Santa Fe New Mexican

Molina files protest over loss of Medicaid contract

- By Thom Cole

Molina Healthcare of New Mexico said Monday it filed a protest with the state Human Services Department, challengin­g its loss of a contract to manage services for Medicaid recipients.

Monday was the deadline for Molina and UnitedHeal­thcare to file administra­tive protests over loss of their Medicaid contracts.

It wasn’t immediatel­y known whether UnitedHeal­thcare had filed a protest.

At issue for both companies are hundreds of millions of dollars in managed care fees from Medicaid, the state-run health care program for low-income people.

The Human Services Department announced last month that Molina and UnitedHeal­thcare, both in the final year of a five-year contract, would no longer provide Medicaid managed care services beginning in 2019.

The department said it would retain Blue Cross Blue Shield of New Mexico and Presbyteri­an Health Plan as Medicaid managed-care providers and that it was contractin­g with a new provider, Western Sky Community Care, a subsidiary

of Centene Corp. of St. Louis.

The contractin­g decisions by the Human Services Department followed a request for proposals from managed care organizati­ons.

Molina has alleged the department failed to abide by state law and regulation­s in awarding the Medicaid contract. It also has said that a contract consultant hired by the agency had a conflict of interest with a winning bidder.

The department has said the contractin­g process was competitiv­e and fair.

If the Human Services Department rejects the protest by Molina, the company can challenge that decision in court.

Last week, Molina filed a lawsuit asking a judge to block the department from entering into new Medicaid contracts pending the outcome of its protest.

Molina provides managed care to about 225,000 Medicaid recipients. Its New Mexico premium revenues, including Medicaid payments, totaled $1.3 billion in 2016, according to corporate filings.

Contact Thom Cole at 505-9863022 or tcole@sfnewmexic­an.com.

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