Judge Cashes Out Medicaid Managed Care Lawsuit
Cashes Out Medicaid Managed Care Lawsuit
Court Judge Richard Sheward dismissed a lawsuit brought by Aetna against the
Ohio Medicaid program over the Medicaid managed care procurement process. Aetna
originally was given a contract for a portion of the $5 billion business, but
when other plans protested, Medicaid took the award away from Aetna. The main
issue in the lawsuit was whether Aetna had taken full risk in other states, as
the insurer was not in the Ohio Medicaid managed care program in the past.
Judge Sheward, after four days of trial, ruled that Medicaid was correct in
determining that Aetna had not been at full risk. Although the litigation was
over the existing managed care program for Medicaid recipients, it is of
interest because five managed care plans have protested Medicaid’s scoring of
the applications for the dual eligible population under the proposed Integrated
Care Delivery System.