Glitches resolved in new managed-care Medicaid systemBy GARRY RAYNO
State House Bureau
December 11. 2013 12:25PM
CONCORD – Glitches in the new managed-care Medicaid system have been resolved, state health officials said Wednesday.
The biggest difficulty concerned pharmacy claims, according to Health and Human Services officials. Pharmacies need to know which of the three private managed-care companies handle a customer’s coverage in order to process prescriptions.
The agency and the three managed-care companies worked with pharmacies last week to resolve the problem, according to Lisabritt Solsky, state deputy Medicaid director.
“Though some instances have required work behind the scenes to assure continuity of care and timely payment,” said Solsky, “in nearly every such instance, the challenges were resolved rapidly and the member experience was smooth.”
All Medicaid recipients should carry their health plan identification cards, but should not discard their Medicaid cards. The new health-plan identification cards should resolve the issues, Solsky said.
The agency said the daily calls to the new insurers are about what was expected during the first week of the transition from a fee-for-service to a managed-care program.
“We are pleased with the transition thus far,” said Department of Health and Human Services Commissioner Nicholas Toumpas. “We had a very thorough implementation plan, and the issues that have come up are the types of things we anticipated and planned for. That said, we continue to closely monitor daily operations of all three health plans and our internal processes so that we can take care of clients and providers’ needs as they arise.”
The managed care program began Dec. 1.
Each health plan — Meridian, NH Healthy Families and Well Sense — has a call center for members to call with questions.
State lawmakers first approved moving to a managed-care system for Medicaid in 2011, but the program failed to get off the ground when hospitals, mental health and community health centers balked at the low rates offered by the three companies hired to administer the program.
The state’s largest hospitals sued the state two years ago, claiming the reimbursement rates under the Medicaid program were too low to sustain the health care system for the poor and were set illegally. That case is still pending in federal court.
To entice the hospitals to join the managed-care networks, Gov. Maggie Hassan, the House and Senate put additional money into the uncompensated care program and increased some provider rates.
The budget passed by lawmakers in June uses general fund money for some of the state’s uncompensated care share, but health care providers had to join the managed-care networks by July 1 to receive the money.
The nine community mental health centers were the last to agree to join the program in August. The hospitals and community health centers agreed to join the managed care networks in July.
There are about 130,000 Medicaid recipients in New Hampshire.
Information about the managed-care Medicaid program and the three insurers is available on the DHHS website at www.dhhs.nh.gov.