Indiana company quits Missouri Medicaid contract

An Indiana company hired to assess the needs of thousands of Missouri Medicaid patients has quit after barely three months on the job following numerous complaints about its service and disagreements with state officials.

The CEO of SynCare LLC said Thursday that the contract she viewed as a mission to help the disabled and elderly had become a public relations debacle -- in part because of the state's actions -- and was no longer worth continuing.

State officials countered that SynCare had failed to live up to the contract -- worth up to $5.5 million annually -- to determine whether Medicaid recipients qualified for home-based health care and help with performing daily activities such as cooking, bathing and getting dressed.

The Missouri Department of Health and Senior Services said Thursday that it will immediately begin taking over the duties that were supposed to be performed by SynCare, which so far had been paid $1.3 million. The agency previously handled the state's caseload before hiring a private company.

"We are overjoyed," said Donna Thompson, the director of personal services at SEMO Alliance for Disability Independence in Cape Girardeau. "We've been advocating this for several weeks. It's been a long journey."

Patients, home care providers and advocates went public this week with their complaints. On Tuesday, more than 50 gathered at SADI's office for a news conference to get the word out about their displeasure. Similar conferences were held Tuesday in four other cities across the state.

For now, Thompson said service providers have been instructed to wait for the next few weeks for instructions about what will happen next. Thompson doesn't know whether the state will opt to come back to providers for assessments as has been done in the past or try to find another third-party assessor.

"But anything is better than what we've had, because that was horrible," she said. "Now SADI will have to roll up our sleeves and sort through the mess to make sure that our consumers are getting the services they are qualified to receive."

The quick end to the contract marks a setback for Missouri, which hired SynCare under a 2010 state law that had been intended to save the state money and avoid potential conflicts of interest in which home care providers also conducted the assessments of the amount of care clients needed. SynCare, based in Indianapolis, was selected to make independent determinations about the in-home care needs of patients.

On its first day of work in mid-May, SynCare's customer call center was overwhelmed by about 1,000 telephone calls, resulting in unusually long waits for patients and care providers dialing in. During the ensuing months, complaints also were raised about delays in receiving service.

Patients and advocates held news conferences around the state Tuesday alleging that SynCare staffers were unprepared, overwhelmed and poorly trained. On Wednesday, members of a Missouri House committee grilled state health department officials about the contract with SynCare.

SynCare CEO Stephanie DeKemper said she had discussions late into Wednesday night with state health department officials about potential contract changes. Ultimately, DeKemper sent the agency a letter withdrawing from the contract, and the department responded with a 10:20 p.m. Wednesday email acknowledging company's decision.

"This was as much a mission for us as it was a contract to deliver services. We really had a heart for the participants," DeKemper said Thursday. But "we came into an environment that was controlled by providers and a contract that, was obvious to us, was not going to be given an opportunity to work itself out through normal processes."

Health Department director Margaret Donnelly said Thursday that the agency had been preparing to fire SynCare.

"SynCare sent us the letter knowing that we would be terminating the contract," Donnelly said. She declined to elaborate on the specific reasons why the state would have cut ties with SynCare but said in a written statement released earlier Thursday that the company "is not able to meet the terms and conditions of their contract."

"We're working as quickly as we can to get people the services they need and to transition SynCare out of the contract," Donnelly said.

State Rep. Ryan Silvey, R-Kansas City, claimed the contract was ended as a direct response to the tense hearing held Wednesday by a budget transparency committee for which he is chairman.

"This has been a disaster since day one and I will be demanding that the department take any measures necessary to make the Missouri taxpayer whole," said Silvey, adding that he hoped the state would quickly find another contractor.

State Rep. Tom Flanigan, R-Carthage, who is chairman of a House committee that handles the health department budget, said Thursday that "it became increasingly evident that this contract needed to be terminated."

DeKemper said it was unfair to pin the problems solely on her company. She said that when the contract began, state officials advised the company it would need 20 people in a call center and 110 employees in the field to perform care assessments for patients. After the call center got repeatedly overwhelmed, she said the department only belatedly agreed to allow a change in the company's staffing levels.

It was only recently that the call center had been built up to 60 employees and the field assessment staff had been reduced to 57 people, and not enough time had passed since then evaluate the success of the changes, DeKemper said.

Donnelly declined to comment on DeKemper's assertions about the state's staffing guidance.

In its first 75 days, SynCare handled more than 73,000 telephone calls and conducted more than 11,000 in-home care assessments, DeKemper said.

"We were implementing the contract," she said, while acknowledging there were some glitches. But "it was handled publicly very wrong [by the state] and it wasn't given an opportunity to work itself out."

Staff writer Scott Moyers contributed to this report.