Montana, one of the only states with a fully government-run Medicaid program, has hired a new director of Medicaid who has overseen managed care programs in Iowa and Kansas and championed the idea let outside companies do the work.
Mike Randol took over May 31 as head of Montana’s Medicaid program, which serves 280,000 people who live in low-income households or who have a disability in a state of 1.1 million people. The program has an annual budget of about $2.3 billion, with the federal government providing about 80% of the total.
Randol was most recently an executive at Cerner Corp., which provides health information technology services. Previously, he ran Medicaid programs in Kansas and Iowa, both of which hired national administration companies to administer benefits, instead of outsourcing that task to state employees.
“I’m a big believer in managed care,” Randol told reporters in 2019 as he defended Iowa’s program at a press conference announcing an 8.6% annual increase in the rate the state would pay. to its two management companies.
Montana Health Department spokesman Jon Ebelt declined to comment on whether Randol’s hiring signals that Montana plans to privatize the management of its Medicaid programs.
Adam Meier, director of the Montana Department of Public Health and Human Services, said in a statement that he looks forward to working with Randol to better serve Montana Medicaid recipients. “Mike is a proven leader with extensive experience overseeing state Medicaid programs,” Meier said.
The health department declined interview requests from Meier and Randol. Ebelt declined to provide copies of Randol’s application for the job, saying the documents are confidential.
Managed care got a bad rap in Montana after the State has contracted with an outside company to manage mental health care covered by Medicaid in the 1990s. The state eventually took over management after numerous complaints from patients and providers and after the company, Magellan Behavioral Health, reduced provider rates to compensate the loss of millions of dollars in its first year. In 2011, widespread opposition led the state to abandon plans for a managed Medicaid pilot program in five counties.
Under managed Medicaid, state and federal governments pay insurance companies a fixed amount per enrollee to cover health care services. If companies can do this for less money than they get paid, they pocket some of the difference as profit. All but 11 states, including Montana, have privatized at least some of their Medicaid programs, according to KFF.
Randol became Kansas Medicaid director in 2012, the year before privatized its program. Those who supported the change said the privatization helped control costs, while critics said it reduced program coverage and transparency.
Iowa Gov. Kim Reynolds, a Republican, hired Randol in 2017. His arrival in Des Moines came about two years after Iowa moved to a privately managed Medicaid system, which was plagued by complaints that disabled Iowans had been unduly refused treatment and that management companies have lost hundreds of millions of dollars in the early years.
When Randol resigned in 2020, Reynolds praised his service: “I am so grateful for the work he did not only to stabilize the program, but also to improve the system, incorporate technology and establish a basis on which we can build moving forward.”
Deb McMahon, an Iowan resident who has become an outspoken critic of Medicaid privatization due to her family’s experience, said if she lived in Montana she would view Randol’s hiring as a sign that the State intends to subcontract its program to management companies. “His record speaks for itself,” she said.
Vulnerable Montana residents who rely on Medicaid could see major disruption if the system is privatized, McMahon said. “Their services, the people they rely on to help them – all of that is going to change,” she said.
McMahon said that when Randol was in Iowa, he liked to quote statistics and talk about algorithms. But, she said, he seemed to get irritated when members of the public described how Medicaid changes were affecting people.
McMahon’s 41-year-old daughter, Annie Stender, has a developmental disability and uses Medicaid-funded services. Before Iowa’s Medicaid system was privatized, Stender had the same case manager for 15 years, McMahon said. This person knew her well and helped her navigate the range of services.
But under private Medicaid management, Stender was assigned to multiple case managers. “We lost that bond,” McMahon said. “We have lost this person in our lives.”
Mary Windeckerexecutive director of the Behavioral Health Alliance of Montana, said Randol’s past in Kansas and Iowa “doesn’t really give us a warm, fuzzy feel.”
Windecker said she fears a return to managed care could lead to lower reimbursement rates for medical providers. She said she would be surprised if Montana did not consider some form of privatization, in part because of how many other states have done so. “What we’re hoping is that whatever model the state is considering, providers will be at the table,” Windecker said.
Randol comes ahead of a massive review of Medicaid enrollees’ eligibility for the program. Enrollments have increased steadily since the start of the pandemic, and the federal public health emergency imposed during the covid-19 pandemic has suspended routine examinations. At the end of the emergency order, some beneficiaries in Montana will likely experience more eligibility checks to maintain their coverage in the future.
Health advocates have said people who meet coverage requirements could unwittingly be left behind in the process.
Heather O’Loughlin, co-director of Montana Budget and Policy Center, said that as new management takes over, she hopes the priority will be helping people maintain access to their coverage. “Now is not the time for political ideology, but an opportunity to listen to health care providers, tribal leaders, rural residents and those facing barriers to health care to ensure that this transition goes as smoothly as possible,” O’Loughlin said in a statement. statement.
State legislators are also review of Medicaid payment rates in Montana in response to a shortage of providers and services, starting with the mental health system. Health providers have long said that Medicaid reimbursements are well below the cost of operation. A program-wide review is expected to take years.
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