Senators Drawn Into Conflict Over Medicaid Policy

A fund-raising event and public hearing on the controversy occurred on the same day, raising eyebrows.
June 2, 2010 -- A fund-raising event for two prominent Democratic senators – Alan Bates and Laurie Monnes Anderson – occurred the same day as a controversial hearing on the fate of more than 10,000 children enrolled in the Oregon Health Plan.
 
Was it a coincidence? Or, did an insurance executive and the leader of Portland’s largest pediatric group engineer this event on May 24? The Lund Report learned about this potential conflict from two confidants – one an insurance lobbyist.
 
Dr. Resa Bradeen, president of The Children’s Health Alliance, a 110-member pediatric group, and Jeff Heatherington, president of FamilyCare, had testified earlier that day in front of the Senate Health Care Committee. They shared their frustrations after the Medicaid agency determined that the children under the care of CHA would be transferred to CareOregon on July 1-- unless their families informed Medicaid officials – by drafting a policy recommendation favoring CareOregon, according to Heatherington.
 
“I’d been receiving a lot of calls regarding clients who were confused about letters they got; they wanted to make sure they could stay with their own provider,” Monnes Anderson told The Lund Report after the informational hearing.
 
She adamantly denied there was a link between the fund-raising event and the hearing on the same day. Nothing could be further from the truth, she insisted.
 
“We just had a general fund-raiser,” she said. “It was planned well in advance -- before this issue was on the committee agenda – three or four months ago. The Children’s Health Alliance wasn’t even on the invitation list.”

Bates called the accusation “pure nonsense. Accusing me of siding with one side or another because of campaign contributions is the worst side of politics,” he said. “There was no connection between the fund raiser and the hearing. We plan these fund raisers months in advance; they’re not thrown together at the last minute.”

Bates believes the children now seeing pediatricians at CHA should be allowed to stay with them, and not have to change doctors.
 
“FamilyCare was willing to take all providers and fulfill all the contracts; the patients would never have had to make any changes, but the Medicaid agency felt the contracts were more important than the doctor-patient relationship, and I disagree with that,” Bates said. “When the plans get into a controversy, we need to do what’s best for the patients, not what’s best for the plan. That’s what the hearing was all about. My position is that we disrupted the patient and doctor relationship when we didn’t need to.”
 
In retrospect, Monnes Anderson believes communication fell short between Medicaid officials and the patients and providers impacted by the new contract. “I don’t think it was a very smooth process,” she said.
”If she continues hearing complaints, the Senate committee she chairs may take this issue up again. “I’m very concerned about MCOs cherry picking who they want; I’d like them to take their share of Medicaid clients”.
 
As far as the fund-raising event is concerned, Heatherington said that neither he nor Dr. Bradeen attended or gave a campaign contributiion. “We didn’t have anything to do with putting on this event,” he said. “It’s a lie."
 
CONFLICT WITH MEDICAID AGENCY
Heatherington pointed the finger at the Medicaid agency for hampering what should have been a smooth transition. “They’ve done everything they can to scare off the patients from choosing FamilyCare. When the agency takes sides, we’re dead in the water, and don’t have any other recourse. It’s very clear that their interpretation has all along been an advantage to CareOregon and a disadvantage to clients who want to move.”
 
But Judy Mohr-Peterson, administrator of the Medicaid agency, said her primary concern has been with the families involved in this transition.
“Our goal has been to protect our clients and allow them to make an informed choice,” she said. “We’ve made that very clear to CareOregon and FamilyCare. We haven’t shown favoritism to any one plan, but were given very challenging timelines. We want to help people make an informed choice and are focused on moving forward.”
 
Families can either call the agency (1-800-273-0557) or send a letter by June 15 indicating they want to change to FamilyCare, she said. Her agency will also accept such requests through September.
 
BATES TRIED TO RESOLVE CONFLICT
 
On May 19 Bates sent a letter to the parties involved in this transition -- CareOregon, FamilyCare, Medicaid and state officials.
 
Here’s what he wrote:
 
“I want to clarify that for me, this is not about CareOregon , Children’s Health Alliance or FamilyCare; it is about the provider/patient relationship (which has everything to do with patient care.) It is of vital importance that this relationship not be disrupted by changes made by DMAP or health organizations. I want to learn more about this situation to ensure that it is the care of patients that is being considered, first and foremost. The best way to do this is to hear from each of you before the Senate Health Care committee when we meet in Salem next week.
 
“I made a suggestion to DMAP that could resolve this highly-charged issue in favor of the patient, and for whatever reason, that was ignored. I
want to understand the policy with regard to MCOs and DMAP when these transitions occur. If those policies are in the best interest of the patient, and if they are applied consistently, I will be satisfied.”

TO LEARN MORE

Read the letter Mohr-Peterson sent on May 28 about this change, click here.
 
To read a previous story about this issue, click here:
 
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