With health care providers fleeing Molina Healthcare’s managed-care Medicaid network in much of the Springfield area, state officials decided Friday to “disenroll” all 26,750 of the company’s local members and place them in traditional fee-for-service Medicaid on May 1 and beyond.

The move was commended by Southern Illinois University School of Medicine officials, who had worried that the growing lack of doctors and hospitals in Molina’s network would lead to potentially dangerous and stressful gaps in care for people unaware that their health care providers had severed ties with California-based Molina. SIU has served 17,000 Molina members.

“We are very pleased to hear that this action is being taken so that the potential lack of access to care for our most vulnerable patients will be minimized,” said Dr. Harald Lausen, chief medical officer for SIU Medicine, the medical school’s Springfield-based, multi-specialty physician practice group.

“While there have been gaps in specific types of care since the beginning of 2017, we have made every effort to provide or facilitate access to care for our patients.”

To eliminate potential confusion, SIU officials would like all Molina patients in Sangamon, Christian, Logan, Macon, Menard and Piatt counties immediately placed in traditional Medicaid, which is accepted by virtually all major health care providers in the region, Lausen said.

That’s not the plan, however, according to John Hoffman, spokesman for the Illinois Department of Healthcare and Family Services.

Lausen said SIU Medicine doctors’ offices “will continue to work with HFS and Molina to communicate with and support our patients during this transition.”

If any Molina members seek care between now and May 1 from providers who have dropped out of Molina’s network, Molina spokeswoman Danielle Smith said the company will do “everything we can to avoid any disruption in care.”

Hoffman said Molina is contractually obligated to provide all of its members access to needed services, regardless of whether in or out of its network.

“We are making this change to ensure quality care for our beneficiaries,” he said.

The change, Hoffman added, “further demonstrates the need” for the statewide Medicaid managed-care “reboot” announced by Gov. Bruce Rauner earlier this year.

State government, which began moving Medicaid recipients to managed care in 2011, will accept bids from managed-care companies this summer and award up to seven contracts so the redone program can be launched Jan. 1, Hoffman said.

Lausen, however, said he and others at SIU are concerned that the timeline for the reboot is too aggressive and could result in unprepared companies and a replay of problems that led to the collapse of Molina’s network.

Molina was the only managed-care provider in the six-county region after Urbana-based Health Alliance, citing financial losses from Medicaid managed care, ended its service to the state program. Health Alliance Connect had been serving 121,700 people in Illinois through the program’s “family health plan” and 7,800 in the “integrated care program” for senior citizens and people with disabilities.

Citing “financial losses from the Medicaid managed-care business line,” Health Alliance announced last July that it would pull out of the state’s managed-care program effective Dec. 31.

In the six-county area — with Sangamon County home to 15,200 Molina members — Molina was the only remaining Medicaid managed-care provider.

The decision by Healthcare and Family Services to remove Molina’s members and remove Molina as a provider for the six-county region came because Molina’s network in these counties “was not meeting department standards for beneficiary access,” Hoffman said.

With only one provider, Molina members, by law, had the option to leave and transfer to fee-for-service Medicaid, Hoffman said. But Lausen said state officials didn’t make it clear to the public that Molina members had the option to transfer to traditional Medicaid by notifying the state.

Hospital Sisters Health System doctors and hospitals, including HSHS St. John’s Hospital, withdrew from Molina’s network Dec. 31 because of “ongoing and unresolved issues around medical management, claims payments and credential of physicians,” HSHS spokeswoman Catie Sheehan said. But if Molina members show up at HSHS sites seeking care, they won’t be turned away, she said.

Memorial Health System, including Memorial Medical Center and Memorial Physician Services, had planned to drop out of Molina’s network April 17 for similar reasons, according to Scott Kiriakos, senior vice president for clinical integration.

“At its peak, we had approximately $28.7 million in billed charges rejected by Molina,” Kiriakos said. “On a percentage basis, claims rejected by Molina were as high as 11 percent, the highest total of any managed-care plan we contract with.”

After Friday’s announcement, Memorial and Molina agreed to extend the health system’s participation through April 30, Memorial spokesman Michael Leathers said.

“This will allow for a seamless transition of Molina members back into traditional Medicaid,” he said.

Memorial Health System Chief Executive Officer Edgar Curtis said his not-for-profit organization backs the state’s efforts to save money on the state-federal Medicaid program through managed care. “We just need a responsible company” to work with, he said.

Asked to comment on the problems hospitals and doctors were having getting paid by Molina, Smith said: “The introduction of managed-care programs in Illinois was complex and resulted in initial implementation issues. As a company with demonstrated success in managed care, we worked consistently with local providers for months to reach an agreement. However, certain hospitals still moved forward in terminating their contracts with Molina.”

If Molina members need help finding a doctor in the Medicaid fee-for-service system, the company asks that they call Illinois Connect toll free at (877) 912-1999.

— Contact Dean Olsen: dean.olsen@sj-r.com, 788-1543, twitter.com/DeanOlsenSJR.


Medicaid beneficiaries in Molina Healthcare’s network by county

Sangamon   15,200

Christian      450

Logan         1,550

Macon        8,800

Menard       450

Piatt           300

Source: Illinois Department of Healthcare and Family Services

Go to Source

Molina's managed-care Medicaid patients to be placed in fee-for-service system – The State Journal-Register