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Why Medicaid contracts worth $2.1 billion shouldn’t go to private insurers

A move to hand over Oklahoma Medicaid contracts to out-of-state conglomerates has people scratching their heads—and calling their lawyers. A Modern Healthcare article published on February 9 explains why.

As we recently noted, the Oklahoma Health Care Authority (OHCA) decided to shift management of its Medicaid business to four for-profit health insurance companies, including UnitedHealthcare, in a deal estimated to be worth $2.1 billion. Under this model, the state would pay the private insurers a set fee to coordinate Medicaid recipients’ care and would allow the insurers to decide how they reimburse providers. That’s totally different from the way it works now, where the OHCA directly reimburses providers through a fee-for-service model.

That may be why the Oklahoma State Medical Association (OSMA), a non-profit state association that provides legislative and regulatory advocacy for Oklahoma physicians, has challenged OHCA’s decision. The group objected to the move to have private companies operate the state’s Medicaid program rather than the Health Care Authority, citing a number of concerns, including private insurers’ potentially inflated administrative fees.

With a court injunction in hand, OSMA is not only protesting OHCA’s decision. It’s also challenging OHCA’s right to make such a choice on behalf of the state’s 903,000 Medicaid enrollees, and questioned the wisdom of allowing the OHCA to commit the state to major spending without involving state legislators in the process.

It seems like we aren’t the only ones doubting that the national insurers bidding for this contract really have Medicaid recipients’ best interests at heart.

Original Article:

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