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COLUMBUS, Ohio--(BUSINESS WIRE)--Aetna Better Health Inc., an Aetna (NYSE: AET) Medicaid company, has filed a protest of the Ohio Medicaid Managed Care awards announced on June 7, 2012. The protest outlines significant legal issues in the Ohio Department of Job and Family Services’ (ODJFS) decision to cancel its original contract award to Aetna and requests that the ODJFS immediately reinstate the award to Aetna.
Aetna’s protest notes that, after the submissions were all made, and after announcing the original contract award, ODJFS made the decision to retroactively change the definition of certain requirements outlined in its Request For Application (RFA). These changes contributed to the state’s flawed determination that Aetna, a company with over 25 years of experience in the Medicaid business, did not deserve credit for its experience in fully managing Medicaid plans in other states. Aetna provided substantial evidence demonstrating the accuracy and strength of its response to the RFA; however it does not appear that this evidence was factored into the amended contract awards.
In addition, Aetna has learned that representatives of ODJFS had previously undisclosed communications with another bidder after the initial protest period had closed. Aetna’s understanding is that, in these previously undisclosed communications, the other bidder made a number of false and misleading statements about Aetna’s Medicaid managed care experience, to which Aetna was not provided the opportunity to respond by ODJFS, in violation of the express terms of the RFA and state law. Those statements appear to have resulted in the state's decision to reverse its previous award to Aetna.
“It's extraordinary for a state to introduce a new definition or standards after responses have been submitted, much less after awards have been made," said Jan Stallmeyer, senior vice president, Central Region, for Aetna Medicaid. "The hallmark of the Aetna Medicaid approach is to develop innovative partnerships designed to serve the members better. We appear to have been penalized and discredited for our successful approach to collaboration.”
Aetna Medicaid owns and operates fully managed Medicaid plans for states and uses various models for doing so, fitting the model to match the state's needs. The company most frequently uses models that are either fully-owned or fully-managed, in which Aetna assumes the operational and management oversight of the health plan, including the hiring of all health plan employees and the provision of all health plan operational systems.
Aetna is one of the nation's leading diversified health care benefits companies, serving approximately 36.1 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services and health information technology services. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.