The controversy over how much Minnesota health plans profit from the taxpayer-funded Medicaid program has lingered for well more than a year. Answers are needed.
A new, decade-spanning "actuarial analysis" ordered by state Human Services Commissioner Lucinda Jesson is a welcome, though limited, step.
Jesson deserves credit for publicly tackling the obvious question raised by UCare's voluntary $30 million refund to the state: How were Minnesota's wealthy nonprofit plans paid for managing Medicaid enrollees in the years leading up to the 2011 giveback?
Medicaid covers care for the poor and disabled. Like many other states, Minnesota outsources much of its program to state health plans.
But the review -- calling it an audit goes too far -- isn't likely to end accountability concerns about the state's $4 billion a year in Medicaid-managed care contracts. Nor should it.
Jesson and her staff should have focused on doing this review well. Instead, their priority appears to be doing it in a hurry -- 30 days originally; now 60 days, with some flexibility -- raising legitimate concerns about whether this is a drive-by analysis or a serious investigation.
The unnecessarily rushed time frame did not allow Jesson to adequately consult stakeholders and create the buy-in needed for confidence in the results. Given that the Legislature passed its own health plan audit bill this year (focusing on later years), it's disappointing that lawmakers were not consulted about the new review's scope and methodology. Neither were the state's medical and dental providers, who have weighed in vocally on the issue.
Moreover, DHS's use of the term "actuarial analysis" creates concerns. It suggests that the review's goal is actuarial soundness -- whether the health plans were paid enough money, not whether they were paid too much.
It also looks unlikely to yield answers on other key questions, such as whether the money allocated for the program was used appropriately for its intended purpose. Or whether the state improperly used federal Medicaid money to subsidize state-only medical assistance programs.
DHS officials said Wednesday that the review will be broad -- and that it will determine best practices for rate-setting, plus address whether the payments to plans were higher than allowable under state and federal laws.
Because of Jesson's other reforms on Medicaid contracts inherited from former Gov. Tim Pawlenty's administration, the agency's assurances should be taken on good faith. But the review had better deliver solid, credible results.
Missteps by DHS this week have heightened credibility concerns. DHS staff failed to head-off the appearance of a conflict in having Jay Brunner, a state employee who is the brother of the Minnesota Council of Health Plans' executive director, supervise contracting for the outside review.
Agency officials also inaccurately implied that Legislative Auditor Jim Nobles had signed off on the initiative. Nobles, in a letter to legislators and in an interview, made it clear that he has not endorsed the project, and that he, in fact, raised questions about the time frame during the last-minute chance he was given to quickly read the proposal.
Nobles' concerns are a serious red flag. His office should be viewed as an ally for accountability -- one with deep expertise. It should have been brought in at the beginning and should be consulted when results come in to determine if the work measures up to professional standards and expectations.
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