For the first time, Georgia leaders are devising a program that could expand Medicaid to more poor people under the Affordable Care Act and bolster the act’s insurance exchange. Consultants will research the most effective ways to do that — a $2.6 million job funded by a special line item the Legislature inserted into the state budget this year.
It’s an important job never before done in Georgia.
But not every consultant can bid for the work.
Citing the need for speed, the Kemp administration, through the Department of Community Health and the Department of Administrative Services, has chosen a different path. It invited six vendors to apply, and it will not advertise the contract for open bidding.
Instead, the agencies say, this is not really a new contract. By their reasoning the six already won an open-bid contract, back in 2016: to join a list of vendors approved for the state’s ongoing administrative needs, such as reducing costs, setting goals and streamlining office processes.
Not only were the vendors on that list not vetted for a specific job like this one, it wasn’t even a possibility. Throughout that time, the governor was legally prohibited from applying for an ACA Medicaid waiver.
The decision has left a number of companies who have done such work across the country closed off from the opportunity. Some were surprised to learn they couldn’t bid.
“I have no doubt that Navigant would have qualified to be on the list,” David Mosley, a managing director with the consulting firm Navigant, told The Atlanta Journal-Constitution the day the governor’s office made the procurement details public. “I wasn’t aware that the list that’s referenced existed.” Indeed, he found that initially the contract wasn’t searchable on the Department of Administrative Services website.
State officials have noted that such companies are still able to be included in bids as subcontractors of the bidders.
Common system, unique twist
Procuring services is where government decides how taxpayers’ money can be paid out to private companies and individuals. The state has laws and rules about how procurement should go, and violating them can be a crime.
Contract experts interviewed by the AJC said the DCH has a lot of leeway.
But some asked whether it’s the best system. The speed with which the process is moving is dictating the choices the government will have, said Marc Pfeiffer, a senior policy fellow in Rutgers University’s Bloustein Local Government Research Center. Another factor is that companies change over the years, and since 2016 some have acquired new services that could now make them qualified.
“Do you want to get something that’s OK?” asked Pfeiffer, who said all six bidders are nationally known consultants probably capable of doing an adequate job. “Or do you get something that’s the best you could do for something this significant?”
Looking at the contract documents and their tight deadlines for the work to get done, he said, “I think the time frame is really hard.”
An open-bid process takes months. It typically includes a period for advertising the bid, making sure potential bidders can know about it whether they have personal connections in government or not. Then there can be several steps for prequalifying bidders, then selecting the most qualified to submit actual bids.
Gov. Brian Kemp signed into law Senate Bill 106, authorizing the health care waivers, on March 27. The consultants competing for the job are in interviews this week, and the state will choose a winner after they conclude Friday. The posted schedule calls for the consultant's work to begin Saturday.
They are to deeply research the state’s health care demographics and possibilities, propose three possible plans for each of the two waivers, and help the state to send a complete proposal to the federal government by the end of this year.
The state, its consultants and the federal government would then work through the application in 2020.
The Department of Administrative Services referred questions about the reasons for this process and schedule to the DCH. Both the DCH and the governor’s office declined to comment.
Several factors make speed a priority.
The Kemp and Trump administrations appear generally aligned on the desire for a conservative framework to the waivers, but there is no guarantee that after the 2020 presidential elections Kemp will still have a conservative partner in the White House. The Kemp and Trump administrations have been in close contact throughout Georgia's development of its waiver idea, and Kemp has even had discussions with the key Trump official in the process, Seema Verma, the administrator of the Centers for Medicare and Medicaid Services.
The Kemp-Trump partnership is essentially written into law. The law passed by the GOP-led Legislature cancels the Georgia governor’s ability to apply for a Medicaid waiver after June 30, 2020, before Trump’s first term ends.
In addition, health care was a weapon for Georgia Democrats in the 2018 elections, and it won't hurt to have a high-visibility GOP health care program launching in the midst of the 2020 election season.
A big important job
The chosen consultant’s research and conclusions will guide Kemp to make decisions that could help broad swaths of the state — or not. They could determine some nuts are still too tough to crack and keep the program small.
All six consultants invited to apply are big, well-known companies: Accenture, Deloitte, Ernst & Young, KPMG, McKinsey, and Public Consulting Group. The state would not say how many had chosen to apply. State officials said they had chosen the six as the ones on the list who had experience in the waiver field.
Many even advertise that fact, such as Deloitte, which hosts a webpage dedicated to Medicaid waivers and trends. Deloitte also contributed heavily as a company to GOP leaders in the 2018 elections, donating the maximum of $6,600 to Kemp in the general election. Most of the companies had individual employees who made donations to various candidates, including Stacey Abrams, but not donations as companies.
Pfeiffer said the requirements laid out in the procurement documents are detailed and well done, and the key now to make the schedule will be to manage the consultant.
In his original statements initiating the process, Kemp said he just wants a quality product.
“By leveraging the private sector to develop waivers, Georgia will lead the way in health care innovation,” he said. “As we move into the next phase of this process, we will continue to work closely with federal officials to develop the best options for Georgia patients and families.”
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