HELENA (AP) — Montana lawmakers and others said Thursday they are skeptical about Gov. Brian Schweitzer's plan to privatize Medicaid services, especially those who remember a disaster in the mid-1990s to contract out some of those services.
Only recently have health care providers and interested legislators learned about plans in the Schweitzer administration to consider a test letting a private, managed-care firm run Medicaid in part of the state, although many of the details have not been disclosed.
"On first blush it sounds too good to be true. They don't decrease care, they don't decrease provider rates and plus they take their profit on top?" said Rep. Mary Caferro, a Helena Democrat. "I just think if it sounds too good to be true, then it probably is."
The Lee Newspapers State Bureau reported the state is considering asking companies to bid on a contract to manage Medicaid, the state's $900 million health care program for the poor, in a five-county area that includes Helena and Great Falls.
It would cover all Medicaid patients in the area as a test to see if it works — assuming the federal government, which pays for most of Medicaid, approves the idea. The state has been discussing the project with Centene Corp., a St. Louis-based company that does similar work for other states.
Anna Whiting Sorrell, director of the state Department of Public Health and Human Services, said the discussions are still early.
But she said it could be possible to improve care by reducing duplication of services and by pointing patients to the most efficient care. And that doesn't necessarily mean that rates paid to providers like doctors and nursing homes would be paid less as they fear.
"It's not about eliminating care. It's not about paying less for the care I get. It's about managing the care I get to make sure I get the optimal care I need," the agency director said.
The administration pointed out that many states have managed care programs, some of them run by private companies and that the federal health care reform directs states to manage care for reduced cost.
Whiting Sorrell said the proposal would focus on improving care, and saving money would be a side effect.
The state attempted privatization of Medicaid mental health services in the 1990s, only to abandon the plan under harsh criticism. At that time, it was blasted as a failure.
Lawmakers said the governor should bring his new plan to them — but acknowledged he probably doesn't have to since the original 1995 law allowing such programs is still on the books.
Sen. Dave Lewis, R-Helena, said federal health care reform will eventually expand Montana's Medicaid roles by 90,0000 people.
"I think it is a major public policy change. And I think it should be fully discussed and vetted in the legislative process," Lewis said. "We better think this thing through, and talk it through and be very careful."
Nursing homes and long-term facilities that can get as much as 60 percent of their business or more from Medicaid worry cost-saving efforts increasingly will focus on squeezing their rates.
"We can't help but wonder why the department has not made an effort to collaborate with us or other providers. It seems like they are not talking to the people in the trenches who have the knowledge about potential pitfalls and knowledge about how you make it work," Hughes said. "It's disappointing to find that this has been worked on now for over a year and that there's been no advisory group or work group that would indicate a desire to be collaborative."
Hughes said a timeline released be the agency that could put the program in place by 2012 leaves little room for doctors and others to help design the privatization.
"The intent seems clear that we are going full speed ahead no matter what anyone says."