Health Care Authority releases Managed Care Organization RFP

The Health Care Authority has released a Request for Proposals for Managed Care Organizations to support integrated managed care through the Medicaid Transformation Demonstration. Responses are due by April 12 by 2pm.

According to the RFP, its purpose is:

  • To select MCOs to perform all services listed herein in the North Sound, Greater Columbia, King, Pierce, Spokane, Salish, Great Rivers and Thurston-Mason RSAs
  • To select a third MCO to operate in Southwest RSA effective January 1, 2019
  • To assess the network adequacy of the current MCOs in the Southwest region while expanding the service area to include Klickitat County
  • To assess the network adequacy of the current MCOs in the North Central region while expanding the service area to include Okanogan County.

Southwest Washington currently has Molina Healthcare of Washington and Community Health Plan of Washington as its contracted MCOs. North Sound has Molina Healthcare, Coordinated Care, and Amerigroup Washington.

Each region will be awarded a set number of MCOs, and the HCA can limit the number of clients enrolled in each MCO.

Since Thurston-Mason and Great Rivers are both a part of the Cascade Pacific Action Alliance, that ACH region could contract with all five existing MCOs.

There are five existing MCOs serving Medicaid enrollees across the state: Amerigroup Washington, Coordinated Care, CHPW, Molina Healthcare, and UnitedHealthcare Community Plan.

Here is the current managed care enrollment by procurement region as of a few weeks ago. For a breakdown by county, click here.

CHPW has criticized the current procurement process where the HCA cuts existing MCOs out of the region for Medicaid enrollees. In a recent op-ed, CEO Leanne Berge wrote:

“This scenario [patients losing their existing plans and providers] is exactly what Medicaid patients in North Central Washington have experienced over the last several months, after the Health Care Authority (HCA) reduced the number of plans serving those patients in the region, as it moved toward Integrated Managed Care (IMC). For many patients, this meant having to change their health plan, which also meant having to change their clinic and providers. This scenario is a looming probability for 1.6 million more Medicaid patients in eight regions across the state, as those regions transition to Integrated Managed Care over the next two years, stripping control from Medicaid patients over this fundamental choice in their health care.”

We’ve heard that Speaker Frank Chopp is proposing a change to the Medicaid procurement rules that would allow any MCO already in a region to remain. Given the language in the RFP that the “HCA reserves the right to limit the number of clients enrolled in any single MCO,” the HCA may be giving itself the opportunity to significantly reduce enrollment while still letting a MCO technically remain in a region.