MetroHealth move could affect 4,000

Anthem Blue Cross and Blue Shield has already pulled out of the state.

Plain Dealer

The MetroHealth System will cancel its contract with one of the only two Medicaid managed care companies available in Northeast Ohio, a move that could force more than 4,000 patients to get new doctors.

In letters to patients, the hospital system said that as of Nov. 1, MetroHealth, its community clinics and all of its doctors would no longer accept WellCare of Ohio health coverage.

“The cost of doing business with WellCare under the terms of their proposed contract was simply not acceptable to us,” said MetroHealth spokeswoman Eileen Korey.

For years, doctors, hospitals and clinics have complained that reimbursements for medical care don’t cover what it costs to provide it. Many private doctors refuse to accept Medicaid patients, low-income or welfare recipients, but the pullout by hospitals is a new phenomenon.

WellCare, based in Tampa, Fla., also has contracts with University Hospitals and the Cleveland Clinic, and under Ohio’s setup the company is responsible to assign patients to new doctors.

But that may be problematic for these MetroHealth patients because doctors affiliated with UH and the Clinic, unlike MetroHealth, do not necessarily take Medicaid patients. So Wellcare patients who have been going to MetroHealth doctors and its community clinics may balk, but there’s little they can do.

Ohio lawmakers mandated enrollment in managed-care companies for nearly all the state’s Medicaid patients about two years ago. The aim was to get low-income pregnant women and children on Medicaid established with regular doctors to ensure they receive quality health care.

The idea was to give patients a continuity of care with doctors that also would ultimately save the state money.

“There’s a lot of potential advantages,” said Dale Lehmann, assistant chief of the bureau of managed care for Ohio health plans. “For the consumer, trying to establish that medical home is a valuable concept.”

That stable relationship between doctor and Medicaid patient has proved somewhat elusive in Ohio.

A few months ago, Anthem Blue Cross and Blue Shield, stating it was losing money, pulled out of the state. That forced 145,000 patients, including nearly 87,000 in the Cleveland area, into new plans, possibly with new doctors.

And a hospital system in Columbus intends to quit a managed-care plan this month because of reimbursement rates, the same reason MetroHealth is canceling with WellCare.

In its letter to patients, MetroHealth told those in WellCare that October is open enrollment and that they can switch to the other Medicaid-managed-care company — Dayton-based CareSource — to stay with MetroHealth and its doctors.

And Wellcare pledged in a statement to continue to make care available.

“WellCare continues to serve approximately 100,000 CFC [Covered Families & Children] members and maintains a network of over 7,700 providers and 39 hospitals in the northeast region of Ohio,” the company said in a statement. “WellCare members will not experience any gap in coverage due to this change.”

The Northeast Ohio region includes seven other counties — Erie, Huron, Lorain, Medina, Geauga, Lake and Ashtabula — besides Cuyahoga.

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