An unhealthy lack of concern

HMO survey: State is too quick to excuse the serious failings of HMOs serving Medicaid patients.

January 24, 1999

AN EARLY look at the HMOs that contract to provide medical care for Maryland's Medicaid recipients has turned up disturbing problems.

In a state-funded audit, the independent Delmarva Foundation evaluated the nine HMOs providing medical treatment for some 300,000 Medicaid patients under the state's 19-month-old HealthChoice program. Among the failings identified: Six months into the program, not one HMO was providing the care required for new patients or diabetics. Only two HMOs provided required prenatal services.

Equally troubling is the reaction of state officials to the poor report. "It doesn't alarm me," said state Health Secretary Martin P. Wasserman. And in spite of the failure of HMOs to meet their contract obligations, they won't be sanctioned by the state.

Such nonchalance shows an unacceptable lack of concern about the medical care provided to some of Maryland's most vulnerable patients. When the state's welfare families and disabled patients were shifted into nine HealthChoice HMOs in June 1997, the state promised they would get better health care while taxpayers could look forward to more predictable Medicaid program costs.

Yet the survey raises serious questions about both promises. In addition to the obvious medical problems, the audit results raise another question: Are the taxpayers, who ultimately fund HealthChoice, getting what they paid for?

HMOs receive a flat fee from the state to provide Medicaid patients with a comprehensive set of services. Yet the audit shows that participating HMOs failed to provide some of the basic health services they were paid to deliver.

Dr. Wasserman says he believes the HealthChoice program is working much better now than when the survey was completed a year ago. But until there's clear proof, Medicaid patients and taxpayers have good reason to be worried. Even if the state isn't.

Pub Date: 1/24/99

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