Insurers accuse Texas of improperly choosing health insurance contract winners

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Over half a dozen plans have launched appeals to STAR+PLUS contract decisions.

Texas health insurance contract choices have been placed in the spotlight as insurers accuse the state of making its choices improperly.

The contracts being appealed were chosen for Texas’ privatized program for blind, disabled and elderly residents.

Texas is aiming to award various types of health insurance contract with a total value of about $10 billion. To apply for consideration, applications must take a standardized test-like process and score well. Applicants are health insurers that want to be able to offer products – and collect premiums – for plans covering blind and disabled adults as well as the elderly. This coverage is a component of the Medicaid program.

The applicants spent several months answering the nearly 60 pages of test questions. They questions were comprised primarily of a handful of true-false questions in addition to mainly essay answers. However, according to some of the insurers that took the test, over 30 individuals were involved in the response evaluation. Moreover, the evaluators weren’t in agreement regarding even the appropriate true-false answers, let alone the essay responses that are far more detailed and subjective.

Over half a dozen insurers are protesting the Texas STAR+PLUS health insurance contract awards.

They are appealing the decisions on the grounds that the application process’s test scoring process didn’t make any sense.

“The manner of scoring proposals was irrational, arbitrary, and failed to comply,” with Texas legal requirements, said Amerigroup lawyers. Similarly, the legal team for Cigna argued that the state health commission’s “reliance solely on technical scores was unreliable due to failures of certain evaluators to meaningfully evaluate the proposals.”

This is only the most recent STAR+PLUS controversy in the state government’s efforts to award billions of dollars in coverage and health care contracts.

The insurers are hoping that the Texas Health and Human Services Executive Commissioner Courtney Phillips, will intervene. This will need to happen quickly, as Health insurance contract - Papers - BusinessPhillips has now announced her intentions to resign next month. As of the writing of this article, she has not made any official statement regarding the health insurance contract choices.

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