August 22, 2019

Maine reschedules changes in Medicaid > Only four counties to meet Nov. 1 start date

AUGUSTA — The state has put off until next year the start of managed care in the Medicaid program in six Maine counties.

The Department of Human Services blamed the delayed start-up in Kennebec, Somerset, Penobscot, Lincoln, Waldo and Knox counties on concerns about the adequacy of the doctor and hospital networks lined up by the two health maintenance organizations serving the Medicaid clientele.

“Some of these contracts are not settled yet” in the six counties where managed care has been delayed, said Francis Finnegan of DHS. “I think the key to this was that all along we wanted to assure there was an adequate supply of providers and choice.”

The Nov. 1 target date remains in effect in four other counties — Cumberland, York, Sagadahoc, and Androscoggin — and state officials say they have no plans to make Medicaid changes in the remaining six counties — Piscataquis, Aroostook, Hancock, Washington, Franklin, and Oxford.

Finnegan said the managed-care companies hired by the state — AssureCare of Maine and NYLCare Health Plans of Maine — have stronger links with hospitals and physicians in southern Maine than elsewhere.

Officials from Assurecare and NYLCare claim they could have started working in all 10 counties Nov. 1, but they also said a slower startup has merit.

It will be easier to solve startup problems in smaller areas, said Lauren Hampton Rice of NYLCare.

“This is prudent on the part of the state,” said Marshall Kelly of AssureCare. “We have to debug the system before we get massive enrollment.”

Officials hope to have 4,500 Medicaid recipients in the four initial counties enrolled in managed care by Jan. 1. Plans then call for a rapid expansion that would boost total enrollment in those four counties to 52,000 by next spring.

The state contends managed care will improve health care for Medicaid recipients and save the state money. Under the plan, the state will pay the two HMOs flat fees and they will contract with hospitals and doctors to provide health care.

The original 10-county plan would have affected about 100,000 Medicaid recipients.

When the program was unveiled last spring, state officials said three HMOs would introduce managed care July 1 in 10 of the state’s 16 counties. They said then the contract would be shared by Blue Cross and Blue Shield of Maine, Healthsource Maine and NYLCare Health Plans of Maine. The state later decided to seek new bids and postpone the launch until Nov. 1 because the three contractors reportedly did not have agreements with enough doctors and hospitals.

Six companies initially expressed interest in the second round of bids, but only NYLCare and AssureCare submitted bids.

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