Pa. Med­i­caid ex­pan­sion plans strug­gle to sign up providers

Modern Healthcare - - REGIONAL NEWS - —Vir­gil Dick­son

Med­i­caid man­aged-care plans pro­vid­ing cov­er­age un­der Penn­syl­va­nia’s Med­i­caid ex­pan­sion are strug­gling to find enough hos­pi­tals and physi­cians for their net­works.

In­sur­ers say the prob­lem arises from false ex­pec­ta­tions set by the ad­min­is­tra­tion of Gov. Tom Cor­bett and the state Depart­ment of Pub­lic Wel­fare that the plans would pay providers more than tra­di­tion­ally low Med­i­caid rates.

“The prob­lem is, it’s not funded as a com­mer­cial-type of­fer­ing,” said Pa­tri­cia Darn­ley, CEO of Gate­way Health. Gate­way is one of nine plans cho­sen for the Healthy Penn­syl­va­nia demon­stra­tion pro­gram to ex­pand Med­i­caid to as many as 500,000 adults in the state with in­comes be­tween 100% and 138% of the fed­eral poverty level. Providers “are look­ing for com­mer­cial fund­ing, and in our state com­mer­cial fund­ing is nowhere near Med­i­caid fund­ing,” she said.

Den­nis Olm­stead, chief strat­egy of­fi­cer for the Penn­syl­va­nia Med­i­cal So­ci­ety, said doc­tors also are balk­ing be­cause of the rate is­sue. “Ab­so­lutely, some may de­cline be­ing part of the net­works if they are given a choice, while oth­ers may feel it’s their moral duty to serve th­ese in­di­vid­u­als,” he said. But he added that some doc­tors may not be able to de­cline be­cause they have “all-prod­uct” clauses in their con­tracts with in­sur­ers, re­quir­ing them to serve mem­bers of all plans of­fered by that in­surer, in­clud­ing a Healthy Penn­syl­va­nia plan.

The Med­i­caid plans have un­til Oct. 17 to re­ceive state cer­ti­fi­ca­tion con- firm­ing they have enough providers to of­fer ad­e­quate ac­cess to the ex­panded Med­i­caid-el­i­gi­ble pop­u­la­tion. En­roll­ment is sched­uled to be­gin Dec. 1.

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