LSU signs Medicaid health providers
LSU’s health division signed on with four out of the five private health plans that would provide the care for some 900,000 of the state’s Medicaid recipients beginning next year.
Medicaid recipients in the first phase of a statewide roll-out must start Dec. 15 deciding with which of the plans they will enroll. The initial phase includes Livingston, St. Helena, Tangipahoa, St. Tammany and Washington parishes as well as much of the New Orleans area.
Medicaid recipients in the area must sign up with one of the private health plans or they be automatically assigned to one before the program goes live Feb. 1.
The five private companies will share in more than $200 million of the state’s Medicaid business as the major shift in health-care delivery is fully-phased in by mid-2012. Medicaid is the government’s health insurance program for the poor. The state is moving to a more private-insurance-based system.
The agreements between LSU and the health plans came with some reservations and a lot of assurances from the state Department of Health and Hospitals that LSU’s financial interests will be protected, said Fred Cerise, LSU System vice president for health care and medical education.
“That’s the only way we could play,” Cerise said. “We cannot be a participant and get underpaid.”
DHH has already agreed to carve out LSU’s graduate medical education financing from Bayou Health — the new name for the program under which companies operate insurance-like coordinated-care networks.
Cerise said the majority of LSU’s business is Medicaid and uninsured clients and that it has no ability to have reserves or to make any financial gap up with private pay patients like other health-care providers.
Cerise said LSU has signed agreements with AmeriGROUP Louisiana Inc., Amerihealth Mercy of Louisiana Inc., Community Health Solutions of America, Inc., and UnitedHealthcare of Louisiana, Inc.
There’s been no agreement with the fifth network — Louisiana Healthcare Connections Inc., whose parent company is Centene.
All five companies have been recruiting hospitals, physicians and other health-care providers to be part of their care delivery networks.
The companies must demonstrate the adequacy of their provider networks to DHH in order to begin operations. DHH is expected to have the verification done by Friday.
“At this point, we don’t have any concerns that they aren’t going to have adequate networks,” DHH Medicaid Deputy Director Ruth Kennedy said.
None of the plans can do direct marketing of their networks to Medicaid recipients, Kennedy said.
The state will launch an education and outreach initiative in the phase one period immediately after Thanksgiving, Kennedy said.
DHH will mail a brochure to households where eligible Medicaid recipients live announcing Bayou Health and providing a brief description of the five plans in which they can enroll, including how they differ in benefits being offered and how to find out more about each, Kennedy said.
During the first week of December, Kennedy said, a postcard will go out advising households about enrollment events occurring nearby so people can get more information about the five companies and their plans.
She said some 40-plus such events are planned throughout the area.
People will be able to enroll on-line, via toll-free phone call or by mail, Kennedy said.
DHH has approved advertising and marketing plans the five companies will use as they solicit business, including radio and television spots, Kennedy said. If they host an event, other companies must be invited to participate and DHH personnel be present, she said.
During the period, Maximus — the state’s enrollment broker — will do reminder phone calls urging people to choose a health plan, otherwise they will be automatically assigned to a plan, Kennedy said.