Washington State Denies Medicaid Provider’s Appeal

Feb. 21--The state Health Care Authority has declined Columbia United Providers' appeal to continue serving 47,000 Clark County Medicaid patients.

The appeal was CUP's response to a state decision that may force local Medicaid patients to find new doctors and leave 80 CUP workers unemployed. As a result of the state's decision, CUP officials said the organization will pursue legal action.

The state Health Care Authority last month selected five health insurance plans that appear to have successfully bid to provide Medicaid services to Washington residents. The selected insurance plans will manage care for the state's Healthy Options and Basic Health members, who are mostly low-income women and children.

Columbia United Providers, a Vancouver-based group which has provided those services in Clark County since 1994, was not selected.

CUP filed a formal protest to the decision on Feb. 3. The Health Care Authority, after an internal review,

determined CUP's protest lacked merit and upheld its earlier action. CUP was notified of the decision Friday.

"It's just perplexing or concerning to us that the state is continuing to uphold its decisions when we believe they don't have an adequate plan in Clark County based on who they awarded contracts to," said Cindy Orth, vice president for external affairs at CUP.

The Health Care Authority tentatively designated three plans as Clark County providers: Community Health Plan of Washington, Molina Healthcare of Washington and Coordinated Care Corp. The contracts won't be finalized until Feb. 29.

Community Health Plan and Molina Healthcare are current Clark County providers. Molina, according to its website, has 28 contracted primary care providers in Clark County. Community Health Plan has 13, according to its website. Coordinated Care Corp. does not currently provide Medicaid services in Washington.

In its protest, CUP asked the state to explain how it determined whether insurers had adequate provider networks in Clark County. State officials didn't provide an answer, Orth said.

CUP officials also asked the state to explain why Clark County had a bid range that went 12 percent below the state's target reimbursement rate while the low end in other counties was 3 percent. That question went unanswered as well, Orth said.

"They didn't provide us with any of the answers that would be helpful for us in understanding their decisions," she said.

State Rep. Jim Moeller, D-Vancouver, also sought answers from the Health Care Authority.

On Feb. 3, Moeller held a meeting with a handful of local legislators, CUP officials and HCA officials. Following the meeting, the legislators sent a letter to Gov. Chris Gregoire, sharing details of the meeting and voicing concerns about the HCA action.

During the meeting, HCA officials said if the selected insurers couldn't establish an adequate network of providers, the state would eliminate Medicaid managed care in Clark County and revert to fee-for-service, Moeller said Monday.

That would mean providers would treat the patient and then bill the state. The problem: virtually no primary care practices accept fee-for-service Medicaid members in Clark County, according to the legislators.

"We strongly believe that without the CUP network in place, the Medicaid managed care recipients in Clark County will not be able to access care beyond hospital emergency rooms," legislators wrote.

In addition, fee-for-service is much more costly than the managed care system CUP provides, Moeller said.

Moeller said Monday he was also planning to provide a budget proviso, or condition, that would allow CUP to continue providing services in Clark County. The proviso, if accepted, would prohibit the HCA from ending contracts with Healthy Options and Basic Health plans that have successfully provided services for 10 years or more, Moeller said.

Moeller said he was unsure whether other local legislators would support the proviso.

In addition, CUP has requested a meeting with Gregoire and has launched a website, http://www.patientsloseout.com, to organize a signature campaign and encourage writing letters of support.

In response to the failed protest, CUP officials Monday said they plan to challenge the state's decision in Clark County Superior Court.

Marissa Harshman: 360-735-4546; http://twitter.com/col_health; http://facebook.com/reporterharshman; [email protected].

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