New Medicaid plans lead to confusion across state [Yakima Herald-Republic, Wash.]

July 08--YAKIMA, Wash. -- On July 1, the state went live with a revamped Medicaid coverage system designed "to create the most innovative, person-centered, and cost effective managed health care system in the country," according to Health Care Authority's website.

Patients were assigned to one of five newly contracted insurance plans within the state's Healthy Options managed care program.

Trouble is, despite assurances that Medicaid patients would see little or no difference, local providers say the new system brought an onslaught of confusion for many patients who were told they'd been assigned to an unfamiliar plan or doctor.

"We will be months and months in the process of fixing things so that patients can continue care where they intend to be," said Dr. Mike Maples, CEO of Community Health of Central Washington, a Yakima-based clinic.

Medical coverage and benefits have not changed; rather, in some cases, the doctor has.

The new system assigned 650,000 patients in the state's Healthy Options managed care Medicaid system to one of the five plans. Each plan has a specific network of providers. With the change, the plans assigned their new patients to one of the providers in that plan's network.

Another 100,000 patients in Medicaid's aged, blind and disabled population who were previously on open coupons were also added to the Healthy Options program and are in the process of moving to the new plans.

Open coupons allow patients to go to any willing and contracted provider, whereas under managed care, the state's contracted plans are responsible for assigning patients to specific doctors.

While the state alerted patients of the change in time for them to request a plan they preferred, in reality, many patients were assigned to one that had no partnership with their doctor.

The confusion is heightened in Yakima, where an estimated 19,000 Medicaid patients were under the Regence Blue Shield plan. Regence declined to bid on the contract, so its patients were all reassigned to new plans.

The switch is the result of the Health Care Authority's recent "joint procurement project," in which five insurance plans, including three national players, won contracts to cover Medicaid patients.

Meanwhile, several longtime Washington plans -- such as Regence and Group Health Cooperative -- didn't win or didn't bid on the contract, instead discontinuing their work with Medicaid in the state.

Locally, that's caused significant turmoil for patients who were previously with Regence. When the state awarded the contracts to the five new plans -- Amerigroup, Community Health Plan of Washington, Coordinated Care Corp., Molina Healthcare of Washington Inc., and UnitedHealthcare Community Plan -- it sent out letters to current Medicaid patients explaining the change and telling them how to request a plan and provider of their choice. Otherwise, they would be assigned automatically.

But, providers say, many patients either didn't read or didn't understand the letters.

"It has a very large impact in Yakima County because Regence was one of the largest plans here," said Rhonda Hauff, chief operating officer at Neighborhood Health. Within their clinics, close to 6,000 patients were displaced.

"We've been very busy helping them re-enroll in the plan of their choice; the majority have chosen Community Health Plan," she said. Community Health Plan is a new partner for Neighborhood Health's Medicaid population, but a familiar plan in Yakima. It is not related to Community Health of Central Washington.

Patients who are unhappy with their assignment can ask to be reassigned to the correct provider, and can change up to once a month. The state is encouraging patients to contact the call centers of the various plans for help, but acknowledges that the process has been challenging.

"There is confusion all over the state," given the magnitude of the change, said Alison Robbins, supervisor of the state Healthy Options contract unit. She said the agency has spent the past three months giving community presentations around the state to help educate local clinics on how to navigate the system so they can assist patients.

Otherwise, Maples explained, patients have to first call the Health Care Authority or submit a form requesting a different plan, then call that plan and request a specific provider -- after learning from their doctors which plans they're contracted with.

Allowing patients to meet one-on-one with "system navigators" from their clinics is really the only way to sort out the confusion, Hauff said.

On Monday alone, "our staff had over 75 patients who had been assigned to the wrong" doctor, she said of the first day the switch took effect.

Four of the five state contracted plans are available in Yakima County. Neighborhood Health is partnering with all four; Community Health will continue to contract with Molina and added Coordinated Care.

The state's shift to managed care is intended as a cost-saving measure, as Washington looks to increase efficiency in providing care for Medicaid patients. And, with the new health reform act ready for implementation in 2014, the number of newly insured Medicaid patients is expected to grow significantly.

Maples said the manner in which the shift was implemented has left a large number of patients in upheaval. Roughly 6,000 Community Health patients were on Regence and had to be reassigned, plus another 3,000 open coupon patients who were assigned to Healthy Options for the first time.

Maples said his clinic sent out additional letters to all 9,000 of them, trying to clear up the confusion. Neighborhood Health also sent out letters to its patients.

Part of the problem was a compressed timeline for implementation. The new contracts were awarded in January. Since then, the plans have been working to establish contracts with providers around the state, and the state had to assign more than 700,000 patients to the plans.

The state knew which providers had contracted with which plans, Robbins said, but didn't know which patients were with those medical providers. Without feedback from those patients, they weren't able to reassign them to their current provider.

Health centers won't feel the full impact of that confusion until all patients eventually show up at their customary doctor's office, only to be told they're not covered there under their new plan.

The centers say they will continue to serve their established patients, even if they were reassigned to a different provider, until they can sort out the correct assignments.

Despite the messy start, managed care is good for patients, Maples said. While open coupon patients ostensibly had more choices, many doctors wouldn't see them because the reimbursement was so low. Under Healthy Options, they are guaranteed to have a willing medical provider.

"After the turmoil of this change gets settled down, it will be a good thing for patients because it does improve access to primary care services," Maples said.

Medicaid plan assistance

Medicaid clients who need help with their plan are encouraged to talk to their health care provider or contact the customer service line for their assigned health plan:

--Amerigroup: 800-600-4441, www.amerigroup.com

-- CHPW: 800-440-1561, www.chpw.org

-- Coordinated Care: 877-644-4613, www.coordinatedcarehealth.com

-- Molina: 800-869-7165, www.molinahealthcare.com

-- UnitedHC: 877-542-8997, www.uhccommunityplan.com

Clients can also contact the state Health Care Authority at 800-562-3022 or http://hrsa.dshs.wa.gov

--Molly Rosbach can be reached at 509-577-7728 or mrosbach@yakimaherald.com.

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