MCOs-Ohio Medicaid rejects Mercy Health’s request to have members changed from Anthem plan

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[MM Curator Summary]: In which a hospital recommends the state take away Medicaid enrollment from the plan it can’t come to payment terms with and give it to another plan. LOLZ.



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Credit: Bill Lackey


Mercy Health’s Springfield Regional Medical Center. BILL LACKEY/STAFF

Credit: Bill Lackey

Credit: Bill Lackey

The Ohio Department of Medicaid has rejected a request from Mercy Health to freeze enrollment in Anthem’s Medicaid managed care plans and transfer members to new Medicaid plans if they are an active Mercy Health patient.

Anthem Medicaid members became out-of-network at Mercy Health beginning July 1 after both sides could not agree to a new contract following negotiations. Mercy Health also plans to treat Anthem Medicare Advantage members as out-of-network beginning Oct. 1.

“It is indeed unfortunate that Ohio Medicaid members find themselves in the position of having to make potentially urgent or otherwise significant health care decisions because of a disagreement between two established and committed health care organizations that have told us that they have these members’ best interests at heart,” said Maureen Corcoran, director of Ohio Medicaid.

ExploreMercy Health prepares to go out-of-network for Anthem Medicaid members as negotiations stall

Mercy Health recommended Ohio Medicaid “freeze new enrollment in Anthem [Ohio Medicaid] for a period of ninety (90) days to ensure that new patients do not enroll without the understanding that they would not have long-term access to Mercy Health,” according to a letter from Corcoran sent to Don Kline, chief operating officer of Bon Secours Mercy Health.

That recommendation was unnecessary, Corcoran said, also finding another recommendation to transfer members to different Medicaid managed care plans unnecessary. Mercy Health recommended Ohio Medicaid “conduct a block transfer” of all Anthem Ohio Medicaid members “who have seen a Mercy Health provider in the last 12 months” to other Ohio Medicaid managed care organizations.

“Moreover, like MH’s proposed enrollment freeze, a block transfer would be disruptive to individuals, as well as unacceptably and impermissibly overbroad,” Corcoran’s letter said.

Corcoran said Ohio Medicaid will not override members’ choices of Medicaid managed care providers.

“ODM (Ohio Department of Medicaid) will not use its members as an incentive to force a resolution to that commercial, non-Medicaid disagreement,” Corcoran said. “I strongly encourage MH and Anthem to put their business dispute on another track and leave individuals served by Ohio Medicaid out of it going forward.”

Hospitals have faced increased costs, a Mercy Health spokesperson said, while Anthem says the requested cost increases for its employer-sponsored and Affordable Care Act plans is too high. Cost increases are not being requested for the Anthem Medicaid and Medicare supplement plans, but they are the ones feeling the pinch in these negotiations. The dispute involves rates for employer-sponsored and Affordable Care Act plans, Anthem said.

“We continue to stand ready and are in active conversations with Mercy,” said Greg LaManna, president of Anthem Ohio Medicaid. “We proposed creative solutions to them and put those on the table to try to resolve this without jeopardizing access to affordable care for any of our members.”

Mercy Health also referenced quarterly earnings for Anthem’s parent company, Elevance Health. Elevance Health’s operating gains increased to $2.6 billion, an increase of 12.0% year-over-year. Its operating revenue grew 12.7% year-over-year to $43.4 billion, according to Elevance Health.

“It is incomprehensible that Anthem refuses to reimburse the full cost of care to Mercy Health while simultaneously bringing in record profits, paid for by patients and employers,” said Adam Groshans, president of Mercy Health – Springfield. “We implore Anthem to return to the negotiation table to resolve this issue.”

ExploreMercy Health, Anthem agree to transition period for Anthem Medicaid members

References to Anthem’s parent company’s earnings are a distraction, LaManna said.

“Mercy is not honoring a contract that went into effect just a year ago that addresses the concerns that they’ve been highlighting publicly right around inflation and higher staffing costs,” LaManna said.

Anthem and Mercy Health have recently-signed contracts in place for all lines of business until Jan. 1, 2025. Medicaid, though, allows hospitals to terminate contracts with 60 days notice.

“The contract (that) went into effect last year has language in it that addresses those things,” LaManna said. “The fact of the matter is that Mercy is asking for three times inflation rate.”

In the meantime, Anthem is approving all continuity of care requests, LaManna said, which provide temporary coverage for care from an out-of-network provider.

Anthem Medicaid members who want to change plans should call the Ohio Office of Medicaid at 800-324-8680, a Mercy Health spokesperson said, where members can initiate a just cause transfer to an alternative managed care provider.