While states like Illinois and Florida have publicly debated cost control legislation this year for troubled Medicaid health insurance programs for the poor and disabled, New Mexico has quietly put its own Medicaid restructuring plan out to bid, without public hearings.

“There is no public comment period for the RFP [Request for Proposals],” Human Services Department (HSD) spokeswoman Betina McCracken told Veritas New Mexico when asked if there would be public input about the  planned restructuring. “I do not know beyond this point.”

Acting state Medicaid director Julie Weinberg will be unavailable to describe the overhaul or bidding process until after a contract has been signed, McCracken said.

“Unfortunately due to the procurement process Julie is not available for an interview,” McCracken said. “That can happen after the procurement process is over.”

Health Action New Mexico Executive Director Barbara Webber is “not sanguine about this process, especially in light of the national effort to dismantle and significantly cut Medicaid,” she wrote in an e-mail.

HSD plans to expand the role of private-sector managed care organizations (MCOs) in the state’s Medicaid program, Webber suspects — though Weinberg “has never said that,” according to McCracken.

More than half of the N.M. Medicaid program budget already goes to private-sector MCOs, the Santa Fe New Mexican’s Trip Jennings has reported.

“Things are always better if they’re done out in the open, and we feel the legislature should be involved,” Health Action New Mexico legislative committee chair Dick Mason said Monday. “I don’t want to infer anything here was not well-intentioned, but when you do something out of the sunlight, without legislative or public input, you have to ask. I assume there will be a series of public meetings.”

The RFP states that after a proposal has been accepted and the contract awarded, the contractor will be expected to”(a)rrange for, conduct and participate in public meetings with stakeholders” and “(d)evelop presentations, information packets and other educational materials for public meetings.”

But since the main components of the restructuring will already be specified in the contract, it is unclear what role public meetings will serve, other than to educate the audience about what’s been decided.

One-month bidding process

Firms had a tight schedule for drafting proposed overhauls to the system. The HSD went out to bid March 14 and proposals were due April 14.

A contract should be signed by May 12, HSD records indicate.

According to the HSD request for proposals, New Mexico seeks a “unique and innovative” plan that will change benefit packages “and their availability to Medicaid enrollees,” and will change cost-sharing responsibilities for enrollees, to achieve cost savings and ensure the system’s “long-term sustainability.”

The federal government covers most of N.M.’s $3.9 billion annual Medicaid program budget, but the state must still come up with $1 billion for its share, each year. More than 150,000 additional residents are expected to join the system by 2014 under the federal health insurance reform law.

Approximately 25 percent of New Mexico households are currently enrolled, state records indicate.

Fourteen firms initially expressed interest in submitting proposals — including health insurance companies with apparent conflicts of interest, like Amerigroup Community Care New Mexico, a Medicaid MCO, and the Lewin Group, a subsidiary of health insurance giant and MCO United Health.

Four firms submitted proposals by the April 14 deadline, according to a HSD document provided by McCracken:

• Alicia Smith & Associates
• JVGA Potentia
• Public Consulting Group
• Practical Government Solutions

McCracken did not provide street addresses or phone numbers for the firms, noting that the procurement process requires HSD to release only names of bidders.

Alicia Smith & Associates of Washington, D.C. already holds at least one contract with HSD, to monitor the state’s directed corrective action plan with its behavioral health contractor OptumHealth New Mexico (owned by United Health). The firm also provides “other technical support” to HSD related to oversight of the state’s behavioral health system, according to a questions-and-answers sheet regarding the RFP.

Alicia Smith & Associates has helped with several states’ expansions of private-sector MCO involvement in their Medicaid programs, including Florida, Georgia, Tennessee and Missouri, according to the company’s website.

Founder Alicia C. Smith, a former Florida state Medicaid director, has also “partnered with private sector providers to improve their position in Medicaid and other health and human services programs,” according to the firm’s website.

The names of those companies are not listed on the website.

Smith did not return a phone call Monday for comment.

According to a website by the same name, Practical Government Solutions is “affiliated with Turner Government Operations and the American Institute for Full Employment.” A company named Practical Government Solutions was registered in Wisconsin April 6, according to a state corporations database. Turner Government Operations is a defunct Wisconsin company, according to the database.

Calls to Practical Government Solutions Chief Executive Officer Jason Turner were not returned.

A company called “Turner & Associates” appears on the HSD’s “potential offerors” list (the list of firms initially expressing interest in the restructuring contract). That firm is based in Milwaukee, Wisc., McCracken confirmed.

But no firm by that name could be found in the state’s corporations database.

The American Institute for Full Employment also appears on HSD’s potential offerors list. The company is based in Klamath Falls, Ore. Executive Director Ted Abram also serves on the board of the FreedomWorks Foundation , a group “dedicated to Social Security reform, repeal of the Death Tax, tax cuts in general, and limiting the size and scope of government,” according to the group’s website.

JVGA Potentia is in the process of reincorporating in Texas after a move from Arizona, according to co-founder John Villegas-Grubbs. The company does not yet appear in Texas state corporations databases.

Villegas-Grubbs and his firm have consulted for Medicaid programs in Washington, D.C., Arizona, Florida, Idaho, Minnesota, and Oregon, he wrote in an e-mail to Veritas NM.

“Ashish Abraham MD, the other co-lead on this project, became a partner of JVGA after serving United Health Group as a Senior Vice President,” Villegas-Grubbs wrote. “He is nationally recognized as a managed care and disease management expert.  And our other (three) principals represent over 100 years combined experience in these programs.”

(Note: Villegas-Grubbs’s e-mailed comments are posted in their entirety in this story’s “comments” section, below.)

Documents cited in this story:

HSD Medicaid redesign project – request for proposals (RFP)

HSD RFP amendments

List of “potential offerors” — firms initially expressing interest

List of firms that submitted proposals by April 14 deadline

HSD RFP questions and answers