Aetna takes Nebraska to court for $1B share in long-term Medicaid contracts

Aetna Better Health of Nebraska is fighting the state in court after officials denied Aetna's bid to share in a $1 billion contract covering some 230,000 long-term Medicaid recipients, the Lincoln Journal Star reported.

In a complaint filed Tuesday in the Lancaster County District Court, Aetna asked the decision be overturned on the grounds that one of the insurers, Tampa, Fla.-based WellCare, is less established and unqualified based on its current legal issues in other states and outsourcing to India. Additionally, Aetna claims the state's decision process violated the law and was flawed, since two reviewers were unfamiliar with Medicaid and the review process was too short.

The decision "jeopardized the state of Nebraska's ability to satisfy the basic needs of hundreds of thousands of its most vulnerable citizens," Aetna's attorneys told the Lincoln Journal Star.

A share in the contract would make Aetna plans accessible to Medicaid and Children's Health Insurance Program recipients under Heritage Health, Nebraska's new managed care program. The plan aims to cover approximately 230,000 recipients under single plans as opposed to separate physical and behavioral health plans.

State officials disagreed with Aetna's arguments, saying officials impartially chose which insurers would be best for Nebraskans.

WellCare provided a statement regarding Nebraska's decision, saying the payer "has more than 30 years of experience in coordinating managed care for low-income children and families, the disabled and seniors. In recent years, it has become standard practice for unsuccessful bidders to protest the results of large procurements. The state of Nebraska conducted a fair bidding process, and we expect this to be validated in court. We remain focused on preparing to serve Nebraska’s most vulnerable citizens and on being a transparent and accountable partner to the state."

Six insurers applied and three were chosen.

Aetna controls plans for more than 100,000 Medicaid participants in Nebraska and has been in the state for five years. 

This article has been updated with a statement provided by WellCare. The previous version did not have WellCare's statement. 

 

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Top 40 articles from the past 6 months