Centene Wins MO Medicaid

Clayton-based Centene wins Missouri Medicaid contract

BY JIM DOYLE • jdoyle@post-dispatch.com > 314-340-8372 | Posted: Wednesday, February 22, 2012 8:49 am

Centene Corp. has won a major contract to manage health care and behavioral health services for Medicaid beneficiaries across Missouri, the Clayton-based company announced today.

The firm will share the business with two other companies, Missouri Care Inc. and Health Care USA, which is a subsidiary of Maryland-based Coventry Healthcare Inc., state officials said.

Missouri’s Medicaid program, serving 427,000 patients, spends $1.1 billion annually, said Wanda Seeney, a spokeswoman for the state Office of Administration. Centene did not release an actual contract value, and company officials could not immediately be reached for comment.

The companies will compete for Medicaid enrollees during an annual open enrollment period, Seeny said.

Centene is the nation’s fourth-largest Medicaid contractor, and among the most successful companies in the region, with about 5,300 employees nationwide, including more than 900 in the St. Louis area. With the award of the Missouri contract, those numbers are expected to grow.

The managed care company’s subsidiary, Home State Health Plan, was chosen by Missouri officials after submitting a competitive bid to provide services.

“We expect to commence operations in the third quarter of this year,” Centene said in a news release.

Centene and the other companies will provide coordinated healthcare and behavioral health services to Medicaid patients including those receiving benefits under categories of aid for parents and caretakers, children, newborns, pregnant women and refugees. It will also provide services for children in the care and custody of the state pending adoption, and the Children’s Health Insurance Program.

“We are honored to be awarded a Medicaid managed care contract to begin serving managed care members here in Missouri,” said Jesse Hunter in the release. Hunter earlier this week was named Centene’s executive vice president of operations of Centene. “We believe our strategic provider partnerships in Missouri will help us deliver improved health outcomes for our members at a lower cost for the state.”

“For more than 15 years, we have called Missouri home to our corporate headquarters. We have added hundreds of jobs and made significant investments into the region,” said Michael Neidorff, Chairman and Chief Executive Officer of Centene, in the release. “We embrace the opportunity to bring our award-winning quality programs and healthcare services to our most vulnerable neighbors across the state.”

Centene lobbied hard for the Missouri Medicaid contract. It has fielded a dozen registered lobbyists, including attorney Chuck Hatfield, one of Democratic Gov. Jay Nixon’s closest advisers, according to Missouri Ethics Commission records. Since January 2006, Centene and its executives have given more than $400,000 in campaign contributions to dozens of Missouri politicians.

A growing number of states have privatized their Medicaid programs, paying fixed per-patient rates and letting contractors assume the risk of rising health care costs.

Centene’s network of providers tries to reduce costly use of emergency rooms by encouraging patients to see primary care physicians, take the medications, and pursue healthy lifestyles.

But Centene came under scrutiny last year because one of its affiliated businesses, the embattled Missouri contractor SynCare LLC, was ousted as a state contractor after high-profile failures in delivering eligibility assessments of homebound Medicaid patients. Centene provided nearly $2 million in business loans to SynCare and its owner.

Seven companies submitted contract bids to participate in Missouri’s Medicaid managed care program known as MO HealthNet Managed Care, said Jim Miluski, a purchasing director with the state’s Office of Administration.

Three of the bidders were awarded contracts on Feb. 17, he said, and all three firms will be able to operate in the state’s central, west, and east managed care regions.

Health Care USA has participated in the Missouri Medicaid market for about 16 years.

“This award extends that relationship and represents another major step forward for Coventry as we continue to expand our Medicaid presence,” Allen Wise, chairman and chief executive of Coventry, said in a news release.

Centene previously held a Missouri Medicaid contract, but left the state’s market in 2006.

For the latest contract award, Miluski said, the state’s evaluation panel considered factors including the bidders’ organizational experience, method of performance, quality, and access to care. He also said that bidders could win extra points if affiliated with a certified business owned by a minority group or women.

The successful bidders including Centene were awarded one-year contracts and the potential of two additional one-year renewals.

The new contracts are scheduled to begin on July 1.

Supreme Ct. Denies CA Medicaid case

Article published February 22, 2012
Calif. Medicaid case heads back to lower court
By Gregg Blesch Posted: February 22, 2012 – 12:45 pm ET
The U.S. Supreme Court sent a widely watched California Medicaid case back to a lower court, declining to rule whether providers can sue states to enforce the federal statute.
California hospitals and other providers argued in five lawsuits that state amendments to the Medicaid program, including a 10% reimbursement cut, violated language in the federal law that payments are sufficient to sustain quality and access for beneficiaries. The 9th U.S. Court of Appeals agreed and issued injunctions
blocking the state from making the changes.
In the meantime, however, the CMS approved some of the plan amendments and the state withdrew most of the others.
“While the cases are not moot, they are now in a different posture,” Justice Stephen Breyer wrote in an opinion for a 5-4 majority. “The providers and beneficiaries continue to believe that the reductions violate the federal provision the agency’s view to the contrary notwithstanding.” The 9th Circuit’s injunctions remain in place.
Breyer noted, however, that the providers may now more appropriately seek review of the CMS’ decisions rather than basing their challenge on the supremacy of federal law over the state actions. Breyer noted that the administrative review requires deference to the agency’s decisions and “to permit a difference in result here would subject the states to conflicting interpretations of federal law by several different courts (and the agency), thereby threatening to defeat the uniformity that Congress intended.”
The Supreme Court remanded the case to the 9th Circuit.