NC Medicaid contract challenges now over with layoff
The end of appeals from two insurers fighting over how the North Carolina Department of Health decided who would lead its new Medicaid managed care initiative means that legal challenges over contract awards are now over.
The Court of Appeal last week accepted the request for voluntary dismissal of the two providers who lost contracts awarded in 2019 by the Department of Health and Human Services. Four conventional insurers and a physician partnership received the awards to run the program, which began last July and covers 1.6 million Medicaid consumers.
My Health by Health Providers — made up of 12 local hospital systems and a New Mexico-based insurer — argued that the DHHS process was flawed and biased against provider-run organizations like My Health. Aetna Better Health Care of North Carolina also challenged the process, but a Superior Court judge limited its involvement in the case. Last year, the judge upheld an administrative law judge’s decision upholding DHHS award decisions.
The two claimants appealed and were scheduled to participate in oral arguments before a three-judge panel on Wednesday. But lawyers for the groups asked last week that their appeal be withdrawn.
“While My Health still believes in the merits of its appeal and the promise of provider-led managed care, My Health and its owners in the North Carolina health system decided they did not want to disrupt care management. for more than 1.6 million in North Carolina. Medicaid recipients during this global pandemic,” the motion read. Aetna also requested dismissal in light of My Health’s decision, the petition states.
The dismissal means there are no outstanding challenges to the awarding of managed care contracts, a DHHS spokesperson said Tuesday.
DHHS Deputy Secretary Dave Richard, who oversees Medicaid, said in a press release this week that agency leaders are “satisfied with this outcome and believe it confirms the integrity and fairness of the process. supply department”.
Under managed care, the state Medicaid program has moved most of its beneficiaries from a traditional fee-for-service model to one in which organizations receive fixed monthly payments for each patient that its providers see and treat.