Monday, January 4, 2010

Is Hawaii paying DC lawyers for advice on violating Federal Medicaid law?

Over the holidays, I found documentation for almost $3.5 million in contracts between Hawaii's Department of Human Services and Office of the Attorney General and Washington D.C. law firm Covington & Burling.

At about the same time an official in the state's Medicaid office admitted Hawaii is re-negotiating its $2.5 billion in Medicaid contracts with UnitedHealth and Wellcare.  Covington & Burling were paid for writing the original RFP and contracts, and had other contracts with both DHS and the state Attorney General's office for advice on Medicaid policy and federal compliance.

The federal regulators for Medicaid (CMS, or the Centers for Medicare and Medicaid Services) have been in discussions with Hawaii since August, attempting to bring the state's Medicaid services for the disabled, blind and elderly populations into compliance with federal law.  Not only is the state refusing to comply, they're digging in their heels by issuing written policy documents supposedly to support their position.

A UnitedHealth executive has stated they have increased their enrollment in the state's program for home and community services for the "aged, blind and disabled" (ABD) population by 60%.  All that says is the for-profit corporation has increased its revenue by 60% (since they're paid on a per person basis) but not that they're actually spending the money.  In fact, they're cutting existing services and crying poor to the state, that they're losing money.

Third quarter financial news for both UnitedHealth and Wellcare indicates both companies' revenue and/or profits are up.  There are no signs of a dire financial loss due to Hawaii that would necessitate re-writing the contracts.

The same person from UnitedHealth told me his company is in discussions with the state on how to get around the federal mandate for case management under EPSDT services.  Is that the sort of policy and compliance advice the state might be paying for?

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About Me

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I'm the mom of a child with disabilities. Hannah's first neurologist said she might never develop beyond the level of a 2 month old infant, and there wasn't anything I could do about it. The brain damage was just too severe. Nine years later, she walks, uses a touchscreen computer and I've just been shown she can learn to construct sentences and do simple math with the right piece of technology. Along the way, I discovered I needed to teach myself what Hannah's rights to services really were. Learning about early intervention services led to reading about IDEA and then to EPSDT. I've been waiting for the Obama administration to realize the power and potential of EPSDT for the medical rights - including the right to stay at home with their families - of children with disabilities. The health reform people talk about long term care, and the disability people talk about education and employment, but nobody is talking about EPSDT. So I am.