Aug 16, 2018
Presbyterian Health Plan is taking on some 85,000
Medicaid patients in New Mexico from another insurance carrier,
UnitedHealthcare, the Presbyterian president said Thursday.
The move comes as United has resolved its appeal in state
District Court of a state decision to end its Medicaid managed care contract in
the coming year. That leaves another care provider, Molina Healthcare, whose
contract ends in January, with a pending challenge. Molina provides managed
care to more than 217,000 Medicaid recipients..
Starting Sept. 1, United clients of Centennial Care 2.0,
the state Medicaid program, will be served instead by Presbyterian, said
Presbyterian Health Plan President Brandon Fryar.
In most cases, those patients will be able to keep their
doctors, as well as the care coordinators the patients worked with at United,
he said.
Presbyterian is also bringing about 340 United employees
who worked directly with plan members into its fold.
“The members are seamlessly transitioning to another
carrier,” Fryar said. “In the vast majority of cases, those members are able to
maintain their relationship with their doctor and, to the extent we’re able to
bring on employees, they’re able to retain their relationship with their care
coordinator.”
The New Mexico Human Services Department in January
announced it would not renew its contract for managed care with
UnitedHealthcare and Molina Healthcare of New Mexico.
The state at the same time renewed five-year contracts
for Centennial Care with Presbyterian Health Plan and Blue Cross Blue Shield of
New Mexico. It added a contract with Western Sky Community Care, a subsidiary
of publicly traded Centene Corp. Those contract renewals take effect Jan. 1.
Molina Healthcare, UnitedHealthcare and two other
insurance carriers whose bids were rejected filed protests over the state
decision to end or deny their contracts. Molina’s appeal is still pending, said
Human Services spokeswoman Mary Elizabeth M. Robertson.
“The Human Services Department is pleased United
Healthcare’s appeal of the Centennial Care 2.0 procurement process has been
dismissed. We are working with Presbyterian Health Plan as they prepare for the
transition of members from United Healthcare on Sept. 1,” Robertson stated in
an email.
The 85,000 United plan members Presbyterian agreed to
take on represent all United subscribers to Centennial Care, said Presbyterian
spokeswoman Melanie Mozes. Presbyterian Health Plan, a subsidiary of the
nonprofit Presbyterian Healthcare Services, is the largest manager of Medicaid
services in the state. Centennial Care is the largest insurance plan in the
state, with about 675,000 members.
Medicaid serves low-income clients, often working poor or
disabled patients. Insurance companies are paid monthly for each insured
patient based on age and health conditions, whether or not the patients receive
services.
Former members of the UnitedHealthcare plan will have the
option, like any other plan member, to select another carrier during the open
enrollment period that opens Nov. 1, Fryar said.
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