Montana, one of nearly a dozen states with a fully government-run Medicaid program, has hired a new Medicaid director who oversees managed-care programs in Iowa and Kansas and championed the idea of working outside agencies.
Mike Randall took over as head of Montana’s Medicaid program on May 31, which serves 280,000 people who live in low-income families or have disabilities in a state of 1.1 million people. The program has an annual budget of about 2.3 billion, with the federal government raising about 80% of the total.
Randol was most recently an executive at Cerner Corporation, which provides health information technology services. Previously, he led Medicaid programs in Kansas and Iowa, both employing national management agencies to manage benefits for state employees rather than doing it.
“I am a firm believer in managed care,” Randall told reporters in 2019 when he defended the Iowa program at a news conference and the state announced an annual growth rate of 8.6% for both of its management firms.
Montana Health Department spokesman John Ablet Randall’s appointment signaled that Montana was planning to privatize the management of its Medicaid programs.
Adam Meyer, director of the Montana Department of Public Health and Human Services, said in a statement that he looks forward to working with Randall to provide better services to Montana Medicaid recipients. “Mike is a proven leader with vast experience overseeing the state Medicaid program,” Meyer said.
The health department declined Meier and Randol’s request for an interview. Ablet declined to provide a copy of Randall’s application for the job, saying the documents were confidential.
Managed Care gained a bad reputation in Montana after the state contracted with an outside company to manage Medicaid-covered mental healthcare in the 1990s. After complaints from many patients and providers, and the company, Magellan Behavioral Health, reduced the provider’s rate to cover millions of dollars in losses in the first year, the state finally regained management. In 2011, widespread opposition led the state to scrap plans for a five-county-run Medicaid pilot program.
Under managed Medicaid, state and federal governments pay a certain amount of money to insurance companies for each enrolled person to cover healthcare services. If companies can do this for less money than they pay, they pocket some difference as profit. According to the KFF, all but 11 states, including Montana, have privatized at least part of their Medicaid programs.
Randall became director of Medicaid in Kansas in 2012, the year before his program was privatized. Proponents of her case have been working to make the actual transcript of this statement available online. Proponents of her case have been working to make the actual transcript of this statement available online.
Iowa Gov. Kim Reynolds, a Republican, hired Randall in 2017. His arrival in Des Moines came almost two years after Iowa switched to a private Medicaid management system, which was plagued by allegations that people with disabilities in Iowa were not properly cared for and that management companies lost millions of dollars in the early years.
When Reynolds resigned in 2020, Reynolds praised his services: “I am grateful for the work I have done, not only to stabilize the program, but also to improve the system, to incorporate technology, and to lay the groundwork for progress.”
Dave McMahon, an Ivan who became a vocal critic of Medicaid privatization because of his family experience, said that if he had lived in Montana, he would see Randall’s appointment as a sign that the state wants to outsource its program to operating agencies. “His record speaks for itself,” he said.
Weak Montana residents who rely on Medicaid could face major disruptions if the system is privatized, McMahon said. “Their service, the people they depend on to help them – everything will change,” he said.
McMahon said that when Randall was in Iowa, he loved quoting statistics and talking about algorithms. But, he said, he seemed upset when members of the public made changes to Medicaid affecting people.
McMahon’s 41-year-old daughter, Annie Stender, has an intellectual disability and uses Medicaid-funded services. Prior to the privatization of the Iowa Medicaid system, Stender was the same case manager for 15 years, McMahon said. That person knew him well and helped him navigate the array of services
But under private Medicaid management, Stender has been assigned several case managers. “We lost that bond,” McMahon said. “We lost that person in our lives.”
Mary Windecker, executive director of the Montana Behavioral Health Alliance, said Randall’s past in Kansas and Iowa “doesn’t give us a really warm, vague feeling.”
Windecker said he was concerned that managed-care returns would lead to lower compensation rates for medical providers. He said he would be surprised if Montana did not consider some kind of privatization, partly because some other states did. “What we expect is that, regardless of which model the state sees, providers will be on the table,” Windeker said.
Randol is coming before a comprehensive review of Medicaid enlistment qualifications for the program. Enrollment has steadily increased since the epidemic began, and the Federal Public Health Emergency Routine Review imposed during the Covid-19 epidemic has been suspended. Once the emergency order is completed, some of Montana’s beneficiaries will experience further eligibility verification to maintain their coverage in the future.
Health lawyers say those who meet the coverage requirements may inadvertently be excluded from the process.
Heather O’Loughlin, co-director of the Montana Budget and Policy Center, said that with the new leadership taking over, she hopes the priority will help people maintain access to their coverage. “This is not a time for political ideology, this is an opportunity to listen to healthcare providers, tribal leaders, rural residents and those who are facing obstacles in healthcare to ensure this transition is as smooth as possible,” O’Loughlin said in a statement.
State legislators are also reviewing the rate of Medicaid delivery in Montana in response to the shortage of providers and services, ranging from mental health systems. Healthcare providers have long argued that Medicaid pays much less than operating costs. A program-wide review is expected to take several years.
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