Isles’ new Medicaid plan off to bad start

34,750 calls made in 3 weeks involving QExA problems, confusion

 By Greg Wiles

Advertiser Staff Writer

Administrators heading the state’s new Quest Expanded Access program admitted the new system got off to a rocky start this month, but that the problems were to be expected and were being fixed.

“Some of this is inevitable,” said Dr. Kenneth Fink, state Med-Quest division administrator, testifying yesterday at a legislative hearing. He noted problems were to be expected with launching such a large program and pointed to problems involving pharmacies, transportation, state payments and computers.

“It is short-term (problems) for a much longer-term return,” he said.

The state changed the way it operates the Medicaid program for 40,000 elderly, blind and disabled residents on Feb. 1, contracting two for-profit Mainland health plans to provide managed care instead of the fee-for-service program it had offered.

The state has said it believes it can offer expanded services by having health plans manage them.

The program’s start was accompanied by people confused about how it operated, problems getting some drugs and people unhappy about possibly having to change doctors. Some of the state’s federally qualified health centers, or rural and urban clinics that serve the poor and elderly, have balked at signing up with the two contractors because of concerns about their business practices on the Mainland.

PROGRAMMING GLITCH

Fink and Patti Bazin, a state Department of Human Services administrator who helps oversee Quest Expanded Access, or QExA, acknowledged the state, contractors and others had received 34,750 telephone calls from people with questions or problems during the program’s first three weeks.

The calls ranged from people inquiring about plans, to those worried about getting prescriptions or keeping physicians, and those questioning why they were being asked to make co-pays on drugs.

One of the bigger problems occurred at pharmacies where a programming glitch caused confusion about state payments for drugs and whether rates paid by the plans to pharmacies were at the right level.

One Neighbor Island drugstore, Maui Clinic Pharmacy, last week reported problems getting plan identification numbers for patients and that it had one person working full time to resolve issues and billing problems related to QExA.

“Everything fell through on this,” Les Krenk, the pharmacy owner, said last week. “It was like the Grand Canyon. Patients were there on the bottom and we were trying to fish them out.”

He and others have said the state should have rolled out the program slowly instead of switching over everyone to a new system on a single day.

‘A HUGE DISCONNECT’

Bazin said there had been problems with transportation, primarily stemming from a previous loose system that in some instances reimbursed for patient cab rides to Ala Moana Center for shopping. The contractors have more rigid controls on setting up transportation.

Fink and Bazin said those and other issues are being resolved with the state employing more than two dozen people working to identify and resolve problems.

“We are making meaningful steps to take care of them and resolve them,” Fink said.

But the picture painted by Fink and the state contractors, Ohana Health Plan and Evercare Quest Expanded Access, was challenged by Richard Bettini, chief executive of the Waianae Coast Comprehensive Health Center. Ohana is a unit of WellCare Health Plans of Florida and Evercare is part of UnitedHealth Group Inc.

“There’s a huge disconnect here,” said Bettini, explaining the change to managed care through QExA had caused upheaval for patients and center workers.

Bettini has yet to sign up to become a provider with Ohana or Evercare and had been telling patients they might have to find someone who is part of the plan networks for their healthcare needs.

REIMBURSEMENT ISSUE

Several other healthcare centers, including Waimanalo Health Center, have said they don’t want to work with for-profit health plans and question whether enough specialists have signed up.

Bettini learned during the hearing that his patients won’t have to go to elsewhere if he doesn’t agree to become a part of Ohana or Evercare networks.

The state said Medicaid requires patient access to federally qualified health centers and as such, Waianae Comprehensive will continue to be reimbursed for services, though it may take longer than being part of Ohana’s or Evercare’s network.

The reimbursement issue also has been looked at by Faith Action for Community Equity, a group that has questioned whether the state should have contracted with WellCare or UnitedHealth, both of which have dealt with fraud allegations in other states. Last week, the federal government ordered WellCare to stop enrolling new customers in Medicare-backed drug and medical plans.

“We have become aware of some real issues with the parent companies of Ohana and Evercare,” said the Rev. Bob Nakata, FACE president.

“That’s something the committee should continue to monitor.”

The state acknowledged it was aware of WellCare’s Medicare issue, but that it did not affect operation of Hawai’i's Medicaid program and that it would be monitoring reimbursement practices of both Ohana and Evercare.

Reach Greg Wiles at gwiles@honoluluadvertiser.com.

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Medicaid program under fire

An assortment of problems with the new plan have affected 39,000 in the state

By Kristen Consillio 

Health-care services have been disrupted for some of Hawaii’s 39,000 aged, blind and disabled Medicaid recipients under the state’s new controversial managed-care program.

The program has had its share of problems since it began Feb. 1 under affiliates of UnitedHealth Group Inc. of Minneapolis and Tampa, Fla.-based WellCare Health Plans Inc., including computer glitches with pharmacies that resulted in co-pay charges covered under insurance, disruption in the transportation system used by patients, and lengthy wait times and busy signals at health plan call centers.

The state and health plans have received 34,750 calls from clients and providers over the past three weeks due to enrollment issues, health plan changes, pharmacy issues, questions about physicians, service coordination and transportation, according to Patti Bazin, state Department of Human Services health care services branch administrator.

“We’re trying to minimize the disruption,” she said. “I would be negligent if I did say that no one has been disrupted with this.”

Thousands of Medicaid recipients still have not been assigned a primary-care physician under the new health plans, while others have been turned away from their longtime doctors who have chosen not to participate in the program, according to Arleen Jouxson-Meyers, president of the Hawaii Coalition for Health.

“DHS has created an astronomical problem beyond belief by rational thinking people,” Jouxson-Meyers said in a letter written earlier this month to Bazin. “Patients will be harmed and some could even die as a result.”

The program has come under fire by patients’ advocacy groups opposed to the award of a $1.5 billion Medicaid contract to the two for-profit mainland firms, whose parent companies have been accused of fraud on the mainland. The state previously ran a fee-for-service Medicaid program.

“Their parent companies do not have a good reputation,” said the Rev. Bob Nakata, president of Faith Action for Community Equity, at a legislative briefing yesterday. “There are suits in 37 states, federal investigations going on – this is what these people are up against.”

The U.S. Centers for Medicare & Medicaid Services recently stopped WellCare from marketing and enrolling new members in its Medicare plan and prescription drug program nationwide. The ban doesn’t affect its currently enrolled members or Medicaid recipients.

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Honolulu’s Kukui Gardens to get up to $3.8M in stimulus funding

Up to $3.8M in federal funds will allow sale, construction of housing

By Rick Daysog, Advertiser Staff Writer

Efforts to save the Kukui Gardens low-income housing project will receive a kick start from the federal stimulus plan.

The rescue of Kukui Gardens, one of the state’s largest and oldest affordable rental complexes, had been in jeopardy since November because of financing problems caused by the meltdown in the nation’s financial markets.

But under the stimulus plan signed by President Obama earlier this month, the project will be eligible for up to $3.8 million in financing, allowing affordable housing developers to proceed with the purchase and construction of low-income apartments, said Drew Astolfi, lead organizer for Faith Action for Community Equity, or FACE, which represents tenants.

“We’ve been on a roller coaster ride for three years, so this is such a relief,” said Winona Sardinha, a 38-year Kukui Gardens resident. “This will help us tremendously.”

The fate of Kukui Gardens has been in limbo since 2006 when the former owner of the 857-unit low-income apartments offered to sell the property to upscale developers.

The affordable housing complex was saved a year later after a campaign by tenants, community leaders, the Lingle administration and other elected officials persuaded Kukui Gardens’ buyers, San Francisco-based Carmel Partners, to sell half, or 11 acres of the land and more than 400 apartments, for $72 million to affordable developers, EAH Housing and Devine & Gong of San Francisco.

But the purchase hit a snag in November when the market for a key component of the deal — state housing tax credits — dried up with the collapse of the nation’s financial markets.

Astolfi said the federal stimulus plan will provide $3.8 million to fill in much of the gap created by the loss of the state housing tax credits. State tax credits had accounted for about $5 million of the purchase price.

Astolfi said U.S. Sen. Daniel K. Inouye was instrumental in securing funding from the stimulus plan for Kukui Gardens and other affordable rental projects in Hawai’i. He also credited state House Speaker Calvin Say for supporting tenants.

Overall, the state is eligible for up to $9.7 million in this form of federal financing.

Chan U Lee, senior associate at Devine & Gong, said the developers hope to complete the purchase and start construction by fall. The original timetable called for the purchase to be completed last month with construction starting in March.

Lee said the 15-month project will create 100 to 160 construction jobs. “Once we get the money, we can close and can hire right away,” she said.

Built in 1970 by the late developer Clarence Ching, Kukui Gardens is a 22-acre low-income rental project. The former owners, Kukui Gardens Corp., put the complex up for sale in January 2006.

Kukui Gardens agreed to sell the property in March 2006 to Carmel for $131 million.

“Hundreds of residents can all breathe a lot easier now,” said Astolfi, the tenant’s representative. “The shadow of losing their homes will be removed by this.”

Reach Rick Daysog at rdaysog@honoluluadvertiser.com.

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FACE of Maui Housing Summit

Come and hear housing experts from around the country, including two who helped with President Obama’s transition team! Discussions will focus on Rentals, Homeownwership, Foreclosures & Land Use/Sprawl.  This event is being co-sponsored by Maui County Mayor Tavares.

Saturday, March 7, 2009

Maui Community College, Ka Lama Building

9:00 a.m. – 2:00 p.m., registration from 8:30 a.m.

Housing solutions call for coordinated approach

Opinion

The related issues of affordable housing and homelessness should be among the top priorities on the 2009 legislative agenda.

This year, with public housing ranking among the targeted concerns for the economic stimulus funds, Hawai’i needs a coordinated plan of attack to fully leverage federal dollars with state and county funds. To get the best bang for the buck, all of our elected leaders and housing officials have to be on the same page.

Housing and homelessness are somewhat distinct concerns — helping the homeless also includes a large component of assistance with employment and social services — but they’re part of the same continuum. For the homeless to transition out of emergency shelters, there needs to be rentals to accommodate them.

Affordable rentals are in short supply and market-priced homes are moving beyond reach. Even under the best of circumstances, many families in low-income housing have been a paycheck away from homelessness. And these are not the best of circumstances; most social service experts expect homelessness will continue rising.

To that end, key committees at the Legislature seem poised and armed with the right policies aimed at coordinating efforts at city and state levels.

Norman Sakamoto, Senate housing chairman, said he wants to explore ways to use some of the state’s rental trust fund to support transit-oriented development along Honolulu’s transit line. That’s encouraging: Meshing city-state redevelopment strategies for the benefit of affordable and low-income rentals would be a worthwhile goal.

More immediately, economic woes have soured prospects for financing critically needed low-income rentals, with the Kukui Gardens redevelopment project most prominently in the public eye. Those involved in the financing arrangements are hopeful that some kind of deal can be struck, but an extra assist will be needed to cover the $5 million needed.

Some advocates say improving the terms for state tax credit incentives would make financing easier, but the recession makes tax credits a tough sell in any case.

A better solution to kickstart low-income housing projects should come from the Congressional delegation in D.C., especially Sen. Daniel K. Inouye, chairman of the Senate Committee on Appropriations. The problem is a national one and deserves greater attention: Advocates say many low-income developments across the country face perils similar to Hawai’i's.

They can be helped through the federal Housing and Urban Development HOME block grant program for state and local affordable housing. These funds should be extended to projects that also tap tax-credit options, which appear to be ineffective in this economy.

The federal stimulus package also is expected to include roughly $45 million to help restore the Islands’ public housing units to the inventory; additional block grants to cities such as Honolulu also have been proposed.

Whatever money is bound for Hawai’i, state officials must ensure it is spent efficiently and with transparency to bring more public housing units online. The economic boost that comes from quick deployment of the funds is crucial.

Other initiatives that should be pursued this session:

• The allocation of the conveyance tax to the rental housing trust fund must be extended to June 30, 2013. Lawmakers may have to fight to boost the fund’s share to 50 percent of the tax, as Senate Bill 773 proposes, because there are many competing interests.

• Senate Bill 1182 would pull together scattered state services for the homeless into a new Office of Homeless and Community Services, under the Department of Human Services. That’s a sensible idea, if it can be accomplished at no additional cost.

• The Democratic majority seeks to maintain funding for the homeless services at current levels, said Sen. Suzanne Chun-Oakland, who chairs the human services committee. It will be a tough battle to accomplish this, given budget constraints, but it’s the right thing to do.

Maintaining the safety net for the homeless, especially during a period when more hardship is looming, will be the mark of success in a challenging lawmaking session. Caring for its most vulnerable people is a core value in Hawai’i, one that must not be cast aside, especially when the going gets tough.