Medicaid service provider CUP to stay in county

Patients will remain under the care of their current providers

By Marissa Harshman, Columbian health reporter

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Columbia United Providers officials on Friday got the news they and thousands of Clark County residents have been waiting months to hear: CUP can continue to serve local Medicaid managed care members.

State Health Care Authority Deputy Director Preston Cody said Friday the state had approved a contract that would allow CUP and Community Health Plan of Washington to work together and remain in Clark County.

“I hope everybody is pleased with the outcome,” Cody said. “I know the Health Care Authority certainly is.”

After months of uncertainty, the state appears to have found a solution that benefits everyone involved. Medicaid patients will remain with their current providers, if they so choose. Renegotiated physician reimbursement rates will save the state money. And CUP and Community Health Plan will continue to operate in Clark County.

“We’re happy,” said Lance Hunsinger, chief executive officer of Community Health Plan. “We have historically served in Clark County. Our interest was to continue to serve that population, and this result allows us to continue to do that. so we’re pleased.”

The agreement will also mean no disruption in care for local Medicaid members, which was an ongoing concern for CUP officials.

“Our goal from the start was to keep this critical health care safety net intact for this community,” Ann Wheelock, CUP chief executive officer, said in a written statement.

New partnership

Columbia United Providers, a Vancouver-based health insurance plan owned by PeaceHealth Southwest Medical Center and other Clark County health care providers, currently provides services to 47,000 Clark County Basic Health and Health Options members, who are mostly low-income women and children.

The nonprofit Community Health Plan of Washington currently provides services for about 3,000 Clark County residents.

The state announced in January it would not renew its contracts with the two current plans. Instead, the state opted to contract with Molina Healthcare of Washington, which currently serves a small portion of Clark County Medicaid members, and Coordinated Care Corp.

That decision was complicated last week when the state announced the two plans couldn’t meet the terms of the contract. The state was forced to re-evaluate the situation in Clark County because Molina and Coordinated Care were unable to establish a network with enough providers to care for the county’s entire Medicaid population — about 65,000 people.

In response, Community Health Plan and CUP joined forces and submitted a new proposal to the state.

On Friday, the state approved that proposal.

Under the new deal, Community Health Plan will hold the Medicaid services contract with the state, and CUP will process all claims and referrals for local providers. Patients will stay with their current providers.

CUP worked with providers to negotiate lower reimbursement rates, with decreases ranging from 10 to 30 percent. CUP will also receive a lower premium, as it will be split with Community Health Plan.

As a result of the lower reimbursement rates, the state will achieve some of the savings it had been seeking. Cody said it’s too early to know exactly how much the state stands to save under the new contracts.

Member options

In addition to approving the Community Health Plan-CUP deal, the state also approved the request of another insurance plan, UnitedHealthcare, to expand into Clark County. In addition, Molina and Coordinated Care will remain options for county residents.

Since they don’t have complete provider networks, UnitedHealthcare, Molina and Coordinated Care can accept only as many members as their provider caseloads allow, Cody said.

In an effort to expand its provider network, Molina is working with Kaiser Permanente. Kaiser currently provides care for 1,400 Clark County members but did not enter a bid for a new contract. Current Kaiser members will be assigned to Molina and remain with their Kaiser providers, Cody said.

Clark County Healthy Options members who currently receive services from CUP will be automatically assigned to Community Health Plan and will remain with their current providers, Cody said.

The local Basic Health members who were already assigned to either Molina or Coordinated Care — about 2,000 of the 3,000 members in Clark County — will have the option of switching to a different plan. The open enrollment deadline has been extended to 5 p.m. June 15 so members can review their options. Premiums and copays for Basic Health members won’t change.

The new contracts are effective July 1 and run through 2013.

Marissa Harshman: 360-735-4546; http://twitter.com/col_health; http://facebook.com/reporterharshman; marissa.harshman@columbian.com.