- Associated Press - Thursday, November 26, 2015

DES MOINES, Iowa (AP) - An administrative law judge has recommended that the state of Iowa throw out one of four contracts awarded to private companies set to take over the state’s Medicaid program in January, a move that challenges whether plans to switch oversight can remain on schedule.

Judge Christie Scase said in a ruling Wednesday that Iowa should reverse its contract with Florida-based WellCare. The Des Moines Register reported (https://dmreg.co/1Q13JaY ) that the ruling is considered a “proposed decision,” and it’s unclear how it will affect plans to let WellCare and three other companies take over running Iowa’s $4.2 billion Medicaid program beginning Jan. 1.

Iowa Department of Administrative Services Director Janet Phipps is expected to review the decision.

The ruling said WellCare should have disclosed information early to state officials about fraud or mismanagement involving former executives.

“Without this information, they could not exercise reasoned judgment as to whether WellCare’s failure to disclose these events in its initial response was an intentional or material omission,” Scase wrote.

WellCare officials said in a statement it will challenge the ruling.

“WellCare strongly disagrees with Judge Scase’s recommended order,” spokeswoman Crystal Walker said. “We intend to bring its erroneous conclusions to Director Phipps’ attention and urge that she uphold the Department of Health and Human Services’ contract awards.”

Gov. Terry Branstad said in a statement Wednesday the ruling allows the privatization plans to move forward.

“We continue to evaluate the next steps in the administrative review of the procurement process and remain on schedule to implement our plan on January 1, 2016.”

Roughly 560,000 people are enrolled in Iowa’s Medicaid program, which provides care to poor children, families and disabled people, as well as some low-income adults. It is funded with state and federal dollars.

Plans to switch to private care on Jan. 1 have been challenged by some Democratic lawmakers, who argue the state isn’t ready. Branstad said the move will save the state money and offer better care to patients.


Information from: The Des Moines Register, https://www.desmoinesregister.com

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