D.H.S. Says Medicaid Contract With VI Equicare Has Been Executed; Others Still Pending

ST. CROIX — Department of Human Services Commissioner-Designer, Anita Roberts, told this publication on Monday that the department has been working tirelessly to ensure that the Medicaid — called Medical Assistance Program or MAP in the territory — contract with VI Equicare was executed, and expressed disappointment in Senator Nereida Rivera-O’Reilly’s harsh criticism of the process.

The D.H.S. Bureau of Health Insurance and Medical Assistance is the division responsible for administering Medicaid in the Virgin Islands. But for reasons unknown, the government has been slow in approving multiple contracts, according to Mrs. Rivera-O’Reilly.

Ms. Roberts chided Mrs. Rivera-O’Reilly for “not doing her due diligence,” while calling the senator’s reaction “disturbing.” Ms. Roberts said that under her leadership (she refused to respond to problems that might have been caused by the prior leadership), D.H.S. employees have been working overtime to ensure that MAP beneficiaries would not experience any lulls in receiving care. Ms. Roberts also expressed concern over the federal government’s perception of the territory’s handling of federal dollars. “They are looking at us, they are reading this,” she said.

Emails between Mrs. Rivera-O’Reilly, Department of Justice and D.H.S. officials, to including Ms. Roberts, obtained by The Consortium revealed that many Virgin Islands residents who depend on MAP, had been unable to receive medical care because a number of Virgin Islands physicians, to include those who are part of the VI Equicare team, as of Friday, had yet to receive approval for their MAP provider agreement.

Founded in 1997, VI Equicare is the largest independent preferred provider organization in the U.S. Virgin Islands, with a goal to increase the availability of affordable healthcare in the territory, according to a blurb on the About Us page of the firm’s website. Furthermore, the company provides a single contracting authority for a wide range of medical initiatives for insurance carriers, third party administrators, employers, and the cruise line industry. Within its network of healthcare providers, VI Equicare performs a number of service and organizational functions including credentialing, education and information, quality assurance, and communication, according to information on the company’s website.

On Monday, however, Ms. Roberts said the VI Equicare contract had been executed.

“The contract has been signed and executed,” Ms. Roberts said. “And you have to ask yourself why would a person put that kind of information out there. What is the motive?” Ms. Roberts called herself a “tyrant,” referring to her ability to be consistent in making sure that contracts are signed. She said when she realized the importance of the VI Equicare contract, including the vast amount of people that the firm services, it was the first item on her list when she became commissioner-designee.

Mrs. Rivera-O’Reilly, resigned from Ms. Roberts’s frustration, told The Consortium on Monday that she was pleased to hear that VI Equicare’s contract was now in place, “but the truth of the matter and the reality is, as of last week, VI Equicare wasn’t aware that the contract had been executed, and that is obvious from the emails that I got back.”

Ms. Roberts said she would contact VI Equicare to better understand what might have caused the issue, and respond further to this publication. She later said that she called, left a message, and would respond to The Consortium once she was able to make contact with officials at VI Equicare. At time of publishing, however, we had not yet heard from the commissioner-designee.

“The point I was really trying to make was why do we have a doctor who applied in February of 2016, still waiting to be accepted as a MAP provider?” Asked Mrs. Rivera-O’Reilly. “That same doctor’s office, as of last week, was still waiting and could not see any patients. And it’s not like we have neurologists falling over each other here. So the whole point of my inquiry was why is it that this doctor’s application to be enrolled in MAP has been taking this long,” the veteran senator added.

Mrs. Rivera-O’Reilly was referring to Dr. Luis A. Frias, who works out of Dr. Kendall Griffith’s cardiovascular operation.

Mrs. Rivera-O’Reilly said her inquiries revealed that the contract was “in limbo” somewhere, and it wasn’t clear whether it was at Government House, Property and Procurement or at D.H.S. “People need to take responsibility,” she added. And in response to Ms. Roberts’s decision not to comment on problems she met at D.H.S., Mrs. Rivera-O’Reilly said: “I may not be responsible directly for something that happened in my office, but at the end of the day it’s stuck with me. And so I am not one that passes the buck; I take responsibility and I correct it.”

In the emails, Mrs. Rivera-O’Reilly roasted government officials for their seeming negligence, and demanded speedy action. “Sick people relying on MAP get sicker because their government has no sense of urgency. What is the written procedure governing the processing of contracts? Who keeps track of the date it was written, reviewed, revised, signed, and moved from one government dark hole to the next? Folks we are doing our people a disservice. It is never a holiday for elected officials,” she demanded. “Either do your job or move aside and let someone else capable and willing do it. I am tired of hearing the same complaints and excuses. I need a response,” she later added.

On Monday, the senator said she was relieved to hear that progress had been made: “I’m glad that, according to them, the contract is in place so that’s all that matters. Now, let’s make it work.”

Feature Image: From left to right: Anita Roberts, Senator Nereida Rivera-O’Reilly. (Credit: VI Legislature)