Modern Healthcare

Pa. Medicaid expansion plans struggle to sign up providers

- —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.

Newspapers in English

Newspapers from United States