CT medicaid managed care study gets pushback from advocates

Providers and advocates renewed their calls to reject a potential return to Medicaid managed care during multiple meetings hosted by the Department of Social Services last week. 

The stakeholder meetings were intended to collect feedback on the current state of the Medicaid program as part of the “landscape analysis” that Gov. Ned Lamont charged the department to conduct. The study is meant to explore different Medicaid models, including managed care, which 45 states use in some form for at least part of their Medicaid programs. Connecticut is one of five states that do not.

Lamont’s curiosity about managed care has drawn fierce criticism from some Medicaid providers, advocates and enrollees, who pointed to potential downsides of the model, including reduced access, increased cost and lack of transparency. A handful of participants in last week’s meetings reiterated those concerns.

“We should be very concerned about access to care in the long-term care environment, and managed care would not be an answer to any of those significant issues,” said Matthew Barrett, president of the Connecticut Association of Health Care Facilities, during one of the sessions.

David Bednarz, a spokesperson in the governor’s office, said that the study is merely a tool to ensure the state is best serving its Medicaid members, adding that Lamont is not proposing any policy changes as of now. 

“This review will provide the administration and the General Assembly with information on whether there are improvements to achieving this goal that could be implemented, and we shouldn’t be afraid of receiving that data. At this time, Governor Lamont is not proposing any policy changes — whether administratively or legislatively — on this topic,” said Bednarz in an emailed statement. 

The study report is due by the end of this year, stated Christine Stuart, a DSS spokesperson.

Connecticut used managed care until 2010 but then transitioned to a managed fee-for-service model, where the state pays providers directly for services delivered to Medicaid beneficiaries. In a traditional “capitated managed care” model, the state instead pays a set monthly fee per member to insurance companies to manage the Medicaid program, and the insurance companies pay providers. 

States often turn to managed care for increased budget predictability and improvements to quality and access, but according to KFF Health News, its impact on both access and costs is “limited and mixed.”

Other concerns

Some critics of the governor’s plan to study managed care say that the results of last Tuesday’s presidential election make it even more important to defend the Medicaid program.

“We have a ton of work to do to adjust to the changing landscape in Washington and protect the Medicaid program, and certainly as part of that, we have to fulfill our promise to raise rates for providers,” said Sen. Matt Lesser, D-Middletown, in an interview with The Connecticut Mirror. “Throwing additional chaos into the program at a time when the very future of the Medicaid program is potentially on the line is unwise and a major unneeded distraction for the Department of Social Services and the administration.”

During President Donald Trump’s first administration, he approved Section 1115 waivers that allowed states to impose certain work requirements for Medicaid eligibility, though many of the approvals were struck down in the courts.

Project 2025, which Democrats tied to Trump policies and future plans on the campaign trail despite the GOP candidate’s insistence he wasn’t tied to it, also includes a proposal to restructure Medicaid as a block grant program, which would cap the amount of federal funding it receives. Currently, the federal government pays a fixed percentage of states’ Medicaid costs, regardless of the amount. Affordable Care Act subsidies that lower the cost of buying a health plan on state exchanges are also set to expire in 2025, unless they are renewed by Congress. 

Others have concerns that the study is being conducted by an organization with interests in the managed care industry. 

At the beginning of November, over 30 organizations and individuals sent a letter to Lamont criticizing the selection of Manatt, one of the consultants conducting the Medicaid study. According to the advocates, several of Manatt’s clients are Medicaid managed care providers. The firm has also done legal work on behalf of Medicaid Health Plans of America, a trade association of managed care organizations. 

“In sum, it is impossible for Manatt to provide an independent, evidence-based assessment of our current nation-leading, efficient managed fee for service Medicaid program,” stated the advocates.

A spokesperson with Manatt did not respond to a request for comment. DSS spokesperson Stuart and Bednarz, the governor’s spokesperson, did not address specific questions about the concerns regarding Manatt.