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Joke: Guy walks into a room. You hand him $625 million to do a job for you. He goes out and spends the money. But it looks like the job didn't really get done. So you ask him how he spent the money.

Sorry, he says. Can't tell you.

Ba-dump bump.

You're right: That's not much of a joke. It's no joke at all. In fact, it's a true, sad story.

It's what HMOs in Connecticut are doing with $625 million meant to cover struggling families' health care.

This no-joke will develop a punchline of sorts, beginning with a Freedom of Information hearing on Wednesday pressed by some persistent people from New Haven. The outcome will determine just how much of a joke this state considers the idea of keeping private companies accountable for how they spend public money and determine how hundreds of thousands of families get health care.

Public Health = Private "Function"

The hearing takes place at 10 a.m. at the the Freedom of Information Commission's (FOIC) quarters across the street from the gold-domed state Capitol in Hartford. Cities like New Haven have a lot of stake in the case.
The case was brought by a Yale public-health professor named Kari Hartwig and by legal aid lawyers statewide. They wondered why the state's Medicaid plan isn't working the way it should--â€"why, for instance, struggling families have a hard time finding doctors to treat them. It's an important question. That $625 million in taxpayer money goes to four HMOs to manage Medicaid (aka "Husky A"). That affects how 310,000 people in Connecticut, most of them children, get health care.

Usually you can find some answers in cases like this from the government, since Medicaid is a public program. You file a request under the Freedom of Information Act and eventually receive the data.

But in Connecticut, state government contracts out Medicaid, as well as other health-care programs for the poor, to private health maintenance organizations (HMOs). When Hartwig and the legal aid lawyers filed a freedom of information (FOI) request, the companies refused to turn over the info. They said it was private information.

Most incredibly, they said what they were doing isn't a "government function."

And get thisâ€"the Rell Administration agreed. At first.

One of the HMOs is Community Health Network of Connecticut.

"CHNCT is a private nonprofit corporation and, as such, is not subject to FOIA," wrote the president and CEO, Sylvia B. Kelly, in a letter released this week. Because her company does not "participate in making policy decisions that bind" the state government on Medicaid, her company is not performing a "government function" as defined by FOIA statutes, Kelly argued.

Her words were echoed by lawyers and officials of the other HMOs involved, Anthem, Preferred One, and Health Net. They noted in letters in response to the requests that the Rell administration's Department of Social Services has long been on record agreeing with them.

A vice-president of Health Net made it clear the company considers itself free from laws like FOI that hold government programs accountable.

"In creating the Medicaid managed care program, the Department [of Social Services] contracted with private companies not subject to the FOIA. As a result, the relationship between the Department and Health Net exists through and is defined by our contract," wrote the vice-president, Janice C. Perkins. "Neither party to the agreement can change the terms unilaterally."

"The HMOs are playing games," responds Sheldon Toubman, a New Haven legal aid lawyer involved in the case. "They don't want to produce these documents. And [the Rell administration's Department of Social Services], despite statements by the deputy commissioner, doesn't really want to be held accountable by the public. They're more interested in making the HMOs happy."

(To learn more about efforts to make HMOs accountable in Connecticut, click here.)

Public Health = "Trade Secret"

Under political pressure, the Rell Administration changed its mind, sort of. It asked the HMOs for the documents after all. Rell's staff didn't concede that the Freedom of Information Act covers this case. But it noted that its contracts with the HMOs allowed it to request the information. So it did.

The HMOs still balked. They released some of the documents to the Rell administration. But they asked that the requested information not be released to the general public, because they allegedly contain "trade secrets."

In other words, now that government is contracting out public business (Medicaid) to private companies, public information (what kind of health care we're getting for the money) has become a "trade secret."

So the Rell administration got out its black markers. Before releasing the documents to legal aid and Kari Hartwig, they made the documents look like Xeroxes from Nixon-era FBI files-â€"worthless sheets with a little introductory verbiage, then huge blacked-out sections concealing all the meat.

At this point the Rell administration is waiting for an opinion from Attorney General Richard Blumenthal about whether the "trade secrets" argument has merit. Blumenthal's working on the response. Prominent politicians, including New Haven State Sen. Martin Looney, are urging him to back public disclosure. Connecticut mayors including New Haven's John DeStefano have also written to Gov. Rell urging that the documents be made public. DeStefano called the release of the documents "critical" to the interests of 25,000 New Haveners enrolled in state's Medicaid and SAGA (State Administered General Assistance) programs, as well as "the taxpayers who pay for their services."

A whole bunch of lawyers will gather in the FOIC hearing room Wednesday to begin arguing over whether the real, full documents should be released. First up is the argument over the HMOs' contention that they don't serve a "government function." An upcoming second hearing will cover the trade secrets argument. Blumenthal's office will be there Wednesday on behalf of the Rell administration's Department of Social Services, arguing that the government function point is moot, since the Rell administration has asked for the documents under the terms of its contract with the HMOs. (Legal aid disagrees that the point is moot, since at least one of the HMOs is arguing that the contract language doesn't cover all the material requested for release.) Lawyers will be there representing HMOs. Legal aid lawyers will be there, too, as well as a lawyer representing Kari Hartwig.

What They Want

Here's some of what Hartwig and the legal aid lawyers specifically want to find out, and what the HMOs want to keep secret:

â-ª What rates the HMOs are paying specialists like cardiologists when they see Medicaid patients and patients covered under other state programs. The info-seekers have a hunch that the HMOs pay these specialists lower than the normal rates, in order to save money; that would explain why so many families under Medicaid are having trouble finding specialists willing to take their cases.

â-ª How often the HMOs are denying patients' requests for prescription medicine. And, when patients get denied, what percentage get a temporary supply of the medicine. And of those who don't get temporary supplies, what percentage are OK'd to receive similar drugs.

• Raw numbers on how often the HMOs approve braces and retainers for kids under orthodonture plans.