Indiana dropped Molina as a contender for its managed long-term care program, known as Pathways for Aging. (From FSSA presentation)
The Family and Social Services Administration (FSSA) dropped one of four companies it previously recommended to operate as one of the state’s Managed Care Entities after determining that finalist Molina Healthcare didn’t meet its standards.
According to the agency’s website, Molina “has been unable to secure a (Dual-Eligible Special Needs Plan) contract with the Centers for Medicare and Medicaid Services” as required.
A Dual-Eligible Special Needs Plan, or D-SNPs for short, are Medicare Advantage plans for beneficiaries who are enrolled in both Medicare and Medicaid, programs which serve the elderly and impoverished populations, respectively.
D-SNPs started operations in 2006 and were enacted permanently in 2018. As of February 2022, D-SNPs existed in 45 states, but few were integrated into managed long-term care plans, according to the Medicaid and CHIP Payment and Access Commission.
FSSA, on its site, said that overseeing care for Hoosiers who qualify for both programs was central to its anticipated launch of managed care in Indiana, noting that all contractors needed this qualification to continue with the readiness review.
The state initially received seven responses to its request for proposals from Anthem, CareSource Indiana, Humana, Coordinated Care Corporation (doing business as Managed Health Services), MDwise, Molina and United. CareSource, Coordinated Care and MDWise were eliminated from consideration in March.
According to a shareholders’ filing from the U.S. Securities and Exchange Commission, FSSA notified Molina on Sept. 27 about dropping its recommendation, though the state didn’t update the website until Oct. 3.
“Indiana is the only state in (Molina’s) portfolio in which a Medicaid contract … has been affected by the CMS administrative proceeding,” according to the filing.
Molina didn’t specify which CMS regulation impacted its anticipated contract with Indiana, though it said it would have met that obligation by January of 2025 — one year after FSSA’s deadline.
An August update from CMS on D-SNPs specified that state Medicaid agency contracts needed to be submitted to the federal department for review by the first Monday of July going forward. The document details several requirements for entities, including:
- Coordinating delivery of services
- Categories of eligibility
- Benefits covered
- Cost sharing protections
- Sharing of information
- Verification process
- Service area
- Contract period
This article originally appeared on Indiana Capital Chronicle.
