UnityPoint drops Molina Healthcare’s Medicaid plan

Feb. 13--PEORIA -- UnityPoint Health has terminated its contract with Molina Healthcare's Medicaid managed care plan.

The change was effective Jan. 1, but in an effort to ease the transition for patients, UnityPoint is allowing those with previously scheduled appointments in-network coverage through the end of February. After that, all patients on the plan will be charged out-of-network rates for appointments with UnityPoint physicians or for using UnityPoint facilities, including Methodist and Proctor hospitals.

The good news for patients affected by this change is that the open enrollment period for Medicaid is now. Through March 31 patients can enroll in the other three Medicaid plans accepted by UnityPoint -- Meridian Health Plan, IlliniCare Health and BlueCross BlueShield of Illinois.

OSF HealthCare is still accepting Molina Healthcare's Medicaid managed care plan.

Though he didn't have an exact number of how many patients are affected by the change, UnityPoint Chief Financial Officer Rob Quin said that roughly a third of Medicaid patients admitted to UnityPoint Methodist are insured by Molina.

UnityPoint began sending out letters to notify affected patients in late November. Patients who had scheduled appointments got a phone call.

"All of our staff who interfaces with patients at the point of care got a lot of training on helping patients through this," said Blake Long, marketing communications manager for UnityPoint. In some cases UnityPoint is also reaching out to Molina to help patients in on-going treatment plans.

"We've worked with Molina to see if they are willing to authorize payment for things that people are scheduled for, and, in some cases, we might be the only provider of a service in the region," said Dr. Keith Knepp, president of UnityPoint Health-Methodist and Proctor. "Child and adolescent behavioral health services would be an example of that. So we are certainly willing to see those patients and we try to work with Molina to arrange with them to provide out-of-network coverage if that's the case."

Molina Healthcare is one of the six Medicaid plans offered by the state of Illinois this year, a reduction from the 12 offered last year. The reduction, along with a push to get 80 percent of Medicaid recipients into managed care organizations, is part of a dramatic revamp of the state's Medicaid program announced by Gov. Bruce Rauner in February 2017. Unlike traditional Medicaid programs run by the state, the managed care plans are run by private insurers that administer Medicaid benefits.

"So what that means for a health system like UnityPoint is, rather than working with the state of Illinois to get claims paid, we now work with an intermediary, which is a for-profit insurance company," said Knepp.

Private insurance companies are required to reimburse at the state's Medicaid rate, so reimbursement rates are not negotiated, said Knepp. However, policies determined by the individual insurance company are part of the discussions.

"Each of those companies puts their policies in place on how they chose to administer those claims and make those payments and manage what kind of authorizations people need in order to get tests done and procedures done," said Knepp.

Ultimately, UnityPoint was unable to reach an agreement with Molina.

"We want to be able to provide high quality and high service to our patients, and having a strong partnership with the managed care organization is part of that," he said.

Leslie Renken can be reached at 686-3250 or lrenken@pjstar.com. Follow her on Twitter.com/LeslieRenken, and subscribe to her on Facebook.com/leslie.renken.

___

(c)2018 the Journal Star (Peoria, Ill.)

Visit the Journal Star (Peoria, Ill.) at www.PJStar.com

Distributed by Tribune Content Agency, LLC.