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What are the next steps for Medicaid patients as Anthem, Mercy Health part ways?

By Staff report Mahoning Matters
As the Anthem Ohio Medicaid coverage relationship between Bon Secours Mercy Health hospitals comes to a close, here’s what the next steps are for patients.
As the Anthem Ohio Medicaid coverage relationship between Bon Secours Mercy Health hospitals comes to a close, here’s what the next steps are for patients. McClatchy

As an end-of-the-month deadline approaches, there’s an update to negotiations between Bon Secours Mercy Health, Elevance Health insurance company called Anthem and the director of the Ohio Department of Medicaid.

Bon Secours Mercy Health announced it would only accept Ohio Medicaid members through July 31 after Anthem and Mercy Health could not agree on negotiations.

As the Anthem Ohio Medicaid coverage relationship between Bon Secours Mercy Health hospitals comes to a close, here’s what the next steps are for patients.

Here are a few statements from each representative, starting with Mercy Health’s Kara Franz:

Mercy Health tells Anthem Medicaid patients to call Ohio Medicaid to switch plans.

Mercy Health says Anthem Ohio Managed Medicaid patients can switch plans by calling the Ohio Office of Medicaid at 800-324-8680 to initiate a “Just Cause” transfer.

Patients can request transferring to an alternative Managed Medicaid plan to ensure they can retain long-term access to their Mercy Health facilities and providers.

Mercy Health is contracted with all Managed Medicaid plans in Ohio, except for Anthem, and “we will continue to serve our patients under their new health plans.”

They also requested the Ohio Dept. of Medicaid to investigate Anthem’s “lack of network adequacy for Youngstown and Lima areas” and an enrollment freeze on Anthem “so no new individuals enroll without understanding Mercy Health is no longer participating with Anthem.”

Here’s information from Jeff Blunt from Anthem:

Anthem is working with members to transition care

Because Mercy Health has “chosen to refuse Anthem Medicaid coverage effective August 1, we are assisting our Medicaid members to transition elective care to one of the many high quality health systems in our network.”

According to Blunt, Anthem representatives are also “working with Mercy Health to assist members who require continued care with their current provider for certain serious and complex conditions.

Anthem Medicaid members with questions can call the phone number on their ID card.

To provide clarity on the issue from the other side, Blunt claims Mercy Health terminated its contract with Anthem Medicaid early.

“This was despite our repeated asks to rescind their termination and protect our Medicaid members in a dispute over pricing in another line of business,” said Blunt. “They are needlessly disrupting care for thousands of vulnerable people as a negotiating tactic to force higher prices on people covered through their employers or the Affordable Care Act.”

And finally, here’s a letter from the Ohio Dept. of Medicaid director Maureen Corcoran:

Ohio Dept. of Medicaid mediates dispute, clarifying next steps for patients

ODM Response to BSMH 7-25-23 by Chris Pugh on Scribd

Highlights from the letter include:

  • “BSMH and Anthem agreed to work together to develop communications to members that ODM, Anthem Ohio Medicaid, and BSMH could use in interaction with members, and disseminate those communications and principles to staff at both BSMH and Anthem Ohio Medicaid. Unfortunately, this did not occur.”
  • “Individuals in a longer course of care for a significant illness who did not want to change either their relationship with BSMH or their Ohio Medicaid coverage through Anthem would be allowed to continue their current course of treatment without any further authorization, other than ordinarily required on a particular claim or procedure. For those members, BSMH said it would continue to accept the Ohio Medicaid rate.”
  • It “thus came as a surprise to us that in subsequent communications to ODM, BSMH announced that it would only accept Ohio Medicaid members through July 31, 2023. That date was not discussed during our conference on July 1, and is entirely at odds with the arrangement ODM understood the parties to have reached. Regardless of that apparent disconnect, ODM suggested to Anthem that it proceed under the assumption that the agreement between BSMH and Anthem Ohio Medicaid will cease on July 31, and Anthem Ohio Medicaid has taken steps to that end.”
  • Medicaid members seeking to continue a relationship with Mercy Health may make a “Just Cause” request to enroll in another MCO at any time.
  • “Ohio Medicaid is presently in the process of notifying all Ohio Medicaid members that the annual open enrollment is forthcoming in the month of November, during which any member can freely choose to enroll in any Ohio Medicaid plan.”
  • It is unfortunate that Ohio Medicaid members find themselves having to make potentially urgent or otherwise significant healthcare decisions because of a disagreement between two established and committed healthcare organizations that have told us that they have these members’ best interests at heart. ODM will not use its members as an incentive to force a resolution to that commercial, non-Medicaid disagreement. I strongly encourage BSMH and Anthem to put their business dispute on another track and leave individuals served by Ohio Medicaid out of it going forward.”
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This story was originally published July 26, 2023 at 12:52 PM.