The state's new QExA Medicaid program is being touted to residents through television commercials and direct mail, but apparently it is having a tough time signing up hospitals and others to provide the care.

Only two hospitals have signed up to be part of the program offered through two large health plans, and the number of physicians and other medical service providers is less than hoped as the start of the initiative nears.

"It's time to blow the whistle and relook at this," said Richard Bettini, chief executive of the Waianae Coast Comprehensive Health Center, who questioned why the state was asking Medicaid patients to choose health plans if the insurers are still trying to sign medical and care providers.

"It's a shibai in terms of the market."

Bettini and others testified during a seven-hour briefing at the state Legislature yesterday, during which numerous questions about the program, set to start in February, were raised. An interfaith organization, Faith Action for Community Equity, had pushed for the briefing after voicing concerns about the contracts for the program being awarded to two for-profit insurers from the Mainland, both of which have been accused of fraud in some states.

Critics also raised questions about whether one of the insurers, Wellcare Health Plans, was properly licensed and questioned whether the insurers would deny medical treatments or delay payments.

Rev. Bob Nakata, of the Kahaluu United Methodist Church, gave legislators binders on each company that he said detailed the contractors' business practices and investigations.

"We would ask that you look at these for-profits very carefully," Nakata said.

The state Department of Human Services is rolling out the program after looking for more than two decades for ways to improve delivery of healthcare to more than 37,000 Medicaid clients who are either low-income elders, have permanent disabilities or are blind. It settled on a program that expands the number of services under a managed-care model.

Until now, the Medicaid services have been delivered under a fee-for-services model that allows patients to access medical services on their own. The department said it hopes to improve on that model through managed care and and using healthcare coordinators who work with patients to make sure they get everything they need.

The state hopes the system will improve on the care received by Medicaid patients, and hopes that it may lower costs by decreasing hospital and nursing-home admissions while improving the quality of life for clients.

The estimated $1.5 billion program was awarded in February to 'Ohana Health Plan, a unit of WellCare Health Plans of Tampa, Fla., and Evercare Quest Expanded Access, part of UnitedHealth Group Inc., the largest U.S. health insurer. Yesterday, representatives from both firms said they were making progress signing up physicians, home care providers, nursing homes and hospitals for their provider networks.

Evercare said it had signed up about 1,600 providers, including two hospitals that it didn't name. Wellcare said it had signed up a similar number of providers, and that it hoped to sign its first hospital, The Queen's Medical Center, in the next week or so.

Both said the numbers are below what they'd like to have and that typically, provider numbers rise after such programs begin.

But it remains to be seen how many hospitals will sign up, with Rich Meiers, head of the Healthcare Association of Hawaii, saying hospitals continue to have a difficult time financially, in part because Medicaid reimbursements are below cost, and that every Medicaid patient they serve is served at a loss.

"What we need now is more money in the system," Meiers said.

That sentiment was echoed by Ginny Pressler, executive vice president of Hawaii Pacific Health, whose hospitals include Straub Clinic and Hospital and Kapi'olani Medical Center. She said her company, while supporting the aims of the new program, has yet to sign on as a provider. The Waianae Coast Comprehensive Health Center hasn't signed on, either.

"Given the current level of reimbursement offered by insurance companies, Hawaii Pacific Health may not be able to participate in the QExA program," she said, adding the hospitals will continue to serve Medicaid patients even if the hospitals can't reach agreement with 'Ohana or Evercare.

Dr. Kenneth Fink, who helps run the program for the state, acknowledged the hospital signups were inadequate at this point but said he and the insurers are continuing to talk with them. The Centers for Medicare & Medicaid Services has a say over whether the QExA program starts on Feb. 1, and the state must submit information on it on Dec. 15 for the centers to approve.

He also said the state has built-in monitoring systems to make sure the insurers are paying on time. Both insurers yesterday offered statistics showing they do well in paying reimbursements quickly and would make medical care decisions locally.

"I genuinely believe patients and providers will be better off in QExA than our current fee-for-service program," Fink said.

"I'm hoping that we can continue to work together to make this the best program it can be, if not a model for the nation."