Aetna, Coventry challenge $2B Medicaid decision


Aetna and Coventry are challenging the Louisiana Health Department’s decision to award a statewide Medicaid program worth $2.2 billion to other health insurers.

The Louisiana Department of Health and Hospitals, in an effort to transform its Medicaid program, issued a request for proposals to run pre-paid coordinated care networks, in which the state pays the networks a monthly fee for each of its Medicaid enrollees and the firms to manage patient care. The Health Department chose Louisiana Healthcare Connections, Amerihealth Mercy of Louisiana, and AmeriGROUP Louisiana, reports the Hartford Courant.

As a result of that decision, Aetna and Coventry said they want Louisiana to release information that bidders submitted, as well as records related to how the proposals were scored. The insurers say the Health Department didn’t follow its own rules in scoring 10 firms' proposals, the New Orleans Times-Picayune reports.

Aetna argues that state analysts unfairly compared the bidders’ proposals to each other rather than evaluating them based on the actual request, notes the Courant. Three of the companies that won contracts have sued Louisiana to block full public disclosure of their proposals. The state district court recently heard a request for a temporary order against such disclosure, according to The Republic.

"Given the size of the award, and the importance of the services that will be provided, it is in everyone's best interest to have a thorough and transparent review of how the contracts were awarded,” said Pat Powers, head of Aetna’s Medicaid subsidiary, Aetna Better Health of Louisiana. "We have already identified several areas of inconsistency in the scoring of the proposals, and full transparency will ensure that each of the proposals was scored in accordance with the guidelines set forth by DHH," he added.

The Louisiana Health Department has 10 days to respond to the Aetna and Coventry protests, the Times-Picayune notes.

To learn more:
- read the New Orleans Times-Picayune article
- see the Hartford Courant article
- check out The Republic article

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