Government Accountability

The National Health Law Program, with the support of the Nathan Cummings Foundation and the Public Welfare Foundation, launched its Sunshine and Accountability Project in the fall of 2008. The project is to monitor how state and federal governments use taxpayer funds that have been appropriated for health care, and to engage in aggressive, systemic, consumer-based advocacy to hold government and their contractors accountable for how they use public funds.

Through the project, we have collected and analyzed publicly-available information about Medicaid managed care. Working with partners in Connecticut, Florida, Missouri, New Mexico, Virginia, and Washington, we obtained data and information from the state’s Medicaid agencies and private managed care organizations participating in Medicaid. Reports detailing and analyzing this information, as well as issue briefs and analysis of Medicaid managed care and the legal requirements for making information publicly available, are available through this page. Advocates seeking to replicate these activities in other states will find the necessary tools here.

For further information and assistance in obtaining this information in your own state, contact us at nhelp@healthlaw.org.

Background on the Sunshine and Accountability Project

• State Partners
• Report: The Pursuit of Medicaid Managed Care Quality Information in Six States (Jan. '10)

Background on Medicaid Managed Care Quality
and Legal Requirements for Publicly Available Data

• Accountability and Transparency in Medicaid Managed Care (Dec. '12)
• Medicaid Sunshine and Accountability: Listing of Requirements for Information (Jan. '10)
• 2008 CAHPS Health Plan Survey Chartbook (Oct. '08)
• External Quality Reviews in Medicaid Managed Care (June '08)

State Reports and Data

• Medicaid Managed Care Quality: HEDIS Measure Comparisons for Five States (Jan. '10)
• California Medi-Cal Managed Care Quality Information
• Medi-Cal Managed Care Enrollment/Disenrollment Reports
• Florida Medicaid Managed Care Quality Reports
• Florida HEDIS Measure Data 2005-2007 (Microsoft Excel)
• Cost Savings By Eliminating MCOs: Oklahoma's Medicaid program shifted from capitated managed care to primary care case management, saving money and improving care. The attached reports and presentation explain how:
  • SoonerCare 1115 Waiver Evaluation: Final Report Part 1 | Part 2
  • SoonerCare 1115 Waiver Evaluation: Presentation to Oklahoma Health Care Authority Board
  • SoonerCare Choice: Oklahoma’s PCCM Program (PowerPoint Presentation)
• New Mexico Medicaid Managed Care Quality Reports
• Virginia HEDIS and CAHPS Data (Microsoft Excel)
• Washington Medicaid Managed Care Quality Reports

Issue Briefs and Reports

• Issue Brief:  Obtaining Information About Medicaid Prescription Drug Denials  Prepared by the NHeLP Sunshine and Accountability Project (Feb. '10)
• GAO: Promoting Accountability and Transparency in Government (March '09)
• Q & A: Due Process: Issues with Private Contractors (Oct. '08)
• Q & A Preparing for Discovery of Electronically Stored Information (Sept. '08)
• Q & A: Fee Waivers for Freedom of Information Act Processing (Sept. '08)
• Items of Note from Kaiser Report on Medicaid FY 2008 and 2009 (Sept. '08)
• Q & A: Obtaining Documents Through the Recently-Amended Freedom of Information Act (March '08)
• CAHPS: Assessing Health Care Quality From the Patient's Perspective (Sept. '07)
• NHeLP 2001 Report Money - Money Talks: The Politics of Health Care

Litigation

• Federal Court Orders Disclosure of Medicaid Managed Care Treatment Guidelines:
  • Press Release
  • Court Order in Salazar v. D.C.
  • Memorandum Opinion: Motion for Reconsideration granted in part and denied in part; Motion for Protective Order granted in part and denied in part (Nov. 12, 2010)
  • Order: Motion for Reconsideration granted in part and denied in part; Motion for Protective Order granted in part and denied in part (Nov. 12, 2010)
• Connecticut Court Decision on FOIA Access to Medicaid Managed Care Plan Information

Accountability in the News

• AG Under Fire in WellCare Case (Oct. '10)
• Unsealed Federal Complaint Slams Florida Medicaid HMO (June '10)
• WellCare Charged with Fraud
• 2008 Presidential Race Health Industry Contributions
• Industry's Role in Hypertension Definition (May '06)
• Conflicts of Interest at Drug Advisory Committee Meetings for the FDA (April '06)
• Pharmaceutical Industry Puts $44 Million into State Lobbying (April '06)
• Decision of Connecticut Freedom of Information Commission Regarding Access to Managed Care Organization Records (Dec. '05)
• Performance Standards for Serving People with Disabilities and Chronic Conditions (Nov. '05)

• Assuring Accountability and Stewardship in Medicaid Managed Care
• D.C. Medicaid and Private Contractor Must Reveal Their Criteria for Determining Home Health Care Eligibility
• Decision of CT Freedom of Information Commission Regarding Access to Managed Care Organization Records
• Q & A: Assuring Accountability and Stewardship in Medicaid Managed Care: Public Reporting Requirements for States and MCOs
• Items of Note from Kaiser Report on Medicaid FY 2008 and 2009 (Sept. '08)
• Q & A: Publicly Available Data in Medicaid Managed Care (June '07)
• The Auctioning of the Public's Health (August '00)