The Republican lawsuit targets reinsurance that helps insurance companies provide universal coverage without accounting for pre-existing conditions.
June 01--After years of ineffective allergy medications, 7-year-old Bridget Smith of Vancouver is finally receiving treatment that will eventually reduce the number of bottles in the medicine cabinet. Her doctor at The Vancouver Clinic ran tests and created a specialized injection based on the allergens causing Bridget the most discomfort.
But the last eight months of allergy shots could be for nothing if Bridget is forced to find a new health care provider who wants to establish his or her own treatment plan, said Bridget's mother, Jennifer Smith.
Bridget is one of the thousands of Clark County Medicaid managed care members who receive care through Columbia United Providers. When the state Health Care Authority decided in February not to continue its contract with CUP, local Medicaid Basic Health and Healthy Options members, who are mostly low-income women and children, were left searching for answers.
The months that followed have offered few solutions.
The state selected two health plans -- Molina Healthcare of Washington and Coordinated Care Corp. -- to provide care for 65,000 local members. Basic Health members have until Monday, the deadline for open enrollment, to select one of the insurance plans. Otherwise, the state will assign one for them.
But last week, the state announced those two plans were unable to meet contract requirements in Clark County. Neither was able to establish a network of local providers capable of caring for the county's Medicaid population.
Health Care Authority spokesman Jim Stevenson said state officials are working on a resolution and hope to have an answer "soon." Depending on the outcome, the state may extend the open enrollment deadline for Clark County residents. Neither Molina nor Coordinated Care would disclose if they were still trying to sign up local providers.
"If members can make a choice in the Molina and Coordinated Care networks that is good for them, they should do it," Stevenson said. "If they do not see an option that works for them, I would advise holding on to see how their options change."
The wait-and-see approach, however, is making some Medicaid members anxious.
Bridget's provider isn't going to accept Molina or Coordinated Care. The only specialists Smith could find to provide care to her daughter under the new plans are in the Kelso-Longview area or Tacoma. Smith can't afford to move or make weekly trips north for appointments.
No doctor means no allergy shots for Bridget, who also takes medication for asthma and attention deficit hyperactivity disorder.
"She'd be without allergy medicine and asthma medicine and she couldn't go outside," Smith said.
Like Smith, Vancouver residents Suzy and Richard Hooper are worried their 9-year-old grandson, Matt, won't receive sufficient medical treatment.
Matt, who has a disorder on the autism spectrum, has an oral aversion. His fear of putting things in his mouth, including food, led to doctors insert a feeding tube in the boy's abdomen. He also works with speech and occupational therapists. His grandparents, who are his guardians, receive guidance for caring for the boy.
"He's come a long way, and we've had excellent care because of CUP and The Vancouver Clinic," Suzy Hooper said.
Before Matt became a Healthy Options member, Hooper tried unsuccessfully to find a developmental pediatrician in Vancouver. The pediatricians she did find weren't accepting new patients.
"It was hard enough to find help, to find a pediatrician, even with CUP," Hooper said. "I just think we're in deep trouble if we don't have CUP to back us up."
Robin May of Vancouver has been with her provider for the past 15 years, five of which she's been a Basic Health member. Her provider's office, Legacy Salmon Creek Medical Group, will only accept the Molina plan when the new contracts beginning July 1, but May said she hasn't been impressed by others' experiences with Molina.
The 49-year-old said she feels like she's being forced to choose between the unfavorable insurer tied to her provider and a Fortune 500 company she knows nothing about.
"Basically, they have my back against the wall," May said, "and a lot of other people's as well."
Marissa Harshman: 360-735-4546; http://twitter.com/col_health; http://facebook.com/reporterharshman; firstname.lastname@example.org.
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