HMOs stepping up participation in Maryland Medicaid program

Expansion viewed as sign state pays them adequately

July 27, 2002|By M. William Salganik | M. William Salganik,SUN STAFF

HMOs are expanding their participation in the state's Medicaid program, Debbie I. Chang, deputy health secretary, said yesterday.

This month, Chang said, Americaid expanded to cover most of the state, and Priority Partners, which had frozen enrollments in four counties, reopened enrollment throughout the stat

e. Two other health maintenance organizations with enrollment limits, Helix Family Care and United Healthcare, lifted their restrictions a few months ago, she said.

Chang said the expansion is a sign that the rates the state pays the HMOs are adequate. Last fall, as the rates were being set, some HMOs froze enrollment in some counties and said they would consider dropping out of the program.

The state provides health insurance for more than 400,000 people, mostly low- and moderate-income children, through HealthChoice, a Medicaid program.

Under the program, the state pays a monthly fee for each member to participating HMOs, who contract with doctors and hospitals to provide care for members.

Don Gilmore, chief executive officer in Maryland for Americaid, said a state evaluation of the program, leading to a decision to extend it for three years, left his HMO feeling "stable and confident."

Americaid expanded this month to most of the Eastern Shore and to Carroll and Frederick counties. It covers the state except for Worcester and the three westernmost counties, and enrolls about 123,000 people.

"The rates in place now are adequate to enable us to expand," Gilmore said.

Eric R. Wagner, president of Helix Family Choice, said his HMO, which operates in Baltimore, Baltimore County and parts of Anne Arundel and Harford counties, is "still losing money, but we're at a point where incremental enrollees are not costing us money."

Wagnere said the HMO has added about 1,500 members, bringing enrollment to about 18,000, since it ended an enrollment freeze in February.

"Right now, we're in a guardedly OK position," Wagner said.

Laurie Norris, a staff attorney at the Public Justice Center, said that "on the surface, more choice looks better," but she has a "very strong concern" that the HMOs have been expanding without having enough doctors to care for the patients.

For example, she said, she represented a client from the Eastern Shore who was enrolled in HealthChoice and had to travel to Baltimore to see an orthopedist and a rheumatologist.

Chang said health officials reviewed the adequacy of physician networks before allowing the expansions.

Wagner said the HMOs are "absolutely" having difficulty finding and retaining doctors. "We are under constant pressure on the physician side to increase our reimbursement," he said. Helix Family Choice members have been able to find doctors, he said.

Gilmore said, "There are some specialties that are hard to recruit." He said Americaid has built a strong network in primary care and some specialties, such as obstetrics, but that "we continue to work on filling in other specialties."

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