HSD snubs 4 protests over contract rejections

Complainants plan to take fight to court

The New Mexico Human Services Department has denied all four protests from health care organizations that were not awarded contracts in the state’s $4.6 billion Medicaid procurement process known as Centennial 2.0.

The decision means that, barring any successful lawsuits, the Medicaid program that begins Jan. 1 2019 will be administered by incumbents Blue Cross Blue Shield of New Mexico and Presbyterian Health Plan, as well as Western Sky Community Care.

A spokeswoman for the department said in a statement the decision “was in the best interest of New Mexicans. These plans will provide the highest quality of care for New Mexicans, at the lowest cost.”

The companies that filed protests were incumbents Molina Healthcare of New Mexico and United Healthcare, as well as AmeriHealth Caritas New Mexico and WellCare of New Mexico.

Both Molina and United told the Journal they will fight the decision in state District Court.

“Regardless of the final outcome of its legal action, Molina is committed to fulfilling all of our contractual agreements for the remainder of the year by continuing to deliver the high-quality care our members need and deserve,” said a Molina spokeswoman in a statement.

Molina has said in court documents it will “likely” leave the state if not awarded a Medicaid contract.

In an email, a United spokeswoman said that the company is “committed to serving the nearly 110,000 individuals in New Mexico enrolled in our Medicaid plans who have entrusted us with their health care needs.”

A spokesman for AmeriHealth said the company is evaluating next steps. WellCare did not respond to a request for comment.

Among the allegations made by the four companies in their protests: that bidders were asked

to submit cost proposals based on rates that were not “actuarially sound or sustainable;” that some insurers were given more points in the scoring process based on exhibits the state did not require them to submit;” and that a consultant involved in the process, Mercer, had a conflict of interest involving Western Sky’s parent company, Centene Corp.

The department has maintained that the process was conducted appropriately and complied with applicable law. A spokeswoman for Western Sky said in an email the accusations regarding Centene and Mercer are “without merit.”

A Mercer spokesman directed the Journal to a court filing in which the company’s legal counsel writes that “nothing that Western Sky ... could do as a successful offeror could result in compensation to Mercer.”

Medicaid members currently enrolled in the program through Molina or United will have the option of choosing a new insurer during the open enrollment period that begins in October. If they do not choose one, they will be automatically assigned to Presbyterian, Blue Cross Blue Shield or Western Sky, according to the department.

There were about 750,000 New Mexicans enrolled in Medicaid in February, according to the Kaiser Family Foundation.