2 Medicaid health care groups freeze local enrollment [The Frederick News-Post, Md.]

Jan. 18--ANNAPOLIS -- Two Medicaid health care organizations have stopped accepting new Frederick County members into programs serving low-income families with children and people with disabilities.

The high cost of providing health care in rural areas coupled with diminished revenue prompted Priority Partners Managed Care Organization to halt expansion in Frederick County and 11 other Maryland jurisdictions. Another organization, Maryland Physicians Care, is also freezing enrollment in its comprehensive care program.

Physicians Care is also shutting down a program that provided almost 300 county adults with primary care, according the local health department.

Many of the 424 primary adult care members with Priority Partners will lose vision and dental coverage, according to a memo written in late November by the organization. Those with diabetes will still receive a vision benefit.

The changes that kicked in Jan. 1 mean fewer choices for the county's needy, and they worry some staff at the Frederick Community Action Agency.

"It's a big deal because a lot of our patients are in need of dental care, and now, they can't access it with primary adult care," said Janet Jones, a coordinator for the agency, which provides food, shelter, health care and other services to poor and homeless county residents.

Priority Partners will continue to serve all of its Medicaid recipients, and Maryland Physicians Care will cover all current members except those in the primary adult care program. But the decisions leave only two managed care organizations, United Healthcare and Amerigroup, open to new Medicaid members in Frederick County.

Those eligible for comprehensive coverage, including families with children, pregnant women and the disabled, can still seek it through these two groups, said Dr. Barbara Brookmyer, Frederick County's health officer.

However, the changes could shrink the pool of physicians who treat Medicaid recipients, she said. It also takes the number of managed care organization options from four to two in Frederick County.

"I think it's good for individuals to have a choice when they're looking at insurance companies," she said. "And when the options ... are reduced, when there's less choice for people, that's not as preferable."

Greater confusion could result from changes in the primary adult care program, which is open to low-income adults who might not be eligible for the comprehensive health care coverage.

Former Maryland Physicians Care members could have difficulty moving to a new managed care organization, Brookmyer said.

The Frederick County Health Department can help people if they get lost amid the switch.

The shifts come as the state prepares for Medicaid expansion in January 2014. Recent counts show Frederick County'sMedicaid enrollment at 28,477; Brookmyer estimated that federal reforms could make as many as 5,000 additional local residents eligible for Medicaid.

Though some managed care organizations are scaling back, others are looking to grow and push into new areas of the state, said Charles Milligan, deputy secretary for health care financing at the Maryland Department of Health and Mental Hygiene.

"We're adding three new managed care organizations this year and adding more physicians," Milligan said. "We're building up capacity for the expansion, and we think we're doing all the steps that are necessary to get ready for that."

Robert Neall, CEO of Priority Partners, wrote in a December letter to state lawmakers that recent state rate reductions factored in his organization's move to close enrollment in Frederick, Allegany, Calvert, Carroll, Cecil, Charles, Garrett, Kent, Queen Anne's, Somerset, St. Mary's and Washington counties.

"As you are aware, health care access is a challenge in rural areas," the letter stated. "In many of the rural areas, Priority Partners operates at a loss because the rates paid by the state to provide care is actually lower than the cost of care."

The rates were lowered, Milligan said, because an actuarial analysis indicated the state had been overpaying managed care organizations.

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