N.M. shuffles its Medicaid contracts

The state Human Services Department is shuffling its managed care contracts for Medicaid starting in 2019.

The state said Friday it was retaining five-year contracts for the program, now called Centennial Care, with the Presbyterian Health Plan and Blue Cross Blue Shield of New Mexico, but was not renewing contracts with Molina Healthcare of New Mexico and United Healthcare.

In addition, the state will offer Centennial Care through Western Sky Community Care, a subsidiary of the publicly traded Centene Corp.

“By reforming Medicaid through Centennial Care, we’ve been able to improve health care for New Mexicans who need it the most — making it more patient-centered and connecting more patients with primary care providers like doctors and nursing professionals,” said Brent Earnest, Cabinet secretary for the Human Services Department.

“Through the partners we’ve announced today,” he said, “we’ll be able to continue improving care for New Mexicans by making it even more patient-centered and cost effective.”

The changes will take effect next year. Medicare patients can stay with their current managed care organizations

through 2018. The state has 675,000 individuals enrolled in Centennial Care, the largest health insurance program in the state.

The contract decision comes after the state has imposed more rigorous cost standards on those who provide health care services to the working poor and disabled, as well as other measures to ensure better patient outreach.

Under the managed care model, companies receive monthly payments for each insured patient based on age and health conditions. The amounts are paid whether or not the patient receives any treatment.

Presbyterian and Blue Cross are well-known in the state, while Western Sky is a subsidiary of Centene Corp., a Missouri-based Fortune 100 company that focuses on underserved insurance markets.

Brandon Fryar, president of Presbyterian Health Plan, a subsidiary of the umbrella nonprofit Presbyterian Healthcare Services, said the company is “humbled and privileged” to again serve as a partner in the state’s Centennial Care program.

“Presbyterian’s roots are in New Mexico,” he said, “and we have served members in the Medicaid managed care program since its inception in 1997.”