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.
Last Updated on Tuesday, 01 October 2013 03:11
LACONIA — Fire Chief Ken Erickson said yesterday that the eight fires that lit the city from one Saturday to the next, including two major building fires, are all considered "suspicious" and under investigation.
The spate of fires began shortly before 3 a.m. on Sunday, September 22 when one fire destroyed a large, multi-tenant commercial building at 161 Court Street while a second charred a garage on Bay Street. The fires continued this past weekend with three minor fires around Water Street, another that damaged Pitman's Freight Room on New Salem Street and a third that burned the former Christmas Island Motel on Weirs Boulevard.
"I'm definitely very concerned," said Erickson, who said that along with members of his department and local police officials, the Office of the State Fire Marshall and federal Bureau of Alcohol, Tobacco and Firearms (ATF) are participating in the investigation. "There were eleven people working the scene at Christmas Island until 2 p.m. on Sunday," he said.
Erickson said the most recent fires began around 1 a.m. on Saturday morning as firefighters extinguished fires in two dumpsters and a shed in the Water Street neighborhood. He said that as Captain Landry and his crew were returning to the station shortly after 2 a.m. they received a call of an alarm activation at Pitman's Freight Room, where they found flames from a fire outside the building reaching to the interior. Erickson said that although firefighters stopped the fire before it reached the ceiling of the wooden frame structure to spare the building, the damage could run to $20,000.
At 8:48 p.m. on Saturday numerous callers reported fire at the Christmas Island Motel. Firefighters from the Weirs Beach Station arrived within four minutes to find much of the two-story, wood-framed building ablaze. Captain Kirk Beattie sounded a second alarm while firefighters aboard the engine from the Weirs station ran two hoses from a hydrant in front of the nearby Christmas Island Steakhouse, which poured 1,000 gallons of water per minute on the fire. The ladder truck from Central Station, supplied by an engine from Gilford, added another 1,200 gallons per minute while another engine from Central Station laid hose from a hydrant near Stonecrest Condominiums to feed a portable deck gun
Erickson said that the overriding concern was to confine the fire to the motel, which was scheduled for demolition. At the Christmas Island Steakhouse, the Laconia High School Class of 1973 was celebrating its 30th reunion and there are a number of private homes in the neighborhood. Although the fire was contained relatively quickly, Erickson said that a crew remained on the scene throughout the night and it took hours to extinguish it.
Units from Gilford, Tilton-Northfield, and Franklin responded to the fire while firefighters from Belmont and Meredith and personnel from Stewart's Ambulance Service staffed the fire stations.
The motel land is to be used as the site for a housing development.
Erickson said that that the fire at Pitman's Freight Room began outside, where there was no apparent source of ignition, and the the Christmas Island Motel was without power when it caught fire. Likewise, he said there were no obvious causes for the minor fires downtown. Moreover, he said that the investigation of the fire on Court Street the week before "began turning suspicious" last week.
Chief of Police Chris Adams said that the fires have been referred to the detective bureau, which is investigating each as a separate incident. "We don't want to jump to conclusions that they're related, which could hinder our investigations," he said, stressing that "we're taking this rash of fires very, very seriously."
Last Updated on Tuesday, 01 October 2013 02:22
LACONIA — The Sachems (2-2) held off a second half rally from the Hanover Marauders (1-3) to win their first game on Jim Fitzgerald Field on Friday night, 26-20. Hanover scored 20 points in the second half, trying to mount a late comeback. But Laconia secured the win when Hanover turned the ball over for the third time by fumbling on Laconia's 18 yard line with 3:14 remaining in the game.
"The kids really wanted this game to prove they were better than the 1-2 record." said Coach Kozens. "They worked extremely hard during practice this week. They wanted to notch their first win at home," Kozens continued. "This young defense has done a great job. They bend but don't break."
Laconia scored first,on the Sachem's second possession, when sophomore Kyle Chiasson capped a 12 play drive by sneaking in the end zone off the right side for a four yard touchdown. Laconia then looked to benefit from a punt that was blocked by Jordan Mcrae and recovered by Efran Noel, who led the team with seven tackles, on the Marauders six yard line. But Laconia would not capitalize on the good field position.
Laconia would strike again with one remaining in the half when Matt Swormstedt found Chris Frontiero open along the sideline for a 21 yard hookup to extend the lead to 13-0.
Hanover came out in the second half looking to throw the ball. The Marauders first drive ended quickly when Jacob Filgate picked off Hanover quarterback Shawn Cavallaro.
The Sachems would take advantage of the interception three minutes later when Chiasson would score his second TD off the evening, scampering 24 yards down the right side. Hanover would respond on the very next offensive play when Joey Porter broke out from midfield and sprinted for Hanover's first points of the night.
Both teams would trade touchdowns to end the third quarter.
The fourth quarter saw four out of five drives end with turnovers. Laconia coughed up the ball on its last three possessions. Hanover would return the favor fumbling and tossing an interception on the last play of the game.
Laconia's Defense held Hanover to 97 yards on the ground and 145 yards passing. The Sachems had 358 yards rushing, led by Chiasson with 178.
Laconia will host Monadnock Regional next Friday at 7:00
Last Updated on Wednesday, 31 December 1969 07:00
Briarcrest described as 'cash cow' banks are standing in line to loan residents the money to buy as a cooperative
LACONIA — More than 50 residents of Briarcrest Estates who gathered at the Gilford Youth Center last night heard from representatives of the New Hampshire Community Loan Fund that it would be financially feasible for the tenants to purchase the manufactured housing park, which would become owned and operated by a cooperative.
"It's realistic and it's doable," said Kevin Kelly, a former commercial banker and member of the Lakemont Cooperative, formed by a group of residents to bid for the park.
In July, Mark and Ruth Mooney, the owners of the park, tentatively accepted an offer from Maple Holding and Redevelopment, LLC of Orlando, Florida, an affiliate of Hometown America, Inc., among the largest owners of manufactured parks in the country, to purchase the 183-acre park with 241 home sites for $10 million. However, state law entitles the tenants to make a counter offer by presenting a purchase and sales agreement within 60 days of the first offer.
Lakemont Cooperative matched the $10 million offer. The statute grants the cooperative "a reasonable time beyond the 60-day period, if necessary, to obtain financing for the purchase" and, in the meantime, requires the owners to bargain in good faith with the cooperative.
Kelly, along with Angela Romeo of the Community Loan Fund, presented financial projections that indicated that the cooperative could acquire the park and service the resulting debt while confining rent increases within historical limits.
Kelly explained that the projections assumed that the cooperative would borrow $5-million from a bank at 6.10 percent. To limit the principal and interest payments payments, the loan would amortize over 30 years and mature in 20 years; that is, for 20 years principal and interest payments would track a 30-year fixed rate loan, but after 20 years the remaining principal and and interest would be rolled into a balloon payment, which Kelly explained would be refinanced. The cooperative would also borrow $5-million from the Community Loan Fund at 6.25-percent, which would amortize in 40 years and mature in 20 years.
Annual revenue from current rents at Briarcrest Estates, allowing for some vacant units, amounted to $1,087,374 in the most recent reporting period and annual operating expenses, including $30,000 set aside as a capital reserve for major expenses, to $369,306. The total debt, including all taxes, fees and $70,000 to establish a capital reserve, would be $10,582,736 with an payment of $715,808 in the first year. In other words, Kelly said that after operating the park and servicing its debt, the cooperative would be left with a surplus of $2,260 the first year, which would increase annually.
Romeo described the park as "a cash cow," adding "that is why four banks are competing for the loan." She anticipated that the cooperative would not only be offered a very competitive rate but also that the banks would be willing to fund as much as 80 percent of the acquisition. She said that because a bank can offer a lower rate than the Community Loan Fund, the greater its share of the financing, the lower the cooperative's debt service.
Kelly cautioned that the projections were based on the information available at this time, noting that the Mooneys have yet to provide all that is required for the prospective lenders to complete their due diligence.
Robert Shepard, an attorney who represents 25 of the 107 cooperatives that own manufactured housing parks in the state, said that neither the Community Loan Fund nor the banks would consider financing the purchase if it were not financially feasible. He also dispelled suggestions that individual residents could be held liable for debt incurred by the cooperative, explaining that it would be a corporate debt for which no one would be personally responsible.
Conceding that "$10 million is a lot of money," Romeo said that cooperatives in New Hampshire have purchased manufactured housing parks for as much as $15 million. She also pointed out that cooperative owners are eligible for grants and low-cost financing to fund necessary improvements.
Shepard said that so far the Mooneys have failed to bargain in good faith with the Lakemont Cooperative. The statute provides that a park owner who fails to bargain in good faith with its tenants or a cooperative may be liable to a penalty of $10,000 or 10 percent of the sale price, which in this case would amount to $1 million.
The Mooneys have petitioned the Belknap County Superior Court to approve the sale of the park to Maple Holding and Redevelopment, LLC. Attorney John Giere, representing the Mooneys, contends that the state statute is intended to safeguard the interests of tenants of manufactured housing parks. The owners twice polled the tenants, finding initially that 164 tenants opposed a sale to the cooperative and later that the number had risen to 176. On the strength of the poll results, the Mooneys believe that the interests of the tenants, which the statute intends to protect, would best be served by selling to Maple Holding and Redevelopment, LLC. Consequently, they asked the court to find that they have met their obligations under the statute and that their refusal to accept the cooperative's offer would not violate the law and subject them to penalties.
Shephard said that he is in the process of preparing a response on behalf of the cooperative.
Last Updated on Saturday, 28 September 2013 03:28
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