In a rare bipartisan move, Pa. legislators decry planned change in Medicaid gatekeeper

Democrats and Republicans in Harrisburg don’t agree on much, but this week at a joint hearing held by four committees, they were united in their dismay over a Wolf administration effort to change who conducts physical assessments of elderly and disabled Pennsylvania residents when they apply for at-home services under Medicaid.

County agencies on aging such as the Philadelphia Corporation for Aging now provide those assessments by the thousands, while Maximus Inc., a publicly traded company based in Reston, Va., collects financial information from individuals and enrolls them in Medicaid if they qualify. The company is getting paid $36 million this year for those services.

Now, the Human Services department, which administers Medicaid, wants to take the contract for physical assessments for home and community-based services away from the local agencies and give it to Maximus, as well. Department officials declined to say how much additional money Maximus would receive under the proposed new contract.

The change, which also would take business away from agencies that serve disabled people, doesn’t sit well with consumer advocates and elected officials, who say they already hear regular complaints about Maximus in its current role. Kansas dropped Maximus from its Medicaid program at the end of the last year. The company has also come under fire in New York and other states.

“We’ve spent millions of dollars on a company that has time and time again fallen short on meeting the individual needs of our loved ones,” State Sen. Michele Brooks, a Republican from Northwestern Pennsylvania who chairs the Health and Human Services Committee, said during opening remarks.

The three other panels were the Senate Aging & Youth Committee, the House Aging & Older Adult Services Committee, and the House Human Services Committee. Republicans control the state legislature.

“The fact that we have never had a joint hearing this large before and with so many members in agreement about the impact this decision could have for our communities underscores our collective resolve to see our commonwealth’s government do better by our constituents,” said State Sen. Maria Collett, a Democrat who represents parts of Montgomery and Bucks Counties and is minority chair of the Aging & Youth Committee.

Neither the human services department nor Maximus, which says on its website that it already conducts similar assessments in 14 other states, testified at the hearing Monday because the department’s award of the assessments contract is under protest by the Pennsylvania Association of Area Agencies on Aging.

After the hearing, officials at the department and at Maximus, which had $3.5 billion in revenue and $214 million in net income in the year ended Sept. 30, 2020, said they could not comment. The stock is up about 15% year-to-date and closed Thursday at $84.60.

Maximus’ performance improved last year, state records show. The company completed processing for 73,611 applications, and 94% of them were done within the expected 90-day window, up from 84% in 2019, according to the state data.

The Human Services department did not act in a vacuum when it hired Maximus five years ago as an independent Medicaid enrollment broker. Federal regulators had urged the agency to separate the enrollment function from the provision of services to Medicaid beneficiaries. The fear was that the local agencies had a conflict of interest because they were doing both at the time.

Financially, the stakes are still significant for the aging agencies. Statewide, the 52 local agencies received nearly $34 million for assessment services. The Philadelphia Corporation for Aging alone was paid $11 million for assessment services in the year ending June 30. Najja Orr, the agency’s chief executive, testified that the nonprofit had $87 million in revenue last year.

JR Reed, executive director of the Lehigh County Office of Aging and Adult Services, testified that losing the revenue from the assessments would cost his agency six case workers — about a quarter of the total — and one supervisor.

The contract, technically a grant agreement, for physical assessments is currently held by the Pennsylvania Association of Area Agencies on Aging Inc., though the work is done by local agencies.

It is common for losing bidders to formally protest contract decisions by the Human Services and other state departments, as the Pennsylvania Association of Area Agencies on Aging did in this case. Since 2015, the Human Services department has been trying to award new contracts for insurers to manage Medicaid benefits that cover physical health, but has been stymied by protests and court losses.

Following protests, the state Department of Health at least temporarily abandoned its plan to award contracts to new local agencies to manage the Special Supplemental Nutrition Program for Women, Infants, and Children, commonly known as WIC, Spotlight Pa. reported Wednesday.

Elected officials at Monday’s hearing heard the excruciating account of Tammy Schwab’s 11-month — and counting — struggle with Maximus to secure home care for her 20-year-old daughter, Teneille, who has physical and intellectual disabilities. The Mercer County woman said the only person she could count on for help was a representative of the Mercer County Area Agency on Aging.

Directors of four area agencies on aging and one county commissioner testified about the problems — delays, lost paperwork, unreturned phone calls — seniors already have with Maximus, even before the company takes on the additional responsibility of physical assessments.

Diane Marseglia, a Bucks County commissioner and social worker by training, said that in addition to performing 3,300 assessments last year, her county’s Area Agency on Aging fielded 842 calls from people asking for help dealing with Maximus.

Reed, from Lehigh County, said at the hearing that a hospice case worker complained that it took six months for one client to get through Maximus and become eligible for hospice care at home.

“Their clients don’t have this amount of time to be without services,” he said.