“Horizon just brazenly failed their members and the citizens of New Jersey who pay them,” said Gov. Chris Christie.
Call it late inning political hardball in Trenton’s bare-knuckle budget season. In a hastily-called news conference, Gov. Christie slammed Horizon Blue Cross/Blue Shield — NJ’s largest nonprofit health insurer — for alleged incompetence and putting profit over patients.
Here’s some context: Christie’s spent months fruitlessly pushing to siphon off $300 million from Horizon’s reserves — money to fund his legacy drug addiction treatment agenda. That’s gone nowhere. Today the governor applied leverage stating Horizon’s failed to do its job.
“This was a systemic, not an isolated, set of failures that touched many aspects of Horizon’s Medicaid operations. And because Horizon serves 55 percent of the eligible Medicaid population it impacted nearly the entire Medicaid program as well,” Christie said.
The governor says New Jersey’s Department of Human Services sanctioned Horizon and levied $16 million in fines for alleged non-compliance with managed care contracts, untimely processing of claims, inadequate handling of complaints and inaccurate reporting of information to the state. He also said New Jersey’s Department of Banking and Insurance last fall fined Horizon $55,000 for mishandling claims between July 2015 and March 2016.
“The issue resulted in Horizon’s improper denial of 4,500 claims by home care and hospice patients they were insuring, 4,500 improper denial of claims,” said Christie.
Horizon, an underwriter of NJTV News, admits it had issues switching to a different vendor to process claims, but states “…problems have since been remediated and our current claims payment timeliness complies with both the contract and all state regulations.”
Horizon says Christie’s comments “…strongly suggest that this is further retaliation for Horizon’s unwillingness to submit to his demand for $300 million from the reserves we hold to protect our members and an abuse of power.”
This all played out today as Assembly Democrats caucused to discuss the Legislature’s latest budget proposal. But sources say there’s little appetite for the Horizon deal among Democrats, although it’s still part of the conversation, according to Speaker Vincent Prieto.
“Those are things that everybody knows the governor wants, and everybody knows where I stand on both,” Prieto said.
“I think everything necessarily is on the table. I think that discussions need to be heard,” said Assemblyman Gary Schaer.
These discussions of course occurred within the overall state budget debate, which include a new school funding proposal from Speaker Prieto and Senate President Steve Sweeney. Yesterday they met privately with the governor — who wants his Horizon deal to be part of the package. Horizon today lobbied legislators, calling Christie’s plan to repurpose its reserves a “backdoor premium increase.” And Steve Forbes tweeted Gov. Christie was threatening a budget deadlock over the Horizon proposal calling it “bullying.” Prieto’s spokesman also tweeted Prieto remained opposed to the plan.
Horizon says it will appeal the sanctions. Meanwhile, both parties in the Senate and Assembly caucus tomorrow. The budget’s got to be balanced, passed and signed by June 30. The hardball’s going to get rough.