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Forced to choose 1 of 3 networds, some Medicaid recipients worried their specialists won't be included

LACONIA — An official from the state Department of Health and Human Services said yesterday that there has been some initial confusion about the new managed-care Medicaid enrollments — especially surrounding recipients who have extraordinary medical needs.

Assistant DHHS Commissioner Mary Ann Cooney said the state is asking recipients to choose one of three private managed care organizations by determining which organization has his or her primary care physician included. Each participant has been given a deadline to make the selection.

Each recipient can only pick one managed-care health plan and must use doctors who are certified and participate in that plan. The three plans are Well Sense, New Hampshire Healthy Families, and Meridian.

Those who haven't enrolled by the middle of November will be assigned a primary care provider and a health plan at random.

The deadline for enrollment by health care providers is December 1 and the plan, which is part of the federal government's Affordable Care Act, is scheduled to become effective on January 1, 2014.

The initial confusion, said Cooney, is that some of the primary care providers and hospital providers are still in the process of becoming certified and have not been listed on the state Website that lists which physicians have signed up with which plan. When recipients call their primary care physicians to see which network they are on, many are told the provider hasn't made the decision yet.

Those with special health care needs are having a particularly hard time because they are not finding all of their doctors on one single plan.

One local woman who asked that she not be identified has a 7-year-old son with multiple medical needs and sees different kinds specialist as needed. Medicaid insures her child through a program that supplements parents primary private insurer if they have children with severe medical needs.

She said it has taken her the better part of her son's life to put together a panel of physicians/specialists where each one provides a different component of his care. She said he had had multiple surgeries and sees specialists in Concord, Laconia, Manchester, Lebanon and Boston.

"We're on the third nephrologist (kidney specialist)," she said, adding that she is terrified about disassembling the medical team she and her husband have worked so long to put together.

"I have three shells. If I pick the wrong one, I'm without a doctor," she said. "I feel like I'm gambling with my son's life."

This mother is a member of New Hampshire Family Voices — a network of parents with children with multiple medical diagnoses. Network Co-Coordinator Terry Ohlson-Martin said at first she shared the same concerns as the Laconia mother.

Also a mother of a child with multiple medical needs, Ohlson-Martin said she is feeling more confident now than when the new plans were first announced because it appears the state has settled on a final program and that many providers are signing contracts with all three managed-care providers.

"It's a new world for those with Medicaid, but for those of us who have private insurance, we've been on a managed-care system all along," she said.

She said she was ready to keep asking the hard questions but not ready to panic yet.

Cooney said the DHHS "recognizes that there are families with special health care concerns" and they are "working hard to see that their needs are met."

"There will be some delays for some of them," she said, but added that every day more and more providers are enrolling in one, sometime two, and in many cases, all three of the managed-care providers.

"If you don't see your medical provider on one of the plans, check back in a day or two and check again," she said.

Cooney also said there has been "cross-borders" outreach to medical providers that are not in New Hampshire — like Boston Children's Hospital that has signed up for all three plans.

She said that participants can change networks 90 days after their selection so as more providers become certified by the private managed-care providers, participants can reselect a plan that better fits their needs.

Ohlson-Martin said she has also heard that many health care providers are selecting all three managed-care plans. Locally, LRGHealthcare has decided to participate in all three, said Executive Vice President Henry Lipman.

Cooney said there are about 120,000 people in the state who qualify for Medicaid and to date about 11,000 of them have chosen their health-care plan and every day more and more physicians and medical providers become certified with one of the plans and their information get added to the website.

She said any Medicaid-eligible people can contact the DHHS in two ways — the first is to go to www.nheasy.nh.gov to either created a NH Easy account or to manage the one they have.

The second option is to call 1-888-901-4999 to speak to someone at the Care Management Enrollment Call Center.

"I am confident that the vast majority of people will be happy with us," she said.

 
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