The Kansas Department of Health and Environment’s decision to press — and keep pressing — Aetna Better Health on its performance as a Medicaid contractor is wise. Pushing to hold state contractors accountable makes a difference for those served and sends a signal that incomplete or incompetent service won’t be accepted.
The problems identified with Aetna were basic ones. There were questions about what doctors were covered, about authorization of procedures and being reimbursed. These aren’t the kinds of fiddly problems that challenge patients and providers in the private insurance arena. These are the kind of problems that made it difficult for KDHE to know if Aetna was fulfilling some of its most basic duties.
But KDHE didn’t just raise the problem. State agencies have done so with other contractors before, and for years. In previous administrations, that would sometimes result in revised contract terms that were more favorable to the private companies, or even increased payments to them.
Not this time.
When Aetna submitted a plan to fix the issues, the state drew a line in the sand. Sorry, officials told the insurance. The proposal simply wasn’t good enough.
“Upon review, KDHE does not feel that the plan submitted by Aetna adequately addresses the State’s concerns, nor does it present a clear path to compliance,” wrote KDHE spokeswoman Ashley Jones-Wisner.
We trust that the state and the insurance company will work something out eventually. It’s in the interests of both to do so. It’s certainly in the interests of KanCare recipients who depend on Aetna to provide reliable and health-promoting insurance coverage.
But it’s likewise worthwhile to show that a new sheriff is in town and that incomplete or otherwise problematic repair initiatives won’t be rubber-stamped. Simply going through the motions won’t be rewarded. The people of Kansas, including taxpayers and Medicaid recipients, deserve high-quality service, and KDHE has been working to make that happen.
The process of cleaning house in Kansas state government departments has been a lengthy and complicated one. The damage wrought by the neglect of previous administrations — neglect both benign and less so — has permeated agency upon agency, department upon department.
Repairing these issues takes dedicated work by a host of officials. It will likely require serious investments of time and challenging conversations.
KDHE challenging Aetna shows the department has the right approach. All of the state should benefit.