Delaware Is Latest State to Face Retiree Pushback on MA Transition

by Lauren Flynn Kelly

 

A newly formed retiree advocacy group called RISE Delaware has filed a lawsuit to stop the “unilateral implementation” of a private Medicare Advantage plan that will replace state retirees’ current health care coverage in Delaware. The plan’s opponents maintain that it was established by the State Employee Benefits Committee (SEBC) in a clandestine manner without proper input from stakeholders and without consideration for a suitable alternative proposed by a separate committee.    Advocates worry about prior authorization  Highmark Blue Cross Blue Shield of Delaware in February was awarded a three-year contract to serve some 30,000 retired state employees. Highmark currently contracts with the state to offer a Medicare Supplemental retirement benefit.  Beginning Jan. 1, the state intends to offer one Medicare plan option, Highmark’s Freedom Blue PPO MA plan, with Part D prescription drug coverage provided through SilverScript.  According to a slide deck from a September town hall held by the state and Highmark, the new plan has been “specifically designed to provide the same coverage as the old plan” and features added benefits.  But advocates are concerned about the “extensive list” of services that can be subject to prior authorization in MA and worry that retirees will be limited to a specific network of doctors, unlike with their Medicare Supplemental coverage.   Lawsuit alleges move could delay care  The lawsuit, filed on Sept. 25 in the Superior Court for the State of Delaware, cites survey data from the American Medical Association reporting that 93% of physician-respondents said prior authorization requirements caused delays in necessary treatment and a recent HHS Office of Inspector General report indicating that 75% of MA denials that are appealed get reversed.  The plaintiffs also allege that the SEBC did not follow procedures required for an open government or seek input from the affected parties when deciding to overhaul retirees’ health care benefits, and that communications to retirees about the change have been “at best, confusing and misleading.”  NYC remains committed to MA transition  The lawsuit echoes a similar case in New York City, where Mayor Eric Adams (D) is reportedly working out a deal with union representatives to salvage the planned switch to MA coverage for retired municipal workers.  The city’s plan to switch to a private plan managed by Anthem, Inc. was expected to save up to $600 million annually and begin on April 1. But retirees petitioned to block the move, and Supreme Court Judge Lyle Frank in March ruled that the proposal violated city law by requiring retirees who opted out of the switch to pay $191 per month to maintain their fee-for-service coverage.   Elevance Health, Inc. (formerly Anthem) in July backed out of the deal.   According to a report from nonprofit news organization The City in partnership with New York Focus, union leaders agreed to a proposal from the administration to jointly request an amendment to city law allowing the city to charge retirees for their current health care coverage.

 

From Radar on Medicare Advantage

 

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