Keeping to its timetable, the Oregon Health Authority late last week issued contracts to all 15 insurance entities the state tentatively approved earlier this year to run the state’s Medicaid programs starting 2020.
Just what each contract says won’t be publicly known until later this week, when the agency will release them, said spokeswoman Allyson Hagen.
The state hopes the insurers sign the contracts promptly, cementing the changed lineup of Medicaid insurers for next year.
Hagen said the state also plans to provide more information this week about “readiness review,” a process in which the state has been examining each Medicaid insurer’s ability to fulfill its obligations to the state’s one million Medicaid recipients starting Jan. 1.
The “readiness review” procedure aims to see whether each insurer has the financial and organizational strength and skills and the health care provider network needed, or whether they have “deficiencies” they must correct before Jan. 1.
At least one insurer, Trillium Community Health Plan, has faced a major obstacle: signing up big health care providers in the Portland metro area so it can offer a full slate of care. The Providence and Legacy hospital systems have rebuffed Trillium, as have Multnomah and Clackamas county governments and two physician groups, The Children’s Health Alliance and The Oregon Clinic, Trillium complained to the state in a Sept. 13 letter. Trillium asked the Oregon Health Authority to withhold certain payments from those entities for “unreasonably” refusing to sign contracts with Trillium. Trillium also asked the state to give it more time to complete contract negotiations. It’s unclear how the state has responded, if at all.
It’s also unclear how another Medicaid insurer, PacificSource, is faring in Marion and Polk counties, where PacificSource was picked by the state over a Salem-based nonprofit created by arms of the Salem Clinic, the Salem Hospital & Clinics, and WVP, a large association of primary care and specialty doctors in Marion and Polk counties.
According to sources, some Marion/Polk health care providers are balking at signing contracts with PacificSource.
Asked whether it was having trouble lining up a provider network in Marion and Polk Counties, a PacificSource spokesman replied: “PacificSource is working closely with all key providers in Marion County and Polk County to serve … members in January 2020.”
At least one Medicaid insurer, nonprofit Health Share of Oregon, has already signed its 2020 contract with the state. Health Share announced Friday it had signed a contract. Health Share is the longtime Medicaid insurer in the 300,000-member Multnomah/Clackamas/Washington market.
The state needs the signed contracts with Medicaid insurers so it can be certain it will have entities to administer Medicaid spending statewide, estimated at $5 billion next year. Meanwhile, insurers, technically known as coordinated care organizations, need contracts with a wide slate of health care providers in order to pass readiness review, properly serve Medicaid members and lock in special low-cost rates the insurers will pay for services.
