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The Honolulu Advertiser
Posted on: Tuesday, February 23, 2010

Ruling reaffirms QExA program


Advertiser Staff

The state has won another round in court involving its Quest Expanded Access health care program.

Last week the Hawaii Coalition for Health lost its appeal at the U.S. 9th Circuit Court of Appeals of a dismissal of a lawsuit that sought to stop the implementation of Quest Expanded Access, or QExA.

The lawsuit which was filed by the coalition, a doctor and health care provider group sought among other things to block the award of QExA to two Mainland health plans because it claimed the state did not have adequate assurances about the plans' ability to deliver services.

"The Ninth Circuit Court of Appeals has affirmed the decision of Judge (J. Michael) Seabright dismissing the claims brought by the Hawaii Coalition for Health in the second of the three federal court cases that were filed to stop the QExA program," state Department of Human Services Director Lillian Koller said in an e-mail statement.

"The Court issued its decision without oral argument."

The ruling was a setback for opponents who fought the award of the $1.5 billion in contracts to units of UnitedHealth Group Inc. and WellCare Health Plans Inc. Another case filed by AlohaCare, a Hawai'i health plan that sought the contracts, was also dismissed by courts.

The Health Coalition lawsuit was dismissed in August 2008 in U.S. District Court in Honolulu by Judge J. Michael Seabright, but later appealed to the 9th Circuit.

Rafael del Castillo, an attorney representing the coalition, acknowledged the group had lost the ruling, but said a similar case filed by 11 patients involving the state's QExA program was proceeding toward trial in U.S. District Court.

He said some patients are still not receiving care they were entitled to under the program.

QExA involves Medicaid coverage for more than 37,000 aged, blind and disabled people who were transfered into a managed-care program after receiving treatment on a fee-for-service basis.