Delegate Don Perdue Asks for Federal Rejection of West Virginia's Medicaid Managed Care Expansion

PRICHARD, W.Va., May 5, 2015 /PRNewswire/ -- Delegate Don Perdue, a former chairman of the West Virginia House Health and Human Resources, has written to U.S. Secretary of Health and Human Services Sylvia Mathews Burwell, a West Virginia native, to ask her to reject an application for an expansion of West Virginia's Medicaid managed care program. He is particularly opposed to the state's waiver request that would put behavioral health and substance abuse services into managed care.

"It appears the behavioral health network for the managed care program has many service gaps and might not include a significant number of the community-based comprehensive behavioral health centers," Perdue wrote. "These comprehensive providers have historically served persons with Medicaid who are severely and persistently mentally ill and/or have substance abuse problems. They are the safety-net providers for this population."

Perdue, D-Wayne, also wrote in his letter that the Medicaid recipients who might need the behavioral health and substance abuse services include children, pregnant women and individuals covered under the state's expansion of the Medicaid program under provisions of the Affordable Care Act. He noted that West Virginia has the highest drug overdose mortality rate in the nation, the highest percentage of people with frequent mental distress and high suicide rates.

"The stated goal for the managed care expansion is to integrate services, including behavioral health services, which is a lofty and laudable goal; however, the performance of the current managed care providers (HMOs) contracted with West Virginia's Medicaid program is more laughable than laudable," Perdue wrote. "These HMOs have earned more profit on West Virginia's Medicaid program than their counterparts in any other state save one…. Their quality scores appear to be below national averages, as well."

Noting that he has had discussions with comprehensive behavioral health providers, Perdue wrote he is concerned the current health maintenance organizations (HMOs) contracted with the state do not understand the needs of Medicaid members with mental health issues.

The West Virginia Bureau for Medical Services has filed an application for a waiver to accommodate changes in the Medicaid managed care program that could begin as early as July. That application has gone to the Centers for Medicare and Medicaid Services (CMS), which is part of the U.S. Department of Health and Human Services that Burwell is in charge of.

SOURCE Don Perdue