Aetna Challenges Oklahoma Medicaid Managed Care Contract Picks

Aetna has challenged Oklahoma’s picks for its Medicaid managed care program, SoonerSelect, stating that there were flaws in the bid review process.

“Aetna understands and appreciates the hard work, challenge, complexity, and dedication involved in making final award decisions,” the protest acknowledged. “In bringing this protest, Aetna aims to improve (1) Oklahoma’s transition from predominantly fee-for-service to managed care, and (2) the healthcare outcomes of the beneficiaries in the SoonerSelect program.”

The payer found three faults in the Oklahoma Medicaid program’s process for choosing managed care organizations.

First, Aetna alleged that the contracts were not presented to the Oklahoma Health Care Authority (OHCA), the only entity with the authority to approve the contracts. The contracts were only approved by the chief executive officer of the OHCA, not the entire board.

Second, the process did not follow the criteria outlined in Oklahoma’s requests for proposal, according to Aetna.

“The SoonerSelect Proposals were evaluated on unknown criteria,” the payer stated. “While there were broad categories to be scored, there was a lack of information guiding the evaluation team regarding how the wide-ranging score should be broken down and points assigned.”

OHCA decided not to use its typical scoring system in favor of the PQMI note system—which stands for positive, minus, uncertainties, and interesting or innovative. Aetna found the new system much more subjective.

The payer also argued that the process was rushed and that evaluators did not review important materials that OHCA required payers to include in its request for proposals.

And finally, violations of the Open Records Act and Open Meetings Act occurred during the bidding process, the protest said. The details of how evaluators assigned scores in the bidding process should be released to the public, according to law. However, in this case, OHCA did not make those records public.

“Aetna respectfully requests that the OHCA takes the appropriate corrective action by including Aetna in the contract award or voiding the contract award and issuing a re-bid,” the protest concluded.

“While this protest is being reviewed, to avoid further prejudice, Aetna reiterates its earlier request that the execution of and/or the implementation of the contracts be stayed until all avenues of appeals relative to this protest are exhausted.”

The stakes are high for this bid, given the immense price tag. Totaling over $2.1 billion, these Medicaid contracts are some of the largest in the state’s history.

OHCA officials announced the four Medicaid contracts that they had selected for the state’s Medicaid managed care program toward the end of January 2021. Centene, UnitedHealthcare, Humana, and Blue Cross and Blue Shield of Oklahoma won the bid.

Oklahoma’s Medicaid program is entering this fray after emerging from a particularly tumultuous year in 2020.

The state was the first of two states—as of February 2021—to adopt Medicaid expansion during the pandemic. By a margin of less than one percent, voters approved altering the state’s constitution through a ballot vote. This vote and the debate surrounding it demonstrated the sharp divide between urban and rural residents in Oklahoma.

Missouri became the second state to adopt Medicaid expansion during the pandemic—also by ballot vote—in August 2020.

The managed care bidding process has received legal opposition from other entities aside from Aetna. Oklahoma State Medical Association (OSMA) filed an injunction on February 11 to stop the contracts and the Supreme Court has directed OHCA to respond by March 15, 2021.

OSMA’s argument was that the legislature did not sufficiently outline the principles that were to guide the managed care program’s design and implementation and that the OHCA overstepped its authority.