Molina Healthcare of Kentucky, Inc. v. Anthem Kentucky Managed Care Plan, Inc.

Court of Appeals of Kentucky·Decided September 8, 2022·No. 2021 CA 000806·Unknown

Opinion

RENDERED: SEPTEMBER 9, 2022; 10:00 A.M.

TO BE PUBLISHED

Commonwealth of Kentucky

Court of Appeals

NO. 2021-CA-0806-MR

MOLINA HEALTHCARE OF KENTUCKY, INC. APPELLANT

APPEAL FROM FRANKLIN CIRCUIT COURT v. HONORABLE PHILLIP J. SHEPHERD, JUDGE ACTION NOS. 20-CI-00719 AND 20-CI-00987

ANTHEM KENTUCKY MANAGED CARE PLAN, INC.; AETNA BETTER HEALTH OF KENTUCKY INSURANCE COMPANY D/B/A AETNA BETTER HEALTH OF KENTUCKY INC.; COMMONWEALTH OF KENTUCKY; ERIC FRIEDLANDER, IN HIS OFFICIAL CAPACITY AS SECRETARY OF THE KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES; HOLLY M. JOHNSON, IN HER OFFICIAL CAPACITY AS SECRETARY OF THE KENTUCKY FINANCE AND ADMINISTRATION CABINET; HUMANA HEALTH PLAN, INC.; KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES; KENTUCKY FINANCE AND

ADMINISTRATION CABINET; UNITEDHEALTHCARE OF KENTUCKY, LTD.; AND WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC. D/B/A WELLCARE OF KENTUCKY, INC. APPELLEES

AND

NO. 2021-CA-0819-MR

HUMANA HEALTH PLAN, INC. APPELLANT

APPEAL FROM FRANKLIN CIRCUIT COURT v. HONORABLE PHILLIP J. SHEPHERD, JUDGE ACTION NOS. 20-CI-00719 AND 20-CI-00987

ANTHEM KENTUCKY MANAGED CARE PLAN, INC.; AETNA BETTER HEALTH OF KENTUCKY INSURANCE COMPANY D/B/A AETNA BETTER HEALTH OF KENTUCKY INC.; COMMONWEALTH OF KENTUCKY; ERIC FRIEDLANDER, IN HIS OFFICIAL CAPACITY AS SECRETARY OF THE CABINET FOR HEALTH AND FAMILY SERVICES; HOLLY JOHNSON, IN HER OFFICIAL CAPACITY AS SECRETARY OF THE FINANCE AND ADMINISTRATION CABINET; KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES;

KENTUCKY FINANCE AND ADMINISTRATION CABINET; MOLINA HEALTHCARE OF KENTUCKY, INC.; UNITEDHEALTHCARE OF KENTUCKY, LTD.; AND WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC. D/B/A WELLCARE OF KENTUCKY, INC. APPELLEES

AND

NO. 2021-CA-0822-MR

UNITEDHEALTHCARE OF KENTUCKY, LTD. APPELLANT

APPEAL FROM FRANKLIN CIRCUIT COURT v. HONORABLE PHILLIP J. SHEPHERD, JUDGE ACTION NOS. 20-CI-00719 AND 20-CI-00987

ANTHEM KENTUCKY MANAGED CARE PLAN, INC.; AETNA BETTER HEALTH OF KENTUCKY INSURANCE COMPANY D/B/A AETNA BETTER HEALTH OF KENTUCKY INC.; COMMONWEALTH OF KENTUCKY; ERIC FRIEDLANDER, IN HIS OFFICIAL CAPACITY AS SECRETARY OF THE KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES; HOLLY M. JOHNSON, IN HER OFFICIAL

CAPACITY AS SECRETARY OF THE FINANCE AND ADMINISTRATION CABINET; HUMANA HEALTH PLAN, INC.; KENTUCKY CABINET FOR HEALTH AND FAMILY APPELLEES SERVICES; KENTUCKY FINANCE AND ADMINISTRATION CABINET; MOLINA HEALTHCARE OF KENTUCKY, INC.; AND WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC. D/B/A WELLCARE OF KENTUCKY, INC.

AND

NO. 2021-CA-0824-MR

AETNA BETTER HEALTH OF KENTUCKY INSURANCE COMPANY D/B/A AETNA BETTER HEALTH OF KENTUCKY INC. APPELLANT

APPEAL FROM FRANKLIN CIRCUIT COURT v. HONORABLE PHILLIP J. SHEPHERD, JUDGE ACTION NOS. 20-CI-00719 AND 20-CI-00987

ANTHEM KENTUCKY MANAGED CARE PLAN, INC.; COMMONWEALTH OF KENTUCKY; ERIC FRIEDLANDER, IN HIS OFFICIAL CAPACITY AS SECRETARY OF THE KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES; HOLLY M. JOHNSON, IN HER OFFICIAL

CAPACITY AS SECRETARY OF THE KENTUCKY FINANCE AND ADMINISTRATION CABINET; HUMANA HEALTH PLAN, INC.; KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES; KENTUCKY FINANCE AND ADMINISTRATION CABINET; MOLINA HEALTHCARE OF KENTUCKY, INC.; UNITEDHEALTHCARE OF KENTUCKY, LTD.; AND WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC. D/B/A WELLCARE OF KENTUCKY, INC. APPELLEES

AND

NO. 2021-CA-0847-MR

KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES CROSS-APPELLANT

CROSS-APPEAL FROM FRANKLIN CIRCUIT COURT v. HONORABLE PHILLIP J. SHEPHERD, JUDGE ACTION NOS. 20-CI-00719 AND 20-CI-00987

ANTHEM KENTUCKY MANAGED CARE PLAN, INC.; AETNA BETTER HEALTH OF KENTUCKY INSURANCE COMPANY D/B/A AETNA BETTER HEALTH OF KENTUCKY INC.; HUMANA HEALTH PLAN, INC.; KENTUCKY

FINANCE AND ADMINISTRATION CABINET; MOLINA HEALTHCARE OF KENTUCKY, INC.; UNITEDHEALTHCARE OF KENTUCKY, LTD.; AND WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC. D/B/A WELLCARE OF KENTUCKY, INC. CROSS-APPELLEES

AND

NO. 2021-CA-0849-MR

ANTHEM KENTUCKY MANAGED CARE PLAN, INC. CROSS-APPELLANT

CROSS-APPEAL FROM FRANKLIN CIRCUIT COURT v. HONORABLE PHILLIP J. SHEPHERD, JUDGE ACTION NOS. 20-CI-00719 AND 20-CI-00987

KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES; AETNA BETTER HEALTH OF KENTUCKY INSURANCE COMPANY D/B/A AETNA BETTER HEALTH OF KENTUCKY INC.; HUMANA HEALTH PLAN, INC.; KENTUCKY FINANCE AND ADMINISTRATION CABINET; MOLINA HEALTHCARE OF KENTUCKY, INC.; SECRETARY ERIC FRIEDLANDER, IN HIS OFFICIAL CAPACITY AS SECRETARY OF THE KENTUCKY CABINET FOR HEALTH AND

FAMILY SERVICES; SECRETARY HOLLY JOHNSON, IN HER OFFICIAL CAPACITY AS SECRETARY OF THE FINANCE AND CROSS-APPELLEES ADMINISTRATION CABINET; UNITEDHEALTHCARE OF KENTUCKY, LTD.; AND WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC. D/B/A WELLCARE OF KENTUCKY, INC.

AND

NO. 2021-CA-0855-MR

FINANCE AND ADMINISTRATION CABINET CROSS-APPELLANT

CROSS-APPEAL FROM FRANKLIN CIRCUIT COURT v. HONORABLE PHILLIP J. SHEPHERD, JUDGE ACTION NOS. 20-CI-00719 AND 20-CI-00987

ANTHEM KENTUCKY MANAGED CARE PLAN, INC.; AETNA BETTER HEALTH OF KENTUCKY INSURANCE COMPANY; CABINET FOR HEALTH AND FAMILY SERVICES, COMMONWEALTH OF KENTUCKY; HUMANA HEALTH PLAN, INC.; MOLINA HEALTHCARE OF KENTUCKY, INC.; UNITEDHEALTHCARE OF KENTUCKY, LTD.; AND

WELLCARE HEALTH INSURANCE CROSS-APPELLEES COMPANY OF KENTUCKY, INC.

OPINION

AFFIRMING IN PART, REVERSING IN PART, VACATING IN PART, AND REMANDING1

** ** ** ** **

BEFORE: GOODWINE, JONES, AND MAZE, JUDGES. GOODWINE, JUDGE: Molina Healthcare of Kentucky, Inc. (“Molina”), Humana Health Plan, Inc. (“Humana”), UnitedHealthcare of Kentucky, Ltd. (“United”), and Aetna Better Health of Kentucky Insurance Company d/b/a Aetna Better Health of Kentucky Inc. (“Aetna”) appeal the April 28, 2021 opinion and order and the June 16, 2021 order of the Franklin Circuit Court. The Cabinet for Health and Family Services (“CHFS”), the Finance and Administration Cabinet (“FAC”), and Anthem Kentucky Managed Care Plan, Inc. (“Anthem”) cross-appeal. After a thorough review of the record, as well as oral arguments, we affirm, in part; reverse, in part; vacate, in part; and remand.

1 In Molina’s appeal, No. 2021-CA-0806-MR, we affirm, in part, and reverse, in part, the orders of the circuit court. In Humana’s appeal, No. 2021-CA-0819-MR, we affirm, in part, and reverse, in part, the orders of the circuit court. In United’s appeal, No. 2021-CA-0822-MR, we affirm, in part, reverse, in part, and vacate, in part, the orders of the circuit court. In Aetna’s appeal, No. 2021-CA-0824-MR, we reverse the orders of the circuit court. In CHFS’ cross- appeal, No. 2021-CA-0847-MR, we reverse the orders of the circuit court. In the FAC’s cross- appeal, No. 2021-CA-0855-MR, we reverse the orders of the circuit court. In Anthem’s appeal, No. 2021-CA-0849-MR, we affirm the orders of the circuit court.

BACKGROUND

In Kentucky, a managed care organization (“MCO”) is a private company selected through the government procurement process to run the Commonwealth’s Medicaid system. In 2019, during the administration of Governor Matthew Bevin, the FAC and the Department of Medicaid Services of CHFS issued a request for proposals (“2019 RFP”) to determine which five health insurance companies would be awarded contracts to operate Kentucky’s MCO program. Seven companies, Anthem, Passport Health Plan (“Passport”), Molina, United, Humana, Aetna, and WellCare Health Insurance Company of Kentucky, Inc. (“WellCare”), responded to the 2019 RFP. After scoring, Molina, United, Humana, Aetna, and WellCare were awarded MCO contracts.

In December 2019, Governor Andy Beshear was sworn into office.

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Molina Healthcare of Kentucky, Inc. v. Anthem Kentucky Managed Care Plan, Inc., (Ky. Ct. App. 2022).

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