Which company will provide mental health care services to Idaho Medicaid? Legal battle searches for answers – Idaho Capital Sun

After months of legal battles, Idaho still plans to make changes to the company that provides mental health services to about one in five Idahoans.

The state’s decision over which private company to pay $1.2 billion over four years to operate Medicaid mental health services has been playing out in court for months.That is After two other companies filed lawsuitsarguing they wrongly lost the management contract Idaho Behavioral Health Program.But Idaho is still planning A modified contract begins next year with the same company chosen last year.

two An Idaho District Court judge recently agreed In the ruling, they did not have the authority to review how the state awarded the contracts. Optum Health, which currently owns the contract, disagreed and filed a lawsuit in the Idaho Supreme Court.

Last week, the Idaho Department of Health announced in a statement Press Releases Magellan Health will oversee the contract starting July 1, 2024, four months later than the original start date.

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Meanwhile, state health department spokesman AJ McWhorter told the Idaho State Sun that Optum is still offering mental health benefits.

“It’s important for us to do the right thing and get Idahoans the behavioral health and substance use disorder services and supports they need,” Dave Jeppesen, director of the Idaho Department of Health and Welfare, said in a news release. priority.

The contract will affect how mental health benefits are administered to approximately 331,549 Idahoans with Medicaid and 2,090 Idahoans without Medicaid, according to estimates provided by the Idaho Department of Health and Welfare.

Idaho awards $1.2 billion in behavioral health contracts. Both losing bidders sued.

Asked why the contract service date was delayed, state health department spokesman AJ McWhorter said the contract introduced in July reflected a 12-month implementation period, which he said was industry standard.

McWhorter said stakeholders collaborated on the July 1 go-live date, prioritizing doing it right rather than doing it quickly.

Contract dispute is part of Idaho’s possible move to managed care

A task force of Idaho lawmakers just concluded a closer look at Medicaid’s funding structure as a legal battle over the contract unfolds.

Private companies administer Medicaid benefits in 40 states. This structure is often called managed care. Managed care organizations provide care to more than two-thirds of Medicaid recipients in the United States, KFF reports.

Some Medicaid benefits in Idaho are administered this way, such as mental health care, dental care and non-emergency medical transportation.However, inpatient and outpatient hospital services are operated by healthcare providers Through a model that Idaho policymakers call “value-based care.”

Late this year, a group of Idaho lawmakers looked at ways to save money on Medicaid, possibly by converting Idaho Medicaid to managed care.The group concluded its work last month no decision Should Idaho Medicaid be restructured?

Kim Rau, a spokesperson for the agency, said the contract with Magellan is one of the largest awarded by the Idaho Department of Administration’s Procurement Division.

Optum Health’s parent company is United Behavioral Health, which has operated the Idaho Behavioral Health Plan contract since 2013. idaho statesman Uncovered complaints alleging the company violated the privacy of some patients.

Optum argued in the lawsuit that it saved Idaho taxpayers about $400 million compared with projected Medicaid spending.

Optum only manages outpatient mental health care, such as therapy visits. But under the new contract awarded to Magellan, an outside company will also operate inpatient mental health services, such as inpatient stays. Ryan Langrill, Analyst, Idaho Office of Performance Assessment formerly known as Changes to the contract structure are promising.

Judge says they have no authority to review contract, company appeals

Two companies that lost a contract with Idaho’s behavioral health program filed suit in court, and a judge agreed in a recent separate ruling that they did not have the authority to review the state’s contract award decision, citing the state’s Procurement Act’s provisions for judicial review. Limitations of the Idaho Government Contract Law.

A judge dismissed the lawsuit, rejecting the suing company’s request to prevent Idaho from enforcing a new contract with Magellan Health.

Carelon Behavioral Health, a national subsidiary of Beacon Health, argued it wrongly lost the contract and that it was excluded because the state said previous work the company had done helped shape the terms of the contract.

Fourth Judicial District Judge Nancy Baskin wrote in her Oct. 27 ruling that Beacon was unable to avoid the Legislature’s decision barring the court from exercising jurisdiction.

national procurement law Judicial review of a contract award decision is only allowed if the head of the agency executing the contract considers the contract award decision to be controversial. That did not happen in this case, Fourth District Judge James Cawthon noted in a separate lawsuit filed by Optum Health, affiliated with its national affiliate United Behavioral Health.

Even if it finds the allegations in the complaint to be true, the court finds that it lacks subject matter jurisdiction over the case to issue a declaratory judgment…, Cawthon concluded.

Optum Health argued in the lawsuit that the state’s process for awarding the contract was flawed and appealed the Idaho judge’s decision to the Idaho Supreme Court. Nate Poppino, a spokesman for the Idaho Supreme Court, said appeals to the Idaho Supreme Court mostly go smoothly unless the case is discovered late. Popino said Autumn’s appeal is pending.

Optum has filed a notice of appeal asking the Idaho Supreme Court to determine whether the state can choose to shield its procurement decisions from judicial review. Optum spokesman Christopher Smith told the Idaho Capital Sun, “We believe the district court’s decision was erroneous and that the Idaho courts have the authority to consider Optums’ purchase of Idaho behavioral health plans on the merits.” and challenges to the legality of contract awards.

It’s unclear how often contract award decisions in Idaho are considered controversial cases. Spokesperson Kim Rau told the Idaho State Capital Sun that the administration is not aware of any controversial cases over the past decade. Law said the agency does not maintain a database for appeals of its contract decisions.

Editor’s note: This article has been updated to correctly state that Beacon Health’s national affiliate is Carelon Behavioral Health.

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