State officials expect to spend an extra $2 million to $3 million on call centers, data entry and other details as about 800,000 people in public health insurance programs select their health plans for next year.
The plan selection process occurs every year about this time, but the volume of people making switches for 2016 is expected to be much greater with the exit of Minneapolis-based UCare as a managed-care organization for most in the Medical Assistance and MinnesotaCare programs.
UCare lost most of its business in the programs because of a competitive bidding process earlier this year that state officials say should deliver about $450 million in savings to state and federal taxpayers.
So far, about 47,000 people in public programs have made plan selections for 2016, and the first deadline for making changes is Dec. 11.
"It is about where we expect to be," Nathan Moracco, an assistant commissioner at the state's Department of Human Services (DHS), said Friday. "We would expect more of an uptick in selections once we get closer to December's deadline."
About 415,000 people currently receive benefits through UCare and other health plans that won't be options in certain counties starting Jan. 1. Those enrollees must select another plan or they will be placed in the default managed-care organization for their county.
DHS expects about half the 415,000 enrollees facing switches will actively select a new health plan, with the remainder being automatically moved into a default option for their county. If enrollees find they don't like the default health plan, they can make changes in January or February, Moracco said.
"Toward the end of November, if [enrollees] have not selected a health plan they will get a letter letting them know the default plan that they will be enrolled in, which also serves as a reminder letter," DHS said in background materials distributed Friday.
Minnesota hires managed care organizations, including HMOs, for most enrollees in the public health insurance programs. The state started awarding contracts through competitive bidding in 2011 after concerns that health plans were making too much money on the state business.
While previous rounds of competitive bidding have forced plan switches by enrollees, the loss of UCare across most of the state impacts a much larger group — about 369,000 current enrollees.
The HMO will still be an option for certain special populations in the public programs, but UCare said this fall that its smaller role will force the nonprofit group to slash 250 jobs. In 2014, the state contract that UCare is losing generated about half the nonprofit's $3 billion in revenue.
For enrollees, the switches mean on Jan. 1 they could have a health plan that either doesn't include their doctor or hospital in the insurer's network; they could also land in a health plan that doesn't cover their medications. DHS officials believe such problems will be infrequent because health plan networks and medication lists are similar in most cases, but the state is boosting staff to help.
To answer phone calls about switches, DHS has added the equivalent of 85 full-time workers to its call center, according to the DHS background materials. Some are state workers who can shift from other tasks, while others work for an outside vendor and will be tapped as needed.
In the past week, DHS fielded about 3,200 calls at its help desk about annual health plan selections. About one-third of the questions were about the network of providers.
The state has sponsored three information sessions with community groups about the transition and has scheduled four more for this month.
All health plans must cover required services, although there can be differences in how they administer some benefits such as nonemergency transportation for care and interpreter services. No enrollees are at risk of losing coverage as a result of the changes, according to DHS.