How Left-Wing Bureaucrats Hijacked the Bidding Process for Georgia's Multibillion-Dollar Medicaid Contract

How will you ensure access to dental care across the state of Georgia? That's the sort of question the state's Department of Community Health asked in 2015 to determine which insurance providers would administer Medicaid to millions of people across the state. Then, last year, the state reopened the bidding process for the multibillion-dollar contract—and senior career staffers hijacked it to insert a question related to transgender children into the bidding process, internal documents reviewed by the Washington Free Beacon show.

Thanks to the efforts of those staffers, the state picked winners for the 2024 version of the blockbuster Georgia Families Medicaid contract in a manner plainly inconsistent with the conservative agenda of Gov. Brian Kemp (R.). The community health department selected the winning companies based in part on how they answered a question about care for a hypothetical transgender child in rural Georgia. Insurers whose answers reflected left-wing policy priorities—some respondents said they'd refer the child in question to a transgender clinic that provides hormone therapy—secured a piece of the multibillion-dollar contract in December, which is set to go into effect in mid-2026.

The transgender question, however, was not in the contract's initial draft, which instead asked respondents about a hypothetical 14-year-old white female with anorexia and depression who shares a bedroom with her younger sister. In June 2023, months before the bidding application was finalized, Chief Health Policy Officer Lynnette Rhodes; Medicaid project manager Leeclois Bolar; Office of Children, Department of Behavioral Health & Developmental Disabilities official Danté McKay; and other career staffers swapped the biological female for a transgender person, records obtained by the Free Beacon show. Those staffers, along with at least two McKinsey consultants, held a meeting on June 20, 2023, to discuss the changes to the question, emails show. The modified version made it into the final bidding application.

The staffers' decision to insert that question—and reward companies that regurgitated left-wing positions on transgender care—reflects a significant disconnect between Kemp's policy preferences and the career staffers tasked with carrying them out. Kemp signed a law banning gender surgeries and hormone therapies for children in 2023. One year earlier, he signed a law that allowed the Georgia High School Association to bar biological men from competing in women's sports.

Kemp has also worked to roll back diversity, equity, and inclusion policies within state government. The latest application for the Georgia Families Medicaid contract, however, also included a slew of race-based questions. One asked applicants how they would administer care to a 6-year-old Black child, another mentioned a suicidal 44-year-old biracial Filipina, and a third referenced a 17-year Latina with intellectual disabilities. The 2015 version of the application did not include race as a factor, instead probing insurers on how they would respond to common health care scenarios such as congestive heart failure.

The application also asked insurers to detail their internal diversity, equity, and inclusion programs. One company, Humana, responded by touting its mandatory "implicit bias training." It scored higher than other applicants on that question and won a piece of the contract, which is worth roughly $4.5 billion per year, according to the Atlanta Journal Constitution.

State law prevents Kemp from having any involvement in the state procurement process, and his spokesman, Douglas Garrison, touted the governor's support for "protecting girls' sports, outlawing medical procedures that permanently mutilate the bodies of our children, and prohibiting indoctrination in our classrooms."

Kemp's appointee to lead the Department of Community Health, Russel Carlson, is another story. Carlson on several occasions praised the staffers responsible for injecting the transgender question into the Georgia Families Medicaid contract, records show, touting their "very organized and disciplined evaluation effort" during a Feb. 8, 2024, Board of Community Health meeting.

Carlson's department, which did not respond to a request for comment, used a point-based system to grade bidders' responses, with the top four companies earning shares of the contract. The margin between the winners and losers was razor-thin, state records show.

Out of 1,000 possible points on the questionnaire, the difference between the fourth- and fifth-place bidder was less than 10 points. The transgender-child-related question was worth 10 points, and the DEI question was worth 15.

The four winning bidders scored 5.5 points on average on the question about the transgender child, while the losing bidders scored 4.7. Members of the contract review panel, which included outspoken Kamala Harris supporter and donor Marvis Butler, gave high scores to several of the winning bidders for saying they would refer the child to Emory Healthcare's Transgender Clinic, state records show. The clinic's primary purpose is to provide hormone therapy for transgender patients, according to Emory's website.

One winning bidder, CareSource, said the clinic could be of use to the child in question because hormone therapy "could come up in the future." In response, panel member Peter D'Alba, the Georgia Department of Community Health's pharmacy director, awarded CareSource the maximum 10 points.

"Excellent assessment done to address future hormone use," he wrote.

D'Alba was less favorable to bidder Kaiser Foundation, awarding the company just 2.5 points in part for failing to "understand" the transgender child's "pronouns."

"Transgender needs are complex," he wrote. "Supplier did not offer any programming to meet member needs regarding transgender/LGBT. Case worker did not leverage appropriate cultural and sensitivity training to understand members pronouns etc."

Emails and documents obtained by the Free Beacon show that McKay, the former director of an Obamacare advocacy group who now leads the Georgia behavioral health department's Office of Children, Young Adults & Families, inserted the transgender question into the contract bidding process around June 2023.

Bolar, the Medicaid project manager, thanked McKay for his "suggested edits" to the question in a June 20, 2023, email. Bolar requested McKay attend a meeting that afternoon to discuss the changes before a large group of state staffers. Also included in the meeting invitation were two outside consultants with McKinsey, a prominent consulting firm whose alumni include former transportation secretary Pete Buttigieg.

The Georgia Department of Behavioral Health & Developmental Disabilities and McKinsey declined to comment.

In addition to issues over "pronouns," the contract review panel penalized another bidder, Sentara Health, for suggesting that it could connect the transgender child with "local gender-affirming support groups, LGBTQ+ organizations, faith-based organizations, school-based programs, and other relevant community resources." Including "faith-based organizations" in that list was unacceptable, according to panel member Michael Smith.

"Unsure of reason for faith-based service connection when not introduced in scenario," wrote Smith, the behavioral health director for the Georgia Department of Community Health. He awarded Sentara just 2.5 points for its response.

The winning bidders also scored slightly higher on the question that asked them to detail their internal DEI programs. They averaged 9.24 points to the losing bidders' 9.02 points. The DEI question was not asked on the 2015 version of the contract.

Winning bidder United Health detailed its adherence to "health equity" training among its workforce. The insurer said it forced 100 percent compliance for its staff to complete an interactive training course about a fictional gay black man in his sixties who suffered from a stroke.

"Of our staff, 97% achieved a passing score on the first effort, and the remaining 3% engaged in remediation efforts until they passed," United Health wrote in its bid.

This was satisfactory to Smith, the behavioral health director, who said United Health "sufficiently conceived of plan to induce DEI frameworks into the culture."

At the same time, Smith penalized losing bidder AmeriHealth for its answer to the DEI question, awarding the company just 3.75 points because "cultural humility was not mentioned or discussed" in its response.

Review board member Gloria Beecher, the director of population health and quality planning at the Georgia Department of Community Health, in her evaluation also eviscerated AmeriHealth, giving the company just 3.75 points for its response to the DEI question. The company failed to show how it will "reduce disparity and promote cultural competency and humility" within its organization, Beecher said.

Another insurer, Peach State, came in fifth in overall scoring, losing out on a piece of the contract by just under 10 points. Peach State, which won a portion of the 2015 contract and for now administers Medicaid to approximately 700,000 Georgians, said in a legal challenge filed in December that the 2024 award was needlessly politicized and would bring "catastrophic consequences" for nearly 1.2 million state residents, including all of the state's foster children, who may have to find new doctors if the award isn't reversed.

"When procuring contracts for the healthcare services of more than 1.5 million vulnerable Georgians, the State is obligated to do everything in its power to ensure a process that is appropriately supervised, free of undue influence, devoid of controversial political agendas, and conducted pursuant to best practices," Peach State said in its legal challenge.

"Unfortunately, that is far from what occurred in this procurement run amok," the insurer said.

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