STATE OF CONNECTICUT

NEWS RELEASE

    Attorney General Richard Blumenthal

Comptroller Nancy S. Wyman

Healthcare Advocate Kevin Lembo

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WEDNESDAY, NOVEMBER 29, 2006

ATTORNEY GENERAL, COMPTROLLER AND HEALTHCARE ADVOCATE WIN FIGHT TO OPEN MCO MEDICAID RECORDS

            Attorney General Richard Blumenthal, Comptroller Nancy S. Wyman and Healthcare Advocate Kevin Lembo today announced that they have successfully defended a Freedom of Information Commission (FOIC) decision ordering Managed Care Organizations (MCOs) to make public reimbursement rates and the frequency in which prescribed drugs are rejected under the state Medicaid program.

            The State Superior Court upheld the FOIC’s order that the information be released pursuant to a complaint by a Yale professor and supported by New Haven Legal Assistance, which alleges that the reimbursement rates are so low that they hinder coverage.

            “The decision upholds the public’s vital right to know how their tax dollars are being spent,” Blumenthal said. “The importance of this ruling is even more apparent in light of an alarming study reported today that reveals grave health care access obstacles for children of low-income families. Rate reimbursement details must be disclosed in order to determine whether MCOs are doing their job as required – ensuring that children are receiving the most basic medical care. Hiring private contractors to perform government services does not preclude the disclosure of public information.”

            Wyman said, “Opening these books will not only place greater scrutiny on these managed care companies, but hopefully will result in better care for patients. Access to this information also lets Connecticut taxpayers know how their money is being spent and allows me to perform my constitutional duty to monitor these funds.” 

            Lembo said, “Without the transparency that flows from this decision, we would never know what percentage of our HMO premium is actually spent on public health care, and what percentage is spent on executive bonuses and overhead.”

            Anthem Blue Cross & Blue Shield, Community Health Network of Connecticut and Healthnet of Connecticut, Inc. appealed to Superior Court FOIC's December decision ordering them to reveal reimbursement rates they pay physicians under Medicaid, the joint state-federal program that provides medical care for the poor.

            The FOI complaint was brought by Yale Professor Kari Hartwig and supported by New Haven Legal Assistance. It alleges that MCO reimbursement rates are so low that most physicians won't treat Medicaid patients for many illnesses, injuries and conditions.

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