Excellus dropping Medicaid managed care
Insurer tells state it’s ending managed care plans because of huge losses
Oct. 9, 2013; LaCara, Len L.
Nearly 80,000 people in Monroe County would be affected if Excellus BlueCross BlueShield stops participating in Medicaid managed care and Family Health Plus health insurance programs.
The individuals still would be covered, but with a different insurer.
Excellus last month told the state Department of Health it intends to drop out of the program in 25 counties starting Jan. 1 and continuing through the first quarter of 2014, spokesman Jim Redmond confirmed Wednesday.
Excellus would end its programs Feb. 1, in Livingston, Ontario and Wayne counties, affecting close to 24,000 people. It would stop March 1 in Monroe, Orleans and Yates counties, affecting about 85,000.
In all, nearly 219,000 people would be affected from the North Country to the Southern Tier.
The insurer would continue offering Child Health Plus in all counties. Medicare plans would not be affected.
Redmond said Excellus is incurring losses approaching $100 million for 2013 on Medicaid managed care and Family Health Plus, and that amount is expected to increase in 2014. “Losses of this magnitude are unsustainable.”
Medicaid is a state and federal program for low-income people. Family Health Plus is for adults ages 19 to 64 whose income
is too high to qualify for Medicaid. Child Health Plus is for children who are not eligible for Medicaid and who don’t have health insurance.
Under a managed care contract, the state pays an insurer a capped monthly fee to cover people enrolled. Monroe County is served by four managed care plans, and there is at least one other plan besides Excellus in Livingston, Ontario, Wayne and Orleans counties, according to the New York state Department of Health.
Redmond said Excellus is working with the state on a plan to move recipients to other plans. The managed care services are consistent, regardless of the insurer providing coverage.
A spokesman for the state Department of Health was not immediately available.
The prospect of Excellus, the area’s largest insurer, dropping out of the managed care and Family Health Plus plans came as a surprise.
“They have been a strong partner with the county for years and years,” said Nancy Forgue, the deputy commissioner of the Monroe County Department of Human Services, which administers the program. “I’m confident other plans can meet the demands and needs of the Medicaid managed care consumers.”
If Medicaid patients had to change insurers, it’s possible they would need a different doctor. “It’s not overly likely, as many providers in community take multiple types of health insurance,” Forgue said.
Christine Wagner, executive director of St. Joseph’s Neighborhood Center, said there would be no immediate implications. She wrote in an email
, “If no last-minute compromise is found between Excellus and the state, then we may be impacted if some transfer of patients to other carriers gets derailed for any reason, but I think that would be minimal.”
A spokesman for the University of Rochester Medical Center said its leadership was aware of Excellus’ intentions but had not yet received official word. URMC’s Strong and Highland hospitals have 14,300 Medicaid patients affiliated with their primary care practices.
“We remain committed to caring for all patients, including those in Medicaid managed care plans,” said Christopher DiFrancesco. We’ll await word from the state on how these patients will be transitioned.”
Excellus sent letters Tuesday to approximately 6,000 health care providers that participate with the insurer. Redmond said recipients also would receive letters, but they need to be approved by the Department of Health. He said individuals in each county may have different choices based on the insurers participating in that area.
Some Excellus Medicaid customers reserved judgment until they heard from the company.
“I’ll be concerned when they send me a letter,” Sharell Mobley said. “I’ll probably just switch to another one.”
Ti Davis, 26, has had Medicaid through Excellus for four years. He hasn’t had any major health problems in that time and hopes there won’t be a big difference after the switch. “I haven’t really had to use it. I’ll have to wait and see next year.”
Redmond said the decision to drop the programs was not done lightly. “We want to stay in Medicaid managed care and Family Health Plus. We have a long history of supporting safety net programs. We can’t do it at the expense of incurring huge financial losses.”
Redmond said Excellus cut about $25 million by moves such as increasing the use of generic drugs and limiting the network of pharmacies. “We’ve worked to fix whatever problems are within our control.”
He said Excellus would reconsider its decision “if the financial situation changes and allows us to reduce our losses. We’re not saying break even. We’re willing to take a loss, but it can’t be a loss of this magnitude.”