New managed care contracts announced last week mean an estimated 475,000 Minnesotans in public health insurance programs must move to a new health plan for 2016.
That’s about six times the number of switches with previous contract changes, and has advocates worried enrollees could fall through the cracks.
“Any time you’ve got that many people being disrupted, it’s a cause for alarm,” said Ralonda Mason, an attorney with Mid-Minnesota Legal Aid in St. Cloud.
Different health plans can have different networks of doctors and hospitals, so enrollees might find a switch “can disrupt their ability to see their provider of choice, or the provider they have a relationship with,” Mason said.
Such problems are possible, state officials acknowledge, but shouldn’t happen very often. To handle issues, open enrollment for the programs has been moved up to Sept. 2.
“Generally, the networks are similar across the health plans,” said Nathan Moracco, an assistant commissioner at the state Department of Human Services (DHS). “So, for most clients, they will have access to their existing providers and doctors, and that’s not going to be an issue.”
Gov. Mark Dayton announced last week the results from the latest round of competitive bidding on managed care contracts, saying the state and federal governments should save nearly $450 million in 2016 as a result. With the new contracts, the state is dropping Minneapolis-based UCare as an option for most enrollees, and changing the lineup of health plan options in many counties.
Minnesota hires HMOs and county-based purchasing organizations to manage care in the Medicaid and MinnesotaCare public health insurance programs. Medicaid provides coverage for people at or below the poverty level, and is managed by the state in conjunction with counties. MinnesotaCare covers people with slightly higher incomes.
Earlier rounds of competitive bidding resulted in health plan changes for about 57,000 people in 2014, and about 77,000 people switching in 2012, according to the DHS. While Anoka County had to help about 10,000 people make changes for 2012, the job is much bigger this time with about 28,000 people likely needing to switch,” said Jerry Vitzthum, director of economic assistance for Anoka County.
“It’s like when a company switches health insurance policies, there’s always trepidation and people are concerned — will my doctor be there?” Vitzthum said. “It’s a lot of work for everybody to investigate that, and it’s a lot of work to make that a smooth transition.”
The work will hit state and county workers who are pushing this month to resolve a backlog of some 180,000 public health insurance renewals that built up this year in the MNsure system due to technical problems.
In some cases, the same workers handling the backlog will be responding to enrollees with questions about switches, said Moracco of the DHS. The state wants to get the backlog sorted out now both for manpower reasons, and to avoid confusion.
“We would like to have that backlog cleaned up, just so that we’re not hitting [enrollees] with renewal information at the same time as we’re hitting them with enrollment information,” he said.
Nearly 80,000 people will be switching in Hennepin County, said Deborah Huskins, area director for the county’s human services and public health department.
For Medicaid enrollees, the county sends information to enrollees about health plan options for the coming year, and staffs a helpline to answer questions. It’s not yet clear, Huskins said, whether Hennepin County has enough workers to handle the extra work.
Like other counties, Hennepin has been working on the renewals backlog with MNsure, and Huskins said there is overlap between workers who handle those issues and those who will help with health plan choices.
“We want to make sure that people who are eligible for health care are able to maintain it,” she said. “That’s a challenge when there’s especially so many people all at the same time needing to move from one health plan to another.”
UCare currently is the largest managed care provider in the public programs with about 360,000 enrollees. The changes don’t affect UCare’s large business with Medicare enrollees, and the company also will continue as an HMO for certain special populations within the public programs.
The new contracts also mean Bloomington-based HealthPartners is being dropped from Hennepin County, where the HMO currently covers about 31,000 people in the two programs.
In an e-mail, HealthPartners spokesman Vince Rivard wrote: “We are still looking at impact on members and patients, but from what I am gathering at this point not all of our clinics are in the other networks, so some members/patients might need to find new providers.”
In addition, a county-based purchasing organization called South Country Health Alliance will be dropped as an option in 10 of the 11 outlying counties where it currently covers a total of about 31,000 people.
Where some managed care plans currently are losing enrollees, others will pick up membership. Final shifts won’t be clear until the conclusion of open enrollment.
Putting managed care contracts up for competitive bids means some amount of shifts for patients, said Deb Holmgren, president of Portico Healthnet, a St. Paul group that helps people enroll in the public programs. But the amount of changes coming in 2016 seems like too much, she said.
“I don’t think that the government agencies are staffed for this,” she said. “I don’t know if the health plans are staffed for this.”
Moracco of the DHS, however, said the state will be ready. Open enrollment will run through mid-December. Anyone who doesn’t actively pick a new health plan will be automatically enrolled in one, so coverage shouldn’t be lost. In cases where patients find their doctor isn’t in the new health plan’s network, state and county workers will help connect people with new providers.
Allowances will be made for cases where patients are in the middle of a care episode at year’s end.
“No enrollees will lose coverage as a result of this process,” Moracco wrote in a Friday letter to legislators, “however we recognize that the results of this procurement may mean transitions for many enrollees.”