Mediciad patients will still not have access to LRGHealthcare primary care doctors

LACONIA — Although LRGHealthcare is participating in all three medical plans now being offered to New Hampshire residents who use Medicaid to pay for health care, adults in the area will still have to use a non-LRGHealthcare physician for their primary care. Medicaid users must enroll in one of the plans before November 1 as part of a switch to a managed care program.

According to Andrew Patterson, executive director of the hospital company-owned Laconia Clinic, "wrap-around health care networks" like Health First Family Care Center in Laconia and Franklin are better designed to assist adult Medicaid patients with services that are an addition to just primary care.

Some of those "wrap-around" services, said Patterson, are nutritionists, social workers, and other non-physician services not typically provided by a primary care physician. In addition, patients can access clinical psychologists, visiting nurses for the home-bound, and nurse midwives at Health First and other similar networks.

At least one local man, who asked not to be identified, said he was confused when he saw the name of his former LRGHealthcare primary care physician listed under the new Well Sense, New Hampshire Healthy Families, and Meridian managed care plans.

One of the 3,500 area residents who were removed from patient rolls in late 2011 when LRGHealthcare stopped accepting primary care Medicaid users because of what were seen as inadequate government reimbursement rates, this man saw the name of his former primary care doctor at the Laconia Clinic listed when he went to the new exchanges and wanted to reestablish his relationship there.

"I was told they were accepting Medicaid patients," he said, accusing LRGHeathcare of misrepresenting themselves as participating in the exchanges.

Patterson said there was no misrepresentation but allowed there could be some confusion because New Hampshire chose to roll out its managed care networks for Medicaid at the same time as joining the Anthem network for general health insurance access under the Affordable Care Act (Obamacare).

He said all LRGHealthcare physicians who are specialists continue to see Medicaid patients who are referred to them by the rural health centers like Health First and that is why all of their physicians are listed on the three new exchanges created by state's managed care system.

In November of 2011, due to an operating loss of $4-million, LRGHealthcare stopped seeing adult primary care physicians at its 12 primary care offices. The 12 were Andover Family Practice; Belknap Family Practice in Belmont and Meredith; Caring for Women in Laconia, Franklin, and Moultonborough; Franklin Internal Medicine; Hillside Family Medicine in Gilford; Laconia Clinic in Laconia, Tilton and Franklin; Lakes Region Family Practice in Laconia; Moultonborough Family Practice; and New Hampton Family Practice.

Patterson said the 12 above offices still provide pediatric care to children on Medicaid and the emergency rooms at Lakes Region General Hospital and Franklin Regional Hospital accept Medicaid payments.

In addition to not accepting adult primary care patients who are on Medicaid, to cope with decline revenues LRGHealthcare trimmed staff and cut some overhead costs that saved $14-million in 2011.

Triggering the declining revenues were reductions in Medicaid reimbursements from the state government that began when the state Legislature stopped returning the Medical Enhancement Tax to hospitals and kept the federal match in the state's operating budget.

Patterson said the "wrap around" agencies like Health First get higher federal Medicaid reimbursements than LRGHealthcare does for primary care services and until that changes, he said it's not likely his company will serve adult Medicaid recipients for their primary care services.