Centene plans to file protest over Texas state Medicaid scoring

2024-04-04

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Centene plans to file protest over Texas state Medicaid scoring

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来源: FierceHealthcare

The specifics of Centene's protest are unknown.

Centene appears to be crying foul to Texas over the state's scoring of its Medicaid proposal.

Asked for her reaction at Barclay's Global Healthcare Conference last month to unfavorable news, CEO Sarah London said they were "disappointed" and have received information related to the decision.

"We fully intend to protest there," said London. "But I would say the biggest concern for the program overall is the idea that the results are going to force 1.8 million Medicaid members in Texas, which is a state that has a very high choice rate to choose a different place."

Centene did not reply to multiple requests for comment.

The Texas Department of Health and Human Services said the agency does not respond to active procurements but contracts are expected to be awarded in July. Under the authority of the state's attorney general office, governmental agencies can withhold information related to ongoing procurements, the agency told Fierce Healthcare.

Texas is in the process of rebidding its Medicaid managed care programs. The department typically awards three contracts per service area, but in some jurisdictions the maximum number is five, according to research and consulting firm Health Management Associates. Contracts run for six years with three two-year renewal options.

Under the program, insurers provide preventive, acute and behavioral health to eligible pregnant women, children and parents with limited income. Texas HHS shows which geographic areas each insurer currently covers for various programs in a color-coded map (PDF).

The deadline to file an official protest was March 17. Previously, Texas HHS issued a notice of intent to award Molina Healthcare, Blue Cross and Blue Shield, Aetna, UnitedHealthcare and SuperiorHealth Plan, among other awardees.

SuperiorHealth Plan was one of seven payers awarded a contract for the state's STAR +PLUS program, which focuses on Medicaid members aged 65 and older with disabilities. This contract begins in September.

It isn't the first time Centene has had issues with states' Medicaid contract determinations. The insurer protested Louisiana's decision in 2019, sued Tennessee in 2021 and earned a partial victory in California in 2023.

In September 2022, Centene agreed to a $166 million settlement to resolve claims it overcharged the state's Medicaid program for pharmacy services.

The news was first reported by the St. Louis Business Journal.

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