Losing bidders accuse state officials of mishandling Medicaid contracts

The companies also accuse the department of withholding documents that it should have produced under the state’s transparency laws.

At stake, they say, is the fairness and legality of doling out a major state contract.

“The State’s procurement was mismanaged, rife with errors and reckless practices,” Peach State said in a December letter protesting the decision.

State officials contacted by The Atlanta Journal-Constitution did not address the allegations or say whether the contract would be rebid, citing the pending procurement process.

Carlson, who recently left his job with the state for an outside position, did not answer AJC reporters’ questions about the contract. In a joint statement, he and DCH said his departure was unrelated to the contract.

Georgia insures about 2.3 million people under Medicaid, a state-federal health insurance program for poor children and some poor, elderly and disabled adults. Since 2006 Georgia has outsourced the operation of the critical program to private health insurance companies under a handful of contracts.

Credit: Courtesy photo

Credit: Courtesy photo

In December, DCH awarded the contracts to four companies: CareSource, Humana Employers Health Plan of Georgia, Molina Health Care and United Health Care of Georgia. But those companies have not taken over the work while the protest plays out.

Whichever companies ultimately end up with the contract will be responsible for signing up doctors and hospitals to the company’s Medicaid plan, writing the checks for patient care and coordinating care for patients.

Amerigroup and Peach State Health Plan have held those contracts since the outsourcing began in 2006. Amerigroup manages the Medicaid insurance for about 460,000 Georgians, and Peach State Health Plan does it for about 700,000. The contract includes children in foster care as well as adult Medicaid recipients.

A third company, CareSource, covers 380,000 Georgians under the current contract. That company was selected to continue with the state and is not part of the protest.

Peach State alleges Carlson texted with a lobbyist for one of the competing bidders and offered to call him about the timing of the award. The contracting process was at that moment still in a “blackout period,” the complaint claims, meaning state officials were forbidden from discussing the contract with any of the bidders except through designated intermediaries.

In addition, the insurance companies allege the DCH violated the Georgia Open Records Act by failing to produce any text messages until prodded by a court filing, and then producing so few that the company says it was not a good faith effort.

Credit: Georgia House of Representatives

Credit: Georgia House of Representatives

As part of its protest, Amerigroup has accused Candice Broce, the commissioner of the Department of Human Services, of smearing its reputation and scapegoating the company. DHS is separate from DCH and determines eligibility for Medicaid. Amerigroup had sought to win a separate Medicaid contract that would allow the company to manage health care for children in foster care or otherwise under state custody.

The company referenced a letter Broce wrote to then-DCH Commissioner Caylee Noggle saying, “Amerigroup is often difficult to reach, even during normal business hours” and providers complain they do not get paid in a timely manner, prompting many to leave the network.

The state has postponed the contract start date until to 2026 while the protest plays out.