CONCORD — The head of the state’s largest agency hopes having three managed-care companies administer the Medicaid program will result in more innovative health services and will slow the growth of health-care costs.
The Executive Council will be asked to approve the three contracts, totaling almost $1 billion annually, later this month or early next month.
On Monday, the council held a public information session with the three companies — Boston Medical Center Health Plan Inc. or Well Sense Health Plan; Granite State Health Plan Inc. or New Hampshire Healthy Families; and newcomer AmeriHealth Caritas New Hampshire, Inc. of Philadelphia.
Well Sense and NH Healthy Families administer coverage for the 180,000 enrolled in the program, while AmeriHealth, while new, was the top-ranked company in the selection process.
Several councilors raised concerns last month when the contracts were put on their agenda because AmeriHealth withdrew from Iowa’s managed-care program in 2017 as its largest provider when negotiations to increase rates failed, forcing about 200,000 patients to move to other companies.
Not physically at the meeting, but connected by phone, District 5 Executive Councilor Debora Pignatelli, D-Nashua, asked Health and Human Services Commissioner Jeffrey Meyers if he was satisfied that AmeriHealth would not withdraw from New Hampshire as it did in Iowa.
She also asked whether the company would be able to build a statewide network of providers after problems arose five years ago that delayed implementation of the managed-care Medicaid program due to reimbursement rates.
Meyers said New Hampshire’s program has grown from 130,000 to 180,000 enrollees in those five years, a large enough number to support three companies.
Meyers said today, "Providers will be there and willing to work with the new plans."
Pignatelli asked AmeriHealth officials what happened in Iowa that caused the company to withdraw after a short time.
Russ Gianforcaro, the company’s regional president, said AmeriHealth had the largest enrollment and highest number of chronically ill patients.
“Within months, all three managed-care companies had losses of hundreds of millions of dollars because the rates were not sufficient to cover the costs of the program,” he said.
The three companies negotiated with Iowa officials for over a year but failed to reach agreement on rates. By mutual agreement, AmeriHealth agreed to leave the program, he said.
"Didn’t you know what the rates were when you entered the program?" Pignatelli asked. Gianforcaro replied they only found out when it became clear the state contract was not covering costs by more than just a few percentage points, and that took several months.
Karen Michaels, the company’s vice president of population health, noted the Iowa program changed significantly after AmeriHealth left.
Pignatelli asked the officials if New Hampshire’s rate is sufficient so the company would not run into the same issues here.
Gianforcaro said New Hampshire has had managed care for a number of years, and his company’s actuaries had looked at the rate and were comfortable.
He said earlier the company strives to be the best in the states where it operates.
“We are transparent, and we are honest, and we work very closely with all the organizations in a community,” Gianforcaro said. “One of the keys to our success is to build trust with our members."
Officials from New Hampshire Healthy Families and Well Sense said their commitment is to the state and to making the Medicaid program work for everyone.
District 1 Executive Councilor Michael Cryans, D-Hanover, said he had heard from providers who said they wait long periods to be paid for services they provide.
The three companies said they make payments as quickly as possible but several noted claims that lack information or are submitted on paper and not electronically can be delayed.
District 5 Executive Councilor Ted Gatsas, R-Manchester, was concerned about the program’s administrative costs and asked Meyers for a detailed breakdown.
District 2 Executive Councilor Andru Volinsky, D-Concord, urged the companies to speed the credentialing process for providers so they will be able to participate and be paid. He noted that company credentialing has been slow in the past.
Lisabritt Solsky, executive director of Well Sense, said the companies had worked with Health and Human Services to try to simplify the credentialing process, but there has been little progress.
District 3 Executive Councilo, Russell Prescott, R-Kingston, was concerned the department had not developed a plan that would allow the new company to quickly reach the number of enrollees it needs to be viable.
For the first 18-20 months of the contracts, AmeriHealth would be assigned new enrollees who do not choose one of the three companies.
Meyers said the program has 3,400 new enrollees every month, so it should not take long to reach the threshold for viability. After the initial period, he said, the new enrollees who do not choose a company would be evenly distributed among the three companies.
The contracts were originally to begin July 1, but under the current time line are expected to become effective Sept. 1.
New Hampshire’s Medicaid managed-care program began Dec. 1, 2013, after years of fits and starts with three companies, but one withdrew, as AmeriHealth did in Iowa, seven months later.
Meridian Health Plan of Detroit withdrew, citing its growing business in the Midwest. The company had the fewest Medicaid recipients enrolled in its program when it withdrew.
The three companies initially failed to reach reimbursement-rate agreements with providers and had prolonged negotiations with the community mental health system delaying the program for 18 months — before eventually reaching agreements on those rates.
The Medicaid managed-care program covers medical, mental health and substance abuse treatment services for low-income individuals, families and children, and the disabled but does not encompass long-term care services such as nursing home care.
Generally, the federal and state government share program costs along with counties and school districts.
Under the Medicaid expansion program, the federal government pays 90 percent of the cost and the state 10 percent. About 50,000 residents are in the Medicaid expansion program, which began with private insurance coverage, but this fiscal year switched to the traditional Medicaid managed care system.
Garry Rayno may be reached at email@example.com