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State lawmaker asks Pension Benefit Committee to pause change to retirees' healthcare plans

Tom Byrne
Delaware Public Media

State lawmakers met with Delaware’s Pension Benefit Committee on Tuesday to discuss a healthcare change for 25,000 retired public employees.

In February, the state’s Pension Benefit Committee awarded a three-year contract to Highmark Delaware, longtime insurance provider for state employees, to administer a new plan for state retirees known as the Medicare Advantage Plan. The plan would replace retirees’ existing Medicare plan.

Delaware Human Resources Secretary Claire DeMatteis says the plan differs from the existing program in several ways. First, Highmark takes on all risk – risk previously carried by the state.

As a result, Highmark would require pre-authorization for some non-emergency treatments, determining whether a procedure is medically necessary; DeMatteis says that is standard for other state insurance plans.

“We’re telling Highmark, ‘you need to have skin in the game'," she said. "We need to hold you, as a provider, to a standard that says the care is going to be medically necessary.”

She adds the switch will cut monthly premiums in half, and that the new plans can cover some services, including meal deliveries for those recovering after a hospital stay.

But state Rep. John Kowalko raised concerns, prompting Tuesday’s meeting where Kowalko urged putting the new contract on hold. He says it would privatize public employees’ insurance, and lead to more retirees having treatment requests denied.

“The decisions that are being questioned, as far as access or tests or procedures, will now be determined by a private insurer, even if it conflicts with a Medicare plan," he said.

DeMatteis says that worries about an increase in service denials are misplaced, telling lawmakers Tuesday that the denial rate for Medicare Advantage is roughly 8%, and those denied care can appeal. Kowalko argues an 8% denial rate is still concerning.

He has urged the committee to pause the switch and give retirees the option to remain on their current plan for an additional fee; he says that the current plan, although more expensive, offers simpler access to care for older retirees and those with chronic or serious health conditions.

The new plans are slated to take effect on January 1.

Paul Kiefer comes to Delaware from Seattle, where he covered policing, prisons and public safety for the local news site PubliCola.