State to move on HMO transfer

Medicaid enrollees to leave Prudential, despite protests

Health insurance

April 24, 1999|By M. William Salganik | M. William Salganik,SUN STAFF

Despite new protests over a transfer of Medicaid enrollees from Prudential to another HMO, Dr. Martin P. Wasserman, state health secretary, said the state expects to move ahead with the transfer next week.

An association of non-profit health centers filed a petition with the department yesterday complaining about the notice the department plans to send to some 82,000 Prudential Medicaid members about the switch. Its lawyer said it will go to court next week to block the transfer if it is not satisfied with the health department's response.

Maryland Physicians Care, a Medicaid HMO run by Maryland General Health System and three Western Maryland hospitals, also wrote the department to express concerns about the shift.

Prudential decided last year to get out of the Medicaid business and to sell its Maryland and District of Columbia Medicaid operations to Amerigroup, an HMO that specializes in Medicaid.

Wasserman said the department would meet with representatives of the health centers and others who have concerns, but "we're not about to close this process out."

He said a switch of Prudential's

Medicaid operations to Amerigroup, a Virginia HMO which says it will offer the same doctors and benefits, "is the only way -- the only way -- we can assure continuity of care."

Patricia Cassatt, director of the People's Community Health Center in Baltimore and legislative chair of the Mid-Atlantic Association of Community Health Centers, said the issue in the dispute is whether a business should be allowed to sell a Medicaid contract and the patients (sometimes called, in insurance parlance, "covered lives").

"Are Medicaid lives an asset? Are public premium dollars a salable asset?" she asked.

Her association, which represents 12 centers operating 38 clinic sites in Maryland, said in yesterday's petition that the notice the state plans to send violates health department regulations and "amounts to nothing more than an advertisement for Amerigroup."

James L. Feldesman, lawyer for the health centers, said the centers could seek a court injunction next week to block the transfer.

Michael V. Johansen, a lawyer for Maryland Physicians Care, said, "We were surprised to see the department so willing to accept a sale of Medicaid lives, which to date has not been allowed."

The state will allow enrollees to switch out of Amerigroup. But Feldesman and Johansen said if the enrollees do not choose Amerigroup, the state should assign them among participating HMOs.

Wasserman, however, said the objectors were advancing the interests of the other HMOs in the Medicaid program, who want to "get all these patients."

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