HARTFORD, Conn. - Now that a legal aid attorney has requested information from a Medicaid provider, and Connecticut's Department of Social Services has agreed to release it, state Attorney General Richard Blumenthal has said he will do whatever he can to make sure it is made public.
New Haven attorney Sheldon Toubman, a member of the New Haven Legal Assistance Association, requested the information. He claims it is necessary to determine if the four HMOs contracted by the state to provide Medicaid services are following the proper standards, according to a report in the Hartford Courant.
The report adds that Blumenthal told DSS Commissioner Michael Starkowski that he will defend the agency in court if the move is challenged.
"I am troubled by indications that Medicaid HMOs may apply unauthorized, unduly restrictive criteria to deny care in violation of state law," Blumenthal said. "I have asked the governor and the Department of Social Services twice since November to require Medicaid HMOs to reveal their definitions of medical necessity. I urge them to seek this vital information, assuring that HMOs adhere to their state contracts and Medicaid clients receive treatment required by law."
The four HMOs under contract with the state are WellCare, Anthem, Health Net of the Northeast and Community Health. Those four companies spent $722 million in state funds last year, the report says.
It is WellCare's information that will be released.
According to the report, Toubman thinks the HMOs have created their own guidelines on what constitutes Medicaid treatment.
"State law sets the 'medical necessity' standard that Wellpoint and other HMO contractors must follow," Blumenthal said.