Anthem Kentucky Formally Challenges Removal From Medicaid Program

Dec 12, 2019

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Anthem Kentucky has submitted its appeal to the state protesting its exclusion from the Medicaid contracts issued two weeks ago by former Governor Matt Bevin’s administration. Anthem is asking for Governor Andy Beshear’s new administration to halt the new contracts and reconsider.

About two weeks ago, former Gov. Matt Bevin’s administration issued contracts to five insurance companies that will administer Medicaid benefits in the state starting in July; Anthem Kentucky and Passport Health weren’t among them. Meanwhile, United Healthcare and Molina were granted contracts to offer the benefits starting in July.


But the new administration under Gov. Andy Beshear could revoke those contracts, which is what Anthem is asking the state to do. Passport Health didn’t immediately respond to questions about whether it has submitted an appeal. That company currently serves a little more than 306,000 enrollees. Anthem, meanwhile has about 128,000 members.

Many other states have gone through similar issues when Medicaid insurers have appealed decisions to eliminate their contracts. When appeals fail, insurers usually sue states, which can result in years of litigation.

In a statement Anthem spokeswoman Amanda Stamper said the formal protest is a necessary step to make sure, “Kentuckians’ interests are being met through appropriate processes. While a formal protest is necessary to preserve all of our options, we strongly believe the best path forward is to start fresh with a new request for proposal,” she wrote.

In a document obtained by WFPL, Anthem Kentucky makes a case for why the state should reconsider the contracts:

Other companies were awarded contracts over Anthem because they earned points on how they’d help Medicaid enrollees with changes from Gov. Bevin’s never-implemented waiver.

Courts have ruled former Gov. Bevin’s work requirement and premium payment changes to the Medicaid program invalid, though Bevin’s administration was still pursuing an appeal when he left office. But the administration still asked Medicaid insurers to answer questions about how they’d help people meet these requirements and manage other changes. Anthem said that companies such as Aetna earned points for answering questions on how it would help people meet those requirements despite that program not being in place.

“Shortly after his election … Governor Beshear publicly confirmed that the Commonwealth would not impose a work requirement on Medicaid beneficiaries, creating a material change to the program and the contracts to be awarded,” Anthem said. “Nevertheless, the Cabinet awarded the contracts under this RFP, despite that fact that the scope of the contracts would be vastly different with the elimination of the waiver.”

The state never gave Medicaid insurers the chance to give oral presentations on applications.

The Cabinet could have required oral presentations from the applicants, though the Cabinet doesn’t have to if the awards wouldn’t have been affected by presentations.

Anthem said the chance to give a presentation on why they should have a contract would have won them extra points.

The people within the Cabinet who scored applications didn’t make detailed notes on why insurers didn’t get all the points that could have been earned, even though they were supposed to. 

Anthem also said other companies received higher scores than it did, even though Anthem provided more detailed responses. The insurer also said it didn’t get enough points for sections where it went into detail about how it would meet the needs of the Medicaid program.

Anthem said it filed an open records request within hours of officials becoming aware that the company hadn’t won a contract, but hasn’t received all the documents it asked for, including applications for the contracts from other companies and information from individual judges who evaluated the applications.

Requests to the Finance Cabinet, which issued the awards, the Cabinet for Health and Family Services or the Governor’s office were not returned.