participants, especially for intensive care coordination. Charron said that by September, most of the issues had been resolved, and the department is working with the organization to improve training for care coordination in Idaho.

Sen. Melissa Wintrow, D-Boise, said some of these issues with the intensive care coordination had come to her attention.

“There’s been some negative impacts to families, in particular, maybe resulting in institutionalization or Department of Corrections for youth,” she said Monday. “At the end of the day, we’re talking about all this data, but boy, when you have a kid with complex needs and they’re going to keep you in the Department of Corrections instead of into the appropriate treatment, that’s a problem.”

OTHER CONTRACTS, PANEL’S GOALS

The panel members received an overview of a variety of Medicaid’s contracts, which included 12 administrative contracts — many of which are federally mandated — totaling about $27 million. Contracts for Medicaid management information systems, which is in the process of being updated, total around $42 million.

Managed care contracts, which in addition to behavioral health also include dental programs and a program for people dually enrolled in Medicaid and Medicare, total more than $1 billion.

Cook asked a number of questions about the dental program, known as Idaho Smiles.

He told the Idaho Press he’s received complaints from the Idaho Oral Health Alliance that the organization was not given a seat at the committee formed to oversee the program, when the contract stipulated that it should.

Cook said this was an example of where he wants to see the Legislature get more involved in understanding the state’s contracts and holding the agency and its vendors accountable.

Wintrow told the Idaho Press that she had originally voted against forming the panel, because she thought its function could be handled by the existing House and Senate Health and Welfare Committees, but she found Monday’s meeting valuable.

“It really helps the Legislature have a picture of how we are spending taxpayer dollars and for what,” Wintrow said.

The panel is likely to meet again during the legislative session, which begins in January, said co-Chairperson Julie VanOrden, R-Pingree.

Guido covers Idaho politics for the Lewiston Tribune, Moscow-Pullman Daily News and Idaho Press of Nampa. She may be contacted at lguido@idahopress.com and can be found on Twitter @EyeOnBoiseGuido.