CHARLESTON, W.Va., April 26, 2015 /PRNewswire-USNewswire/ — Several West Virginia taxpayers are taking steps to require the state to follow state purchasing laws in the Medicaid managed care program. One of those steps is that they have filed for an injunction in Kanawha County Circuit Court to stop the use of no-bid contracts to implement expansion of Medicaid managed care.
The taxpayers also have sent notice, as required under state law, that they intend to sue state agencies over the agencies’ failure to follow state law and purchasing regulations in obtaining contracts for managed care in the Medicaid program. Their planned lawsuit will ask the court to require the agencies to follow state law by getting competitive bids for Medicaid managed care services, and the injunction would prevent the agencies from going forward in the next few months with plans to expand services in the Medicaid managed care program and add more than 150,000 newly eligible individuals to it until the lawsuit is filed and resolved.
“The requirement for competitive bidding is common sense,” Patricia Rucker, a resident of Harpers Ferry, W.Va., and one of the taxpayers filing suit, said. “Just as the average citizen would not buy a car without shopping around for the best deal, state government should not enter into contracts without ensuring that taxpayers get the best deal possible.”
The West Virginia Department of Health and Human Resources and its Bureau for Medical Services (BMS), as well as the West Virginia Department of Administration and its Division of Purchasing, are the agencies targeted by the injunction and the plan lawsuit. BMS is in charge of the state’s Medicaid program. The Division of Purchasing is required to oversee state agencies’ contracts with vendors, such as the contracts that BMS has with managed care companies, and ensure that they adhere to state law. The lawsuit names the current heads of each of those agencies.
Not getting competitive bids for the Medicaid managed care contracts goes against the intent of the West Virginia Legislature when it passed Senate Bill 194 in 2013 and Senate Bill 356 in 2014. Those bills established with more clarity than previously the need for state agencies to go through the process of open and competitive bidding before entering into managed care contracts.
West Virginia’s Medicaid program has managed care contracts with four health maintenance organizations (HMOs):
- The Health Plan of the Upper Ohio Valley, Inc., which is based in St. Clairsville, Ohio;
- UniCare Health Plan of West Virginia, Inc., which is affiliated with Anthem Blue Cross-Blue Shield, based in Indiana;
- CoventryCares of West Virginia, Inc., a wholly owned subsidiary of Aetna, Inc., which is based in Connecticut; and
- The West Virginia Family Health Plan, Inc., a provider-sponsored plan affiliated with Highmark of West Virginia.
None of these current contracts are the result of competitive bidding. BMS operates its program under a waiver approved by the federal Centers for Medicare and Medicaid Services (CMS) last year. CMS is part of the U.S. Department of Health and Human Services, which is led by Secretary Sylvia Mathews Burwell, a native of West Virginia. The taxpayers bringing the suit are hopeful for her particular interest in the wise use of taxpayers’ money in her home state.
One of the provisions of the waiver is that the state must contract with at least two HMOs. Having multiple awards in competitively bid contracts is allowed for in Division of Purchasing rules. In the waiver application, BMS said it intended to use an open cooperative procurement process in selecting its HMO contractors for the years ahead, but that is not the same as the competitive bidding process required by state law.
(For reference: The petition for injunctive relief was filed April 24, 2015, at 11:03 a.m. in Kanawha County Circuit Court. It is Civil Action No. 15-C-786.)
SOURCE Patricia Rucker