Originally published on December 13, 2019 12:55 pm
A little under a half a million Medicaid enrollees in Kentucky may be confused about what recent news about the state’s Medicaid contracts means for their health benefits. About 435,130 Kentuckians currently have Medicaid health insurance through Passport and Anthem, both of which recently lost out on contract renewals.
The companies are still offering coverage now, and people are able to sign up for a plan from either during open enrollment, which ends December 13. But as the situation stands, these two plans won’t offer Medicaid benefits starting July 1; Molina and United Healthcare will take their places. And all that could change depending on decisions by new Gov. Andy Beshear’s administration or the success of the companies’ appeals.
That uncertainty is likely confusing for Medicaid enrollees, according to health care consultant Jerry Vitti.
“To the member, it’s confusing and it’s scary; when you hear ‘I’m losing my Passport coverage,’ most folks don’t understand whether they’re losing just their plan or their eligibility,” Vitti said. “So the fear is that they’re going to lose both. And that can be a very dramatic thing especially folks who have high healthcare needs.”
So here are some things to know.
Here’s the background.
About two weeks ago, previous Gov. Matt Bevin’s administration issued contracts to five insurance companies that will administer Medicaid benefits in the state starting in July; Anthem of Kentucky and Passport Health weren’t among them. Meanwhile, United Healthcare and Molina will offer the benefits starting in July.
But the new administration under Gov. Andy Beshear could revoke those contracts, and legislators haven’t been pleased about what they say was a lack of transparency in awarding the contracts.
You can keep your Passport or Anthem plan until July of 2020.
Enrollment is currently open until Dec. 13, when enrollees can switch plans if they choose to. This coverage will start Jan. 1 and last until the end of June. At that point, that’s when Anthem and Passport will no longer offer plans, and United and Molina move in.
Christina Dettman, former spokeswoman for the Cabinet for Health and Family Services, said the state will send out information before the July enrollment period starts. Passport and Anthem will also send enrollees information telling them they will need to choose a new plan. Enrollees should make sure the state has updated addresses and contact phone numbers to ensure they’re notified.
Frank Siano, a health care consultant at EMD Consulting, led Aetna when it entered Kentucky’s Medicaid market. He said both United Healthcare and Molina are likely building networks of providers right now to make sure new enrollees have a choice of doctors come July. That can be important if an enrollee has a chronic health condition and wants to keep their existing health providers.
“I would encourage anybody who has any concerns is to check with their providers to make sure that they are enrolled in the new health plans,” Siano said.
And after an enrollee picks a new plan in July, they’ll have at least 30 days to make a change for any reason.
You may not be able to keep your doctors.
If you change from Passport or Anthem to a new plan, there’s a chance your current doctors won’t be signed up with your new plan, meaning you won’t be able to see them. This could be a big deal, especially for enrollees who have complex medical conditions.
Vitti said the state may have care navigators that help enrollees figure out if a new plan includes their doctors. The health insurance plans should have that information as well when open enrollment starts next year.
“What I mean by help, is figuring out if you switch a plan, if you can see your doctors,” Vitti said. “Not all folks will be able to see the list of specialists that they see now, or even primary care doctors.”
UnitedHealth and Molina are hopefully staffing up on people that will take those calls, according to Frank Siano.
“They need to be making sure that they’ve got the people hired to take care of the enrollees, making sure they have all their care managers in place to deal with the medical needs of the members as well as answering questions for providers,” Siano said.
The transition may be messy.
Almost half a million Medicaid enrollees will have to pick a new plan. That’s a lot of people who will be calling and logging in online to make their choice.
“You’ve got to remember that we’re talking about hundreds of thousands of enrollees who will be transitioning from one plan to another, so just the sheer error of numbers can happen,” Siano said.
Siano recommends that once enrollees make a plan choice, to trip check with both the plan and state to confirm that they will have coverage.
The state should also send out clear communications to enrollees about what’s happening to make sure everyone knows what they need to do.
“And how are they receiving that information is going to be important,” Vitti said. “The state needs to have culturally competent communication with folks that take into consideration their varied health needs, the geography, their languages, and their reading level in order to make a cogent decision about their coverage and their healthcare.”
That communication should ideally come in the form of radio and TV ads, outreach at public gatherings and putting care navigators in places where Medicaid enrollees can get help.
“You need a whole you need an entire continuum of communication, and outreach and assistance in order to make any transition with this population successful,” Vitti said.
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